Pathologist or Radiologist ??(not a cliche question)

[PathDiagnosis]

Hi all,

I'm 26 now and will be starting the MA in Medical Science at Boston University. It's an SMP where you can take medical school classes to prove your worth. I'll be starting medical school (hopefully) older than the traditional age but that doesn't bother me. I never seriously considered medicine until after some time in full time work.

I gradauted undergrad with a 3.2 GPA four years ago with a Cytology degree and have been working as a Cytotechnologist since. I'm sure at least some of the Residents here know that Cytotechnologists work closely with Pathologists (who obviously don't just work with dead people, in practice they hardly do that).Cytotechnologists prepare FNA slides, pre screen slides, prepare slide blocks, etc.

Pathology and Radiology are both diagnostic fields. Right now, due to my experience as a Cytotechnologist, I am very interested in Pathology as a specialty.

For any Radiologists (Residents, Attendings, Fellows), are you satisfied with your role as a diagnostician. If so, how? It seems like Pathologists come to definitive diagnoses at least more often than Radiologists (cellular detail, etc) Is there something about radiology that interests you more than diagnosis? If it was diagnosis that got you interested in radiology, but diagnostic component was lacking in pathology that led you to radiology?

I don't mean to bash radiology at all.

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[cowme]

Hi all,


For any Radiologists (Residents, Attendings, Fellows), are you satisfied with your role as a diagnostician. If so, how? It seems like Pathologists come to definitive diagnoses at least more often than Radiologists (cellular detail, etc) Is there something about radiology that interests you more than diagnosis? If it was diagnosis that got you interested in radiology, but diagnostic component was lacking in pathology that led you to radiology?

I don't mean to bash radiology at all.

I would hardly say that pathologists come to a definitive diagnosis more than radiologists. Both fields have an absurdly high rate of hedging to cover their azzes. They are both strikingly similar fields: one is diagnosis on a microscopic level, one is diagnosis on a macroscopic level. I personally found seeing a lung mass on a ct more interesting than seeing adenocarcinoma cells on a slide. I like anatomy but hate histology, that made my decision easy.

I also like technology. There is a lot more technology on the horizon for rads than path, which has done nothing new in 50 years other than invent new stains and put microscopes on computers.

Either way, Both fields need eachother: without the radiologist discovering the lung mass, the tissue would never be biopsied to look under the microscope. Without a tissue diagnosis of cancer, a radiologist staging the extent of disease is meaningless.

 

[PathDiagnosis]

I would hardly say that pathologists come to a definitive diagnosis more than radiologists. Both fields have an absurdly high rate of hedging to cover their azzes. They are both strikingly similar fields: one is diagnosis on a microscopic level, one is diagnosis on a macroscopic level. I personally found seeing a lung mass on a ct more interesting than seeing adenocarcinoma cells on a slide. I like anatomy but hate histology, that made my decision easy.

I also like technology. There is a lot more technology on the horizon for rads than path, which has done nothing new in 50 years other than invent new stains and put microscopes on computers.

Either way, Both fields need eachother: without the radiologist discovering the lung mass, the tissue would never be biopsied to look under the microscope. Without a tissue diagnosis of cancer, a radiologist staging the extent of disease is meaningless.

Thanks for the response. When I hopefully enter medical school I'll do a radiology rotation or two to figure things out.

Yeah, Pathology is kinda old school...even Pathologists I worked with say that.

 

[Enkidu]

I would hardly say that pathologists come to a definitive diagnosis more than radiologists. Both fields have an absurdly high rate of hedging to cover their azzes.

I think that radiology is quite a bit heavier on the hedging. In my experience in pathology, the report tends to contain a single diagnosis, whereas a radiology report seems to provide a differential.

I like radiology as well, I suppose it's a second to pathology, but for me it has a different draw. Radiology reports are quite a bit more timely than pathology reports and have a large role in emergent situations. The closest that pathology comes to that is in frozen sections.

Radiology also has some cool stuff with nuclear medicine that can provide really interesting information to clinicians, although it's not clear how cost-effective some of them are.

As far as technological advancement, radiology definitely wins, although there are significant advances in genomic and personalized medicine that are going to be a major part of pathology during our lifetimes.

