Pathologist/Dermatopathologist Attending - AMA

[Mace1370]

Hi everyone,
I am a practicing staff pathologist/dermatopathologist at a medium to large academic medical center. These forums were very helpful for me when I was applying to medical school. I attended a US allopathic medical school and fell in love with pathology during my third year general surgery rotation. I was introduced to the specialty by following down specimens for frozen section to the pathology department. I completed a residency in anatomic and clinical pathology (4 years) and then a fellowship in dermatopathology (1 year). During medical school I also considered radiology and anesthesiology, but enjoyed my pathology rotations more.

My day to day practice is roughly a 60/40 split between signing out dermatopathology and general pathology. I work in a department with about 15 pathologists, most of whom have a subspecialty of their own, so I receive dermpath consult cases from inside the department and also from regional labs around the US. I can also easily consult someone in my department if I'm having trouble with a case. There are residents at my hospital, so when I sign out I am sometimes sitting with one of them. Work days are typically 8 hours and consist of 6-8 hours signing out cases, 1-2 hours of admin, and 1-2 hours of conferences or meetings. I come in when I please and leave when I please as long as I get my work done.

Feel free to ask me about anything regarding pathology that you are interested in. I think it's a great specialty and that it can be one of the hidden gems of medicine.

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[Psai]

Why does it take like three weeks for us to find out that its cancer

 

[deleted645092]

Maybe a dumb question but with a fellowship in dermatopath, if you decided you wanted to could you technically decide to market yourself as a dermatologist and see patients in clinic?

 

[7331poas]

Maybe a dumb question but with a fellowship in dermatopath, if you decided you wanted to could you technically decide to market yourself as a dermatologist and see patients in clinic?

Pathologist dont do procedures or surgery yes?

 

[Bacchus]

How often do you need out over samples? I feel I can tell by the depth of detail in the notes and the amount of terms I don’t remember how excited you all are looking at my biopsies.

 

[Bacchus]

Why does it take like three weeks for us to find out that its cancer

I feel I get my atypia+ back more quickly than other samples. At least, the prelim.

 

[lawrencewellsbourne]

talk to me about AI and pathology,
what are the limitations?
which machine learning algorithms do you like?

what are the differences compared to AI in the field of radiology

 

[PhillyMed777]

Is it easier to get a dermpath fellowship as a dermatology resident?

Some have answered the above question as yes....however does it make a difference if the dermpath fellowship originates from the derm or path side? I.e. dermpath is part of upenns and UT houstons derm department but its from harvards and baylors path departments...

 

[Mace1370]

Why does it take like three weeks for us to find out that its cancer

It doesn't. A good lab can get slides made in 24-48 hours after accessioning a specimen. If it is a teaching hospital, you may need to add a day for residents to go through the case. A diagnosis should come the next day. Sometimes additional immunohistochemistry is needed, which adds another day or two of processing, but a prelim of cancer/not cancer is almost always possible before IHCs are done processing.

Maybe a dumb question but with a fellowship in dermatopath, if you decided you wanted to could you technically decide to market yourself as a dermatologist and see patients in clinic?

If you haven't done a residency in dermatology and don't have a board certification in dermatology you can't claim to be a dermatologist. Technically any specialty can open up a clinic, see patients, and do whatever procedures they feel like. You are opening yourself up to a ton of liability, however, if you make a mistake and are practicing outside the scope of your specialty/training. A pathologist is definitely not qualified to practice dermatology (even with a fellowship in dermatopathology).

Pathologist dont do procedures or surgery yes?

Pathologists do procedures, but not many. The most common are FNAs. Some pathologists also do bone marrow biopsies, but this varies a lot based on region and whether there are heme/onc fellows at your institution. You could consider autopsies a procedure, but despite common belief, most pathologists do not enjoy doing autopsies. We definitely don't do surgery.

How often do you need out over samples? I feel I can tell by the depth of detail in the notes and the amount of terms I don’t remember how excited you all are looking at my biopsies.

