path or surg? help me decide

[music2med]

Wrapping up MS3 and having a quarter life crisis, as many of us are wont to do at this stage. Anyway, I had toyed with the idea of pathology as an MS1 because I really loved histo and sucked at OSCEs (i.e pt interaction made me nervous). However, I have always had surgery in mind since something that really motivates me is developing skills and constantly having to improve my hands-on abilities. I started with surgery as my first rotation and really loved it, so I began making connections and trying to get research and leadership in the field. However, near the end of the year I took a Pathology elective and also loved that, I really vibed with the people and had fun grossing and working on my histology skills, was also less stressed than I was on surgery.

Some things to mention- I spent a bunch of time on MIS for surgery and loved it, I could actually work with the bariatric pt population and robotics is a fascinating field. However, I did not especially love ACS, which I know surgery residents spend a lot of time on, it is definitely an exciting field but very stressful in my opinion- I definitely want to know how to manage emergencies but wouldn't want to do it forever. Also, many of the personalities in surgery seemed more "type A" than I am. Regardless, surgery felt like the reason I went into medicine- to be an expert, take care of patients, and to be the one to provide the definitive "fixes" if possible. Lifestyle wise, for the next 5 years at least I don't plan on having kids and I don't have an SO or anyone putting pressure on me just yet so I really am free to pursue whatever I want without worrying about lack of family time, but who knows if these priorities will change later in life.

As for path- everyone else I know who wants to do path is obsessed with forensics but I kind of don't love that aspect, autopsies are interesting but I don't think I'd want to do that for my whole career. I'm most interested in surgical path- I really love the pattern recognition aspect of path, and also being the one to find a definitive diagnosis. Funny enough, I am a little worried about lack of patient interaction because I have come to value some of the meaningful interactions I have had during rotations. Of course, everyone in pathology loves to educate (which is something I value and want to continue), has lives outside of medicine, and are generally very nice people so that really appealed to me. I definitely will be asking around about the job market since I know that's always something that comes up- I'd probably be ok with lower pay though to get my location of choice but we'll see.

I also am not sure that I'm the most competitive surgery candidate- if I'm lucky I'll have 2-3 pubs by application time but only 1-2 would be in general surgery (other research is gyn surg). Have only high passed a couple clerkships (including surgery), no honors. Step 1 was pass/fail (I passed) but no Step 2 yet, generally have been between 50th-70th percentile on shelves. With not really having planned on my interest in path, I don't have any pubs or anything else proving an interest in the field, not sure how much of a red flag that would be if I were to make the switch.
Anyway, any insight on figuring this out would be appreciated!

edit: I don't have an SO or kids so length/intensity of training is not an issue at this point (although I know burnout is real). Having my choice of location (west coast) is important to me though.
Edit pt. 2: People keep mentioning floor management so I thought I'd mention that after doing my IM rotation, I realized that I also appreciated being able to handle inpt management of patients and I noticed that gen surg out of all of the subpecialties seems to have the best grasp on that aspect of pt care so that actually drew me to the field as well. Obviously no one really loves handling all of the dispo issues but I do enjoy following up on people and seeing how they're doing/getting to know them some is valuable to me as well. Really what it comes down to is burnout- would it end up being a "too much of a good thing" situation especially since there are some lifestyle specialties that I would be fine with doing even if they don't have everything I value.

---

Members don't see this ad.

 

[SunBakedTrash]

Pathology is a great field and outside of the complaining in our pathology forum for issues that cannot be readily escaped in any medial specialty except cash only concierge medicine, I think most people are very happy in it. I love working with surgeons and discussing their cases. I would much rather deal with other doctors than patients directly. I would not want to be in clinic or draining butt abscesses in the middle of the night. I think your decision needs to be based on how much of a patient interaction you want. Avoid the fallacy of “i went to medical school wanting to do this, so i should just do it.” That’s why we have tons of people who switch into pathology mid-residency, be honest with yourself. Pathology does critically important work. The job market is fine if you are flexible on location. The pay is not bad either, especially outside of academics and considering you will rarely spend time in the hospital outside of M-F, 8-5 if that.

 

[ChordaEpiphany]

Honestly it sounds like you'd be a fine candidate for either. Having relevant pubs at all is a plus for either specialty and you just need to be average to match surg, just don't expect MGH or Hopkins to come knocking.

