Pathology again?

[cozmopak]

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If you guys would have had to do it over, would you have chosen pathology?

 

[KeratinPearls]

If you guys would have had to do it over, would you have chosen pathology?

Yes, I would since I hate everything else in medicine. Maybe radiology, but I'm not a big fan of physics either.

 

[Nilf]

If you guys would have had to do it over, would you have chosen pathology?

I'm not so sure.

 

[cozmopak]

Yes, but only assuming I would do dermatopathology or hematopathology afterwards. Otherwise, I'm not so sure.

Is that because they offer the best job security/income?

 

[pathstudent]

At this point, unequivocally yes, and I thrived and adored all my med student rotations.

But, IMO, med school should inform students what income potential is. I don't believe that whole spiel about doing what you like best. Let's face it, all else being equal more money is a good thing. A friend I went to school with just interviewed at a GI group in the SE and he said the partners there make 3million a year. They own their own biopsy center, histo lab and pathologist. I have no reason to doubt him. I am sure that is way above the norm, but it is out there. I am happy to do pathology for 150K a year, but do I enjoy it that much more that I wouldn't have gone into GI and been an endoscopist in ATL making in 1 year what I would make in 20 years in pathology? At this point I have to say yes. But had I known at the time would I have gone the same way, I don't know. But at this point, yes, I would do it again. It is kind of like asking would you date your same girlfriend again? The answer is of course Yes, but if you knew that you could have dated megan fox had you blown her off. Well then maybe I wouldn't have.

 

[stainedglass]

Hell yes. The rest of medicine is a swirling cesspool of despair....well at least that's the impression I got in med school. 😍

 

[Nilf]

Is that because they offer the best job security/income?

I wouldn't say that these two fellowship will give you the ticket to the best job out there, but they do make you more marketable, and I happen to enjoy both. However, given relatively poor job market in path in general as compared to other specialties, I am hesitant to recommend pathology to medical students. Like pathstudent said before... I like path but I don't know if I would do it over knowing I might be making 150K and work harder than my medschool friends who are breaking 500K.

I smell another job market thread... sorry.

 

[ZZPath]

No. Had I understood the job market issues, I would not have considered path for more than 2 seconds. My career has been a disaster so far.....

 

[LADoc00]

No. Had I understood the job market issues, I would not have considered path for more than 2 seconds. My career has been a disaster so far.....

Eh? What can we do to help?

 

[pathstudent]

It is one of the strange things about medical training. You can spend 7-8 years of school and training to become a pediatrician or a pathologist or a gasser. Yet the compensation is wildly different. My gas friends get offers of 400k to start for shift work with "overtime" per hour for over 40 hours a week. It is true that if you love your job you are lucky . But what if you could do something you just kind of liked but could earn 2-3 times as much?

 

[yaah]

I would do it again, no question.

It is very ill advised to make career decisions based on current market trends in markets that fluctuate. This is why many people shunned radiology and anesthesia 10-20 years ago and now wish they hadn't. This is why some people jumped into pathology 5 years ago and now wish they hadn't. Health care may or may not be completely unrecognizable in the next 15-20 years. Reimbursement might stay the same, it might go down. It is highly unlikely to go up. But if you are doing something you love and that you are good at, a lot of these problems become less important (although obviously you need to pay attention to them).

Debt is a major issue - too many people (in my opinion) are going into med school with a devil-may-care attitude about debt. They figure that they'll be able to pay it off. They go to the most expensive med school even though they are accepted at a cheaper one of similar quality. They don't factor in their career choice, the amount of debt, the changes in health care, the changes in their personal life (what if you marry someone with the same huge amount of debt?). At some point doing what you love becomes too much for everyone.

For the past 20 years or so, medicine has become all about doing more with less. Clinicians have less time with their patients, get paid less, work longer hours, have to learn more to stay on top of things, have to deal with more diagnostic possibilities and tests, etc. The only thing that seems to be improving is hours worked during residency, which is not necessarily a good thing, along with residency salary, which is a good thing. A lot of future doctors are becoming complacent and getting run over by businessmen who see healthcare as a profit model. And now THESE people are the ones who are going to be defining how health care delivery happens over the next decades.

"Choosing pathology" is not the question so much as "choosing med school" is the question.

 

[Thrombus]

I love pathology and it looks like a good job will be attainable but NO I would never, ever do it again -- even with a good job secured, you will be constantly looking over your shoulder as outside forces can and probably will either shut you down or severely limit your income potential.

I would go into GI, Uro, Derm, and maybe Radx or Rads if I had to do it again. Anesthesia is not for me but that is a good choice too.

