Path residencies with best lifestyle

[Grace82]

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[2121115]

I am trying to come up with a list of pathology residencies for next year and although the quality of learning in programs is the most important factor for me, I also have two young children (4 mo and 2 years) and therefore hours and lifestyle are also very important. It seems there is a lot of variability in this regard (time spent grossing, number of PAs etc) so I was wondering if anyone had any input on programs I should consider and also ones to avoid? I am particularly looking at programs in NYC, Boston, and CA .

Thanks!

I think that, in general, you will not find very many "lifestyle friendly" programs in those areas.

 

[pathstudent]

I am trying to come up with a list of pathology residencies for next year and although the quality of learning in programs is the most important factor for me, I also have two young children (4 mo and 2 years) and therefore hours and lifestyle are also very important. It seems there is a lot of variability in this regard (time spent grossing, number of PAs etc) so I was wondering if anyone had any input on programs I should consider and also ones to avoid? I am particularly looking at programs in NYC, Boston, and CA .

Thanks!

Look for programs where CP rotations require minimal work. Residents at interviews will be able to give you the scoop on that. If they say, we are required to be here 8-5 for chemistry, then stay away. If they say, "there are days on chemistry where you don't even have to show up", then consider that program.

AP needs to be hard and long especially at the start. But as you get more efficient you can get home at a more reasonable hour.

 

[icpshootyz]

I can only speak for Boston, but I don't know of many path residencies in the Boston area that would qualify as "lifestyle-friendly". I think at most programs you should expect to work a 10hr day most days, sometimes longer, rarely shorter.

 

[pathstudent]

I can only speak for Boston, but I don't know of many path residencies in the Boston area that would qualify as "lifestyle-friendly". I think at most programs you should expect to work a 10hr day most days, sometimes longer, rarely shorter.

Even on CP? What is there to do on Micro, Chem, Molecular, and even BB for that matter that requires 10 hours a day unless they are just making non-MD work for you to do?

 

[mlw03]

Do we really want to be encouraging someone to try and find a program that requires as little work as possible? We talk about some of the issues we have in pathology getting colleagues to respect us and pay us for our fair work (and I'm not saying these issues are directly related), but perhaps there is some resentment by say, a general surgeon, who works 95 hours a week during residency, while a bad pathology residency program in terms of hours requires no more than 60 hours most weeks on AP, 35-40 on many CP rotations.

 

[pianoguy05]

Do we really want to be encouraging someone to try and find a program that requires as little work as possible? We talk about some of the issues we have in pathology getting colleagues to respect us and pay us for our fair work (and I'm not saying these issues are directly related), but perhaps there is some resentment by say, a general surgeon, who works 95 hours a week during residency, while a bad pathology residency program in terms of hours requires no more than 60 hours most weeks on AP, 35-40 on many CP rotations.

Agree 100% with this sentiment. It's residency. It's the package deal...one should expect to work hard and rise to a challenge, which might include time management issues. I don't think it's unreasonable to seek out programs which are "family friendly"...I definitely had some of these - very bluntly stating so in most cases - along the trail. I'd advise being up front about it on your interviews if this is a top priority for you.

 

[pathstudent]

Do we really want to be encouraging someone to try and find a program that requires as little work as possible?

For Chemistry, Micro, iinformatics, Molecular, yes...It is all book learning for the most part... The OP can just go in for a couple hours, catch a lecture and then head home and spend a sunny september afternoon with her toddler children playing in the park, or she can be forced to sit at a desk until 5 pm doing nothing of clinical value, and either way she just needs to read and memorize facts to pass CP boards.

You will work close to 80 hours in AP sometimes.

 

[MetroPath]

For Chemistry, Micro, iinformatics, Molecular, yes...It is all book learning for the most part... The OP can just go in for a couple hours, catch a lecture and then head home and spend a sunny september afternoon with her toddler children playing in the park, or she can be forced to sit at a desk until 5 pm doing nothing of clinical value, and either way she just needs to read and memorize facts to pass CP boards.

You will work close to 80 hours in AP sometimes.

I think Path programs should do away with some CP rotations. I agree its mostly book learning. I think Path programs should substitute with more AP rotations (more surgpath, cytopath) or heme. Those are the areas you need to be strong and that most practicing pathologists really need to know.

