path future

[Ganz]

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Hey guys,

I'm a third year with a sincere interest in Pathology. I worked in a path lab as an assistant before starting med school. I am curious about the future of pathology. I hear many other physicians saying that Path is a dying field. Of course, I know that you guys have a different opinion. But I am honestly trying to decide my future. I know I am supposed to follow my heart, etc etc.. but I need to know that I will have a productive career for the next 30 yrs. I am also curious as to how much microscopy will take a back seat to molec bio tests. Any insight would be greatly appreciated.

thanks

 

[deschutes]

I hear many other physicians saying that Path is a dying field.

Are these also the physicians who order biopsies? 😛

Pathology is the study of disease. It is the foundation on which an understanding of clinical medicine is built. I haven't heard about pathology being a dying field. If anything, the number of labs and specimens ordered continues to increase by leaps and bounds, even as the net number of pathologists remains almost the same.

Others on this board will probably be able to answer your question re: microscopy vs. molec bio testing in greater detail and with better evidence than I can.
My simplistic take on it is that someone still has to order those funky molec bio tests - and that person will be a pathologist. 🙂

 

[yaah]

I dunno. I don't think path is going anywhere for awhile. Most of these ancillary tests (the alternative to the biopsy and glass slide) and fairly non specific. To confirm diagnoses, you still need biopsies, and I don't think that's going to change anytime soon.

Basically, though, I have heard "dying field" about every branch of medicine with the possible exception of dermatology. Radiologists worry because of outsourcing. Anesthesiologists worry because of CRNAs. Surgeons worry because of less invasive procedures. Neurologists worry because no one believes them anymore. Psychiatrists worry because no one can pay them. Medicine folks worry because their salaries keep going down. OBs worry because their insurance keeps going up.

Pathologists are always going to be needed. Perhaps in the distant future the importance of glass slides, or perhaps even the art of diagnosis on a slide will assume less of an importance in the face of molecular testing and profiling of tumors, but I imagine that's a long way off. Plus, tumors and diseases are so incredibly complex and variable, that science is going to have to work long and hard to ever make something that automated. There is still plenty of work for everyone. And the molecular tests are very specific. You can't yet take any random tumor growth, throw it in a machine, and have it spit out what it is. Certain tumors do have common mutations or chromosomal abnormalities, but there are often multiple abnormalities and contaminants, and it ends up "supporting" the diagnosis made on histology, not creating a new diagnosis.

I know though, it's hard when you hear all the naysayers out there. But just realize that there are naysayers everywhere, and for every positive thing you hear, there will be a few other people who want to burst that bubble. It happens in every part of life. Hey, I'm going camping this weekend, weather is supposed to be great! Yeah, whatever, camping sux. It's too crowded, and there are too many bears... (I'm not actually going camping).

 

[rirriri]

i agree with Yaah, there is no chance that Path is a dying field.

One must always keep in mind that even biopsies are one of the more accurate tools that clinicians have to really see what's going on in a patient. Imaging technology and new molecular studies may do alot for the future of diagnostic medicine and may provide less invasive means of testing, however there are a few things to remember:

A) many of them are very expensive, making them impossible to use on a mass scale
B) the window of precision and flexibility is often not as high as microscopy
C) they are not time tested, meaning some of these methods are new and haven't been proven to provide the most useful information.

Personally I feel that Pathology will eventually evolve with technology as well. As everything becomes a bit more digital and image-based, the idea of "Digital Microscopy" keeps popping up into my head....and no, Radiologists would NOT be doing this because only a pathologist has training to identify microscopic features of tissue.

 

[b&ierstiefel]

i agree with Yaah, there is no chance that Path is a dying field.

One must always keep in mind that even biopsies are one of the more accurate tools that clinicians have to really see what's going on in a patient. Imaging technology and new molecular studies may do alot for the future of diagnostic medicine and may provide less invasive means of testing, however there are a few things to remember:

A) many of them are very expensive, making them impossible to use on a mass scale
B) the window of precision and flexibility is often not as high as microscopy
C) they are not time tested, meaning some of these methods are new and haven't been proven to provide the most useful information.

Personally I feel that Pathology will eventually evolve with technology as well. As everything becomes a bit more digital and image-based, the idea of "Digital Microscopy" keeps popping up into my head....and no, Radiologists would NOT be doing this because only a pathologist has training to identify microscopic features of tissue.

agreed. just like how some surgeries are being done by remote control and robots and stuff, pathology is experiencing technical innovation as well. the only part of pathology that may die is old, outdated methodology. pathology as a field shall never die!

 

[Doctor B.]

Pathology will always be around in some form or another. As the genetics and molecular biology of disease become more elucidated, there will be a shift in the dynamic of the practice of pathology. Even now, experience and knowledge in molecular pathology is becoming a desired skill for groups looking for a new pathologist.

 

[LADoc00]

Pathology is dying? Well who is going to make the diagnoses then??? Thats the most laughable thing Ive heard in a while.

It must have been a radiologist who said that. Rule 1: Never listen to radiology, automatically assume that outside of bone tumors they simply make crap up on the fly. Things like "Looks irregular, could be infiltrative, but maybe well-circumscribed, diagnosis: malignant vs. benign" come out of their mouths with shocking regularity and surgeons and internists dont know enough to see how absurd it all is. But I diverge.

 

[2005]

Yesterday one of the pathologists was mentioning that with the change in path residency from 5 years to 4 there may be a shortage of individuals having enough time to get research experience during residency, and therefore a decrease in folks going into academics. She also mentioned something about the possibility of fellowships changing from 1 year to 2. Of course, that would require additional funding coming from somewhere. Interesting, shorten residency, lengthen fellowship. I don't have a PhD in Math but the equation seems to equal 6 no matter how you look at it.

Just food for thought.

 

[kchan99]

Basically, though, I have heard "dying field" about every branch of medicine with the possible exception of dermatology. Radiologists worry because of outsourcing. Anesthesiologists worry because of CRNAs. Surgeons worry because of less invasive procedures. Neurologists worry because no one believes them anymore. Psychiatrists worry because no one can pay them. Medicine folks worry because their salaries keep going down. OBs worry because their insurance keeps going up.

Please clarify...Why don't people believe neurologists?

 

[GreatPumpkin]

You can forget the idea of the fellowships changing from one to two years. It will never happen without funding.

Path as a field is not going anywhere anytime soon. Molecular will just increase the work for path at least for the next 10 to 20 years or so. It will just be used as a tool to go with the histology, just like immunohistochemistry.

 

[yaah]

Please clarify...Why don't people believe neurologists?

Honestly I don't remember what i was going for there. It's probably a typo.

In terms of fellowships, well when residency was 5 years, many people would do a fellowship (or a de-facto fellowship) as their fifth year. I don't think it will change things a ton. And I agree with Great Pumpkin that FUNDING is the important factor.

 

[Mindy]

I had all of these concerns (ask GP) about the death of pathology as a field. After a solid year of surg path and an astronomical volume, I don't think you could convince me that pathology was going anywhere any time soon.

Mindy