No JOBS in pathology

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Pathology GIT

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My advice for all, as a path fellow having done fellowships in ivy leagues and still finding no jobs is DO NOT GO into pathologist. My co-fellows are suffering as well.
Market is absolutely terrible.

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Here is a link to the ASCP survey showing no job offers to 50% of graduating fellows in the past few years!!
 
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Here is a link to the ASCP survey showing no job offers to 50% of graduating fellows in the past few years!!
Link, pls?
And you're referring here to surgical pathology mostly I suppose.
 
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Pathology is dying or no enough jobs
Pathology is not dying! There are probably not enough jobs for the number of residents that finish pathology.
 
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The job market is pretty much two-tiered. Strong candidates have little trouble finding good jobs, although it might not be the area you want. What makes a strong candidate? That's open to debate, but it has very little to do with "doing fellowships at ivy league institutions" and much more to do with things like being an effective communicator, lab management, and quality skills.

I mean no disrespect, but formatting a sentence like, "still finding no jobs is DO NOT GO into pathologist" is probably highly correlated with more difficulty in finding a quality job.
 
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The job market is pretty much two-tiered. Strong candidates have little trouble finding good jobs, although it might not be the area you want. What makes a strong candidate? That's open to debate, but it has very little to do with "doing fellowships at ivy league institutions" and much more to do with things like being an effective communicator, lab management, and quality skills.

I mean no disrespect, but formatting a sentence like, "still finding no jobs is DO NOT GO into pathologist" is probably highly correlated with more difficulty in finding a quality job.


I'm sorry but, this is bull. One scentence does not disqualify a person who was smart enough to go through years of training. Truth is this field is training WAYYY too many pathologist and the entire system is backed up. The specialty has been destroyed and leadership has failed to protect the field. Now you have old attendings who are blaming the fact that fellows can't get jobs on the fellow, when in reality the entire system is just F'ed up. In a specialty where people can work until they are 80+, they should have reduced the number of residents a long time ago.
 
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There are few things here:
1.) There has been for last 20+ years WAYYYY too many pathologists trained. There is simply no arguing with this, the data is clear.
2.) Up until I would say a 5 or so years ago, some residents with top notch interpersonal skills were still able to get partnership track jobs. I would suggest this has dramatically changed and hastened with the Obamacare changes.

Personally I have zero incentive to hire, train and develop new partners. Not that Im a total dick, but because it honestly doesnt make my life any easier having more partners. I think we will see mergers between small and medium groups rather than new hires moving up through the ranks in pp groups.

That said, there are still a host of solid jobs with pensions in the public sector which can offer zero drama allowing you to totally unplug when you arent on service.
 
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There are few things here:
1.) There has been for last 20+ years WAYYYY too many pathologists trained. There is simply no arguing with this, the data is clear.
2.) Up until I would say a 5 or so years ago, some residents with top notch interpersonal skills were still able to get partnership track jobs. I would suggest this has dramatically changed and hastened with the Obamacare changes.

Personally I have zero incentive to hire, train and develop new partners. Not that Im a total dick, but because it honestly doesnt make my life any easier having more partners. I think we will see mergers between small and medium groups rather than new hires moving up through the ranks in pp groups.

That said, there are still a host of solid jobs with pensions in the public sector which can offer zero drama allowing you to totally unplug when you arent on service.


^^ Are you currently in the job market? No. And the whole " f them, I got mine" mentality should make any unhired fellows want to throw people like you in a furnace when you get old and need healthcare.
 
If your screen name is PsychMDhopeful, your comments have no weight in this forum. :laugh::laugh::laugh::laugh::laugh::laugh:.
 
Of course there are no jobs...its pathology. It is the number one topic on this forum every year. No jobs again this year. Five years from now...no jobs. Ten years from now...no jobs. Twenty years from now....no jobs.
Don't go into pathology. Do anything else and get a job. Listen and learn. You are not special or different.
 
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I'm sorry but, this is bull. One scentence does not disqualify a person who was smart enough to go through years of training. Truth is this field is training WAYYY too many pathologist and the entire system is backed up. The specialty has been destroyed and leadership has failed to protect the field. Now you have old attendings who are blaming the fact that fellows can't get jobs on the fellow, when in reality the entire system is just F'ed up. In a specialty where people can work until they are 80+, they should have reduced the number of residents a long time ago.