Aside from general enjoyment of each specialty day-to-day, I'd consider geographic flexibility, attending lifestyle, and training length.

Maybe your next 5 years are clear, are your next 7 years clear in case you decide to specialize? Are you okay with the lifestyle of an attending surgeon? Pathology attendings I know are straight chillin. A surgeon I worked with recently blew up in a meeting and then called me completely frazzled two hours later apologizing and saying they'd only slept 3 hours/night for the last two weeks. They're in their 50s and well established as an attending. Then consider geographic flexibility. If you can't train at a high tier academic pathology residency, it may be tough to get competitive jobs in coastal metro areas. Would this be compatible with your SO's career and your own life plans, or would it throw all that into jeopardy?

 

[ACSurgeon]

Wrapping up MS3 and having a quarter life crisis, as many of us are wont to do at this stage. Anyway, I had toyed with the idea of pathology as an MS1 because I really loved histo and sucked at OSCEs (i.e pt interaction made me nervous). However, I have always had surgery in mind since something that really motivates me is developing skills and constantly having to improve my hands-on abilities. I started with surgery as my first rotation and really loved it, so I began making connections and trying to get research and leadership in the field. However, near the end of the year I took a Pathology elective and also loved that, I really vibed with the people and had fun grossing and working on my histology skills, was also less stressed than I was on surgery.

Some things to mention- I spent a bunch of time on MIS for surgery and loved it, I could actually work with the bariatric pt population and robotics is a fascinating field. However, I did not especially love ACS, which I know surgery residents spend a lot of time on, it is definitely an exciting field but very stressful in my opinion- I definitely want to know how to manage emergencies but wouldn't want to do it forever. Also, many of the personalities in surgery seemed more "type A" than I am. Regardless, surgery felt like the reason I went into medicine- to be an expert, take care of patients, and to be the one to provide the definitive "fixes" if possible. Lifestyle wise, for the next 5 years at least I don't plan on having kids and I don't have an SO or anyone putting pressure on me just yet so I really am free to pursue whatever I want without worrying about lack of family time, but who knows if these priorities will change later in life.

As for path- everyone else I know who wants to do path is obsessed with forensics but I kind of don't love that aspect, autopsies are interesting but I don't think I'd want to do that for my whole career. I'm most interested in surgical path- I really love the pattern recognition aspect of path, and also being the one to find a definitive diagnosis. Funny enough, I am a little worried about lack of patient interaction because I have come to value some of the meaningful interactions I have had during rotations. Of course, everyone in pathology loves to educate (which is something I value and want to continue), has lives outside of medicine, and are generally very nice people so that really appealed to me. I definitely will be asking around about the job market since I know that's always something that comes up- I'd probably be ok with lower pay though to get my location of choice but we'll see.

I also am not sure that I'm the most competitive surgery candidate- if I'm lucky I'll have 2-3 pubs by application time but only 1-2 would be in general surgery (other research is gyn surg). Have only high passed a couple clerkships (including surgery), no honors. Step 1 was pass/fail (I passed) but no Step 2 yet, generally have been between 50th-70th percentile on shelves. With not really having planned on my interest in path, I don't have any pubs or anything else proving an interest in the field, not sure how much of a red flag that would be if I were to make the switch.
Anyway, any insight on figuring this out would be appreciated!

edit: I don't have an SO or kids so length/intensity of training is not an issue at this point (although I know burnout is real). Having my choice of location (west coast) is important to me though.

Gut feeling someone debating surgery vs something drastically different is that surgery is probably not for them. General surgery has 20% attrition. Even people “sure” they wanna be surgeons have doubt during the process.

Surgery isn’t just anatomy and operating. You’ll spend more hours in peri-op care than you will in the OR. You should do surgery if you want to have intense training that sets you up to take care of patients and operate.

That said: the job market and pay for general surgery is so much better. I know medical trainees are indoctrinated not to care about money and to do what they love, but that’s naive.

General surgery training sucks if you don’t truly like it. I enjoyed most of my time in residency. Even with difficult personalities and exhaustion. It was a combination of pride in my work and enjoying what I’m learning to do…

 

[OrganRepo]

if you have to ask -> Not surgery

 

[PathNeuroIMorFM]

I know medical trainees are indoctrinated not to care about money and to do what they love, but that’s naive.

