Path Competitivity

[jackinabox1]

Advertisement - Members don't see this ad

My buddy is planning to apply path. He's a mid-tier US MD Step 1: 240+, Step 2: 250+, honored half his rotations, a few low impact pubs. Given his stats, I told him he could get in a top 10 program given how much everyone here talks about the poor job market.. He said I'm overestimating his competitiveness as he doesn't have AOA or go to a top med school. What say the experts here?

 

[SunBakedTrash]

I had less of those qualifications than he does and I got interviews everywhere (including the top ones) and matched my first choice. I actually got less love from the few crap places I applied because they knew I wouldn’t bother with them. Not sure it’s the job situation. Even if there were tons of jobs, I doubt it would be that competitive. I just can’t imagine most people wanting to be a pathologist.

 

[Alteran]

If he speaks clear and cogent English, with those stats he can go anywhere he wants without any effort. My only question is with those stats, why is he bothering with pathology at all?

 

[Fission Chips]

If he speaks clear and cogent English, with those stats he can go anywhere he wants without any effort. My only question is with those stats, why is he bothering with pathology at all?

This aligns with my N=1 experience. One of my good friends from med school got below average on both steps and failed CS, interviewed at T-10 schools and matched his first choice (arguably the best program in the country). He had "ranked to match" letters from almost all the T-10s. If you are a USMD, you can go anywhere you want regardless of stats.

 

[jackinabox1]

If he speaks clear and cogent English, with those stats he can go anywhere he wants without any effort. My only question is with those stats, why is he bothering with pathology at all?

He loves the field and is a stubborn dude.

 

[deleted314957]

He loves the field and is a stubborn dude.

He may love the field as an intellectual pursuit but, given the current state of affairs, he probably will not like the difficulty and unattractive trade offs of trying to get a fulfilling job/career. If he is single and plans to stay that way or comes from money, go for it. It is now virtually a necessity to be able to afford selective private schools unless you think the teaching of critical race theory is more important than learning critical reading skills and writing clearly and concisely.

 

[futuredoc331]

He may love the field as an intellectual pursuit but, given the current state of affairs, he probably will not like the difficulty and unattractive trade offs of trying to get a fulfilling job/career. If he is single and plans to stay that way or comes from money, go for it. It is now virtually a necessity to be able to afford selective private schools unless you think the teaching of critical race theory is more important than learning critical reading skills and writing clearly and concisely.

I've heard a few times that transfusion medicine has jobs. Is that just because it's relatively better than the rest of the field or that the job market is actually decent?

 

[deleted314957]

I've heard a few times that transfusion medicine has jobs. Is that just because it's relatively better than the rest of the field or that the job market is actually decent?

Both (kind of a low interest field and the CP training the majority of residents get is a joke, by their own admission) and, also, the FP outlook is excellent.

 

[Mad Jack]

I've heard a few times that transfusion medicine has jobs. Is that just because it's relatively better than the rest of the field or that the job market is actually decent?

Don't forget forensic pathology

 

[deleted314957]

that’s what i meant by “FP”. ( not family practice, although the outlook there is great if you can stand patients)

 

[Mad Jack]

that’s what i meant by “FP”. ( not family practice, although the outlook there is great if you can stand patients)

Oh I know, I just posted before I saw your post. FP was an old interest of mine- if it didn't take so long to train for I might have considered doing it once I was tired of psychiatry

 

[Spaziergängerin]

I've heard a few times that transfusion medicine has jobs. Is that just because it's relatively better than the rest of the field or that the job market is actually decent?

The job market is decent in transfusion medicine but still not as good as non-path specialties. It's important your friend go to a program strong in clinical path if that's an interest.

 

[futuredoc331]

The job market is decent in transfusion medicine but still not as good as non-path specialties. It's important your friend go to a program strong in clinical path if that's an interest.

Thanks for the response. I'm not OP though. I was asking about TM for myself. I came into residency thinking I wanted to do TM and have a research career. I'm not so keen on that idea anymore and I don't want to do AP. Thinking about switching to Family Medicine now.

 

[deleted314957]

Thanks for the response. I'm not OP though. I was asking about TM for myself. I came into residency thinking I wanted to do TM and have a research career. I'm not so keen on that idea anymore and I don't want to do AP. Thinking about switching to Family Medicine now.

