Pathology Fellowship Options

[ERDOC555]

Hello Pathologists,

I have read numerous threads about the saturation of pathology and I wanted to know more about the different fellowship options or areas in pathology that may not be saturated/low pay?

What areas have good, in demand, high paying jobs?
How do you get into these fellowships when there are so many path graduates and so few spots?
I've heard DermPath is a very lucrative field with income near or more than a normal derm. Is this true? Anything else to know about DermPath?
Is there any glimpse of hope anywhere in the field of pathology?

Should I bother with an elective in Pathology in Med School if I realize later that I don't want to enter pathology? Will it be good to have a background in pathology via a rotation regardless of whatever other residency I choose to enter?

Thanks for sharing your wisdom!

Edited for clarity

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[KeratinPearls]

Not into Path? WTF? Do you even like Pathology or are you just looking to make money? If you are looking for $$$, go to derm and do cosmetics. Better job market than path.

 

[mlw03]

Your question is too broad. Do some background research and then come with a more specific question. Just read through old threads on here and you'll get some information, although you need to take that with a healthy pinch of salt.

 

[ERDOC555]

Your question is too broad. Do some background research and then come with a more specific question. Just read through old threads on here and you'll get some information, although you need to take that with a healthy pinch of salt.

My two main questions are:
1. What fields within pathology have better job prospects/pay?
2. Is a pathology rotation in medical school beneficial even if you know you don't want to do pathology, or is the time better spent in a different elective?

 

[Johnny Sunshine]

1. What fields within pathology have better job prospects/pay?

Well, first off, you likely won't even be applying to fellowships for 6-7 years. Things may be dramatically different in the field when compared to today. And even today, I feel like things are currently in quite a flux. It's hard to get a clear picture of the state of the various sub-specialties. Perhaps others can be more helpful, but personally all I can say with confidence is that hemepath and most clinical pathology subspecialties are flooded with people. Some subspecialities like derm make better money, but are highly competitive and very small in number.

Rather than focusing on a single subspecialty, these days pathologists generally need to diversify themselves and create an attractive set of complementary skills. Things like cytology, gastrointestinal pathology, and renal path are all nice feathers in the cap.

2. Is a pathology rotation in medical school beneficial even if you know you don't want to do pathology, or is the time better spent in a different elective?

I think it's way too early for you to worry about that. Your life will be so dramatically turned on your head over the next few years, your thoughts on the matter now aren't likely to make much difference.

But since you asked: If you wind up going into one of the big specialties like family practice, surgery, internal med, etc., then I would encourage a month elective in path. Understanding a bit about what happens behind the scenes would be very enlightening. If you do this, I would request quite a variety of exposure (e.g., a week of chemistry, a week of blood bank, a week of anatomic glass pushing, etc.).

If you attempt to go into some highly competitive specialty however, then your elective time will be very precious, and a path elective may not be a great use of your time. But again, I think it's far too early to really know what path you'll be going down.

 

[ERDOC555]

Well, first off, you likely won't even be applying to fellowships for 6-7 years. Things may be dramatically different in the field when compared to today. And even today, I feel like things are currently in quite a flux. It's hard to get a clear picture of the state of the various sub-specialties. Perhaps others can be more helpful, but personally all I can say with confidence is that hemepath and most clinical pathology subspecialties are flooded with people. Some subspecialities like derm make better money, but are highly competitive and very small in number.

Rather than focusing on a single subspecialty, these days pathologists generally need to diversify themselves and create an attractive set of complementary skills. Things like cytology, gastrointestinal pathology, and renal path are all nice feathers in the cap.


I think it's way too early for you to worry about that. Your life will be so dramatically turned on your head over the next few years, your thoughts on the matter now aren't likely to make much difference.

But since you asked: If you wind up going into one of the big specialties like family practice, surgery, internal med, etc., then I would encourage a month elective in path. Understanding a bit about what happens behind the scenes would be very enlightening. If you do this, I would request quite a variety of exposure (e.g., a week of chemistry, a week of blood bank, a week of anatomic glass pushing, etc.).

If you attempt to go into some highly competitive specialty however, then your elective time will be very precious, and a path elective may not be a great use of your time. But again, I think it's far too early to really know what path you'll be going down.

Thanks! That's all really great information. I appreciate such a detailed response.

I'll definitely try to keep an open mind as I gain more experience these next few years!

 

[deleted314957]

Not even in med school yet and it's " money, money,money". Interested in pathology? Hell, you don't even know if you are interested in medicine at this point. By the time you get out you will be salaried and essentially be a government employee, albeit a well paid one.

 

[icpshootyz]

You're not going to go into path, I can tell just by your lust for money. Do everyone a favor and get out of medicine and go into finance or something. Medicine doesn't need what you have to offer.

 

[jp123ok]

How do you get into these fellowships when there are so many path graduates and so few spots?
I've heard DermPath is a very lucrative field with income near or more than a normal derm. Is this true? Anything else to know about DermPath?
Is there any glimpse of hope anywhere in the field of pathology?