The generational divide makes itself known. As a millenial/Gen Zer, I couldn't disagree more. My family/marriage, hobbies, friends, and free time will always take priority over work. Medicine is one of the few realistic career paths that allow a great salary, even in low paying specialties, without sacrificing too much personal freedoms post residency.

OP, I would greatly focus on what you enjoy. Also consider looking into alternative paths, like anesthesia, blood banking path (for patient interaction), or radiology.

For everyone else, it is important to remember that surg does historically have awful attrition rates, but so does pathology. Saying "if you aren't 100% surgery, do something else" could very well apply to path, as well. And even more so for psychiatry, apparently.

See 2022 attrition article here: Residency Attrition and Associated Characteristics, a 10-Year Cross Specialty Comparative Study | Auctores

 

[EmbryonalCarcinoma]

Do a Sub-I in surgery early in 4th year and then reassess. Your only exposure to surgery so far is the clerkship. Btw, most people in path don't do forensics.

 

[collegestud2013]

Wrapping up MS3 and having a quarter life crisis, as many of us are wont to do at this stage. Anyway, I had toyed with the idea of pathology as an MS1 because I really loved histo and sucked at OSCEs (i.e pt interaction made me nervous). However, I have always had surgery in mind since something that really motivates me is developing skills and constantly having to improve my hands-on abilities. I started with surgery as my first rotation and really loved it, so I began making connections and trying to get research and leadership in the field. However, near the end of the year I took a Pathology elective and also loved that, I really vibed with the people and had fun grossing and working on my histology skills, was also less stressed than I was on surgery.

Some things to mention- I spent a bunch of time on MIS for surgery and loved it, I could actually work with the bariatric pt population and robotics is a fascinating field. However, I did not especially love ACS, which I know surgery residents spend a lot of time on, it is definitely an exciting field but very stressful in my opinion- I definitely want to know how to manage emergencies but wouldn't want to do it forever. Also, many of the personalities in surgery seemed more "type A" than I am. Regardless, surgery felt like the reason I went into medicine- to be an expert, take care of patients, and to be the one to provide the definitive "fixes" if possible. Lifestyle wise, for the next 5 years at least I don't plan on having kids and I don't have an SO or anyone putting pressure on me just yet so I really am free to pursue whatever I want without worrying about lack of family time, but who knows if these priorities will change later in life.

As for path- everyone else I know who wants to do path is obsessed with forensics but I kind of don't love that aspect, autopsies are interesting but I don't think I'd want to do that for my whole career. I'm most interested in surgical path- I really love the pattern recognition aspect of path, and also being the one to find a definitive diagnosis. Funny enough, I am a little worried about lack of patient interaction because I have come to value some of the meaningful interactions I have had during rotations. Of course, everyone in pathology loves to educate (which is something I value and want to continue), has lives outside of medicine, and are generally very nice people so that really appealed to me. I definitely will be asking around about the job market since I know that's always something that comes up- I'd probably be ok with lower pay though to get my location of choice but we'll see.

I also am not sure that I'm the most competitive surgery candidate- if I'm lucky I'll have 2-3 pubs by application time but only 1-2 would be in general surgery (other research is gyn surg). Have only high passed a couple clerkships (including surgery), no honors. Step 1 was pass/fail (I passed) but no Step 2 yet, generally have been between 50th-70th percentile on shelves. With not really having planned on my interest in path, I don't have any pubs or anything else proving an interest in the field, not sure how much of a red flag that would be if I were to make the switch.
Anyway, any insight on figuring this out would be appreciated!

edit: I don't have an SO or kids so length/intensity of training is not an issue at this point (although I know burnout is real). Having my choice of location (west coast) is important to me though.

Pathology and surgery are about as different as they get.

As others have said above, you really have to like Surgery to just get through the brutal residency training that comes with it, with 80 hrs weeks being typical at most programs (and not uncommon for residency programs to violate the ACGME hours and go over). And don't expect to spend nearly all of your time just in the OR; you'll have other responsibilities as well, such as managing and discharging your post-op floor patients, and seeing pre-op and post-op patients in clinic. There's a reason attrition rates for Gen surg residency is by far the highest at around 20%. Attending life schedule gets a bit better post-residency but for General Surgery there's a good amount of overnight call expect at most practices as an attending, and even when not on call cases often run late, and working 55-60 hrs per week is pretty normal in early attending life. Pay is better than pathology but you really work for it. It's more competitive to match into than pathology but it you have middle of the line grades and step scores, you can still match if you apply broadly and have solid LORs.

