Path vs Rads

[LBJLA23]

Hey guys. I can't decide between Pathology and Radiology. I like both. Here's the way I see it (FYI Step 1 250+, all honors 3rd year, 2.5 years of research w/pubs):

Both are very visual and diagnostic fields with low scut:learning ratio.

Radiology:

Pros- Diagnostic and visual, more procedural, better job market overall, better pay on avg, more clinical, more flexibility

Cons- Has a prelim/intern year, more stress with faster pace, threat of AI, extra year of residency, more competitive


Pathology:

Pros- Intellectually stimulating, low stress with good hours even in residency (for the most part), no prelim or intern year, likely will get into a top 5 program, decent pay

Cons- Poor job market, probability of moving for job is high, threat of AI albeit less so

Thoughts?

---

Members don't see this ad.

 

[DNC127]

Rads.

Path just sounds dead... literally and figuratively lol

 

[MSTP18]

The moment I knew for certain path was for me over radiology (to be frank, I was already leaning that way but this was like the final straw) was after an attending showed me a crazy image he had saved of some mass I asked him what it ended up being and he laughed and was like “hell if I know.”

Frankly, I would not let the prelim year sway you. You’re going to sacrifice 40+ years of doing the specialty you enjoy more because of one year?

Also, unless you’re doing IR, rads isn’t even remotely procedural.

 

[deleted950463]

Ask how many fellowships people from top programs are doing before jobs in pathology. Add that to your training years. Most rads do 1 yr of fellowship.

 

[mrbreakfast]

1) Having to do a prelim is meaningless. You can do anything for a year.

2) The residencies are effectively the same length. The standard currently seems to be multiple fellowships for pathology.

3)

Step 1 250+, all honors 3rd year, 2.5 years of research w/pubs

You're extremely competitive, and could probably match a top program, for either.

4) Maybe meaningless, but everyone I know doing path knew they'd do it from day 1. As you alluded, you'll have much worse job prospects and salary as a pathologist vs a radiologist. You gotta love path.

5)

Pros- Intellectually stimulating, low stress with good hours

FWIW this sentence makes me think you consciously/subconsciously prefer pathology to radiology.


I'm writing this as someone who considered both, and did electives in both during M3/M4. Like you, I observed that pathology is way more "chill" than radiology, and that pathologists seem extremely happy. I ultimately decided to do neither, but while I enjoyed pathology more than radiology (I preferred histology to anatomy, thought the research was more interesting, liked the lifestyle more), I ruled it out first due to job prospect issues (and because I could look through a microscope for only so long).

I personally think being an academic pathologist would be an enjoyable career. It depends how important salary is to you.

 

[radsisrad]

Also, unless you’re doing IR, rads isn’t even remotely procedural.

This is incorrect. Virtually all radiology subspecialties have attendant procedures, and PP jobs usually demand that employees and partners be adept at basic procedures (biopsies, drainages, etc.).

 

[colbgw02]

Also, unless you’re doing IR, rads isn’t even remotely procedural.

This is false.

 

[badasshairday]

Also, unless you’re doing IR, rads isn’t even remotely procedural.

This is not remotely correct.

 

[MSTP18]

My bad on the procedures thing. I guess it depends on the practice setting more than I realized. Where I went to med school the true DR folks didn't do any at all.

I'll stick to what I know:

Ask how many fellowships people from top programs are doing before jobs in pathology. Add that to your training years. Most rads do 1 yr of fellowship.

Top programs? 1 fellowship for 1 year. If you're doing CP outside of Micro/Blood bank and you have a PhD (which ~40% of us do) then there's a good chance you're doing 0 for 0.

Pathology is relatively small and vastly less competitive than other specialties. Many of the institutions that people think of as high quality [insert specialty other than pathology] are not that great in Pathology. Even MGH pathology isn't 100% US MD grads.

 

[nimbus]

1) Having to do a prelim is meaningless. You can do anything for a year.

2) The residencies are effectively the same length. The standard currently seems to be multiple fellowships for pathology.