I don't really understand the question. It is uncommon to be uninterested in a biopsy. This usually occurs when it is clear that a clinician has taken a biopsy of something they have little understanding about and there are non-specific features on the slide. An example is a biopsy from a "rash" taken by a non-dermatologist and the biopsy shows borderline normal skin/scant perivascular inflammation. That type of thing doesn't do the patient any good.

talk to me about AI and pathology,
what are the limitations?
which machine learning algorithms do you like?

what are the differences compared to AI in the field of radiology

I can't speak much to radiology, since that isn't my field. AI is very much in the infancy stages for pathology, so right now are the limitations are essentially that it doesn't exist. The closest thing is probably computers that screen PAP smears for abnormal areas. These areas are flagged and go to a tech who reviews them. The tech can toss many of these out as normal/no big deal and then forwards the more abnormal looking ones to a pathologist. In the future I think AI will help increase the productivity of pathologists and therefore will expand access to care. I am not worried that I will be replaced by a computer.

 

[Mace1370]

Is it easier to get a dermpath fellowship as a dermatology resident?

Some have answered the above question as yes....however does it make a difference if the dermpath fellowship originates from the derm or path side? I.e. dermpath is part of upenns and UT houstons derm department but its from harvards and baylors path departments...

The short answer is that no, it doesn't really matter. The longer answer is that it is a little complicated. Many programs like to have fellows from both backgrounds, since the dermatology trained fellows can help the pathology trained fellows with the clinical aspect of dermatopathology and the pathology trained fellows can help the dermatology trained fellows with cytomorphology, lab medicine, etc. Some programs have a strong link to either the pathology department or the dermatology department and therefore normally have inside candidates coming from that side. That means that those programs are often looking for the other one to compliment what they already have, if they care about that sort of thing. Additionally, dermpath has become less popular among dermatology residents in the last few years do to it no longer being the "hot/super high reimbursing" subspecialty that it used to be and many dermatology residents are pursuing other more lucrative fellowships (or just practicing general derm, which pays really well). As a result, I think pathology applicants represent a larger % of the applicant pool than they used to, so it is probably easier for the derm residents to stand out. Also, derm residents are usually extremely strong academically (they had to be to get into derm) and they continue this trend in their fellowship applications.

 

[CherryRedDracul]

what are the differences compared to AI in the field of radiology

AI in radiology is still in its infancy as well.

Computer-aided diagnosis (CAD) for mammography is pitiful. As only a 2nd year radiology resident, I do way better than the AI. Right now, at most, it can assist the radiologist, but not replace. Will it replace the radiologist eventually? Maybe. But the world will be a vastly different place by then, and many other simpler tasks will be replaced first, there will likely be massive rates of unemployment ... but who knows.

 

[Mace1370]

AI in radiology is still in its infancy as well.

Computer-aided diagnosis (CAD) for mammography is pitiful. As only a 2nd year radiology resident, I do way better than the AI. Right now, at most, it can assist the radiologist, but not replace. Will it replace the radiologist eventually? Maybe. But the world will be a vastly different place by then, and many other simpler tasks will be replaced first, there will likely be massive rates of unemployment ... but who knows.

I think a large factor in the debate over the results of improved AI is that there is a huge demand for medicine which isn't being met. Many people would get an X-ray, an MRI, a biopsy done, etc if it was cheaper. AI will allow physicians to massively increase their productivity and therefore lower prices to take advantage of this demand. Will AI eventually take over completely? Maybe, but I'm not sure the companies who create these products want the liability whenever their algorithm misses a cancer/whatever diagnosis.

 

[Lawpy]

Thanks for doing this

1. What interests you about dermpath? Why did you choose to do a fellowship in dermpath as opposed to anything else or practicing in general pathology?

2. Is the pathology job market saturated? There are fears stated so in the Pathology forums by long-time members, so curious to know what you think.

 

[Mace1370]

Thanks for doing this

1. What interests you about dermpath? Why did you choose to do a fellowship in dermpath as opposed to anything else or practicing in general pathology?

2. Is the pathology job market saturated? There are fears stated so in the Pathology forums by long-time members, so curious to know what you think.

1. Dermpath has a huge variety of diseases. Melanocytic lesions are very difficult to diagnose well and challenge you on a daily basis. Additionally, dermpath has more clinical correlation than any other subspecialty in pathology. You have to know the clinical dermatology very well to be a good dermatopathologist. Employing these different sets of knowledge and combining them to "solve the puzzle" is very rewarding. Also, I like that skin biopsies are usually small and I'm not scrolling through a huge amount of real estate to make my diagnosis.