Cowme, which types of conditions can be definitively diagnosed by radiology without requiring histological confirmation? Pulmonary embolism, Pneumonia, Fractures... those are the main ones that I can think of. Is there a general rule?

 

[cowme]

Cowme, which types of conditions can be definitively diagnosed by radiology without requiring histological confirmation? Pulmonary embolism, Pneumonia, Fractures... those are the main ones that I can think of. Is there a general rule?

In a field like Neuro, they can diagnose plenty without path: Intracranial hemorrhage, hydrocephalus, skull/facial/vertebral fracture, vascular malformations, multiple sclerosis, many tumors that can be confidently diagnosed without tissue (meningioma, acoustic neuroma, Glioblastoma), spinal cord compression. I'm sure the list is much longer, but I am still a prelim.

Plus, if a patient has stage 4 lung cancer metastatic to the brain, who gives a crap if its adenocarcinoma or squamous cell carcinoma? Maybe the pathologist can save the day by saying the primary tumor site was in the testicles, but 99.9% of the time, the diagnosis of terminal lung cancer can be made without tissue.

Another point I forgot to mention in my last post (for anyone choosing between the fields) rads also has the benefits of doing a ton of procedures. Obviously, there is IR, but womens imagers do breast biopsies, body/lung imagers do CT guided biopsies, MSK guys do vertebroplasties, arthrographies, nerve blocks, etc. If you still think you may want to do a lot of procedures, I would take that into account.

 

[colbgw02]

Plus, if a patient has stage 4 lung cancer metastatic to the brain, who gives a crap if its adenocarcinoma or squamous cell carcinoma? Maybe the pathologist can save the day by saying the primary tumor site was in the testicles, but 99.9% of the time, the diagnosis of terminal lung cancer can be made without tissue.

Who gives a crap? Plenty of people, particularly the medical oncologist. In my experience, oncologists are extremely unwilling to initiate chemotherapy without a tissue diagnosis, irrespective of survival outcome. So, as the radiologist, when you are asked to perform a CT-guided biopsy on a patient with stage IV disease, you should still do it.

 

[napoleondynamite]

I am not in either of these fields, but I do have friends in both. I think one very important point to consider is job security - which currently, is terrible in pathology. Also, your earning potential is much higher in rads. So if all else is equal and you have interest in both fields, rads wins by light years IMO.

Of course, these things are dynamic and changing and you have 4-5 years to watch the market in both of these fields evolve with changes in health care policy.

I will probably get bashed for even bringing up financial considerations - save it, we've all heard the speech on these forums dozens of times. Of course we all know that money should not be your sole consideration, blah, blah, blah. All I am trying to say is that if you have equal interest in 2 fields and one is so obviously going to provide you with more financial success and job security, then it makes sense to go with that one.

I'll go put on my flak jacket now to shield myself from the inevitable shelling..

 

[PathDiagnosis]

I am not in either of these fields, but I do have friends in both. I think one very important point to consider is job security - which currently, is terrible in pathology. Also, your earning potential is much higher in rads. So if all else is equal and you have interest in both fields, rads wins by light years IMO.

Of course, these things are dynamic and changing and you have 4-5 years to watch the market in both of these fields evolve with changes in health care policy.

I will probably get bashed for even bringing up financial considerations - save it, we've all heard the speech on these forums dozens of times. Of course we all know that money should not be your sole consideration, blah, blah, blah. All I am trying to say is that if you have equal interest in 2 fields and one is so obviously going to provide you with more financial success and job security, then it makes sense to go with that one.

I'll go put on my flak jacket now to shield myself from the inevitable shelling..

Thanks!

I've only ever worked with Pathologists and in Pathology/Lab medicine departments so I "like" Pathology more by default. I'll explore other possibly fields when I hopefully go to medical school.

What I like about Pathology is making the "final" call based on cells/tissue and intra-operative diagnoses for surgeons, etc.

So far I think what interests me the most is what ever as more of a "final say" per se.

Job markets always change.