Many more opportunities and freedom of choice in family medicine than path at this time.

 

[Spaziergängerin]

Way more options in family med and flexibility of where to practice and what type of place--hospitals, academics, clinics, community, office based--all viable options.

 

[Alteran]

Way more options in family med and flexibility of where to practice and what type of place--hospitals, academics, clinics, community, office based--all viable options.

Let's also not forget in the zero sum game that is CMS funding, Fam med's reimbursement codes went up about 10% overall while Pathology's went down about 9%.

I also have to say that Fam med has become a much different field than what I remember as a med student. You can Telehealth and never actually have to see your patients. Even better is that you can offload most of your patients, especially the annoying ones, to PAs and just sit back and collect. Even I as a physician can't get in to to see my primary care anymore, only the PA. And the truly, truly great thing for Fam Med is that no matter how poorly you treat your patients, there's a near endless supply of them to keep you employed anywhere you go.

 

[deleted314957]

Way more options in family med and flexibility of where to practice and what type of place--hospitals, academics, clinics, community, office based--all viable options.

One of the beauties of family medicine is you can be very financially successful without being that clinically knowledgeable. A family doc “specializing “ in referrals who is easy to get an appointment with, is a hand holder and has great bed side manner is loved and successful. And this is is in NO way a denigration. Such compassion skills are a rarity and deserving of compensation. It’s damned near half of medicine. Unfortunately, I have seen a lot of paths who consulted almost everything as liberally. Doesn’t work so well because consultants and partners eventually get pissed off and paths don’t have any grateful patient’s hands to hold.

 

[coroner]

He loves the field and is a stubborn dude.

If he's that competitive, and likes Path, I would recommend Rads. It's close enough in clinical acumen, with similar or better lifestyle, better pay, and better job prospects. A radiologist friend of mine just told me about another radiologist he knows who works 3rd shift only (night reads), 1 week on, 2 weeks off (this equates to 17.3 weeks/yr or roughly 4 months per year) and makes $415K/yr. Path can't even touch that.

 

[Alteran]

If he's that competitive, and likes Path, I would recommend Rads. It's close enough in clinical acumen, with similar or better lifestyle, better pay, and better job prospects. A radiologist friend of mine just told me about another radiologist he knows who works 3rd shift only (night reads), 1 week on, 2 weeks off (17.3 weeks/yr or roughly 4 months per year) and makes $415K/yr. Path can't even touch that.

You’re absolutely correct. And with pathology adopting an ever increasingly defeatist attitude, it’s only going to get worse. Case in point, read below an excerpt from what hit my inbox recently.

Surviving Future Payment cuts—Hear Advice from Dr. Diana Cardona​

Pathologists are likely to continue facing risks of professional fee payment cuts and value-based payment programs like the CMS’ Quality Payment Program are here to stay. By now you are likely wondering “Is there something I can be doing to lessen the impact of these cuts?”
The answer is yes—develop a longer-term strategy. It may be tempting to request a MIPS hardship exemption in 2021 to avoid reporting, but for those looking for a more sustainable solution, using the Merit-based Incentive Payment System (MIPS) as part of your strategy may, in reality, help offset other payment cuts in the future.
Listen as Diana Cardona, MD, FCAP, Vice Chair, Economic Affairs Committee and Chair of the Measures and Performance Assessment Subcommittee explains while hardship exceptions may seem welcome, accepting an exemption this year, results in a neutral payment adjustment in 2023, and that may not be in your practice’s best interest.

I‘m certainly taking the developing a long term strategy to heart - as in reinvesting my ever shrinking paycheck into something other than pathology that‘s more viable.

 

[WEBB PINKERTON]

Best long term strategy=get your side hustles going and move on to something else. No different than the dust bowl.

 

[Drifter76]

If he's that competitive, and likes Path, I would recommend Rads. It's close enough in clinical acumen, with similar or better lifestyle, better pay, and better job prospects. A radiologist friend of mine just told me about another radiologist he knows who works 3rd shift only (night reads), 1 week on, 2 weeks off (17.3 weeks/yr or roughly 4 months per year) and makes $415K/yr. Path can't even touch that.