2. The pathology job market is ok, but definitely worse than a field like dermatology. Getting a good job requires that you have a pleasant personality, network, and are a hard worker. Being geographically flexible helps.Both of my co-fellows had jobs before fellowship finished. There are many disgruntled people who post in the pathology forums here who are, I think, excessively negative. I did away rotations at three or four different large hospitals when I was a resident. Each one had a program of 5-8 residents per class. Meeting all those people, not a single one had a story of a resident who had graduated from their program and didn't get a job.

 

[thegreengreatdragon]

Thanks so much for doing this! I feel like pathology is a field that is often overlooked.

Do you get any patient interaction in pathology? That's really the one thing that's keeping me away from it. I don't need a lot, but I really enjoy hearing patient's stories. Or, I guess, in general, what does your day look like? Is it a lot of just sitting in a lab and staring into a microscope? Abstractly speaking, path seems really cool, but I worry that I wouldn't enjoy the day-to-day of it.

What are path residencies looking for? Average board scores seem like enough, but what about things like research? Are away rotations necessary for some of the higher tier programs?

 

[deleted938090]

Any regrets at all?

 

[Cuongoff]

I always wondered how dermpath fellows from the pathology side only need 1 year to learn all the derm diseases. Do you guys cover it a lot during residency along with the other systems? I'm a first year and I'm already overwhelmed by how many derm associated diseases there are and I can't imagine learning it all along with the pathology in one year.

 

[Mace1370]

Thanks so much for doing this! I feel like pathology is a field that is often overlooked.

Do you get any patient interaction in pathology? That's really the one thing that's keeping me away from it. I don't need a lot, but I really enjoy hearing patient's stories. Or, I guess, in general, what does your day look like? Is it a lot of just sitting in a lab and staring into a microscope? Abstractly speaking, path seems really cool, but I worry that I wouldn't enjoy the day-to-day of it.

What are path residencies looking for? Average board scores seem like enough, but what about things like research? Are away rotations necessary for some of the higher tier programs?

Patient interaction is pretty minimal. If you wanted to do pathology and increase your patient interaction I would recommend looking into a blood bank fellowship after residency. When on blood banking you can interact with patients during exchange transfusions, etc. Another possibility would be if you build doing FNAs into your practice (in which case a fellowship in cytopathology could help, but certainly wouldn't be necessary). I understand the desire for patient interaction. I enjoyed working with patients as a medical student and when I still run into them. In pathology, you interact with other physicians a lot more. You are constantly talking and interacting with people in your group/practice as well as with other clinicians (surgeons, dermatologists, etc). You are by no means sitting in a room by yourself all day. I spend at least 2/3 of my day signing out cases, and while I'm doing that I'm regularly getting up to show cases to colleagues or they are bringing in cases to show me. Other physicians will call or come to my office to talk about a case. You go to tumor boards and add your input there. I find the day to day to be very engaging. You have the peace to sit and think to yourself to work through a difficult case if you need and can constantly talk through problems with other pathologists around you. You feel useful because clinicians will come to you and ask about a case you read, or to just get your input on a clinical problem (would a biopsy help here? is lab test X indicated in this scenario? etc).

Pathology residencies are very much a buyers market. If you have average to above average boards scores, are a normal human (i.e. not overly awkward or socially inept) you will get into a good program. The "top tier" ones like you to have a little research and probably slightly higher than average board scores. An away rotation is not necessary, but can be very helpful because you can learn if the program is right for you and you can show them that you are a good person who works hard.

Any regrets at all?

No major ones so far. Sometimes I wonder if I should have given surgery more serious consideration. I crossed it off the list of possibilities pretty early because of the bad hours, but honestly I just didn't have it in me to do that grind.

 

[Mace1370]

I always wondered how dermpath fellows from the pathology side only need 1 year to learn all the derm diseases. Do you guys cover it a lot during residency along with the other systems? I'm a first year and I'm already overwhelmed by how many derm associated diseases there are and I can't imagine learning it all along with the pathology in one year.

It is an extremely steep learning curve and you are always learning. Thankfully, some of the derm stuff doesn't get biopsied very often so you don't have to worry about it as much. I think the best dermpaths keep pushing to learn more derm as they practice by attending grand rounds, interacting with dermatologists, etc. How much dermapth you get in residency varies a lot by program. Many do virtually no dermatopathology as it is separated out into the derm department. I was lucky and had a fair bit in residency. My fellowship really emphasized the clinical part and I'm thankful for that.

