Newbie Question

[akaz]

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I probably have a real stupid question. What is the deal in path with the IMG vs. AMG? I am just a medical student at Cornell. I am basically curious why this is so important in pathology. Before, medical school I was in a derm lab for awhile at MGH (HMS) for grad school. I was told that it was impossible for foreign grads to match in derm at MGH or Brigham. Why is that? Is it also tough in pathology? Why so competitive in derm? Pathology is more interesting. I am not foreign--just curious.

 

[uhoh!]

Golden Rule: Follow the money.

 

[yaah]

General rule of thumb: The more "lifestyle" a specialty (as in glamour, less work, more money, etc etc) the more american med graduates will want to do it. Dermatology is the ultimate in this area, and as a result, there are many many american graduates who love skin. And this is also partially explaining why fewer US grads go into family practice. I'm being somewhat facetious, but you get the idea.

The number of residency spots is limited, but I believe it exceeds the number of US graduates. Therefore, programs fill these spots with foreign graduates. Some programs would rather fill with american grads for a number of reasons, others just want the best residents, others just want whoever is going to finish the program and not complain.

A foreign grad will always have a few more hoops to jump through to get a decent residency spot than a US grad, oftentimes because the quality of their education is less of a known commodity, their familiarity with this country and its language (etc) is less, and there are issues with visas and such that make it more of a hassle for the program.

 

[hzma]

others just want whoever is going to finish the program and not complain.

Who's complaining?

 

[yaah]

Who's complaining?

Why do I have to do all this scut? Do you have any projects I could help with? Can you help me with a job search? Can I go to this conference? Can you go over this difficult case with me? Some programs don't like this kind of complaining. 😉

 

[ilovepath]

General rule of thumb: The more "lifestyle" a specialty (as in glamour, less work, more money, etc etc) the more american med graduates will want to do it. Dermatology is the ultimate in this area,
yaah....as far as i heard path is equalent in lifestyle/money. there is still a lot of antiglamour assoc w/ it as shown from our collective comments about everyone's snide remarks about path. do u agree the only think keeping path down is the glamour component?

 

[akaz]

Thanks for the help. I am really interested in pathology. My family thinks derm is more prestigious, but after doing so much research in it, skin is a great model to study disease mechanisms, but nothing more. It isn;t interesting in itself.

 

[yaah]

No, path has minimal glamour mostly because you don't do stuff that laypeople can get impressed with. And the stuff laypeople do know about (autopsies primarily) is "gross." And in addition, in med school you don't get as much exposure to pathology as a career.

I don't really think anything is keeping path down. There will just always be a lot of people who don't want to go into it, either because they don't understand what it is, or because they want to take care of patients.

Dermatologists don't always make as large salaries as some specialties, but their hours are less (as well as the hassle with things like call). Path makes a decent salary, better then primary care but not on the level of some other specialties.

 

[djmd]

No, path has minimal glamour mostly because you don't do stuff that laypeople can get impressed with. And the stuff laypeople do know about (autopsies primarily) is "gross." And in addition, in med school you don't get as much exposure to pathology as a career.

A pathologist freind of mine once said "Pathologist are the least needy, co-dependant doctors, because they don't need people saying to them 'oh thank you doctor.'"

 

[Aubrey]

A pathologist freind of mine once said "Pathologist are the least needy, co-dependant doctors, because they don't need people saying to them 'oh thank you doctor.'"

We still need the love.. it's just more satisfying when it's coming from another doc as opposed to a patient.

 

[ilovepath]

A pathologist freind of mine once said "Pathologist are the least needy, co-dependant doctors, because they don't need people saying to them 'oh thank you doctor.'"

a girl who's in the top of my class that is going into path echoed this. when asked why not do all these competitive specialties that are clinical...she said that half the reason ppl get into them is to ego trip over pts and other docs. i can recall surgeons who don't sit w/ psychiatrists and internists in the drs lounge for ego tripping.

 

[pathdawg]

General rule of thumb: The more "lifestyle" a specialty (as in glamour, less work, more money, etc etc) the more american med graduates will want to do it. Dermatology is the ultimate in this area,
yaah....as far as i heard path is equalent in lifestyle/money. there is still a lot of antiglamour assoc w/ it as shown from our collective comments about everyone's snide remarks about path. do u agree the only think keeping path down is the glamour component?

I would contend that pathology offers a better lifestyle than derm, in terms of hours worked, patient contact, charting and documentation (an often overlooked but incredibly arduous clinicial task that pathologists are spared). However, the money comanded by pathologists is nowhere near that of dermatology. Not even close. This is why derm is so competitive (and rads and optho, too).

I have to chuckle when I hear people say that dermatologists don't have to work hard for their money. Ridiculous. To make decent coin, a derm has to see a ton of patients (50 or more/day). The advantage to derm is that 1) the patients generally are not sick and 2) their job market is incredible-they can go wherever they want. They downside is that those healthy patients are very demanding.

I know several dermatologists. They all work harder than I do.

 

[akaz]

The one thing I do think that is cool about derm. It is only my friends at HMS during their post doc would work one day in private practice. Is that a few private practices made so much money on cosmetic garbage that when children (usually childen if it was genetic) had something bad (like scleroderma), they would be treated or seen for free (or close to) before they were sent where they should be. Besides that I am not sure I coud deal with the boredom.

I would contend that pathology offers a better lifestyle than derm, in terms of hours worked, patient contact, charting and documentation (an often overlooked but incredibly arduous clinicial task that pathologists are spared). However, the money comanded by pathologists is nowhere near that of dermatology. Not even close. This is why derm is so competitive (and rads and optho, too).