Really, one sentence does not disqualify a person? Of course it doesn't. I have no idea why you interpreted what I said that way. All I said (implied) was that someone who types a sentence like that is likely to have other significant factors making them a less desirable hire for many groups.
 
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There are few things here:
1.) There has been for last 20+ years WAYYYY too many pathologists trained. There is simply no arguing with this, the data is clear.
2.) Up until I would say a 5 or so years ago, some residents with top notch interpersonal skills were still able to get partnership track jobs. I would suggest this has dramatically changed and hastened with the Obamacare changes.

Personally I have zero incentive to hire, train and develop new partners. Not that Im a total dick, but because it honestly doesnt make my life any easier having more partners. I think we will see mergers between small and medium groups rather than new hires moving up through the ranks in pp groups.

That said, there are still a host of solid jobs with pensions in the public sector which can offer zero drama allowing you to totally unplug when you arent on service.

Top notch residents are still desirable. I don't think that has really changed. I do agree with you though that partnership type jobs are decreasing. I don't really think this is because of Obamacare though. It's part of the trend in healthcare - more consolidation, more mergers, more cost cutting (most of which is done to finance the extreme bloat of administrative positions). Hospital systems are even merging. Small hospitals are either disappearing or being swallowed up by larger systems. When this happens the stuff like lab, imaging, purchasing, etc all consolidates as well which reduces need for pathologists.

For example, our hospital system could theoretically swallow up a small hospital in the area. If that hospital has 3-4 pathologists for 20,000 specimens the combined lab does not have a need for an additional 3-4 pathologists. I mean, I hear a lot about blaming obamacare and all that but a lot of this is textbook capitalism. Obamacare has a lot of issues but be careful about ascribing everything bad about healthcare currently to it. Many of these trends were set in motion years ago. Obamacare may have helped some come to fruition or exacerbate some, but it has probably lessened some others. Nobody, especially patients, wants to pay for anything anymore, with the possible exception of hospitals wanting to pay more for administrators.

The other trend simultaneously is that of hospital systems purchasing physician practices or hiring their own physicians. Many will contract with large groups (our hospital contracts with radiology and ER, for example). But a lot want all their physicians to be employees, or at the very least partners in the same system. This reduces leakage of patients elsewhere and allows more control. Again, this is capitalism. Regulations do make it harder for physicians to go it alone, however, so don't take my point wrong. Our group is something of a hybrid in that we are partners in a multispecialty physician group which maintains significant autonomy yet is still linked to the larger health system.

And young physicians now want increasingly less to do with any part of the business side of things. They WANT to be employees. They don't want any say over expenses, hiring, budgets, etc. They want to work their shift and go home. This of course works by giving more power to the administrators who are happy to take it in return for compensating these doctors less. Since it is their first job, in a sense, the doctors happily agree in return for more vacation time. You can say they are having the wool pulled over their eyes except they are happy to have this happen. By the time they figure out they could have been getting paid more it might be too late.

There is a lot of very condescending talk on these forums (I am not talking to LADoc here) as though everyone who doesn't agree with them is ignorant. There is some ignorance but it cuts both ways. And people honestly do have different priorities. There are many, many people who are happy to get paid 30% less (which can be >$100k) to not have to deal with the problems of being in private practice.
 
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There are few things here:
1.) There has been for last 20+ years WAYYYY too many pathologists trained. There is simply no arguing with this, the data is clear.
By the way this is 100% accurate. I never argue this point.

The problem in part is related to an increase in programs training residents. This floods the market with less competitive candidates. Although, honestly, the vast majority of these candidates still do get jobs. I have mentioned before that the last time we advertised publicly for a job, we listed specific qualifications we wanted. We got I think 80-100 applications, probably 60-70% were not qualified (many due to just not having the specific skills we needed, but also for reasons ranging from inadequate training, poor communication skills, poor references, poor track record of employment). But yet most of these people got jobs somewhere.
 
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In the Philly area, there has actually been more jobs open then I've ever seen.

I'm not saying the pathology market is good, but it isn't any worse than it was 5 years ago.
 