My first priority would have been to gunned it 1st and 2nd years and gone into Derm and done DermPath for a fellowship if given another chance.

 

[Nilf]

I love pathology and it looks like a good job will be attainable but NO I would never, ever do it again -- even with a good job secured, you will be constantly looking over your shoulder as outside forces can and probably will either shut you down or severely limit your income potential.

I would go into GI, Uro, Derm, and maybe Radx or Rads if I had to do it again. Anesthesia is not for me but that is a good choice too.

My first priority would have been to gunned it 1st and 2nd years and gone into Derm and done DermPath for a fellowship if given another chance.

I share your sentiment.

 

[Nilf]

It is very ill advised to make career decisions based on current market trends in markets that fluctuate.



"Choosing pathology" is not the question so much as "choosing med school" is the question.

I disagree. I career decision SHOULD be made on current and historical market trends, with extrapolation into the future. Granted, such extrapolation might be inaccurate, but it is the only thing to hang your hat on. Choosing residency and subsequent career is a decade-long investment, and if you get it wrong you'll pay dearly. Ignoring job market trends is unwise.

Every medical student SHOULD extensively research the past and current market trends of the specialty that he or she is interested in, and then make informed decision. I know I didn't when I chose pathology, and overwhelming majority of the residents I know did not do their homework either. I discovered pathology, loved it, and simply chose to ignore warnings about sucky job market, while basking in blissful optimism that I should do what I love regardless of employment situation. Not smart.

 

[yaah]

Obviously you should attempt to extrapolate to the future - I thought I said that. What I said was you should avoid basing what is going to be a 30 year career largely on current trends as expectations, which fluctuate.

If you can afford the education, med school is still one of the safest career choices out there (even pathology!). Look at law school, for instance: http://www.nytimes.com/2009/08/26/business/26lawyers.html

It always depends on what you are comparing things to. And be careful to avoid the "grass is always greener on the other side" syndrome. Almost every specialty forum on SDN has a thread devoted to "Would you do this again?" with more posts than not that say no. Most specialties also worry about other professions encroaching on their business (Ophthos worry about ODs, generalists worry about NPs, anesthesia worries about CRNA, etc).

 

[2121115]

If healthcare reform is really going to happen, then I am very happy that I chose pathology. Much of the fat that is going to be cut in the system is going to hit specialist pay for GI docs, etc, for doing quick easy procedures. If everything get neutralized and we all are making 200k then path will be the place to be.

Even if things stay the same as they are now though, I am happy to be a pathologist and I like my job. With that said, there are SERIOUS job market pressures and anxieties that don't seem to apply in other specialties (although some of them have their own issues). My resident colleagues and I are seriously worried about getting a good job, whereas residents in other specialties at my institution are worried about which good job they will get. Big difference.

However, I knew about the job situation beforehand; I was told as a medical student. I knew going in that I had to land at a "big name" program, network my tail off, and cross my fingers in order to get a good job. I knew going in that it was get into a "big national program or bust" and if I had thought that I wouldn't have matched at a place like this I would have scrapped the idea of training in pathology altogether - not because I don't like it but because it wouldn't be feasible. So that is what I tell medical students when they ask - if you can match into a top tier program then consider pathology, but if you can't (for whatever reason be it grades, geography, etc) then you are better off in something else, anesthesia, rads, internal medicine, whatever.

 

[gbwillner]

It always depends on what you are comparing things to. And be careful to avoid the "grass is always greener on the other side" syndrome. Almost every specialty forum on SDN has a thread devoted to "Would you do this again?" with more posts than not that say no. Most specialties also worry about other professions encroaching on their business (Ophthos worry about ODs, generalists worry about NPs, anesthesia worries about CRNA, etc).

One of the reasons I chose pathology was that, as I was finishing med school, most of my friends were finishing residency, and I got to see their satisfaction within their respective fields. I strongly considered IM (where many of you here often cite as having a great market) and Peds. Practically all of my friends in IM told me they never wanted to see another patient ever again, and were jealous of my decision to go into path. I'm sure they will all do well (most went into cards), but they were extremely dissatisfied with their jobs. My friends in Peds, despite coming out of one of the top programs in the country, got to look forward to a cushy PP jobs where they earned about 80K starting (with a bonus of course).
Regarding the job market- I think you need to compare apples to apples. If you are qualified enough to consider Rads vs. Path and choose path, you probably will go to a top program and not have much trouble landing a good job. For those people it probably doesn't matter too much that some people can't find work- ya don't need to outrun the bear, just your buddies. I'm just speculating, of course, but no one at my institution has had a hard time finding either a job or their desired fellowship (that wanted one).