Pathology has pretty normal Mon-Friday work schedules with minimal weekend call responsibilities and virtually no night call. Like radiology, it's a good fit for those who liked pre-clinical years more than 3rd year. Pay is not as high as surgery but with the median currently in the low $300ks, which is still solid for the amount of work. Burnout rate is consistently among the lowest as reported in physician surveys. The only factor making pathology not competitive is that the job market has never been good over the past few decades; this is probably because of the low burnout rate, there's low turnover among physicians (anecdotally there's a good portion of pathologists >65 yrs old still working). It seems in many cases, a 1-2 yr fellowship after a 4-year pathology residency is pretty common to make you competitive in the job market, and even in a lot of cases then you still have to be geographically flexible and be willing in some of the less desirable parts of the country just to find a job as a new grad.

 

[deleted1095841]

Consider Derm, specifically Mohs surgery

 

[operaman]

Tough call. Best answer is that you need more exposure to make a good decision. Worth waiting for your subi in surgery to see if it still feels like a good fit. You really do have to like the work and see it as something you can enjoy doing for 20-30 years. Pay and lifestyle are also very important, but I would argue that basic enjoyment of the work itself is most important.

On that front, you might also want to try shadowing some attendings outside the academic center. The world of medicine is vastly different outside the ivory tower, for better or worse. The day to day of a surgery or pathology intern and that of a private practice attending are lightyears apart. I shadowed some PP docs in my own field when I was a resident for this same reason - life is very different outside academia.

 

[DoctorMD1]

Pathology and surgery are about as different as they get.

As others have said above, you really have to like Surgery to just get through the brutal residency training that comes with it, with 80 hrs weeks being typical at most programs (and not uncommon for residency programs to violate the ACGME hours and go over). And don't expect to spend nearly all of your time just in the OR; you'll have other responsibilities as well, such as managing and discharging your post-op floor patients, and seeing pre-op and post-op patients in clinic. There's a reason attrition rates for Gen surg residency is by far the highest at around 20%. Attending life schedule gets a bit better post-residency but for General Surgery there's a good amount of overnight call expect at most practices as an attending, and even when not on call cases often run late, and working 55-60 hrs per week is pretty normal in early attending life. Pay is better than pathology but you really work for it. It's more competitive to match into than pathology but it you have middle of the line grades and step scores, you can still match if you apply broadly and have solid LORs.

Pathology has pretty normal Mon-Friday work schedules with minimal weekend call responsibilities and virtually no night call. Like radiology, it's a good fit for those who liked pre-clinical years more than 3rd year. Pay is not as high as surgery but with the median currently in the low $300ks, which is still solid for the amount of work. Burnout rate is consistently among the lowest as reported in physician surveys. The only factor making pathology not competitive is that the job market has never been good over the past few decades; this is probably because of the low burnout rate, there's low turnover among physicians (anecdotally there's a good portion of pathologists >65 yrs old still working). It seems in many cases, a 1-2 yr fellowship after a 4-year pathology residency is pretty common to make you competitive in the job market, and even in a lot of cases then you still have to be geographically flexible and be willing in some of the less desirable parts of the country just to find a job as a new grad.

path has excellent job market lately..

 

[collegestud2013]

path has excellent job market lately..

If that's the case would expect pathology residency spots to get a lot more competitive. Considering work-life balance is a top priority for many young physicians nowadays, having a specialty where you can work regular Mon-Fri business day hours with minimal call and make over $300k, and none of the headaches of patient centered clinical specialties. Probably why path has some of the lowest burnout rates compared to other specialties.

 

[airpods]

If that's the case would expect pathology residency spots to get a lot more competitive. Considering work-life balance is a top priority for many young physicians nowadays, having a specialty where you can work regular Mon-Fri business day hours with minimal call and make over $300k, and none of the headaches of patient centered clinical specialties. Probably why path has some of the lowest burnout rates compared to other specialties.

Are salaries in pathology that high now?

 

[PathNeuroIMorFM]

Are salaries in pathology that high now?

