Need advice: Scramble into Pathology?

[wild0ne]

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I'm in a dilemma and am looking for some advice - especially if you've gone through something similar. BTW, I am an US allopathic student.

I've just finished interviewing for IM. I'm now on a pathology rotation, and absolutely love it. In the interests of keeping this post short, my interest is genuine (i.e., not solely based on lifestyle/monetary issues). My question is...what do I do now? I see the following options:

a) Talk to my school's PD and see if it's too late to apply through ERAS for our program. How likely is this?
b) Not rank any IM programs and scramble into an open Path spot.
c) If (b) fails, take year off and do Path research. Match 2010 for Path.

Any ideas on which option to take? Are there any pros/cons to (c)? Am I crazy? I appreciate any help - even PMs if you feel more comfortable.

 

[Napoleon1801]

I'm in a dilemma and am looking for some advice - especially if you've gone through something similar. BTW, I am an US allopathic student.

I've just finished interviewing for IM. I'm now on a pathology rotation, and absolutely love it. In the interests of keeping this post short, my interest is genuine (i.e., not solely based on lifestyle/monetary issues). My question is...what do I do now? I see the following options:

a) Talk to my school's PD and see if it's too late to apply through ERAS for our program. How likely is this?
b) Not rank any IM programs and scramble into an open Path spot.
c) If (b) fails, take year off and do Path research. Match 2010 for Path.

Any ideas on which option to take? Are there any pros/cons to (c)? Am I crazy? I appreciate any help - even PMs if you feel more comfortable.

A. Worth a shot, it can't hurt you. If you can convince them of your genuine interest, maybe.
B. You might consider taking an internship (as did path residents in the recent past) and matching next year in path. It keeps the IM door open in case you find a reason for not liking path.
C. It depends on what type of pathologist you see yourself becoming. If you're looking at a more research oriented career, a research year might be beneficial. If you're looking at a service based career, a year of internship might prove valuable. There are several docs that I've interacted with that were internal docs in another life and they chose to switch to pathology. I've heard it said many times that the clinical experience is invaluable when it comes to some problem solving situations.

 

[Pianoboe01]

So people can scramble into any specialty they want? I would have guessed you could only scramble into the specialty, or specialties, you applied to.

 

[yaah]

No, you can scramble into anything you want if you can get someone to take you (as far as I know). It's just that most of your reference letters and other application stuff that you had in ERAS will already be specialty-specific. So you might have to do some work on those things.

 

[106174]

Any ideas on which option to take? Are there any pros/cons to (c)? Am I crazy? I appreciate any help - even PMs if you feel more comfortable.

DO NOT do an internal medicine internship if you are 100% sure you want to do pathology. It will be a complete waste of your time.

Pathology has one of the lowest match rates every year. If you are willing to move anywhere, you will be able to find a spot through the scramble. Even big university programs get unfilled in pathology. Get all of your stuff ready for the scramble and if you are quick to act, you sure will find a spot.

 

[scurred]

Actually, I would go ahead and do an internal medicine spot...the big pathology places DO FILL UP, and you don't want to end up at a ****ty program

Remember, path used to be 5 years...you'll be a better physician and a better pathologist if you get a clinical year in...a good number of path spots are taken every year by people that change their minds.

In addition, get a spot in IM, and you can always see about openings in January and start on a staggered schedule.

 

[yaah]

There are probably better things to do with your time for a year though if you know you aren't going to stick with IM. Do some research or something. Skipping the scramble and applying for the next cycle is ok, you don't have to do IM for the intervening year. You may get a lot of questions about why you are switching (or why you didn't just apply for path in the first place), so I would start working on your answers to those questions now.

 

[podtsan]

You lose a year of income by doing an extra year of residency. Assuming you earn 50k as a resident, start earning 200k/yr 5 yrs from now, and at a tax rate of 40%, the present value of the lost earnings is about 75k [(200-50)*0.6/(1.04^5)]. Thus, waiting a year is equivalent to taking a stack of 750 Ben Franklins and starting a bonfire -- which would also cause LADoc00 to break out in hives. While a year of IM might have some value, would you trade it for 75k?