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My advice is sincere. If you are a medical student, and you still can make a choice, do not go into pathology. I am a mother and after 6 years of investing so many hours, I am faced with the bitter reality of an absolutely terrible job market. Not only me, but my co-fellows too. I feel betrayed!-
 
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I've been looking to hire. The new pathology graduates are all, whether fellows or residents absolutely pitiful at communication. I don't post and looked via word of mouth because I don't need 400 CV's flooding the fax. I agree with LADoc above, as usual his comments are spot on.
 
Okay, no one is throwing me into a furnace. Let's be 100% clear on that. There is no entire class of path residents, anywhere, that would be standing after 10 minutes toe to toe with me...Valley of Darkness and all that. I was not some pogue in motorpool.

1.) Partners need to actually contribute business ideas that GROW a business not just push glass. New fellows seem incapable of this.
2.) Partners don't send out emails asking to take vacation all the time so their kids can go to Disneyland every quarter.
3.) Partners do not unplug, even when on vacation. They are 'always on' and always ready to 'get it on' should something be needed with the business. Your only excuse might be if you are totally blotto on the weekend AND not on call.
4.) Partners do not roll over when pushed by government entities or admin types. The find loopholes, adapt and overcome obstacles. Again new fellows seem incapable of this.
5.) Partners know who's butt to kiss, know which clinicians need to be told they are looking sharp/hot, know who to be taking out for drinks on a Saturday night. New fellows are more likely to be logging into old Warcraft accounts, Netflix'ing with a Tinder date or most often/pathetic surfing internet porn at home alone with a pump bottle of Jergens on any given night.
6.) Partners know how to manage risk and when mistakes are made, know how to contain problems quickly.
7.) Partners are synergistic elements in a business, adding new revenue streams, thinking outside the box, spreading influence. They are NOT simply overpaid employees.

If you cant quickly rattle off 5 things you and only you do for a business (or relationships you have) that if not done, your business will dramatically suffer, you aren't a partner.

Everything that is evil is not attributable to Obamacare but huge seachanges stem from it: specifically how CMS now can ignore RUC recommendations and fiscal intermediaries feel emboldened to create crazy coverage rules with no input. The skeleton and meat of Obamacare has never been the problem, it is in all the fine print where the devil hid.

But a nice take away is that partnership positions are absolutely not for everyone, in fact they are not even for most path residents. They are for a tiny minority that unfortunately traditionally HAD been offered to most (in error). You are not a failure because you are at a VA for 25 years or retired from Kaiser or ran a state lab to get the pension. Success is liking getting shredded at the gym: it is 95% diet and only 5% your workouts. Focus on your financial inputs and expenditures and be in a place that makes you happy.
 
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Hey LADoc,
Just to play the Devils advocate. If a fellow comes out and has all of those things listed you are looking for . . . he or she probably isn't even going to join your group. They are probably going to open up a competing lab in your city. Just another perspective. If you really found partners that were all that great and can grow the business and do all that, why haven't they left and started up their own lab? If I was in your group, I would actually advise them to do so and I'm surprised they haven't.
 
Hey LADoc,
Just to play the Devils advocate. If a fellow comes out and has all of those things listed you are looking for . . . he or she probably isn't even going to join your group. They are probably going to open up a competing lab in your city. Just another perspective. If you really found partners that were all that great and can grow the business and do all that, why haven't they left and started up their own lab? If I was in your group, I would actually advise them to do so and I'm surprised they haven't.

Answer: No one walks in town and opens a competing lab pretty much ever. That's not how business model works. You need contacts, marketing folks, CONTRACTS, capital etc. Sooo no. Aint happening. Yes someone might pull off a outpatient office or 2 in adjacent region but even that is getting harder and harder with ACOs and multi-specialty groups etc. Basically if you planning on riding into a town you liked and hanging up a shingle with an open sign, Pathology is NOT the field for you.

An "anchor contract" is the key thing. Lose that and you are done. If dont have one to begin with you are asking for a disaster. Anchor contracts once awarded are literally almost never again competed for, trust me I have tried. You could have the biggest screwball of group with an anchor PSA contract and trying to convince the admin you should have a shot at it is tougher than getting Megan Fox undressed at a club in Vegas. I just spent several days wasted trying to muscle a gem PSA with literally nothing to show for it. Luckily I have a stable of others to fall back on. PSA anchor contracts can be roughly divided into turds and gems. Turds are contracts you get because you have to have them to compete for the outpatient business. They suck and usually at crappy hospitals but are a necessity to compete for OP work. Gems are goldmines in and of themselves. OP pull through for a gem is merely gravy.