They've always been decently high, but if you ask any pathologist who's been in the game for 30+ years, they'll tell you reimbursements used to be much higher.

I've read a few articles talking about how compensation has been increasing, but the increase hasn't he[t up with inflation (not that many careers are, but still).

 

[voxveritatisetlucis]

Medicine is one of the few realistic career paths that allow a great salary, even in low paying specialties, without sacrificing too much personal freedoms post residency.

Eh this seems to be less true by the day. Other careers are experiencing massive pay increases while reimbursements for medicine keep falling. For example, Biden just announced a 5.2% pay increase for all federal workers. So now your EPA bureaucrat who does 10 hours of work per week will make nearly as much as a pediatrician in major metro areas. Cops in big cities make like 180k. If these careers pay this much, then no doctor working full time should make less than 450k. But many do.

 

[voxveritatisetlucis]

having a specialty where you can work regular Mon-Fri business day hours with minimal call and make over $300k,

Doesn’t this include remnants of PP in which there is almost none left in path anymore since takeovers by quest labcorp etc

 

[PathNeuroIMorFM]

Eh this seems to be less true by the day. Other careers are experiencing massive pay increases while reimbursements for medicine keep falling. For example, Biden just announced a 5.2% pay increase for all federal workers. So now your EPA bureaucrat who does 10 hours of work per week will make nearly as much as a pediatrician in major metro areas. Cops in big cities make like 180k. If these careers pay this much, then no doctor working full time should make less than 450k. But many do.

We should absolutely fight for better reimbursement rates, but I'm not going to look down on other careers for getting wage increases. No one's wages are keeping up with inflation and any win for the little guy is a win for all of us.

Not sure where you got the figures for that EPA worker or police officer, though. A quick google search yielded absolutely nothing near those figures you suggested.

 

[voxveritatisetlucis]

We should absolutely fight for better reimbursement rates, but I'm not going to look down on other careers for getting wage increases. No one's wages are keeping up with inflation and any win for the little guy is a win for all of us.

Not sure where you got the figures for that EPA worker or police officer, though. A quick google search yielded absolutely nothing near those figures you suggested.

1 in 5 federal workers make more than 100k and they’re notorious for doing no work having endless holidays etc

 

[Terrainport]

agreed. Sub-I will definitely help you decide and when you do it only look to see what the attending is doing - avoid deciding on your future based on what the intern or the resident does because thats only a finite amount of time.

 

[collegestud2013]

Doesn’t this include remnants of PP in which there is almost none left in path anymore since takeovers by quest labcorp etc

Yes, and maybe that's why pathology residency hasn't been very competitive despite showing relatively decent pay on paper. MGMA numbers for the 2021 year have pathology median at $368k. For comparison for General Surgery, the median was $442k.

But keep in mind MGMA numbers alone done tell the whole story. The numbers have been criticized as being inflated (especially for new grads seeking employed positions) since they show total compensation (and not just salary) and include compensation PP partners which tend to drive up the numbers. So new grads from pathology residency/fellowship probably shouldn't expect even the median as starting salary. The 10th percentile on MGMA was $261k and 25th percentile was $319k, which may be closer to new grads total compensation. And while some have pointed out the the job market got better recently, for a long time it was wasn't easy just to find a any pathology job in the first place as a new grad.

 

[shouldntbelurking]

Consider Derm, specifically Mohs surgery

Hello there,

Rising M3 here finishing my first selective rotation in dermatology. Mohs surgery is something that I heard a lot about during my time in clinic. I was wondering if you perhaps had any insight into Mohs surgery vs. gen derm in terms of work-life balance, work hrs/ week, compensation?

I am very drawn towards procedures and the oncology aspect of Mohs, so was very curious when I heard about the subspecialty. Thanks in advance!

 

[deleted1095841]

Hello there,

Rising M3 here finishing my first selective rotation in dermatology. Mohs surgery is something that I heard a lot about during my time in clinic. I was wondering if you perhaps had any insight into Mohs surgery vs. gen derm in terms of work-life balance, work hrs/ week, compensation?

I am very drawn towards procedures and the oncology aspect of Mohs, so was very curious when I heard about the subspecialty. Thanks in advance!

I have no idea honestly, and I'm not going into derm, but a lot of upperclassmen here are really excited about it and talk about it a lot.