3)
You're extremely competitive, and could probably match a top program, for either.

4) Maybe meaningless, but everyone I know doing path knew they'd do it from day 1. As you alluded, you'll have much worse job prospects and salary as a pathologist vs a radiologist. You gotta love path.

5)
FWIW this sentence makes me think you consciously/subconsciously prefer pathology to radiology.


I'm writing this as someone who considered both, and did electives in both during M3/M4. Like you, I observed that pathology is way more "chill" than radiology, and that pathologists seem extremely happy.

One of my best friends from medical school did a pathology internship before his radiology residency. After residency he did 2 fellowships (MSK and Body) while waiting for his wife to finish training. And his job was definitely not chill until he cut back to 1 day/week.

 

[AnatomyGrey12]

Rads- will make money

Path- won't make money

 

[Ho0v-man]

Flip a coin and let it hit the ground.


Before looking at it, admit to yourself that you really want it to land on one thing more than the other.


In this case, it’s probably path.

 

[IMreshopeful]

Oh man one of these pops up every few weeks. Was waiting for it eagerly

 

[Dro133]

1) Having to do a prelim is meaningless. You can do anything for a year.

2) The residencies are effectively the same length. The standard currently seems to be multiple fellowships for pathology.

3)
You're extremely competitive, and could probably match a top program, for either.

4) Maybe meaningless, but everyone I know doing path knew they'd do it from day 1. As you alluded, you'll have much worse job prospects and salary as a pathologist vs a radiologist. You gotta love path.

5)
FWIW this sentence makes me think you consciously/subconsciously prefer pathology to radiology.


I'm writing this as someone who considered both, and did electives in both during M3/M4. Like you, I observed that pathology is way more "chill" than radiology, and that pathologists seem extremely happy. I ultimately decided to do neither, but while I enjoyed pathology more than radiology (I preferred histology to anatomy, thought the research was more interesting, liked the lifestyle more), I ruled it out first due to job prospect issues (and because I could look through a microscope for only so long).

I personally think being an academic pathologist would be an enjoyable career. It depends how important salary is to you.

What did you end up going into?

 

[mrbreakfast]

What did you end up going into?

Neurology. While the diagnostic and "expert" aspects of rads/path appealed to me, these rotations ultimately helped me realize that patient interaction was essential to me.

 

[deleted103644]

Neurology. While the diagnostic and "expert" aspects of rads/path appealed to me, these rotations ultimately helped me realize that patient interaction was essential to me.

 

[Cognovi]

Hey guys. I can't decide between Pathology and Radiology. I like both. Here's the way I see it (FYI Step 1 250+, all honors 3rd year, 2.5 years of research w/pubs):

Both are very visual and diagnostic fields with low scut:learning ratio.

Radiology:

Pros- Diagnostic and visual, more procedural, better job market overall, better pay on avg, more clinical, more flexibility

Cons- Has a prelim/intern year, more stress with faster pace, threat of AI, extra year of residency, more competitive


Pathology:

Pros- Intellectually stimulating, low stress with good hours even in residency (for the most part), no prelim or intern year, likely will get into a top 5 program, decent pay

Cons- Poor job market, probability of moving for job is high, threat of AI albeit less so

Thoughts?

I would focus less on the pay, job market, and threat of AI, which will have varying unpredictable effects on all fields over the course of a career. I would also downplay the need for an intern year, which is a tolerable and important learning experience from the perspective of understanding clinical medicine if you are going into radiology.

I would focus more on the fundamental nature of the day-to-day job. Radiology is more clinical meaning you are having an impact on the management of more patients in more ways than you do in pathology, you interact more with clinical colleagues, and you have a better understanding of how clinical medicine functions in practice. Radiology is perhaps higher stress and more hours than pathology but not highly stressful or burdensome in the grand scheme, when compared to other specialties.

 

[sella.turcica]

Thoughts?

Both boring.