So that way residents dont need to do waste a year and do a surgpath or cytopath fellowship.

 

[mlw03]

For Chemistry, Micro, iinformatics, Molecular, yes...It is all book learning for the most part... The OP can just go in for a couple hours, catch a lecture and then head home and spend a sunny september afternoon with her toddler children playing in the park, or she can be forced to sit at a desk until 5 pm doing nothing of clinical value, and either way she just needs to read and memorize facts to pass CP boards.

You will work close to 80 hours in AP sometimes.

Well, I was AP only so I don't know how one learns the material for those areas. Seeing how it works up here in Canada is interesting, as many more residents do AP only, but it's 5 years. They do have something similar to AP-CP, but it's called GP and is also 5 years. They also have pure hemepath residency... also 5 years. Each of these 5 year programs includes 1 year of internship though. In any case, my point is simply that there is probably some correlation between GI docs treating pathologists like commodities and many pathologists not wanting to put in the hours many clinicians do. How much of a correlation - I do not know.

 

[deleted314957]

The current system of path residency sucks. The people on this board cry too much. The 4 years of path residency are pathetically insufficent for independent for AP and CP practice. Now I will be a "scold": You/we all need 1 year of a "real" clinical rotation/internship (mine was hard-core surgical) . I also had 2 years general practice (helped but not required). My clin path rotations comprised 24 serious weeks of my 48 week residency and were conducted by "real" and serious clin pathologists-e.g. Bob Dufore for clin chem ( he now does the int'l lecture circuit for clin path prep for clinical chem), a dedicated , boarded blood banker, a dedicated, boarded micro, boarded heme, (the admin and other stuff did not exist 30 years ago). The boards were a joke and I was well >95th% in the resident inserv in the spring of my senior resident year. (followed by FP fellowship at AFIP/Baltimore) Then I did 2 years military service as a boarded staff pathologist at a major military teaching hospital. This has served me GREATLY over the years as a solo lab med director of a ~170 bed hospital over the past 25 years in employee, then partner P.P, than "post PP sale" employee. Yes--now I am an "employee" of an evil, mega lab ( and I have an orthopod salary) .If you want to get ahead, get all your tickets punched. I am a prime leader of the medical staff of the hospital where I am and I don't kiss ANYONE'S ass. Generally it is the converse---and I can retire any time I want (but I don't want to because I have it too good and my job is my hobby. Surely I can't be alone--it seems that lots of my mates from residency had a good situation from what i have gathered.

from this board it seems like an a-bomb has gone off that i have never felt. if so, please forgive my ignorance/insensitivity. Stop crying,

 

[malchik]

Everyone is impressed with your resume, what is your point? That experience in medicine makes one a better pathologist?
And who is crying? The comments above all seem to reflect the view that the OP should expect to work hard in residency.

 

[icpshootyz]

Even on CP? What is there to do on Micro, Chem, Molecular, and even BB for that matter that requires 10 hours a day unless they are just making non-MD work for you to do?

Sure on CP rotations life was easier, more like 8hr days. But unless you're CP-only, that doesn't really matter that much, it's really only 18months out of 4 years. If she's really worried about the hours, the AP part is the problem, not CP. I doubt anyone is choosing their AP/CP program just based on the CP hours.

 

[pathstudent]

Sure on CP rotations life was easier, more like 8hr days. But unless you're CP-only, that doesn't really matter that much, it's really only 18months out of 4 years. If she's really worried about the hours, the AP part is the problem, not CP. I doubt anyone is choosing their AP/CP program just based on the CP hours.

40 hours a week? Really? How may I ask was your time spent on Chemistry, Microbiology and Informatics? What sort of useful things would they think up for you to do? And how would you know when you were done?

 

[Kunu]

The OP is a mom with two little kids. I didnt read that she is seeking a lazy river, but just wants to avoid programs with undue time burdens. U Hawaii for example treats Saturdays as a standard workday and everyone is expected to come in as usual unless thats changed. I know of a program on the east coast that is overrepresented by blood bankers and they make the residents run the pheresis unit and work 10-12 days doing H&P's and petty errands on blood bank. OP is just going to have to ask around alot and be coy on interviews and ask things like "what is a typical day like" or what is the hardest rotation- the only right answer should be surg path. Most programs will be about the same in terms of work commitment but I dont fault someone for seeking to avoid places that are malignant or waste excessive time doing dumb crap work.