 

[caffeinegirl]

Good luck with your journey PathDiagnosis.
You will not truly know what you field you will follow unless you actually get experience during rotations in medical school. It's still too early for you to narrow your choice to pathology..this is just the most familiar field for you given your prior experience.
My advice to you is to keep your options open during medical school, learn as much as you can, and at some point in your second or third year of medical school you can decide what is best for you. You never know what may happen.

As for radiology vs pathology..yes they are both diagnostic fields, but radiology is more clinically oriented, with clinically related differential diagnoses and patient contact. Also, this is definitely a more technical field, and you have to have a sure grasp of anatomy to develop a great eye. Both fields can be lucrative as has been discussed, with more opportunities in radiology. But the day-to-day life (including call) is very different in both specialties. Again, actual experience in these fields during medical school will help you gain a clearer picture.

Plus, if a patient has stage 4 lung cancer metastatic to the brain, who gives a crap if its adenocarcinoma or squamous cell carcinoma? Maybe the pathologist can save the day by saying the primary tumor site was in the testicles, but 99.9% of the time, the diagnosis of terminal lung cancer can be made without tissue.

And..there IS a difference between metastatic squamous cell carcinoma or adenocarcinoma of the lung!!! Squamous differentiation precludes avastin treatment!!

 

[cowme]

Who gives a crap? Plenty of people, particularly the medical oncologist. In my experience, oncologists are extremely unwilling to initiate chemotherapy without a tissue diagnosis, irrespective of survival outcome. So, as the radiologist, when you are asked to perform a CT-guided biopsy on a patient with stage IV disease, you should still do it.

The median survival time of lung cancer with brain mets is 3 months. Obviously, path is essential for confirmation of cancer and chemotherapy choices, but once the radiologist makes that diagnosis, the patients fate is pretty much sealed, saving a miracle. I was just giving an example where a the radiologists interpretation seals the patients fate without pathology. There are plenty of examples where path diagnosis is more important/more diagnostic than imaging, but this is not one.

 

[Enkidu]

I am not in either of these fields, but I do have friends in both. I think one very important point to consider is job security - which currently, is terrible in pathology. Also, your earning potential is much higher in rads. So if all else is equal and you have interest in both fields, rads wins by light years IMO.

Of course, these things are dynamic and changing and you have 4-5 years to watch the market in both of these fields evolve with changes in health care policy.

I will probably get bashed for even bringing up financial considerations - save it, we've all heard the speech on these forums dozens of times. Of course we all know that money should not be your sole consideration, blah, blah, blah. All I am trying to say is that if you have equal interest in 2 fields and one is so obviously going to provide you with more financial success and job security, then it makes sense to go with that one.

I'll go put on my flak jacket now to shield myself from the inevitable shelling..

I agree that income and job security are important, but its really difficult to predict the future. How many people wanted to go into dermatology but preferred a higher paying field before the era of managed care? Now they're kicking themselves since they're cardiothoracic surgeons.

Radiology is an awesome field, but I think it will not be as lucrative in the future as it has been in the past, and job security may not be as good either.

Pathology certainly has its problems, but its also plausible that it will be a very competitive and lucrative specialty when clinicians are asking for genomic reports about everything from their patient's risk factors for atherosclerosis, to the types of drugs they can metabolize, to the broken pathways of their cancer.... or things could turn out differently after all.

I dunno how many people are in the situation that they really don't know what interests them, but for those indecisive people it makes a lot of sense to go for the money. For most people it seems a little bit like playing the stock market, but with your happiness and job satisfaction on the line, on the off chance that you'll pick a field that will take off in the future and pay big.

Of course, if when its my time to match and pathology looks like its heading into a weak couple of decades, I may just go into radiology... but its a hell of a bet to make.

 

[PathDiagnosis]

I agree that income and job security are important, but its really difficult to predict the future. How many people wanted to go into dermatology but preferred a higher paying field before the era of managed care? Now they're kicking themselves since they're cardiothoracic surgeons.

Radiology is an awesome field, but I think it will not be as lucrative in the future as it has been in the past, and job security may not be as good either.

Pathology certainly has its problems, but its also plausible that it will be a very competitive and lucrative specialty when clinicians are asking for genomic reports about everything from their patient's risk factors for atherosclerosis, to the types of drugs they can metabolize, to the broken pathways of their cancer.... or things could turn out differently after all.