 

[radsisrad]

OP, with your scores and research, you'd most likely match if you pursued Derm. Please, speaking as someone who wishes he'd had more wisdom as a med student: go Derm and never look back. Yeah, it's boring... good. Jobs are supposed to be boring. It's the "exciting" jobs in medicine that make docs look 55 when they're 45.

 

[19pieces19]

OP, with your scores and research, you'd most likely match if you pursued Derm. Please, speaking as someone who wishes he'd had more wisdom as a med student: go Derm and never look back. Yeah, it's boring... good. Jobs are supposed to be boring. It's the "exciting" jobs in medicine that make docs look 55 when they're 45.

In a similar predicament, but my app is weaker than OP's. Do you actually regret your decision to go into radiology and would rather have done derm? Why do you wish you would have gone into derm?

 

[radsisrad]

In a similar predicament, but my app is weaker than OP's. Do you actually regret your decision to go into radiology and would rather have done derm? Why do you wish you would have gone into derm?

I had the scores to break into Derm (though I'm not much of a research guy, so it would have been at an average program). I found it boring during my rotation, though, and wrote it off early in 4th year. That was - as the President might say - a big, fat mistake. I enjoy too much in life besides medicine to want to slog through 10-hr days and call and weekend shifts. Derm offers the best work:life balance options (that's the key word - options), and a highly competitive student who doesn't feel a personal calling toward anything else in particular should do a Derm rotation, honor it, and cash in on those Step scores.

It's not that I don't like radiology. I do... for the subject matter. But, barring the occasional personal/family experience with melanoma or some disfiguring dermatological condition, the pursuit of Derm isn't about the subject matter (no matter what all the applicants say). It's about the timely realization that there's more to life than one's job.

 

[Cognovi]

I enjoy too much in life besides medicine to want to slog through 10-hr days and call and weekend shifts.

Oh boo-hoo, a 55 hour work week.

 

[LBJLA23]

I would focus less on the pay, job market, and threat of AI, which will have varying unpredictable effects on all fields over the course of a career. I would also downplay the need for an intern year, which is a tolerable and important learning experience from the perspective of understanding clinical medicine if you are going into radiology.

I would focus more on the fundamental nature of the day-to-day job. Radiology is more clinical meaning you are having an impact on the management of more patients in more ways than you do in pathology, you interact more with clinical colleagues, and you have a better understanding of how clinical medicine functions in practice. Radiology is perhaps higher stress and more hours than pathology but not highly stressful or burdensome in the grand scheme, when compared to other specialties.

Very helpful. Thank you.

 

[LBJLA23]

OP, with your scores and research, you'd most likely match if you pursued Derm. Please, speaking as someone who wishes he'd had more wisdom as a med student: go Derm and never look back. Yeah, it's boring... good. Jobs are supposed to be boring. It's the "exciting" jobs in medicine that make docs look 55 when they're 45.

One day in derm clinic and I wanted to blow my brains out. Trust me, I thought LONG and HARD about Derm. But I just can't.

 

[nimbus]

Speaking as someone who started practice before their emergence, TEVAR, EVAR, TAVR, TMVR, and neurointerventions are literally modern technological miracles. If I was currently a smart medical student, I’d look hard at IR and Interventional cardiology.

 

[19pieces19]

I had the scores to break into Derm (though I'm not much of a research guy, so it would have been at an average program). I found it boring during my rotation, though, and wrote it off early in 4th year. That was - as the President might say - a big, fat mistake. I enjoy too much in life besides medicine to want to slog through 10-hr days and call and weekend shifts. Derm offers the best work:life balance options (that's the key word - options), and a highly competitive student who doesn't feel a personal calling toward anything else in particular should do a Derm rotation, honor it, and cash in on those Step scores.

It's not that I don't like radiology. I do... for the subject matter. But, barring the occasional personal/family experience with melanoma or some disfiguring dermatological condition, the pursuit of Derm isn't about the subject matter (no matter what all the applicants say). It's about the timely realization that there's more to life than one's job.