Pathology services by and large are closed sections, meaning you literally cannot compete against the establishment. Its a monopoly in an area granted for the sake of stability and its common in Rads/Path and now moreso in EM/Hospitalists and Gas.

Partners also rarely leave to compete. If they did, this is pretty much an straightforward contract violation and stand to lose millions of $. It does happen on very rare occasion and almost always ends badly for the guy/girl who leaves the firm. Of course some partners leave out of the geographic area for family reasons but not to direct compete.

So to answer your question: Noob pathologists and others here can vouch for this are absolutely dependent on established folks to work in areas. Like the mob, you must come to me with bent knee and once you do, you will pretty much never leave to compete. If I decided to leave it all behind and journey out, I would have bend the knee to the established group in that area to even look at one slide for the most part.
 
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I can't fathom some young path opening competing labs. That's almost comical.

A fella like LADoc has the clinicians in his realm and doubt they are going to bail to the unknown turf of a new lab. LADoc and others bigger threats are the large corporate labs.
 
LADoc. You and I both know those noncompetes often don't hold up in court. I could give you several examples where either A) the group didn't pursue it because they knew it would b e tough battle in court and they didn't wan to lose money on it B) The defendant won or C) there was some sort of agreement worked out before somebody was sued. I think it would be hard for your private group to waste a lot of money on lawyers if somebody did up and leave your group.

You are also right in a sense. If you are a surgical pathologist, you definitely need a contract with a hospital somewhere. However, in GI and Derm things are more open. If you are confident enough in your skills, confident in yourself and have a business mind and have some contacts in either of those fields, I would think you would be better off opening your own lab than joining a group of fat cats that think their stuff doesn't stink. I have friends who did just that OUT OF FELLOWSHIP. It's not that comical Torsed.

If there are no jobs, but you really want to do pathology people need to start thinking outside the box. Sure contracts with insurance companies would be an issue, but it can be worked through.
 
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I can name you guys several groups that I know of where the dermpath got fed up with being a "partner" had all the attributes that you are alluding to LADoc and jumped ship to open their own lab across the street. I DON"T know any of those guys or gals who got sued and "rued the day" they decided to do this. Just some food for thought.
 
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I can name you guys several groups that I know of where the dermpath got fed up with being a "partner" had all the attributes that you are alluding to LADoc and jumped ship to open their own lab across the street. I DON"T know any of those guys or gals who got sued and "rued the day" they decided to do this. Just some food for thought.

Noncompetes are enforceable. In some states, like Texas, a noncompete has to have a reasonable buy out and distance for which the noncompete applies. Without some of these elements you risk that it may be dissolved in court. The company may not have enforced it on the dermpath, but they could easily take it to court and have a cease and desist placed on him.

I was lucky that a few years out of residency I acquired multiple hospital and outpatient contracts. I didn't pursue a fellowship, I pursued an MBA. But as a poster above said well, you are always on, have to be available and communicate well. Three keys to success: availability, affability and ability in that order. Once you get contracts, it is nearly impossible to loose them unless you are doing a horrible job or are not available. You must be able to squash problems right away and be critical to the organization. There is one looming 80 yr old retirement in my group and like others have mentioned, it is hard to find competent replacements.
 
It is very interesting how things vary.
The AZ courts have decided that non competes are not enforceable. My lawyer did not even want one in our employment contracts.
 
I disagree with this image of partner pathologists as all being go-getters who spend their time cultivating and growing their businesses, as if they were like Warren Buffett or Gordon Gecko with a microscope. Only the smallest minority of partner pathologists that I have witnessed ever got a new client or did anything special to make their business grow. They do cater to their existing clients, but that is not dramatically different from what a VA pathologist would do for his "clients", without any incentive.

Also, there is so much talk about good vs bad pathologists. Of course there is a range, but shouldn't we support each other if we all passed the boards? I have never witnessed other specialties trash talk their own kind to the degree pathologists do. I have repeatedly seen surgeons and other clinicians who I have deemed totally incompetent held on pedestals by their peers, even when they can hardly speak English and graduated from the lowest tier residency programs.
 
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Noncompetes are enforceable in many places especially when the parties are partners/shareholders. YMMV.