 

[mlw03]

What some of us may call crap work, in total probably leads to real learning. I think mike is spot on with us needing to do an internship year, and that 4 years of AP/CP is insufficient anywhere for going straight into private practice. Maybe could prepare someone for a pure academic spot if they focused their elective time into a single subspecialty. But no one does that and academic programs expect fellowship training. We cannot collectively ask to be treated and paid in accordance with surgeons but not want to put in the hours/call/lifestyle sacrifices they do in both training and subsequently.

 

[icpshootyz]

40 hours a week? Really? How may I ask was your time spent on Chemistry, Microbiology and Informatics? What sort of useful things would they think up for you to do? And how would you know when you were done?

We were expected to cover the various lab pagers during business hours, and then the on-call CP resident took over off hours. So if you were on Chemistry, you had to cover the Chem pager and answer any lab questions or clinician question related to chemistry, and so on and so forth. You were expected to be in-house for this time, usually 8-5 or so, 1 resident on each core lab. 40 hrs a week was a nice vacation from many AP rotations.

 

[gbwillner]

Advice to OP:
Find the easiest, crappiest path residency program you can find.

Then you can come back to this board after residency and biatch about how you can't get a job.

 

[schrute]

The current system of path residency sucks. The people on this board cry too much. The 4 years of path residency are pathetically insufficent for independent for AP and CP practice. Now I will be a "scold": You/we all need 1 year of a "real" clinical rotation/internship (mine was hard-core surgical) . I also had 2 years general practice (helped but not required). My clin path rotations comprised 24 serious weeks of my 48 week residency and were conducted by "real" and serious clin pathologists-e.g. Bob Dufore for clin chem ( he now does the int'l lecture circuit for clin path prep for clinical chem), a dedicated , boarded blood banker, a dedicated, boarded micro, boarded heme, (the admin and other stuff did not exist 30 years ago). The boards were a joke and I was well >95th% in the resident inserv in the spring of my senior resident year. (followed by FP fellowship at AFIP/Baltimore) Then I did 2 years military service as a boarded staff pathologist at a major military teaching hospital. This has served me GREATLY over the years as a solo lab med director of a ~170 bed hospital over the past 25 years in employee, then partner P.P, than "post PP sale" employee. Yes--now I am an "employee" of an evil, mega lab ( and I have an orthopod salary) .If you want to get ahead, get all your tickets punched. I am a prime leader of the medical staff of the hospital where I am and I don't kiss ANYONE'S ass. Generally it is the converse---and I can retire any time I want (but I don't want to because I have it too good and my job is my hobby. Surely I can't be alone--it seems that lots of my mates from residency had a good situation from what i have gathered.

from this board it seems like an a-bomb has gone off that i have never felt. if so, please forgive my ignorance/insensitivity. Stop crying,

Oh give me a break. I'm sick to death of this (particularly your) arrogant paternalistic and smug attitude. Though I'm equally as annoyed when people go into path for the supposed lifestyle issue ("I have kids" or "i want kids" or [sic] "I don't wanna work"), but at the same time, the hard-core "everyone coming out of training now is a *****" / "I paid my dues and so can you" attitude is unnecessary.

The boards are still a "joke" but not because people think they're insultingly easy. Maybe they were "back in the day", but now the boards are a hodgepodge of irrelevant academic data & not useful for people in the trenches...it's more about proving you can study for and pass a test than proving you can function as an independent pathologist.

Back when you trained, there were, what, 2 types of lymphomas? Small cell and "non small cell"? "Sarcoma NOS?" Histology doesn't change, but the amount of data has gone up exponentially (eg. molecular), as has the degree to which we have to classify/subclassify/sub-sub classify diseases.

And you got your first job at what age? Making how much? For how long? and your med school debt was how much? I'm 33 years old, I've got $205,000 in med school debt (nevermind undergrad) at almost 7% interest (that I'm obliged to start repaying soon...$35k in interest has accrued in barely 5 years...), and every single solitary job requires people to work more for less... I'm not going to jump through the "MikeSheree Hoops of Greatness" for posterity sake or because someone who trained 30 years ago says it will make me a better person.