Thank you for this. I have a similar outlook to work-life balance that you do. Given that I'm not competitive for dermatology, do you think radiology would be a good 2nd choice for those seeking a good work-life balance? What are you thoughts on VA radiology jobs?

 

[radsisrad]

Thank you for this. I have a similar outlook to work-life balance that you do. Given that I'm not competitive for dermatology, do you think radiology would be a good 2nd choice for those seeking a good work-life balance? What are you thoughts on VA radiology jobs?

If you're the kind of person to be satisfied a salary in the mid/high-200s, VA radiology might be a good fit for you. The schedule and pace of work in VAs is probably as close as real-word radiology gets to the perception most med students have of radiology. If, however, you are the type who'd look over at your peers in PP making twice as much as you and be jealous (not knocking this... it's a natural impulse), you might not be satisfied with VA salary.

Radiology definitely gives you some options for W/L balance (e.g., working 3-4 days/week or teleradiology - if that's your thing).

 

[colbgw02]

To me, the biggest problem working for the VA is not the salary. I think most VA radiologists are okay with the lower pay in exchange for the slower pace, especially when you can get that sweet, sweet government cheese at the end (i.e. pension). It's the life-draining, headache-inducing bureaucracy that has the ability to eat your soul one mind-numbing powerpoint presentation at a time. Having worked for the federales for awhile, I disliked how divested I had become in my work because I felt like I couldn't effect positive change. If you're less cynical than I or if such a divestiture doesn't bother you, then the trade off between lifestyle and remuneration is palatable.

 

[AliBabaMD]

How about dermopath or radiology but interventional? You have great scores and a wonderful background. Congrats!

 

[LBJLA23]

I'm going Rads. Thanks for all your opinions. Super helpful! Good luck to all.

 

[Dro133]

I'm going Rads. Thanks for all your opinions. Super helpful! Good luck to all.

What finally made you choose rads over path?

 

[LBJLA23]

What finally made you choose rads over path?

I think what did it for me was the flexibility of Rads. In terms of work (procedures, seeing patients, just reading), work setting (private, academics, telerads, and VA) and job market (has ups and downs but always better than path). After doing rotations and talking to people, I realized path is too academic for me. Something I'm not super interested in. I also like the faster pace of Rads and the possibility of finding lifestyle groups working 3-4 days a week (something you can't find in Path). Hopefully I made the right decision.

 

[Frogger27]

I think what did it for me was the flexibility of Rads. In terms of work (procedures, seeing patients, just reading), work setting (private, academics, telerads, and VA) and job market (has ups and downs but always better than path). After doing rotations and talking to people, I realized path is too academic for me. Something I'm not super interested in. I also like the faster pace of Rads and the possibility of finding lifestyle groups working 3-4 days a week (something you can't find in Path). Hopefully I made the right decision.

Sounds like you did, good luck!

 

[LBJLA23]

Sounds like you did, good luck!

Thanks! You too!

 

[Dro133]

I think what did it for me was the flexibility of Rads. In terms of work (procedures, seeing patients, just reading), work setting (private, academics, telerads, and VA) and job market (has ups and downs but always better than path). After doing rotations and talking to people, I realized path is too academic for me. Something I'm not super interested in. I also like the faster pace of Rads and the possibility of finding lifestyle groups working 3-4 days a week (something you can't find in Path). Hopefully I made the right decision.

Thanks for the reply, sounds like you've thought this through. Best of luck!

 

[LBJLA23]

Thanks for the reply, sounds like you've thought this through. Best of luck!

Thanks! You as well.

 

[deleted103644]

Speaking as someone who started practice before their emergence, TEVAR, EVAR, TAVR, TMVR, and neurointerventions are literally modern technological miracles. If I was currently a smart medical student, I’d look hard at IR and Interventional cardiology.

You know only two of those procedures are (still) done by the specialties you listed, right?

Need to add interventional neuroradiology/endovascular neurosurgery and vascular surgery.