 

[Bacchus]

It doesn't. A good lab can get slides made in 24-48 hours after accessioning a specimen. If it is a teaching hospital, you may need to add a day for residents to go through the case. A diagnosis should come the next day. Sometimes additional immunohistochemistry is needed, which adds another day or two of processing, but a prelim of cancer/not cancer is almost always possible before IHCs are done processing.



If you haven't done a residency in dermatology and don't have a board certification in dermatology you can't claim to be a dermatologist. Technically any specialty can open up a clinic, see patients, and do whatever procedures they feel like. You are opening yourself up to a ton of liability, however, if you make a mistake and are practicing outside the scope of your specialty/training. A pathologist is definitely not qualified to practice dermatology (even with a fellowship in dermatopathology).



Pathologists do procedures, but not many. The most common are FNAs. Some pathologists also do bone marrow biopsies, but this varies a lot based on region and whether there are heme/onc fellows at your institution. You could consider autopsies a procedure, but despite common belief, most pathologists do not enjoy doing autopsies. We definitely don't do surgery.



I don't really understand the question. It is uncommon to be uninterested in a biopsy. This usually occurs when it is clear that a clinician has taken a biopsy of something they have little understanding about and there are non-specific features on the slide. An example is a biopsy from a "rash" taken by a non-dermatologist and the biopsy shows borderline normal skin/scant perivascular inflammation. That type of thing doesn't do the patient any good.



I can't speak much to radiology, since that isn't my field. AI is very much in the infancy stages for pathology, so right now are the limitations are essentially that it doesn't exist. The closest thing is probably computers that screen PAP smears for abnormal areas. These areas are flagged and go to a tech who reviews them. The tech can toss many of these out as normal/no big deal and then forwards the more abnormal looking ones to a pathologist. In the future I think AI will help increase the productivity of pathologists and therefore will expand access to care. I am not worried that I will be replaced by a computer.

Autocorrect got me. Nerd out. Not need.

 

[Bus2MD]

Hey, I'm a 3rd year DO student that recently started considering path (also considering radiology).

What should I look for in a path residency? Looking through Freida it seems IMG's dominate many residency programs. Even a lot of the university programs are filled with IMG's. I know with the job market not being the best it's important to go to a strong program. Should I be using AMG vs IMG filled as my main indicator on the strength of a program?

If you do a fellowship outside of forensics will you ever be expected to do autopsies? It's a major drawback to the field for me. I know you have to do them during residency, I just have no desire to do them after that.

I've heard a lot of people on here saying that the PP partnership model in path is dying. Do you see this happening? Where do you see the path jobs coming from in the future? Hospital based, large corporations...?

Thanks!!

 

[Mace1370]

Autocorrect got me. Nerd out. Not need.

Oooh, that makes more sense. Long, drawn out comments can appear in pathology reports for a variety of reasons. If I receive a case as a consult from another pathologist, I will usually include a detailed microscopic description in the comment as well as my reasoning for a certain diagnosis/differential. I do this because the contributing pathologist likely wants to know why the answer is what it is so they can learn going forward. If the report is going to a non-pathologist (most of the time), I do my best to limit any sort of microscopic description since frankly they don’t care about those details. This is a style thing, and I’ve seen some people put microsopic descriptions in regardless. Is that the stuff you meant about a lot of gibberish words?

Hey, I'm a 3rd year DO student that recently started considering path (also considering radiology).

What should I look for in a path residency? Looking through Freida it seems IMG's dominate many residency programs. Even a lot of the university programs are filled with IMG's. I know with the job market not being the best it's important to go to a strong program. Should I be using AMG vs IMG filled as my main indicator on the strength of a program?

If you do a fellowship outside of forensics will you ever be expected to do autopsies? It's a major drawback to the field for me. I know you have to do them during residency, I just have no desire to do them after that.

I've heard a lot of people on here saying that the PP partnership model in path is dying. Do you see this happening? Where do you see the path jobs coming from in the future? Hospital based, large corporations...?

Thanks!!

The following are desirable traits in a path residence: high case volume, high case complexity, high case variety, as much independence as possible (i.e. you have protected time to preview, you are expected to put in reports before sign out, etc), graduated responsibility, minimal scut, and enough grossing to make you a competent grosser, but not so much that you are just a grossing monkey for the program. You can usually figure out where a program stands on these issues by talking with the residents and the PD when you interview.

There are a lot of IMGs in pathology. This has to do with the residency not being competitive. A lot of IMGs at a residency is not an absolute indicator that the program is bad, but it could be a red flag and would definitely make me take a second look. The biggest indicator of a bad program is that the residents are simply gross monkeys. There are some big name programs out there that have this problem. That is the thing you should worry about.