Agree- with that academic record he is overqualified for path. Path has become a field for IMGs and bottom-of-the-class types. And I’d argue that even the bottom of the class types, people who failed a step or maybe had to repeat a year of med school or something like that deserve better than what the field of pathology now has to offer. It sounds like he would likely match to a top program in pathology, but I have major doubts about whether it would do him much good. Being a top student/candidate and getting good training won’t be enough to protect him from the dumpster fire that is the pathology job market. If anything, working hard, being a high achiever, getting good training etc will just make him even more bitter once he gets out of training and gets chewed up and spit out. In some ways, I wish I’d just been a C student with bare minimum board scores, bottom tier training etc.. my choice to go into pathology would’ve seemed a little less tragic.

 

[AZpath]

Agree- with that academic record he is overqualified for path. Path has become a field for IMGs and bottom-of-the-class types. And I’d argue that even the bottom of the class types, people who failed a step or maybe had to repeat a year of med school or something like that deserve better than what the field of pathology now has to offer. It sounds like he would likely match to a top program in pathology, but I have major doubts about whether it would do him much good. Being a top student/candidate and getting good training won’t be enough to protect him from the dumpster fire that is the pathology job market. If anything, working hard, being a high achiever, getting good training etc will just make him even more bitter once he gets out of training and gets chewed up and spit out. In some ways, I wish I’d just been a C student with bare minimum board scores, bottom tier training etc.. my choice to go into pathology would’ve seemed a little less tragic.

If he's that competitive, and likes Path, I would recommend Rads. It's close enough in clinical acumen, with similar or better lifestyle, better pay, and better job prospects. A radiologist friend of mine just told me about another radiologist he knows who works 3rd shift only (night reads), 1 week on, 2 weeks off (this equates to 17.3 weeks/yr or roughly 4 months per year) and makes $415K/yr. Path can't even touch that.

Apparently there is a lot demand for grave yard shift. Don't go into pathology for the money these days.
Twenty years ago it was easy to find partnership netting 500K and often much more.
Now your lucky to make 400s.

 

[gbwillner]

Geezzzzz y'all need to go outside and get some fresh air and perspective. it's not all roses but come on... Not everyone is either poor or miserable in this field. There is good diversity in it. If you are smart and capable you can rule.

If I was dead set on path I would not have, nor would I now consider any other specialty. I never considered Rads for one second.

 

[Alteran]

Geezzzzz y'all need to go outside and get some fresh air and perspective. it's not all roses but come on... Not everyone is either poor or miserable in this field. There is good diversity in it. If you are smart and capable you can rule.

If I was dead set on path I would not have, nor would I now consider any other specialty. I never considered Rads for one second.

Your vantage point in the field must be better than mine. I don't mean this with any disrespect, but my perspective with just over 10 years of pathology is unrelenting and progressive cuts to reimbursement and increasing encroachment by other specialties into the few profitable areas of pathology that we're powerless to stop. I will freely admit that I am a pessimist and on the hyperbolic side of things, but my business office's balance sheets don't lie.

 

[Drifter76]

Apparently there is a lot demand for grave yard shift. Don't go into pathology for the money these days.
Twenty years ago it was easy to find partnership netting 500K and often much more.
Now your lucky to make 400s.

I agree- the money is worse, but it isn’t just about money. There are many other negatives besides just lower compensation. Lack of stability, lack of professional respect, having to live in places that aren’t even with several hundred miles of anywhere you’d really want to live, numerous dishonest practices lying to people about partnership tracks or misleading people about the stability of their hospital contracts, people having to stay in training and take additional second and third fellowship years not because they need them or want them but because they can’t find a job and need a paycheck while they extend their job search for another year, etc.. I took and left 3 different jobs in my first 4 years or practice. I don’t think that would’ve happened in any other field.

 

[Drifter76]

If you are smart and capable you can rule.

If you are smart and capable, and also stay away from the field of pathology, you will have a much better chance to “rule” than any of those unfortunate enough or naive enough to enter this albatross. Consider derm, ENT, urology, ophthalmology, cards or GI - or radiology if you really don’t want to see patients. All of those fields will give you a much better chance of having a decent life. Even primary care is probably better.. the pay is relatively low but demand is high and you could easily find a job anywhere you want to live. You could also stay away from medical school entirely, get into one of those executive MHA programs and become a hospital executive. Get paid 7 figures to be an empty suit.