I don't want you to hand me a tissue, but for **** sake have some perspective and appreciate that path residency now is not what path residency was because a.) people in your generation are the ones at the helm, b.) medicine is not the same today as it was 30 yrs ago, c.) related to 'b', medicine is going down the tubes and I'm not going to be a martyr for the cause.

 

[schrute]

Additional problems today include the fact that path residents don't have one iota of genuine responsibility prior to graduation. Ok there may be some programs that have 'hot seat' positions or allow fellows to sign out prelims, but nothing even close to the responsibility level of a practicing doc. I have no idea what the rules were 'back in the day,' but it's no secret to anyone that the ACGME rules & regs of today are considerably strict, and billing is a KEY factor in that. more resident/fellow responsibilty = less billing, and that's not a compromise most programs can (or want to) live with financially.

There's a myriad of problems with path training today, but placing the blame for it square on the shoulders of 'lazy trainees' paints a tremendously inaccurate picture.

 

[pathstudent]

Advice to OP:
Find the easiest, crappiest path residency program you can find.

Then you can come back to this board after residency and biatch about how you can't get a job.

She is not asking about that and no one is saying that.

There are many different programs. Some are more flexible about vacation, electives, and schedules. Some provide a greater degree of PA support while some make their residents gross until the wee hours of the morning. Some have forced clock in at 8 and clock out at 5 CP rotations others are less structured.

Just because a program works its AP residents to exhaustion and has structured Chemistry rotations requiring you to be on site 40 hours a week or more doesn't make it a better program or mean that you will actually learn more.

 

[Grace82]

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[MetroPath]

I really didn't mean to offend anyone with my thread... I think it may have been misinterpreted. I am a very hard worker and passionate about pathology I just am trying to avoid some of the programs I have heard about in which there is not enough learning and residents spend the majority of their time grossing others specimens for long hours.

My husband is a surgery resident so I have seen firsthand how demanding residencies can be and I'm just hoping at least one of us can be there for most nights and weekends. Again, I apologize if I upset anyone with this thread, please PM me if you feel uncomfortable posting in the thread but have some input on programs particularly in Boston, NY or Cali.

Go to the best program you can get into. That will open a lot of doors for you when it comes to jobs later on. Also, you might want to go to a city where you can see yourself living and a program that has a fellowship you may be interested in. Good luck.

 

[malchik]

40 hours a week? Really? How may I ask was your time spent on Chemistry, Microbiology and Informatics? What sort of useful things would they think up for you to do? And how would you know when you were done?

On chemistry we spent most of the day entering interpretations for SPEPS, IFEs, molecular tests, going to conferences, and handling calls of all sorts. It was enough to give you stuff to do for 8 hours, albeit somewhat leisurely pace.

 

[wild0ne]

Oh give me a break. I'm sick to death of this (particularly your) arrogant paternalistic and smug attitude. Though I'm equally as annoyed when people go into path for the supposed lifestyle issue ("I have kids" or "i want kids" or [sic] "I don't wanna work"), but at the same time, the hard-core "everyone coming out of training now is a *****" / "I paid my dues and so can you" attitude is unnecessary.

The boards are still a "joke" but not because people think they're insultingly easy. Maybe they were "back in the day", but now the boards are a hodgepodge of irrelevant academic data & not useful for people in the trenches...it's more about proving you can study for and pass a test than proving you can function as an independent pathologist.

Back when you trained, there were, what, 2 types of lymphomas? Small cell and "non small cell"? "Sarcoma NOS?" Histology doesn't change, but the amount of data has gone up exponentially (eg. molecular), as has the degree to which we have to classify/subclassify/sub-sub classify diseases.

And you got your first job at what age? Making how much? For how long? and your med school debt was how much? I'm 33 years old, I've got $205,000 in med school debt (nevermind undergrad) at almost 7% interest (that I'm obliged to start repaying soon...$35k in interest has accrued in barely 5 years...), and every single solitary job requires people to work more for less... I'm not going to jump through the "MikeSheree Hoops of Greatness" for posterity sake or because someone who trained 30 years ago says it will make me a better person.