Whether you do autopsies or not simply depends on what type of job you take. Many academic positions will have you only signing out cases in your subspecialty, so that in that situation you wouldn’t do any autopsies. Other programs share autopsies between all the staff. Some private practice jobs cover autopsies for various hospitals, others don’t, etc. I would say that if you really don’t want to do autopsies then you probably can find a job where you wouldn’t have to. That said, once you are staff at an academic hospital autopsies are not nearly as bad, since if you have residents under you they are doing most of the work.

The partnership model in medicine is dying and that is true in pathology as well. It is probably one of the things that worries me about the future. Large labs are buying out pathology practices. This is in part due to how medicine, and pathology, is being regulated and reimbursed. Hopefully that trend changes in the future. The sad reality is that for now this affects everyone in medicine to some degree.

 

[kraskadva]

Thanks for doing this!
I'm a M2 interested in going into path and I have a few questions...

Pathology residencies are very much a buyers market. If you have average to above average boards scores, are a normal human (i.e. not overly awkward or socially inept) you will get into a good program. The "top tier" ones like you to have a little research and probably slightly higher than average board scores. An away rotation is not necessary, but can be very helpful because you can learn if the program is right for you and you can show them that you are a good person who works hard.

For the research aspect of being competitive, would research prior to med school count as well? I did a MS and my thesis research was very intensive biochem-based bench work, which I frankly got burned out on and so have been disinclined to do more of the same in med school. Would adding some clinical research in 3rd/4th year be prudent/potentially helpful, or unnecessary?

You said that you're at an academic center - how much teaching do you or your colleagues do? Just with the residents, or also with med students? What are the opportunities for teaching if one is inclined towards that - i.e. what would the workload split look like? (I'm guessing variable based on personal preference, but I don't know)

Could you compare hospital path with forensic path as far as work hours, compensation, job opportunities, opportunities to get involved with other aspects of academic medicine (teaching, research, policy, etc.)?

I know this may well change in the 6-8 years between now and when I'm job hunting, but what fellowships are more in demand/more lucrative for job applicants right now?

 

[libertyyne]

I think a large factor in the debate over the results of improved AI is that there is a huge demand for medicine which isn't being met. Many people would get an X-ray, an MRI, a biopsy done, etc if it was cheaper. AI will allow physicians to massively increase their productivity and therefore lower prices to take advantage of this demand. Will AI eventually take over completely? Maybe, but I'm not sure the companies who create these products want the liability whenever their algorithm misses a cancer/whatever diagnosis.

I'm not sure I buy the liability aspect of this argument. Considering autonomous driving is on the horizon. Even if you charge half of what a physician does for a read you essentially have fixed costs with no limit in terms of productivity, these companies could self insure or new insurance products could cover them. Plus who is to say that the missed or wrong diagnosis rate wouldn't be less.

 

[Mace1370]

Thanks for doing this!
I'm a M2 interested in going into path and I have a few questions...


For the research aspect of being competitive, would research prior to med school count as well? I did a MS and my thesis research was very intensive biochem-based bench work, which I frankly got burned out on and so have been disinclined to do more of the same in med school. Would adding some clinical research in 3rd/4th year be prudent/potentially helpful, or unnecessary?

You said that you're at an academic center - how much teaching do you or your colleagues do? Just with the residents, or also with med students? What are the opportunities for teaching if one is inclined towards that - i.e. what would the workload split look like? (I'm guessing variable based on personal preference, but I don't know)

Could you compare hospital path with forensic path as far as work hours, compensation, job opportunities, opportunities to get involved with other aspects of academic medicine (teaching, research, policy, etc.)?

I know this may well change in the 6-8 years between now and when I'm job hunting, but what fellowships are more in demand/more lucrative for job applicants right now?

Research prior to medical school will not count towards your residency app. I think this is true of most programs. PDs want to know what you have done during medical school. I think doing a little research can really help your app, especially to the competitive academic programs that have a research emphasis.

We do a lot of teaching. I would say it is about 30% of my job. Every sign out that I have that was previewed by a resident entails me sitting down with them one on one and going through each case they previewed. At my hospital we are given an extra day to do this, so it is taken seriously. One of the things that attracted me to pathology is that pathology has a ton of teaching opportunities. You can definitely tailor your job search around this if it is something you are interested in.