 

[nimbus]

You know only two of those procedures are (still) done by the specialties you listed, right?

Need to add interventional neuroradiology/endovascular neurosurgery and vascular surgery.

You know it depends on the hospital and region, right? Where I work, IR does TEVAR/EVAR. Vascular or CT surg just does the femoral cutdowns. But the radiologists are the ones who position and deploy the stents. These cases are a bread and butter part of my practice so you don’t have to tell me.

Neurointerventional is also all radiology (neuro IR) in my community. There are no endovascular neurosurgeons in PP where I am.

 

[deleted103644]

You know it depends on the hospital and region, right? Where I work, IR does TEVAR/EVAR. Vascular or CT surg just does the femoral cutdowns. But the radiologists are the ones who position and deploy the stents. These cases are a bread and butter part of my practice so you don’t have to tell me.

Neurointerventional is also all radiology (neuro IR) in my community. There are no endovascular neurosurgeons in PP where I am.

Endovascular neurosurgery is the new name of the specialty, does not specify who does it (could be neurology, neurosurgery, or neuroradiology).

Very, very few places still have IR doing EVAR/TEVAR, so I would not go into that specialty expecting to do it. It’s great that your location still has it, but your hospital is in the minority.

 

[Cognovi]

Endovascular neurosurgery is the new name of the specialty, does not specify who does it (could be neurology, neurosurgery, or neuroradiology).

Who said there was agreement on the name? The main society is Society of NeuroInterventional Surgery. The ACGME calls the fellowship Endovascular Surgical Neuroradiology. The Society of Neurological Surgeons Committee on Advanced Subspecialty Training calls the fellowship Neuroendovascular Surgery. Various academic divisions/programs have names that are all over the map.

 

[mimelim]

You know it depends on the hospital and region, right? Where I work, IR does TEVAR/EVAR. Vascular or CT surg just does the femoral cutdowns. But the radiologists are the ones who position and deploy the stents. These cases are a bread and butter part of my practice so you don’t have to tell me.

Neurointerventional is also all radiology (neuro IR) in my community. There are no endovascular neurosurgeons in PP where I am.

How do you follow your TEVAR/EVARs? You have a clinic for their annual follow ups/imaging? None of the IR guys near us do and it is mindblowing that someone would throw in an EVAR and not have an actual plan for follow up other than, "their cardiologist will take care of it."

 

[nimbus]

How do you follow your TEVAR/EVARs? You have a clinic for their annual follow ups/imaging? None of the IR guys near us do and it is mindblowing that someone would throw in an EVAR and not have an actual plan for follow up other than, "their cardiologist will take care of it."

I don’t know. I’m an anesthesiologist. I can tell you that our vascular and CT surgeons do not have endovascular skills so they are the ones who recruited the radiologists when the program started. It’s a collaborative effort with very good working relationships.

 

[chooks]

Radiology is more clinical meaning you are having an impact on the management of more patients in more ways than you do in pathology,

Although I'm a little slow in responding to this, the idea seems really strange. Are you saying that your experience is that you don't use laboratory values (e.g. BMP, LFT, troponin, etc...) to manage patients? Strange -- in my experience, about 99.99% of patients in the hospital have some kind of laboratory study used to help in management. Labs are typically run by pathology...but maybe you are in a different practice setting where you don't use labs to guide patient management.

 

[LBJLA23]

Although I'm a little slow in responding to this, the idea seems really strange. Are you saying that your experience is that you don't use laboratory values (e.g. BMP, LFT, troponin, etc...) to manage patients? Strange -- in my experience, about 99.99% of patients in the hospital have some kind of laboratory study used to help in management. Labs are typically run by pathology...but maybe you are in a different practice setting where you don't use labs to guide patient management.

CP is basically all automated lol most of the work is done by machines.

 

[Neurointerventionalist]

Endovascular neurosurgery is the new name of the specialty, does not specify who does it (could be neurology, neurosurgery, or neuroradiology).

Not at all.