 

[KeratinPearls]

I know people who got a 195 and low 200s on Step 1 that got into Pathology. The bar is set low unfortunately for a field where one has a serious role in patient care - diagnosing cancer. The stakes are high for a missed diagnosis.

I’ve seen surgpath fellows who couldn’t recognize cancer on a frozen. I’ve had a chairman once tell me he’s had trainees who “didn’t have an eye for pathology”.

 

[deleted314957]

Best long term strategy=get your side hustles going and move on to something else. No different than the dust bowl.

View attachment 338970

Just not real estate. It certainly seems that the govt has no qualms about forcing landlord owners to house deadbeats for longer than pre covid. Who helps them make their nut?
But i guess the folks running the show think all the landlords are rich shylocks.

 

[Drifter76]

I know people who got a 195 and low 200s on Step 1 that got into Pathology. The bar is set low unfortunately for a field where one has a serious role in patient care - diagnosing cancer. The stakes are high for a missed diagnosis.

I’ve seen surgpath fellows who couldn’t recognize cancer on a frozen. I’ve had a chairman once tell me he’s had trainees who “didn’t have an eye for pathology”.

Pathology has become such an undesirable field - it’s going to get to the point where the only people coming in are the ones who are bottom of the barrel and can’t recognize cancer on a slide. Maybe the powers that be might, at some point, decide that it isn’t worth the Medicolegal risk to keep running this scam. That’s about as much optimism as I can muster when it comes to discussing the pathology market, which has been nothing but a steaming pile of excrement.

 

[Drifter76]

He loves the field and is a stubborn dude.

I can see why people might like the actual work. I like it myself. I enjoy looking at slides, making a diagnosis, doing my sub specialty work which involves some CP, etc. I enjoy all of it which is what drew me to pathology. But my problem is, I don’t like being taken advantage of. That seems to be the real key to happiness in pathology moving forward- you need to have a very high tolerance for being disrespected, bilked by shyster employers and “colleagues”, underpaid, scrambling for low quality jobs you don’t really want in places you don’t want to live, and otherwise being taken advantage of. That would be a bigger predictor of satisfaction in the field than simply whether or not one likes the actual work. Does your friend have a high tolerance for being taken advantage of? Most stubborn people don’t. If I had it to do over there is no way in HELL I would choose this ****..

 

[ThatSerb]

He may love the field as an intellectual pursuit but, given the current state of affairs, he probably will not like the difficulty and unattractive trade offs of trying to get a fulfilling job/career. If he is single and plans to stay that way or comes from money, go for it. It is now virtually a necessity to be able to afford selective private schools unless you think the teaching of critical race theory is more important than learning critical reading skills and writing clearly and concisely.

would this outlook of yours change at all if the applicant had no school debt, along with a guaranteed gig with the VA?

 

[deleted314957]

I know people who got a 195 and low 200s on Step 1 that got into Pathology. The bar is set low unfortunately for a field where one has a serious role in patient care - diagnosing cancer. The stakes are high for a missed diagnosis.

I’ve seen surgpath fellows who couldn’t recognize cancer on a frozen. I’ve had a chairman once tell me he’s had trainees who “didn’t have an eye for pathology”.

Years ago I was affronted and thought it was a waste of time to have two paths sign off on a malignancy. I have changed 180 degrees. In complex cases I think the lack of general ability out there requires a consensus dx with at least SOMEONE who has seen and identified one.

 

[deleted314957]

Agree- with that academic record he is overqualified for path. Path has become a field for IMGs and bottom-of-the-class types. And I’d argue that even the bottom of the class types, people who failed a step or maybe had to repeat a year of med school or something like that deserve better than what the field of pathology now has to offer. It sounds like he would likely match to a top program in pathology, but I have major doubts about whether it would do him much good. Being a top student/candidate and getting good training won’t be enough to protect him from the dumpster fire that is the pathology job market. If anything, working hard, being a high achiever, getting good training etc will just make him even more bitter once he gets out of training and gets chewed up and spit out. In some ways, I wish I’d just been a C student with bare minimum board scores, bottom tier training etc.. my choice to go into pathology would’ve seemed a little less tragic.

I knew I was going straight to the navy. Only vaguely knew what the match was and and never tried to impress a soul.
Pissed lots of chiefs off cause i’d laugh at them or refuse to kiss their ass. I don’t think this would work as well today. Thank the lord for the USN.