I totally agree that not all partners match the idea and I dont look like Arnold at the 1969 Mr Universe comp but still manage to get into the gym...gotta strive.
 
I have repeatedly seen surgeons and other clinicians who I have deemed totally incompetent held on pedestals by their peers, even when they can hardly speak English and graduated from the lowest tier residency programs.

I have seen surgeons go after other surgeons pretty badly. Calling the medical boards on each other, peer review...in general, making career ending moves on each other.
 
I am a mother and after 6 years of investing so many hours I am faced with the bitter reality of an absolutely terrible job market.
Big deal? What does having kids and putting the same amount of time in training as the rest of us have to do with the job market? It doesn't make you a special snowflake...

the last time we advertised publicly for a job...We got I think 80-100 applications...But yet most of these people got jobs somewhere.
How would you know...did you follow up with most of the remaining 79-99 applicants to make sure they were employed?

Once you get contracts, it is nearly impossible to loose them unless you are doing a horrible job or are not available.
One would think. Solid work doesn't always deem loyalty. You leave out a big part of the equation which is: who is on the other side of the contract. I have known of pathologists/groups who provided efficient work of solid quality, and were affable/available, etc. But, when the dermatologist in town retired, the new one who came in sent their skins to a dermpath buddy from residency. Or, the chief OB-GYN left because they found their dream job in another state and the new one hired by the hospital wasn't obligated per contract to send Paps or GYN bx's to the hospital-based pathologists. So instead, it went to a reference lab, and so forth. Contracts are much easier to lose than you may think or have experienced. Just give it time...

Only the smallest minority of partner pathologists that I have witnessed ever got a new client or did anything special to make their business grow.
Second that. LA's "7 tenets of partnership" are a noble idea, but many pathologists are simply not wired that way. Most would rather sign out a couple of GI biopsies and scuttle home by 4-5pm. For that matter, it's not just pathologists, but physicians in general who don't have that kind of mindset like they used to. Especially in the era of 80hr work weeks for residents, surgeons who want to take half the call that the generation before them did, and employed physicians who'd rather have a steady paycheck determined for RVU output by a hospital administrator.
 
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As someone who just went through the job hunt I agree that the market is pretty awful. That being said, I walked away with multiple offers from my interviews and chose something I am very happy with. Not all of those offers were great or even ideal, but certainly going unemployed wasn't going to happen. These jobs were all in major cities in the USA. My co-fellows last year all got jobs, some rather late, but all are employed. My co-fellows this year all have jobs lined up for July as well. It is a painful process but certainly how you act, your references, and your connections are critical.
 
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Why are you saying it is awful when you got multiple offers, esp in major cities? It took you a while to find something you liked? Did you find a job in a place you wanted to live?
 
Hey LaDoc, I had a fellow with GI training wanting 400k to start out of fellowship. What say you? I said nein.
 
Hey LaDoc, I had a fellow with GI training wanting 400k to start out of fellowship. What say you? I said nein.


Not happening unless there is more to the story, like this fellow has a patent for something huge. Would guess more 200 to start out of fellowship, which aint bad tbh. Depends on location really as the value of money is dependent on the COLA.
 
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Not happening unless there is more to the story, like this fellow has a patent for something huge. Would guess more 200 to start out of fellowship, which aint bad tbh. Depends on location really as the value of money is dependent on the COLA.

What offers do dermpath fellows get right out of fellowship? It varies tremendously, but what's the ballpark?
 
What offers do dermpath fellows get right out of fellowship? It varies tremendously, but what's the ballpark?

200-250 I would guess without actually being a dermpath fellow applying for a job. Your sign out efficiency just isnt there to warrant higher straight out of training IMO.

But stop focusing on starting salary and focus instead on terminal compensation potential.
 
What offers do dermpath fellows get right out of fellowship? It varies tremendously, but what's the ballpark?

Depends. I now of at least one dermpath-only lab that starts new people at $350K and ramps them up to $500K (maybe more) over time. And those are high-volume, pushing glass sort of places. I would guess very few places start higher than that because there's no need to, even dermpath isn't a guarantee of work any more.
 
Not happening unless there is more to the story, like this fellow has a patent for something huge. Would guess more 200 to start out of fellowship, which aint bad tbh. Depends on location really as the value of money is dependent on the COLA.