 

[yaah]

One of the reasons I chose pathology was that, as I was finishing med school, most of my friends were finishing residency, and I got to see their satisfaction within their respective fields. I strongly considered IM (where many of you here often cite as having a great market) and Peds. Practically all of my friends in IM told me they never wanted to see another patient ever again, and were jealous of my decision to go into path. I'm sure they will all do well (most went into cards), but they were extremely dissatisfied with their jobs. My friends in Peds, despite coming out of one of the top programs in the country, got to look forward to a cushy PP jobs where they earned about 80K starting (with a bonus of course).
Regarding the job market- I think you need to compare apples to apples. If you are qualified enough to consider Rads vs. Path and choose path, you probably will go to a top program and not have much trouble landing a good job. For those people it probably doesn't matter too much that some people can't find work- ya don't need to outrun the bear, just your buddies. I'm just speculating, of course, but no one at my institution has had a hard time finding either a job or their desired fellowship (that wanted one).

This post makes too much sense for this forum. Please go away.

😛

 

[caffeinegirl]

I would absolutely wholeheartedly do pathology over and over again several lives over. I totally love what I do, and that hasn't changed since the first time a histology slide in college.
After being in clinics during my fellowship and seeing what life is like "on the dark side," I'm even happier I've chosen a field where I don't have to deal with the bureaucracy of direct patient care. Also, not having to hear people complain about their medical issues every day is quite a relief.
I still can't believe sometimes that I haven't gotten bored or disillusioned yet about pathology .... here's hoping I won't ever be even 25 years from now. 😍

 

[Patrick O]

Yes, but only assuming I would do dermatopathology or hematopathology afterwards. Otherwise, I'm not so sure.

+1 minus the hemepath......
Being in derm clinic has been a real eye opener to the world of clinical medicine that I left 4 years ago..... I am so glad I chose pathology.

 

[pathstudent]

I would do it again, no question.

It is very ill advised to make career decisions based on current market trends in markets that fluctuate. This is why many people shunned radiology and anesthesia 10-20 years ago and now wish they hadn't. This is why some people jumped into pathology 5 years ago and now wish they hadn't. Health care may or may not be completely unrecognizable in the next 15-20 years. Reimbursement might stay the same, it might go down. It is highly unlikely to go up. But if you are doing something you love and that you are good at, a lot of these problems become less important (although obviously you need to pay attention to them).

Debt is a major issue - too many people (in my opinion) are going into med school with a devil-may-care attitude about debt. They figure that they'll be able to pay it off. They go to the most expensive med school even though they are accepted at a cheaper one of similar quality. They don't factor in their career choice, the amount of debt, the changes in health care, the changes in their personal life (what if you marry someone with the same huge amount of debt?). At some point doing what you love becomes too much for everyone.

For the past 20 years or so, medicine has become all about doing more with less. Clinicians have less time with their patients, get paid less, work longer hours, have to learn more to stay on top of things, have to deal with more diagnostic possibilities and tests, etc. The only thing that seems to be improving is hours worked during residency, which is not necessarily a good thing, along with residency salary, which is a good thing. A lot of future doctors are becoming complacent and getting run over by businessmen who see healthcare as a profit model. And now THESE people are the ones who are going to be defining how health care delivery happens over the next decades.

"Choosing pathology" is not the question so much as "choosing med school" is the question.

Disagree with Yaah. Anesthesia didn't become more popular recently because it became more lucrative. Med students interests changes. Pathology was much more lucrative in the late 90s than it is now, but that was at the nadir of AMGs interest in it with at one time only 100 AMGs filling 400 residency spots.

One needs to be pragmatic. If not for yourself then for your spouse and kids. You might love pathology and only like GI but if you can get that job in ATL making 3 million a year, that would be something else, even if it only lasted 5-10 years. It is still medicine and if you like physiology, biochemistry and anatomy, more or less any area of medicine will give you some enjoyment.

Even in pathology, I have seen many talented people who love and thrive in the university setting, but bail to private practice for a perceived increase in compensation. I don't hold it against them. They do what they need to do to do the best they can for themselves and their families. However, for me, I believe the non-monetary rewards of academics off-set all. And I know that academics make bookoo cash once they are established.

 

[Nilf]

Obviously you should attempt to extrapolate to the future - I thought I said that. What I said was you should avoid basing what is going to be a 30 year career largely on current trends as expectations, which fluctuate.

'Current trends' tend to be reliable in medicine. Your argument is lacking.