The only problem with scrambling is the potential value you give up by scrambling into a less desirable program than you could have obtained through the match. Having not seen a program you might scramble into something miserable or into a program that would not provide as good of career opportunites as you could have gotten through the match. In your case, I think the risk associated with scrambling is rather small -- after all, you can control where you scramble because you can opt out rather than sign at a place that would be significantly less preferred than what you could acheive via the match. Also, the misery index in pathology is orders of magnitude below IM. I suspect the esprit de corps at the worst pathology program is better than the best IM program. Thus, you have little to lose by scrambling.

This could be presented more concisely as a mathematical decision model but I resisted the temptation.....

Actually, it's a lot more than 75K...because the loss of one year is equal to the loss of one's highest paid salary. For example, if you work 25 years and at the end of those 25 years, your salary is 400k, then taking an extra year now will ultimately cost you 400k because you're taking away that 25th year, not the 1st year.

 

[Dral]

The argument can also be made that after a year of IM, one could take their time to interview and get into a better program and subsequently land a better starting job and make a higher yearly salary throughout their whole life.

Or maybe one could scramble and somehow end up in a better program (less likely from an objective standpoint maybe). Who knows?

 

[podtsan]

I think you are mistaken.

If you make a table of earnings (see below), you will see that the incremental change would occur in year 5 or 6 in which you earn a resident salary rather than a consultant's salary. After that, the earnings in both streams would be similar. In particular, your earnings in the last year before retirement would be relatively unaffected (assuming you retirement age is not affected by the decision).

Now, if you assume that you will alter your retirement date to offset the loss, you will find that working longer has much less impact than you would expect because dollars earned tomorrow are not worth as much as dollars earned today. For example, 400k earned 30 yrs from now is worth about 42k in today's dollars (assuming 40% tax rate, 6% opportunity cost of capital). Dollars earned at the end of your life are so heavily discounted that they matter less than dollars earned at the beginning. Thus, the 200k forgone in year 5 hurts more than 400k forgone in year 30. Very roughly, it would take about 2 years of work at the end of your career (at 400k) to make up for the loss of one year at the beginning of your career.

age no IM with IM
26 50 50
27 50 50
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30 50 50
31 200 50
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51 200 200
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61 200 200
62 200 200
63 200 200
64 200 200
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66 200 200
67 200 200
68 200 200
69 200 200
70 200 200

Thank you for enlightening me with graphs and formulas. Your humble servent was only trying to say that taking a year off is potentially a lot more expensive than it may seem. I don't remember the statistics formula that turns 400K to 42K in 30 years, but I was able to spot that the 200 is greater than 50 in the fifth year (with help from my wife, and of course your graph), so I won't get into any of that, but I'm sure if LAdoc had to trade his last working years salary for that of a PGY5 it would be significantly more than "750 benjamins" (again, my wife helped me with the numbers). Good luck with life, 'preciate ya.

 

[Torsed]

I'd try to get what you can, check it out and call around. There are some good places that don't fill, but Path seems to becoming a hot field among new applicants. Better to see the light prior to IM residency rather than a year after. I'd call programs around the area of the country you are interested in and see what they got, I don't know if its too late to match, have to check it out. Even after the match, you can probably get a list of unfilled programs (I know the peeps who don't match get a list) and scramble into path. Everyone yammers about studying at this or than university, which matters politically, but I contend that if you go to a place that has enough specimens you should be fine. I think pathology is an independent journey and studying with the world expert for organ system XYZ, don't really mean too much, they do have a book most likely, and most seem to be too busy with research to harp on education, that was pretty secondary to me.