Forensic path has the same to worse work hours than general pathology for significantly worse pay. I think it might be one of the lowest paying sub specialties in medicine. It does have a very good job market, fwiw, and is a totally different beast than basically anything else out there. For a few it is a calling. For most it is something to avoid. They both have similar amounts of teaching.


Right now the most in demand sub specialties are derm, GI, hemepath, and cytology. As with all of medicine, this can change.

 

[Mace1370]

I'm not sure I buy the liability aspect of this argument. Considering autonomous driving is on the horizon. Even if you charge half of what a physician does for a read you essentially have fixed costs with no limit in terms of productivity, these companies could self insure or new insurance products could cover them. Plus who is to say that the missed or wrong diagnosis rate wouldn't be less.

Just one man’s opinion. Overall, I think AI is going to increase physician productivity and that pathology has as much to worry about as any other specialty in being totally replaced by robots.

 

[thegreengreatdragon]

Forensic path has the same to worse work hours than general pathology for significantly worse pay. I think it might be one of the lowest paying sub specialties in medicine. It does have a very good job market, fwiw, and is a totally different beast than basically anything else out there. For a few it is a calling. For most it is something to avoid. They both have similar amounts of teaching.

Was forensic path something you ever considered? How could I get more exposure to this as a medical student?
Also, do you know any forensic pathologists, and are they happy with their decision?

Also, since you mention salary, how is yours/the average clinical pathologist's?

 

[Mace1370]

Was forensic path something you ever considered? How could I get more exposure to this as a medical student?
Also, do you know any forensic pathologists, and are they happy with their decision?

Also, since you mention salary, how is yours/the average clinical pathologist's?

I actually worked at my local medical examiner when I was pre-med. You can become a diener to assist with the routine aspects of forensic autopsies (doing the y-incision, removing the rib cage, take various samples, etc). It was an interesting way to learn anatomy before first year of medical school and it taught me that I had zero interest in ever pursuing a career as a forensic pathologist. Autopsies can be disgusting. Most are not that bad (or not any worse than many of the gross things you get to deal with in the hospital), but when a bad de-comp comes in... oh boy, that's a bad day. If you want to get exposure to forensic pathology, I would recommend contacting your local medical examiner office and tell them you would like to shadow for a day or two. You can use that opportunity to see if you can get more exposure at a later date.

I know plenty of forensic pathologists who are very happy with their jobs. It is a pretty polarizing field. People know quickly if they want to do forensics once they have rotated through the MEs for a month or two as a resident. The FPs I worked for as a resident all seemed to love their job and had high job satisfaction, but could be stressed out over political pressures due to the nature of the office (I also rotated through a few MEs where there were controversial public deaths that I'm sure stressed them out quite a bit).

The average pathologist will get starting job offers between $175-225k/year. These salaries usually increase to $250-350k within a few years depending on the practice environment. People in private practice can make a lot more. Something to consider when looking at salary is how much work you are doing. Bigger numbers always seem better, but generally if you are paid more you will work more. I think path has some of the best compensation for how long you actually work. We have very nice work hours. Another thing to look out for is the rather predatory practice of employing "junior professors" (or whatever the title is) at larger academic centers. These jobs are extremely low paying (think 80 to 90k per year) and are given with the promise of a full professorship down the line. They tend to be given to IMGs or AMGs with poor social skills and often I think there is no intention of ever actually making them full professors. These are the bottom of the barrel jobs and are not the norm, but it is something to be aware of. Both of my co-fellows started off at >$200k and have bright futures.

I'm a little bit of a unique situation because I work for the Army, so I make what all military pathologists make. For more information about that, I would refer you to the military medicine forum here at SDN.

 

[OrthoTraumaMD]

How much do you make?


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[libertyyne]

How much do you make?


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to piggyback off of this, how many hours do you work per week? Is there call? weekends?Holidays?

 

[Mace1370]

How much do you make?


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I make $160k as an active duty military physician. You make significantly less than you would in the civilian sector, but that’s part of the sacrifice of serving. On the upside the Army paid for medical school, so I don’t have any student loans. I’ll be in the Army to pay back my commitment, then join the civilian work force.

to piggyback off of this, how many hours do you work per week? Is there call? weekends?Holidays?

I work 30-40 hours per week. I take call two weeks per year. I don’t work weekends and get all holidays off (unless I’m on call).