Some fields go up, some go down, but one cycle in these fluctuation is at least 10 years. Training time is very long in medicine, so for a specialty to go from being a noncompetitive to competitive, it takes a generation of medical students to match into the specialty, succeed, and then spread the word to new medical students that their specialty kicks arse. Five years for residency and fellowship, plus 2-3 to establish successful practice, plus another 2-3 to spread the word = 10 years.

Now, 10 years is a PRETTY LONG TIME if your career is only 30 years or so. So rest assured, if a specialty is doing well on your match day, there is a good chance it will be doing well ten years later.

Six years ago when I matched into pathology, ADORE specialties were going strong and they still are. Pathology job market was weak and it still is, possibly it even deteriorated because of recent dramatic increase of graduating residents. And I can bet diamonds against peanuts that 10 years from now ADORE will still rule, and pathology will remain noncompetitive and its job market poor.

 

[2121115]

Here is what I don't understand. Do people go into pathology thinking that it is really competitive and that all pathologists live like kings? If so, where do they get this impression? I was told from the beginning that pathology is a world of have's and have-not's... and that the have-not's far outnumber the have's. That is just the way it is. You have to accept that straight up from the beginning.

Here is a thought though... If someone really believes that the job market is that bad then that person is acting irrationally by staying in pathology. If you are in mid-training, say 2nd year resident, it is not too late to switch to another specialty. Anesthesia is 4 years training and IM is 3. If you bail and re-enter the match after 2nd year, you could be guaranteed that in 4 years you'll have a "good job" in gas or IM. Can you say that if you stay in pathology? You may be still bouncing from fellowship to fellowship in 4 years. You may never get as good a job as you would if you switched now and chalked 2 years of path training up to lessons learned. In fact, if the path job market is as bad as people here say it is, then this would be a good option for attendings as well. So, if it is really that bad, then the rational thing to do would be to leave the field and retrain in another as market forces would predict would happen. But people don't seem to be doing that.

 

[ImmaculateTurd]

Here is what I don't understand. Do people go into pathology thinking that it is really competitive and that all pathologists live like kings? If so, where do they get this impression? I was told from the beginning that pathology is a world of have's and have-not's... and that the have-not's far outnumber the have's. That is just the way it is. You have to accept that straight up from the beginning.

Hahahaha. I really hope people who go into path do not have these disillusioned thoughts and impressions. Shoot, I went into pathology not because I was planning on making a boatload of money but because I knew I was a shoe-in for the top research-oriented programs in the country known for training physician-scientists. I was stupid in my earlier days because where I went to do my "research track training" was more important than what field I entered. So having thought that I would do the research track in the past, I knew that I would be one of the "have not's". Very stupid, narrow-minded thinking on my part.

Not having done a postdoc, which I thought was a wise decision, my life is simpler, happier, and less hectic. I'm relieved that I stayed in pathology and made the best of my training given my change in direction. I really enjoy practicing pathology now. It totally meshes with my way of thinking. So sure, I'd do it again.

One disclaimer: Now that I do not have Nobel Prize aspirations anymore, I would have seriously looked at other fields as well instead of being narrow-minded and tunnel-visioned. This is because I would probably be in a similar situation now but maybe with a bit more money.

 

[Nilf]

Hahahaha. I really hope people who go into path do not have these disillusioned thoughts and impressions. Shoot, I went into pathology not because I was planning on making a boatload of money but because I knew I was a shoe-in for the top research-oriented programs in the country known for training physician-scientists. I was stupid in my earlier days because where I went to do my "research track training" was more important than what field I entered. So having thought that I would do the research track in the past, I knew that I would be one of the "have not's". Very stupid, narrow-minded thinking on my part.

Not having done a postdoc, which I thought was a wise decision, my life is simpler, happier, and less hectic. I'm relieved that I stayed in pathology and made the best of my training given my change in direction. I really enjoy practicing pathology now. It totally meshes with my way of thinking. So sure, I'd do it again.

One disclaimer: Now that I do not have Nobel Prize aspirations anymore, I would have seriously looked at other fields as well instead of being narrow-minded and tunnel-visioned. This is because I would probably be in a similar situation now but maybe with a bit more money.

Good to hear that you're happy with your career. What is your subspecialty (if any), and how would you describe your academic activities?

 

[ImmaculateTurd]

Good to hear that you're happy with your career. What is your subspecialty (if any), and how would you describe your academic activities?

Sorry. I'm not telling.

 

[Pathwrath]

If you guys would have had to do it over, would you have chosen pathology?