The name is "interventional neuroradiology" worldwide, with exceptions ("neuroendovascular therapy" in Japan); as Cognovi already said, in the US also "endovascular surgical neuroradiology" or "neurointerventional radiology" or "neurointerventional surgery" or "neuroendovascular surgery".
"Endovascular neurosurgery" and "interventional neurology" are the rebranding from neurosurgeons and neurologists, only used in their own communities.

The mess with the names reflects the terrible turf war going on in the US (radiologists are still the majority of practiotioners, neurosurgeons are taking the lead in many centers, neurologists are the fastest growing group).
In Europe it is simply interventional neuroradiology in most countries.

 

[Cognovi]

Although I'm a little slow in responding to this, the idea seems really strange. Are you saying that your experience is that you don't use laboratory values (e.g. BMP, LFT, troponin, etc...) to manage patients? Strange -- in my experience, about 99.99% of patients in the hospital have some kind of laboratory study used to help in management. Labs are typically run by pathology...but maybe you are in a different practice setting where you don't use labs to guide patient management.

It's a step more removed because clinical path has turned the art into a science. How often does the surgery team talk to the lab medicine resident?

 

[chooks]

CP is basically all automated lol most of the work is done by machines.

That's absolutely amazing news. Last I was in the lab it was chock full of people (and that's not including phlebotomy running around the entire hospital). I guess I can just tell everyone to go home.

Oh wait....LOL are you one of those people that think that robotic surgeries are actually performed by robots?

 

[deleted103644]

Not at all.

The name is "interventional neuroradiology" worldwide, with exceptions ("neuroendovascular therapy" in Japan); as Cognovi already said, in the US also "endovascular surgical neuroradiology" or "neurointerventional radiology" or "neurointerventional surgery" or "neuroendovascular surgery".
"Endovascular neurosurgery" and "interventional neurology" are the rebranding from neurosurgeons and neurologists, only used in their own communities.

The mess with the names reflects the terrible turf war going on in the US (radiologists are still the majority of practiotioners, neurosurgeons are taking the lead in many centers, neurologists are the fastest growing group).
In Europe it is simply interventional neuroradiology in most countries.

You’re right, I went too far with the current accepted name towards the neurosurgery side of things. The turf battle in the US is indeed bad, and while I agree the name should remain interventional neuroradiology, it’s trending away from that.

The neurosurgeons don’t want to repeat the mistake of the cardiothoracic surgeons, so they’ve marked their territory (at least in the US).

 

[chooks]

It's a step more removed because clinical path has turned the art into a science. How often does the surgery team talk to the lab medicine resident?

I spoke to surgery on a pretty regular basis as a lab resident. I wouldn't say it is a step more removed - it is just a different aspect of medicine. In practice, I talk to clinicians daily about laboratory questions (for that side of stuff, and even more on the oncology side) and deal with continuous issues brought by my staff that I resolve based on my medical judgement. Make no mistake - for all the science of it, there are definitely gray areas that you never hear about. But if the lab starts making mistakes, then lots of people are potentially affected. It's a mix between making medical decisions that affect populations and trying to figure out specific problem patients.

When something is well run by experts and looks like a black box, it is easy to take it for granted. That's human nature. And few people (including pathologists not involved in running clinical laboratories) appreciate the amount of effort and work to keeping a lab up and running, compliant with the 5000 or so items inspected yearly to maintain credentials, and not spitting out crap data that will kill people.

I'll get off my soap-box. I'd be in a better mood if I wasn't in the process of signing off on (literally) 2000 procedure manuals (inspection in 3 months and there are hundreds of people (not machines) preparing for it...)

 

[LBJLA23]

That's absolutely amazing news. Last I was in the lab it was chock full of people (and that's not including phlebotomy running around the entire hospital). I guess I can just tell everyone to go home.

Oh wait....LOL are you one of those people that think that robotic surgeries are actually performed by robots?

I didn't say its ALL done by machines. I said basically all LOL its true. I've seen it. It's an assembly line.