I have to chuckle when I hear people say that dermatologists don't have to work hard for their money. Ridiculous. To make decent coin, a derm has to see a ton of patients (50 or more/day). The advantage to derm is that 1) the patients generally are not sick and 2) their job market is incredible-they can go wherever they want. They downside is that those healthy patients are very demanding.

I know several dermatologists. They all work harder than I do.

 

[yaah]

I would contend that pathology offers a better lifestyle than derm, in terms of hours worked, patient contact, charting and documentation (an often overlooked but incredibly arduous clinicial task that pathologists are spared). However, the money comanded by pathologists is nowhere near that of dermatology. Not even close. This is why derm is so competitive (and rads and optho, too).

I have to chuckle when I hear people say that dermatologists don't have to work hard for their money. Ridiculous. To make decent coin, a derm has to see a ton of patients (50 or more/day). The advantage to derm is that 1) the patients generally are not sick and 2) their job market is incredible-they can go wherever they want. They downside is that those healthy patients are very demanding.

I know several dermatologists. They all work harder than I do.

You're right - a lot of them do work hard. It is relative though. They have minimal call, and a lot of their visits are very short. Derm lends itself quite well to part time practice, another reason why it is popular. Path, it is harder to do this given the follow up required on cases and such, although no doubt it could be done.

You are definitely on about the patients being demanding though. Yikes. I remember my 4th year derm rotation in med school.

 

[Gyric]

I am surprised to read flat out statements like “However, the money comanded by pathologists is nowhere near that of dermatology. Not even close. This is why derm is so competitive (and rads and optho, too).”

I don’t know where you are getting that from Pathdawg. Is it anecdotal? If so there are certainly pathologists making over 7 figures. If you are talking in terms of averages then I don’t think the data supports that assumption.

I know a few practicing dermatologists. They are generalists with a small component of cosmetic work. They work probably 50 hrs/week and complain that their salaries capped out quickly in the low 200s, you just can only see patients so fast.

The mean/median salaries for the specialties you listed (as well as average hrs worked) are listed below for reference. These data are from the 2003 AMA socioeconomic statistics:

Mean/median/avg wrk hrs
Path 246.5/230/41.6
Derm 219.5/180/42
Rads 327.7/300/58.5
Opth 229.2/200/43

The job markets are very different though, with new dermies being in greater demand and therefore perhaps their starting salaries are on average higher than for new pathologists, I don't know. In my program most grads (after fellowship) are starting close to 200K +/-.

 

[akaz]

I am surprised to read flat out statements like “However, the money comanded by pathologists is nowhere near that of dermatology. Not even close. This is why derm is so competitive (and rads and optho, too).”

I don’t know where you are getting that from Pathdawg. Is it anecdotal? If so there are certainly pathologists making over 7 figures. If you are talking in terms of averages then I don’t think the data supports that assumption.

I know a few practicing dermatologists. They are generalists with a small component of cosmetic work. They work probably 50 hrs/week and complain that their salaries capped out quickly in the low 200s, you just can only see patients so fast.

The mean/median salaries for the specialties you listed (as well as average hrs worked) are listed below for reference. These data are from the 2003 AMA socioeconomic statistics:

Mean/median/avg wrk hrs
Path 246.5/230/41.6
Derm 219.5/180/42
Rads 327.7/300/58.5
Opth 229.2/200/43

The job markets are very different though, with new dermies being in greater demand and therefore perhaps their starting salaries are on average higher than for new pathologists, I don't know. In my program most grads (after fellowship) are starting close to 200K +/-.

Maybe its the few that run spas. I do know one guy that did that that was making close to a mill/yr. That is probably rare.

 

[pathdawg]

I am surprised to read flat out statements like “However, the money comanded by pathologists is nowhere near that of dermatology. Not even close. This is why derm is so competitive (and rads and optho, too).”

I don’t know where you are getting that from Pathdawg. Is it anecdotal? If so there are certainly pathologists making over 7 figures. If you are talking in terms of averages then I don’t think the data supports that assumption.

I don't necessarily trust those salary surveys. They just are not always accurate in my experience. Remember that those surveys list base salary and often do not include bonus compensation, which dermatologists enjoy (and which usually are not a factor for pathologists). I am a practicing pathologist and have been for six years now. I have never heard of a pathologist making 7 figures in this day and age, at least not legitimately.

So, my info is antecdotal, yes. My wife is a dermatologist, so I am familar with the market for that field. One major factor in derms making more money is the fact that they can still be partners in a practice. This ability to run your own business is huge. Our (pathologists') inability to do this a big reason why we in pathology don't command the salaries that we used to. The economic forces in play simply don't allow us to run our oun businesses. We have become employees, whether its for a hospital, university, or private lab. Do privately owned pathology corporations still exist? Yes, but they are becoming more and more rare. Thats the reality.

The dermatologists I know (and there are many) who make the same salary that I do only work three days a week. Perhaps things are different in other parts of the country, but here in the northeast part of the US, that is the deal.

 

[torero]

It seems that the playing field levels-out somewhat during residency for AMG vs IMG. Fellowship program directors care about what medical school you attended to as much as they care about your USMLE scores, class rank or AOA status… not much.

Jobs for IMG though, depend entirely on immigration status. If you have an H1b visa, permanent residency, or are a US citizen, then you should have no problem finding a job. If you are stuck with a J-1 visa, then you will need independently funded research and bombastic 4-page LORs from members of the American Academy of Arts and Sciences. You will then pray and hope for the clerk at the INS with a high-school diploma to be favorably impressed with your credentials and approve your application… a total crap shoot.