I don't want you to hand me a tissue, but for **** sake have some perspective and appreciate that path residency now is not what path residency was because a.) people in your generation are the ones at the helm, b.) medicine is not the same today as it was 30 yrs ago, c.) related to 'b', medicine is going down the tubes and I'm not going to be a martyr for the cause.

Well-said. 👍 It surprises me how anyone with an ounce of perspective fails to see this.

 

[dermpathdoc]

Well how do I reply to this? I agree there are programs out there that will will require less time constraints for a resident that as family obligations. But will these programs supply the resident with what they need to function in the high input high output world of Patholgoy labs today. Even the CP residents have their obligations. If you go Blood bank and transfusion medicine....I see many jobs out there as very hi stress..and with heavy late night call schedules.
I see AP Surgpath and Hemepath residents and fellows coming into my practice having no clue how to sign out the basic case...they can gross and do an autopsy with the best of them but can't sign out the case and give a good differential of the possibilities. As far as helping a hospital tumor board or mortality/morbidity conference.... Sorry they fall to pieces. There are some candidates who definitely stand out...But we have to weed those that cant perform out by having them review cases and microscopic slides give presentations and even attend staff conferences before we make the decisions.
My advice to OOP? Look at your prospective programs with a jaundiced eye...if they offer you a great family lifestyle, will they give you a great educational experience that will help you get a job

 

[dermpathdoc]

Wlld one..I am of the same generation as schrute..but don't agree at all with his viewpoint, probably because I did my residency in a smaller and more intimate community hospital environment and then did a Dermpath fellowship in the high pressure Bernie Ackerman program....I had training I needed to perform in the smaller community hospital programs...I never felt I lacked anything when I went to academic settings. As a matter of fact, many large academic pathologists would seek my advice as tomhow to communicate with physicians in our setting. I actually ended up having more autopsies and more clinical exposure than many of my peers. Also had way more exposure with things such as lab inspections and how to set up POLs.
Choose carefully..

 

[Path or bust]

Oh give me a break. I'm sick to death of this (particularly your) arrogant paternalistic and smug attitude. Though I'm equally as annoyed when people go into path for the supposed lifestyle issue ("I have kids" or "i want kids" or [sic] "I don't wanna work"), but at the same time, the hard-core "everyone coming out of training now is a *****" / "I paid my dues and so can you" attitude is unnecessary.

The boards are still a "joke" but not because people think they're insultingly easy. Maybe they were "back in the day", but now the boards are a hodgepodge of irrelevant academic data & not useful for people in the trenches...it's more about proving you can study for and pass a test than proving you can function as an independent pathologist.

Back when you trained, there were, what, 2 types of lymphomas? Small cell and "non small cell"? "Sarcoma NOS?" Histology doesn't change, but the amount of data has gone up exponentially (eg. molecular), as has the degree to which we have to classify/subclassify/sub-sub classify diseases.

And you got your first job at what age? Making how much? For how long? and your med school debt was how much? I'm 33 years old, I've got $205,000 in med school debt (nevermind undergrad) at almost 7% interest (that I'm obliged to start repaying soon...$35k in interest has accrued in barely 5 years...), and every single solitary job requires people to work more for less... I'm not going to jump through the "MikeSheree Hoops of Greatness" for posterity sake or because someone who trained 30 years ago says it will make me a better person.

I don't want you to hand me a tissue, but for **** sake have some perspective and appreciate that path residency now is not what path residency was because a.) people in your generation are the ones at the helm, b.) medicine is not the same today as it was 30 yrs ago, c.) related to 'b', medicine is going down the tubes and I'm not going to be a martyr for the cause.

Couldn't have said it better myself.
👍

 

[Tissue issue]

I'm 33 years old, I've got $205,000 in med school debt (nevermind undergrad) at almost 7% interest (that I'm obliged to start repaying soon...$35k in interest has accrued in barely 5 years...), and every single solitary job requires people to work more for less....

http://www.usnews.com/news/articles/2012/12/04/underutilized-options-could-ease-student-loan-crisis

Are these income based/contingent repayment plans with forgiveness after 25 years helpful to you and others in your position? I'm not aware of how many young doctors are using these plans or how helpful they actually are.

