Two separate scenarios: Fellowship or attending? The likelihood is quite different. e.g. If you do residency in the East coast and then want to pursue a non-competitive fellowship like BB/TM, surg path, or cytopath, then it is practically a lock 🔒 that you will get one of those fellowships somewhere in the West coast.
However, if you are talking about as attending i.e. a job in the West Coast, it probably would be tougher. Again, there are many different variables. For example, if you just did a 4 yr AP/CP residency in the East coast at a bum program, no fellowship, then hung your shingle out as a generalist in the West Coast applying for jobs, then it would be significantly harder to find a job. However, if you trained at MGH, then a neuropath fellowship (East or West coast), it would be likely you get a neuropath job in the West coast in academics, and possibly pp if it's a big enough group. Also, are you ok being rural, or do you want to be in Bay Area, San Diego, Seattle, etc.? Metro areas are always going to be more competitive to land a job on either coast.
So, it all depends on your career track and other variables as mentioned above. As a general guideline (not rule), some pathologists say, "train near where you want to end up". It may help foster connections; however, it is not a dealbreaker by any means. There are a lot of East coast, Midwest, Southern trained pathologists practicing on the West Coast. And, if you want to do subspecialty practice only, then there's usually academic jobs somewhere on either coast that are open (because academics pretty much only hires subspecialists). If you don't want to do subspecialty practice only/academic route, and you trained on the East coast, then you can still end up on the West Coast, but you may have to be patient i.e. start out somewhere out West, but maybe not your favorite city.