Unlike, say, radiology, pathology is intellectually stimulating even after years of practice and is far less parasitic. Much of what we do is still tangibly beneficial to patients rather than pure revenue generation, and that is a good thing.

But our leadership sucks. We don't guard our turf. And we don't stick together. And that means successful pathologists have to spend more and more of their time and energy just maintaining their ground. Less aggressive types are simply cannibalized.

So, no.

 

[cozmopak]

Is there any sign that leadership will improve?

 

[yaah]

Is there any sign that leadership will improve?

Leadership can only do so much, that is part of the problem. The community has to agree to proposals and/or demand them. Lots of support for national organizations comes from those who like the status quo (like large labs), and other support comes from those who simply don't care or don't want to rock the boat. So change is difficult. The right kind of leadership could probably advocate change, but that is also hard. Lots of pathologists in the community and in academics have stars in their eyes, and tend to vote for those who they are familiar with.

Leadership positions in path are sometimes/often seniority based - thus, you pay your dues on committees, grease the wheels, eventually you become the titular president of an organization for a limited term, where you duties mostly include making appearances and presiding over meetings. Real change often doesn't come from the leadership - the leadership can often institute minor changes or change outward appearances of organizations.

 

[Pathwrath]

Leadership can only do so much, that is part of the problem. The community has to agree to proposals and/or demand them. Lots of support for national organizations comes from those who like the status quo (like large labs), and other support comes from those who simply don't care or don't want to rock the boat. So change is difficult. The right kind of leadership could probably advocate change, but that is also hard.

Well said. We probably have the leadership we deserve.

 

[lipomas]

I would do it again if I did medicine as a career. There is a lot of idealizing other fields on here, as though being in radiology or IM is some picnic. Have any of you guys talked to cardiologists lately? They are closing in on full panic mode. Radiologists are also worried because of potential reimbursement cuts. Technology is also a lot closer to making radiologists obsolete than it is any other field.

I would do medicine again if I could have no loans. I had small loans, so my situation isn't as dire. But if I was facing 6 figures worth of loans I would be ****ting my pants daily. I knew someone in med school who owed $350k in loans between med school and college, and he was going into neurosurg plus some specialty which would mean he would begin paying it back seriously when he was about 40. And he was marrying a woman who had $300k in loans. She wanted to do family practice, and wanted to do it part time so that she could have babies. If I was him I would kill myself. He is going to reach 40 and have over a million in loans plus interest (since she won't be paying off anything). Plus he will have kids to pay for and all that. And what is going to happen in 10 years when healthcare is "reformed" using a combination of the most expensive democratic ideas + the worst republican ideas?

Pathology is a relative oasis in the sea. Less paperwork. Fewer annoyances. More interesting. It may be harder to get a job but that's not as relevant if you are a talented or reasonably sane and intelligent individual.

 

[Pathwrath]

Radiologists are also worried because of potential reimbursement cuts. Technology is also a lot closer to making radiologists obsolete than it is any other field.

Problem is, this could have been written twenty years ago, but funny how that radiology gravy train keeps chugging along...

 

[LADoc00]

And he was marrying a woman who had $300k in loans. She wanted to do family practice, and wanted to do it part time so that she could have babies. If I was him I would kill myself. .

You are getting to the core of the issue right there. That plan right there is fail. Assuming best case scenario, she has the loan rate locked, she is looking at ~3400/mo just to service her debt at a 15 yr repayment schedule. Best case scenario.

That is a mortgage in most towns. Complete fail. They really need to match borrowing to income potential from the education. FM and peds to be limited to 100K max.

 

[lipomas]

Problem is, this could have been written twenty years ago, but funny how that radiology gravy train keeps chugging along...

Indeed, that is true. That's why it is so hard to predict the future.

 

[igottaquestion]

Technology is also a lot closer to making radiologists obsolete than it is any other field.

How? Not being confrontational, just curious.

 

[LADoc00]

How? Not being confrontational, just curious.

As someone who has spent some good research time on image analysis technology, I wouldnt be planning on this during any of our lifetimes, LMAO.

Lipomas either doesnt understand radiologists' billable CPT codes and biz model or has watched far too much original Star Trek...

 

[lipomas]

As someone who has spent some good research time on image analysis technology, I wouldnt be planning on this during any of our lifetimes, LMAO.

Lipomas either doesnt understand radiologists' billable CPT codes and biz model or has watched far too much original Star Trek...

Well yeah, I know it's not going to REALLY happen anytime soon, I was just saying that computer assisted radiology diagnosis would be technically a lot easier than computer assisted pathology diagnosis.