 

[Pathwrath]

I agree with the other posters who suggested "CP-lite" programs to give you more time with your family. Don't skimp on AP.

I fail to see the point in (again) resurrecting the 5th year, especially in the form of rotations or as an internship. The clinical pearls you might pick up along the way do not justify the time wasted. You need to learn to push glass efficiently and correctly. CAP pushes clinical exposure as an asinine way of improving our standing with clinicians, but only because they got nothing else. Don't fall for it.

A fifth year doing straight surgical pathology would be more useful, but a path residency today serves only as a prerequisite to getting a fellowship (fellowships), certainly not a job, so why prolong it? A better idea would be to reduce CP to one year and increase AP training.

 

[schrute]

http://www.usnews.com/news/articles/2012/12/04/underutilized-options-could-ease-student-loan-crisis

Are these income based/contingent repayment plans with forgiveness after 25 years helpful to you and others in your position? I'm not aware of how many young doctors are using these plans or how helpful they actually are.

IBR is generally good IF you can afford to make payments during residency...but with a spouse that brings your household income to something more livable than a resident's salary, I would have had to pay the equivalent of a BMW car payment each month, which we couldn't afford (and filing taxes jointly lost us tax benefits; we looked into that as well).

It's a good option if you are single or don't have a family to support, but bottom line--for me anyway, the financial obligation of IBR comprised a greater percentage of my total income during residency than the financial obligation of the 'max 10 yr repayment' will comprise of my big-boy job salary.

 

[cjw0918]

In general, the further West you get the more chill the program will be. I trained on the East Coast for residency and did a fellowship out West. Night and day difference.

I will echo what other posters have said- get all you can from your AP training. If you have to live on macaroni and cheese to hire a nanny to put in the hours, do it. It will be time and money well spent.

Good luck with residency and the babies. They grow up fast.

 

[deleted314957]

Additional problems today include the fact that path residents don't have one iota of genuine responsibility prior to graduation. Ok there may be some programs that have 'hot seat' positions or allow fellows to sign out prelims, but nothing even close to the responsibility level of a practicing doc. I have no idea what the rules were 'back in the day,' but it's no secret to anyone that the ACGME rules & regs of today are considerably strict, and billing is a KEY factor in that. more resident/fellow responsibilty = less billing, and that's not a compromise most programs can (or want to) live with financially.

There's a myriad of problems with path training today, but placing the blame for it square on the shoulders of 'lazy trainees' paints a tremendously inaccurate picture.

I apologize for being shrill and shooting from the hip. Your 1st paragraph is a very sig part of the problem. 20-30 ago there was far more independence and the reimbursement issue did not exist. the nanny state has hurt our training

 

[Euchromatin]

On chemistry we spent most of the day entering interpretations for SPEPS, IFEs, molecular tests, going to conferences, and handling calls of all sorts. It was enough to give you stuff to do for 8 hours, albeit somewhat leisurely pace.

Ditto chemistry.

In between previewing and picking canned messages for all the SPEs/IFEs (plus urine and hemoglobin electrophoresis and other random tests that need interpretations), daily meetings with attending staff to discuss assigned readings, conferences and pages (most often to approve/deny send-outs) we manage to fill most of the day while on chemistry.

There is less "work" for residents to do on some of the other CP months (molecular and micro are pretty chill), but having a couple of months with some downtime to work on presentations, study for RISE/boards and/or do research is actually pretty nice.

 

[pathstudent]

In general, the further West you get the more chill the program will be. I trained on the East Coast for residency and did a fellowship out West. Night and day difference.

I will echo what other posters have said- get all you can from your AP training. If you have to live on macaroni and cheese to hire a nanny to put in the hours, do it. It will be time and money well spent.

Good luck with residency and the babies. They grow up fast.

I also noticed that most of the residents in the east coast wear ties while on the west coast almost nobody wears ties. It probably all goes back to the hippies.

 

[2121115]

There are some candidates who definitely stand out...But we have to weed those that cant perform out by having them review cases and microscopic slides give presentations and even attend staff conferences before we make the decisions.

Wait. Hold up. So on interview day for a new pathologist, you make them take a slide test, present a tumor board, and/or give a presentation? Hard core.