I think I would not match IM if you really don't want to do it, you could take a year off, might mess with your loans and stuff, but I'm sure research would be an option for the year and if you are pretty sharp, you shall probably get a spot for 2010. Good luck with it, hope it works for you. 👍

 

[Torsed]

Seems to infer that big places aren't crappy, which I would argue that while not "crappy" or how you versed it, they aren't education driven. Bear in mind you don't want to be a grossing monkey while faculty work on the books. I've met some excellent people from big programs, yet some duds as well, so be wary of this. I myself chose a medium sized program and it was the best decision for my lifestyle. Absolutely correct on the people switching to path aspect. However, one the year of IM making you a better M.D., didn't one go to med school? Writing ER admits and intern notes, and answering Tylenol requests in the middle of the night really won't make one a better pathologist per say, it may have the affect of one entering into pathology with more zeal! I did fine on Step 3 with just a pathology internship. Just food for thought.

 

[wild0ne]

Thanks for the replies everyone.

I managed to get interviews at a couple places - which I'm excited about. But, I'm worried that I still might not match. If this is the case, and I cannot (or, do not want to) scramble into an IM or other Path spot, I will likely do research or work for a year (outside of medicine, but in a related field). My question is though:

Will I be a weaker candidate next year for having applied this year?

I've been told (and witnessed) that applicants that don't match the 1st time, tend to get even less interview invites the next time they apply. Although, this was in a real competitive specialty.

Also, would PDs accept a request to meet and discuss my application? They might be the best source of answers to some of my questions??

 

[Notsoanon]

Its probably already been said somewhere in the thread, but if you've done well in medical school and you have a nearly normal personality, you'll get a good path spot. Maybe not this year because you started so late, but next year for sure.
Yes, your application will be poo-pooed a little bit for you having been indecisive in your 4th year, but at least you figured it out before you made a commitment to IM. The two types of path defectors that are more likely to get shafted are the "quitters" who drop out of a residency program that was counting on them to finish, and the "settlers" who applied for a year or two to Derm or Optho and didn't get in before deciding they really always wanted pathology.
Doing either a transitional year or a year of research should put you in a good position. Personally, I think a year of research would be much more fun.
My perspective comes from being a PGY3 and having heard (mostly) residents and (some) faculty voice their opinions of candidates over the years.
Good luck.

 

[insertnamehere]

Actually, I would go ahead and do an internal medicine spot...the big pathology places DO FILL UP, and you don't want to end up at a ****ty program

Remember, path used to be 5 years...you'll be a better physician and a better pathologist if you get a clinical year in...a good number of path spots are taken every year by people that change their minds.

In addition, get a spot in IM, and you can always see about openings in January and start on a staggered schedule.

Actuallly The fifth year was added first and then taken away. All the big boy pathologists out there now did 4 year residencies. At least that's what I PD on the trail told me. So I would not waste the time doing the clinical year if you really wanna to path. Pathology does go unfilled, but the big boy programs do fill right off, so you may want to wait until next year when you can get your application in order and have your pick of the litter (as opposed to staying at your school only because you had no choice). Just my op.

 

[HbyHA]

As a Chief Resident this year, I have interviewed about half of our candidates and have spoken to my PD a lot about the matching process recently.

I think that if we saw someone had a year out and they could explain to us WHY that happened for a good reason, we would not hold it against them. we have a current resident who did a year of another specialty, found out it wasn't for him, and then switched to Pathology. If you told us that you found out about pathology too late for the match that year, that would NOT be held against you! in fact, i think that happend to the Chair of our Dept, and he ended up doing a year or two of medicine. i don't even know how most people decide to go into path, because there are so many med students out there that think that pathologist just teach 2nd year med students!!!!

what would be held against you: matching in another program and then being asked to leave by that program after the first year because you have personality or other issues!

 

[podtsan]

Actuallly The fifth year was added first and then taken away. All the big boy pathologists out there now did 4 year residencies. At least that's what I PD on the trail told me. So I would not waste the time doing the clinical year if you really wanna to path. Pathology does go unfilled, but the big boy programs do fill right off, so you may want to wait until next year when you can get your application in order and have your pick of the litter (as opposed to staying at your school only because you had no choice). Just my op.

To become a "big boy pathologist" is it absolutely necessary to go to a "big boy program"?