I dunno how many people are in the situation that they really don't know what interests them, but for those indecisive people it makes a lot of sense to go for the money. For most people it seems a little bit like playing the stock market, but with your happiness and job satisfaction on the line, on the off chance that you'll pick a field that will take off in the future and pay big.

Of course, if when its my time to match and pathology looks like its heading into a weak couple of decades, I may just go into radiology... but its a hell of a bet to make.

If you really like Pathology you could try getting into the best (very reputable, ie Harvard, Hopkins) residency program possible. Two pathologists I work with emphasize this since
since it "buys you jobs".
Good luck.

Thank you everyone for your input regarding path and rads.

 

[cowme]

If you really like Pathology you could try getting into the best (very reputable, ie Harvard, Hopkins) residency program possible. Two pathologists I work with emphasize this since
since it "buys you jobs".
Good luck.

Thank you everyone for your input regarding path and rads.

You realize that there are over 300 people competing for those 10-20 spots (I don't know how big the programs are). The ones that train there have basically a flawless med school record and the highest step scores. They are more less unobtainable for all but the best of the best applicants.

The radiology job market is pretty bad too, but nowhere near as bad as path. But you really can't choose to go/not go into a field because of current job market trends and salaries...residency is 5-6 years long. By the time you are done, the job market and salary will be entirely different than when you started. If you choose a field for the right reasons, then you will be happy, regardless. I'm certain that I would still be happier as a radiologist making 200K than as a hospitalist making 500K.

 

[yaah]

Who gives a crap? Plenty of people, particularly the medical oncologist. In my experience, oncologists are extremely unwilling to initiate chemotherapy without a tissue diagnosis, irrespective of survival outcome. So, as the radiologist, when you are asked to perform a CT-guided biopsy on a patient with stage IV disease, you should still do it.

Indeed, I can give you a long list of biopsy results which were presumed to be metastatic lesions which turned out to be something else. Lymphoma. Granulomas. Infarcts. Endometriosis. Inflammatory lesions. Benign tumors. And as said above, classifying a diagnosis beyond simply "lung cancer" guides therapy and prognosis. If I had a dollar for every time I was told a specimen I received "had to be cancer" and wasn't, I would be very wealthy. And in a lot of cases, you don't even need radiology to tell you a patient has stage IV disease. You can just look at them. So you're just as useless as we are.

I would hardly say that pathologists come to a definitive diagnosis more than radiologists. Both fields have an absurdly high rate of hedging to cover their azzes. They are both strikingly similar fields: one is diagnosis on a microscopic level, one is diagnosis on a macroscopic level. I personally found seeing a lung mass on a ct more interesting than seeing adenocarcinoma cells on a slide. I like anatomy but hate histology, that made my decision easy.

I also like technology. There is a lot more technology on the horizon for rads than path, which has done nothing new in 50 years other than invent new stains and put microscopes on computers.

Yikes, man. There is so much misinformation in this post it strains your credibility. You shouldn't go off discussing the field of pathology if you really don't know anything about it, which I have no idea if you do or not but your post implies you don't.

Pathologists don't hedge as much as radiologists! That isn't an insult, it's just a matter of practice. Technology is getting better but a mass is still a mass, and a non-specific infiltrate is still a non-specific infiltrate. Hedging occurs when the sample is too small, or not representative, or the lesion is bizarre. Radiologists HAVE to hedge. Technology has revolutionized pathology as well. The interesting thing about technology though is that despite all the advances, the best way to make a diagnosis in many cases remains a 2 cent glass slide stained with two colors. We use other technologies every day, but just because we still use a technique that has been in play for 100 years doesn't mean we don't use anything else. Radiologists still use chest xrays more than any other test, and I'm sure you could give me a soliloquy on why they are better in many circumstances.


In terms of jobs, etc. The path job market is weaker than most fields right now, there are many reasons for that. But the majority of solid candidates coming out of solid programs get solid jobs, despite what the internet tells you. And I can't really compare pay across the specialty since there is so much variation. There are many pathologists I know who make more than many radiologists I know, and vice versa. I would not recommend picking a field because of pay or current job prospects - that is a setup for failure because you are bound to be disappointed. Health care is changing. Do what you love.