That was my thoughts. Nothing to the story, not patents, jack squat.
 
Why are you saying it is awful when you got multiple offers, esp in major cities? It took you a while to find something you liked? Did you find a job in a place you wanted to live?

I say awful because I must have sent out close to 50 applications and cold called a dozen other practices. I say that because some offers were small community practice where essentially you are on call 24/7 365 with little to no areas for growth. My wife who is in a diff field of medicine had multiple offers in every city I interviewed. I was on a different timeline since if we couldnt stay local we would both need jobs. The timeline for pathology sucks, the amount of people getting hired in May/June is too high. Getting multiple offers from 50+ applications, when several of those offers are cringe worthy isn't a great market. The job I got is in a city I am okay with living yes. Never thought I would end up there, but it isnt a bad place to be. Unfortunately my academic wife will have to go into private practice in order for me to take the job there. But again.. I got a job, my co fellow got a job, the surg fellows here all got jobs, the hemepath fellows got jobs, all my co fellows from last year got jobs. I know of no one without a job who doesnt have a J1 visa issue.
 
I say awful because I must have sent out close to 50 applications and cold called a dozen other practices. I say that because some offers were small community practice where essentially you are on call 24/7 365 with little to no areas for growth. My wife who is in a diff field of medicine had multiple offers in every city I interviewed. I was on a different timeline since if we couldnt stay local we would both need jobs. The timeline for pathology sucks, the amount of people getting hired in May/June is too high. Getting multiple offers from 50+ applications, when several of those offers are cringe worthy isn't a great market. The job I got is in a city I am okay with living yes. Never thought I would end up there, but it isnt a bad place to be. Unfortunately my academic wife will have to go into private practice in order for me to take the job there. But again.. I got a job, my co fellow got a job, the surg fellows here all got jobs, the hemepath fellows got jobs, all my co fellows from last year got jobs. I know of no one without a job who doesnt have a J1 visa issue.
Welcome to the real world.When supply>demand,one can't be as selective.Be thankful there are some jobs available,even in poor backwash rural areas.With such a condescending attitude, you wouldn't be welcomed in such places for long .ACADEMIA, and their puppet the CAP, are the authors of this surplus of Pathologists giving us no bargaining power in the community job market.
 
Weird. I am actually looking for ONE pathologist fresh out of training with a desired sub-specialty (e.g. heme, derm, GI) for a hospital-based practice. The only issue is you have to relocate to a hot, humid environment in an obscure local. I can guarantee that salary will be more than what is typically offered a newbie pathologist. See, jobs exist.
 
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Welcome to the real world.When supply>demand,one can't be as selective.Be thankful there are some jobs available,even in poor backwash rural areas.With such a condescending attitude, you wouldn't be welcomed in such places for long .ACADEMIA, and their puppet the CAP, are the authors of this surplus of Pathologists giving us no bargaining power in the community job market.

I don't mean to be condescending. When seasoned pathologists in small community hospitals tell you to take another job instead it even though they need help it's a red flag.
 
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My advice for all, as a path fellow having done fellowships in ivy leagues and still finding no jobs is DO NOT GO into pathologist. My co-fellows are suffering as well.
Market is absolutely terrible.
Dear Students I joined for one reason and one reason only, after 30 years in pathology at the highest levels I am here to suggest to you- with all my heart- to avoid this specialty AT ALL COSTS
No one cares about surgical or clinical pathology struggle, not even the so called pathology societies .
99% of people in medical services have no clue what we do,
the training in med schools is almost non existent, in residency whatr ever you learn willbe osolete in 1 year, the cost of credits is astronomical
the corporations/ hospitals/ industry have aimed at destroying the profession of Pathology. Just look at any ANY company that tests for a new mutation or whatever: they do NOT want pathologists to be able to do anything BUT ordering their test. The labs are reduced to post offices run by money hungry interests.
The good jobs are so few AND in super duper universities that the number of graduates and fellows is astronomically disproportionate: unless you are a genius you will STRUGGLE to survive.
THe ACGME does absolutely nothing, should have shut down many programs, force board examination on ALL sub specialties ACGME MUST separate Ap from CP immediately!!
Many interest destroyed pathology, so don t fall in this spiraling down DISASTER is done finished dead..
 
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Calm down mountain and stop growling. Path is cool. I like it.
 
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