Pathology career path

[eastbay]

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I am interested in pathology, but I haven't had any career mentor in the field and don't know the best career path for what I want to do after residency. I am interested in research, and I am taking a bench research year in between my M3 and M4 year. I have been looking at programs that have a PSTP or the AP/NP combined track.

Are these programs generally very competitive? From what I understand people who go into these programs are generally MD/PhD, but I have had many years of bench research experience. I also am not sure what the career path would be coming out of these programs. Do you have to stay in academia? Is there any prospect in commercial industry? I dont know if I have the full resolve to be a principal investigator writing my own grants, but ideally I would want to be part of a larger project and contribute in some way. If that's the case, what's the career projection? What about the salary for those types of positions? Can I still make a decent living? Will there still be opportunities to go back to the traditional career paths and find a job?

 

[gbwillner]

PSTP programs are fairly competitive and rare in Pathology. I helped establish one at my institution. An MD/PhD is probably not required most places but you have to have been fairly productive in your research, the degree you can give a 1-hr talk on your research. I'd say VAST majority I have seen are MD/PhDs. The goal of the PSTP is to train... physician scientists. It is to select people who you the department would consider hiring as faculty and providing research funds to. It will help minimize clinical requirements and maximize time doing research. If your goal is not academia... this may not be a good use of your time. I suppose it would prepare you for a career in industry as well, more or less. But the best way to get a good job in industry is to be a stud in academia.
Most academic faculty at this point that I know are not active in writing grants or not reliant on them for salary support. They do what you state you would like to do- they are involved in projects or do clinical research projects without grant support and on the side.

Re: salary, in general, the more of a genius you are in your field and the more respect you acquire through intellectual pursuits, the less likely you are to earn. Medical professional services are a high-reimbursement group of professions. Research... you beg for government scraps. Unfortunately, it is not much better in industry, if the goal is to do research. Lab director positions in industry are not much different than academia from a salary perspective (although your comps are likely better if you are in a successful company that pays in equity). Now, if you are an executive, that is a VERY different story.

 

[Alteran]

Most residency programs can have research built into them, but they are all primarily service driven. You'll at most be able to squirrel away 2-3 months of dedicated research time because you won't be able to stray too much from the base ABP requirements to qualify for the boards. Where I have seen lots of research done, for those who are interested, is at the fellowship level. There is much more flexibility for departments, primarily the really large academic centers, to take on fellows for several years in academically productive positions irrespective of PhD status.

To specifically answer your questions:
- Are these programs generally very competitive? At the fellowship level at brand name institutions, yes they are.
- Do you have to stay in academia? It would be absolutely pointless to go through all this effort in academia to get into a private practice job. You would actually be less competitive for private practice if you spend 1-2 years only doing research and not at the microscope signing out cases.
- Is there any prospect in commercial industry? There are always jobs in industry. But be forewarned that while the pay may be somewhat better in industry, the job security isn't the same as what academia offers.
- I don't know if I have the full resolve to be a principal investigator writing my own grants, but ideally I would want to be part of a larger project and contribute in some way. If that's the case, what's the career projection? When you take an academic job, you either apply for a tenure track or clinical track position. Tenure track is primarily research based with less service work and/or teaching. As such, you will have to secure extramural funding, somehow, to continue to justify your tenure. In general, research funds are drying up across the board and the entrenched players in each field have no intention of relinquishing their share of the pie for newbies. Clinical track is primarily service based with some research, mostly translational, that will be required for promotion(s), etc. Clinical track is becoming increasingly the norm in most departments and most of your salary, whatever that is, will be paid for by your clinical work. You would not want to go clinical track if you spend a couple of years doing basic science research - it would be a waste of time for you and you would be at a disadvantage from diagnostic skill atrophy.
- What about the salary for those types of positions? Can I still make a decent living? The salary is whatever you're able to negotiate based on your academic pedigree and who you know. Most departments I know of start assistant professors at the same salary irrespective of tenure vs. clinical track. The difference is in the source of salary funds. You must scrounge grant money to make up the bulk of your salary while the clinical track pathologist just shows up and diagnoses stuff for theirs. This of course affords you the right to take no call and minimal service work because you're "paying for you own salary" to be there...so long as you keep the grant dollars rolling in. But to answer the question you're probably wondering, and only with rare exception, you'll never approach the earning potential of a private practice pathologist - not even close.
- Will there still be opportunities to go back to the traditional career paths and find a job? In all likelihood, no. Once you've been out of diagnostic pathology for several years, it is very, very difficult to return. The few instances of this I've personally seen or been told about ended very poorly for those pathologists (i.e. fired, resigned, etc.) Once you commit to this path, you're pretty much in it for life unless you get out within a year or two.