 

[cowme]

Pathologists don't hedge as much as radiologists!

I never said that. I said that both fields hedge a lot. Yes, radiologists hedge a lot more (I'm sorry I didn't clarify). But does any of this sound familiar?

-LSIL, cannot rule out HSIL
-fibroadenoma, cannot rule out low grade malignancy
-atypical squamous cells, cannot rule out SCC

Look, I'm not insulting the field of pathology. I think path is an AWESOME field! Hell, if radiology didn't exist, it would probably be my career! But the technology in both fields are limited. I was simply telling the OP that pathologists aren't always 100% certain of the diagnosis either, even if they have the tissue.

And regarding technology, you said it best: "despite all the advances, the best way to make a diagnosis in many cases remains a 2 cent glass slide stained with two colors." Yes, CXRs are the most commonly ordered studies, but they are far, FAR from the best way to make a diagnosis in radiology. I'm sure technology will continue to advance in pathology, but I personally think that the future improvements in US, MR and CT (and future imaging modalities) will be far more revolutionary for radiology.

 

[PathDiagnosis]

You realize that there are over 300 people competing for those 10-20 spots (I don't know how big the programs are). The ones that train there have basically a flawless med school record and the highest step scores. They are more less unobtainable for all but the best of the best applicants.

The radiology job market is pretty bad too, but nowhere near as bad as path. But you really can't choose to go/not go into a field because of current job market trends and salaries...residency is 5-6 years long. By the time you are done, the job market and salary will be entirely different than when you started. If you choose a field for the right reasons, then you will be happy, regardless. I'm certain that I would still be happier as a radiologist making 200K than as a hospitalist making 500K.

Yeah. I realize that. That's why I said "try". I won't say more as I'm just trying to get into medical school first.

This has all been an interesting read. Thanks everyone!

 

[Ribseye]

Hey I am kind of interested in these fields, primarily because you dont get to see patients. But I naturally have a very low aptitude for anatomy. I get below class average on anatomy even if I put in a lot of effort, while histology is almost as easy for me as physiology (and everyone finds physiology to be easy). Does it mean that if I were to choose between these 2 fields, the choice would be obvious?

 

[Enkidu]

Hey I am kind of interested in these fields, primarily because you dont get to see patients. But I naturally have a very low aptitude for anatomy. I get below class average on anatomy even if I put in a lot of effort, while histology is almost as easy for me as physiology (and everyone finds physiology to be easy). Does it mean that if I were to choose between these 2 fields, the choice would be obvious?

No. Do rotations in both. Just because you find histology to be easy doesn't mean you will enjoy being a pathologist. You might find that the ability to guide management in an emergent situation to be so fulfilling that you're willing to put in the extra hours to master anatomy. On the other hand, you might find the intellectual challenge of fully understanding and diagnosing a patient's disease to be so amazing that you don't mind being more removed from clinical practice.

I took geology in college and found it to be incredibly easy, but I'm pretty glad that I didn't become a geologist.

Incidentally, if everyone in your school finds physiology to be easy, then something is wrong. I may be biased because my PhD is in neurophysiology, but in general physiology is the most mathematical and biophysical area of biology, and most people in other fields of biology struggle through physiology research seminars.

Histology has a closer link to physiology than anatomy does, so its a little more intellectually satisfying, and pathology is the most intellectual field in medicine. Radiology, on the other hand, gives you more immediate access to patients and allows you to do a number of procedures. Think about the shape that you want your life to take and make a choice based on that. It may cost you extra work to struggle through the subjects that you're less talented at, but you'll be a happier person.

 

[PathDiagnosis]

Any radiology residents or attendings here like to take a peek at cells they aspirated?I remember a radiologist doing some sort of funny dance when he finally got adequate material (per me, the cytotech) after a sixth pass.

 

[WEBB PINKERTON]

Any radiology residents or attendings here like to take a peek at cells they aspirated?I remember a radiologist doing some sort of funny dance when he finally got adequate material (per me, the cytotech) after a sixth pass.

PathDiagnosis, what made you decide to go to med school? You ever consider path assistant? Seems like that would be a pretty cool job if you could do some cytology and grossing.

 

[MozartFan]

wrong post