 

[OrthoTraumaMD]

I make $160k as an active duty military physician. You make significantly less than you would in the civilian sector, but that’s part of the sacrifice of serving. On the upside the Army paid for medical school, so I don’t have any student loans. I’ll be in the Army to pay back my commitment, then join the civilian work force.



I work 30-40 hours per week. I take call two weeks per year. I don’t work weekends and get all holidays off (unless I’m on call).

That’s incredible. Two weeks per year of call...wow. I’m on call one weekend a month. How much can you expect to make once you join civilian workforce?


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[Mace1370]

That’s incredible. Two weeks per year of call...wow. I’m on call one weekend a month. How much can you expect to make once you join civilian workforce?


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Ya, I love the lifestyle! Most people in my group start around 350 when they leave the military.

 

[PhillyMed777]

What are some of the best dermpath programs out there?
What would you recommend to a derm resident who wants to target a specific dermpath program which is likely a competitive one in a competitive location? Is there a way to target a program, or is it unlikely to succeed?
Which journal has the best dermpath articles?
Thank you for your time.

 

[Mace1370]

What are some of the best dermpath programs out there?
What would you recommend to a derm resident who wants to target a specific dermpath program which is likely a competitive one in a competitive location? Is there a way to target a program, or is it unlikely to succeed?
Which journal has the best dermpath articles?
Thank you for your time.

Most of the dermpath programs out there are very solid. "Best" program is very debatable, but there are several programs with very well known dermatopathologists. Elston (MUSC), Rapini (UT Houston), and LeBoit (UCSF) are all big names. There are others too. I've heard great things about the Geisinger program with Ferringer. Really though, barring a couple bad apple programs it is hard to go wrong.

If you want to target a specific program, then I would highly recommend setting up a month long visiting rotation there. That's really your best bet.

Journal of Cutaneous Pathology and American Journal of Dermatopathology are the two most popular. JCP tends to publish more bleeding edge academic stuff and AJDP tends to publish more practice relevant articles.

 

[thegreengreatdragon]

I actually worked at my local medical examiner when I was pre-med. You can become a diener to assist with the routine aspects of forensic autopsies (doing the y-incision, removing the rib cage, take various samples, etc). It was an interesting way to learn anatomy before first year of medical school and it taught me that I had zero interest in ever pursuing a career as a forensic pathologist. Autopsies can be disgusting. Most are not that bad (or not any worse than many of the gross things you get to deal with in the hospital), but when a bad de-comp comes in... oh boy, that's a bad day. If you want to get exposure to forensic pathology, I would recommend contacting your local medical examiner office and tell them you would like to shadow for a day or two. You can use that opportunity to see if you can get more exposure at a later date.

I know plenty of forensic pathologists who are very happy with their jobs. It is a pretty polarizing field. People know quickly if they want to do forensics once they have rotated through the MEs for a month or two as a resident. The FPs I worked for as a resident all seemed to love their job and had high job satisfaction, but could be stressed out over political pressures due to the nature of the office (I also rotated through a few MEs where there were controversial public deaths that I'm sure stressed them out quite a bit).

The average pathologist will get starting job offers between $175-225k/year. These salaries usually increase to $250-350k within a few years depending on the practice environment. People in private practice can make a lot more. Something to consider when looking at salary is how much work you are doing. Bigger numbers always seem better, but generally if you are paid more you will work more. I think path has some of the best compensation for how long you actually work. We have very nice work hours. Another thing to look out for is the rather predatory practice of employing "junior professors" (or whatever the title is) at larger academic centers. These jobs are extremely low paying (think 80 to 90k per year) and are given with the promise of a full professorship down the line. They tend to be given to IMGs or AMGs with poor social skills and often I think there is no intention of ever actually making them full professors. These are the bottom of the barrel jobs and are not the norm, but it is something to be aware of. Both of my co-fellows started off at >$200k and have bright futures.

I'm a little bit of a unique situation because I work for the Army, so I make what all military pathologists make. For more information about that, I would refer you to the military medicine forum here at SDN.

Thank you so much for such a thoughtful answer! This is really helpful. I'd sort of ruled pathology out, but I'm starting to think I need to explore a little more. I'll definitely see if I can get some exposure to both clinical and forensic path.

 

[Gilma Hernandez]

Hello
I would like to know, when you finish the pathology residency. Whic are the requirements to have your own little lab? and how is the less investment to have that?