In the past couple of years the job market for dermatopathologists has been quite poor and dermpath fellowships have become much easier to obtain. One of the reasons for the difficult job market is that path trained dermatopathologists are competing with derm trained fellows for jobs. The derm trainees have the upper hand in most cases because they can combine clinical dermatology work (which is in high demand) with dermpath.

If you can find a job as a full time dermatopathologist then this can be very lucrative. However, most advertised jobs require you to do a combination of dermpath and general surgpath and the pay for these types of jobs is average for the field (around $200k starting salary in private practice and around $160k starting salary in academics).

I don't think that any area in pathology can guarantee you an "in demand high paying job". Unless you absolutely love pathology you'd be better off doing some other medical specialty.

 

[ERDOC555]

In the past couple of years the job market for dermatopathologists has been quite poor and dermpath fellowships have become much easier to obtain. One of the reasons for the difficult job market is that path trained dermatopathologists are competing with derm trained fellows for jobs. The derm trainees have the upper hand in most cases because they can combine clinical dermatology work (which is in high demand) with dermpath.

If you can find a job as a full time dermatopathologist then this can be very lucrative. However, most advertised jobs require you to do a combination of dermpath and general surgpath and the pay for these types of jobs is average for the field (around $200k starting salary in private practice and around $160k starting salary in academics).

I don't think that any area in pathology can guarantee you an "in demand high paying job". Unless you absolutely love pathology you'd be better off doing some other medical specialty.

Thank you!!! That is super great information and exactly what I was looking for! I guess now I'll just have to wait and see if pathology is something I become super passionate about. Thanks again!

 

[mlw03]

Is a pathology rotation in medical school beneficial even if you know you don't want to do pathology, or is the time better spent in a different elective?

In my opinion, yes. You understand what pathologists do, can't do, and how they help their clinical colleagues provide care to their patients. An elective with the medical examiner or coroner is also neat and will teach you two very important things most community doctors know almost nothing about - 1) what cases do and do not need to be reported to the ME/C and 2) how to properly certify a natural death on a death certificate.

 

[LADoc00]

I don't blame young people for being $-centric. Everything costs a TON: education, housing, food, women, kids. You name it, it costs 5x what it used to cost meanwhile reimbursement is dropping 4-5% each year with no end in sight.

There are 2 ways you have to approach the coming apocalypse:
1.) from the income side, which you honestly will always have only limited control over
2.) from the expenditure side, which you have 100% control over

Even if you went into the top paying specialty which is probably Spinal Ortho, there are zero guarantees you dont get a bad outcome that results in your early career end before you have made your exit plan.

Risk is everywhere in every corner of medicine. I'm developing some radical theories on how physician careers need to change but still too raw to post. For Pathology, a key might be to completely integrate into a smaller community power structure by being able to do forensics. Integrate into everything: the hospitals, the clinics, private offices, government healthcare, the police and sheriff department, political structure and even military reserve type elements. Shadow syndicate mode.

Now this is very different than doing pure forensics which I think is a "total failplan" (no offense to mlw and others here) due to lack of any leverage but I am slowly beginning to see forensics as a potential necessary practice element like dermpath in the future.

 

[mlw03]

what do you mean by 'lack of leverage' LA?

I don't blame young people for being $-centric. Everything costs a TON: education, housing, food, women, kids. You name it, it costs 5x what it used to cost meanwhile reimbursement is dropping 4-5% each year with no end in sight.

There are 2 ways you have to approach the coming apocalypse:
1.) from the income side, which you honestly will always have only limited control over
2.) from the expenditure side, which you have 100% control over

Even if you went into the top paying specialty which is probably Spinal Ortho, there are zero guarantees you dont get a bad outcome that results in your early career end before you have made your exit plan.

Risk is everywhere in every corner of medicine. I'm developing some radical theories on how physician careers need to change but still too raw to post. For Pathology, a key might be to completely integrate into a smaller community power structure by being able to do forensics. Integrate into everything: the hospitals, the clinics, private offices, government healthcare, the police and sheriff department, political structure and even military reserve type elements. Shadow syndicate mode.

Now this is very different than doing pure forensics which I think is a "total failplan" (no offense to mlw and others here) due to lack of any leverage but I am slowly beginning to see forensics as a potential necessary practice element like dermpath in the future.

 

[LADoc00]

I would assume many U.S. based FPs are:
1.)either a 1099 contractor for a Sheriff Dept
2.) or you are an employee.

If you are a 1099 contractor you might service several neighboring counties giving you a better political pull radius but at the end of day you are the bitch of the local sheriff or police chief (who in turn are bitches of the local mayor or county sup board if not directly elected). If your boss is directly elected it is even worse in my opinion.

Regardless doing JUST FP makes you a target to be thrown under the bus in a number of situations. The risk v. benefit equation is stupidly stacked against you given the lower pay levels. And with lower income and status, you are even less able to defend your interests.

______________________________________
You can be assured in your defense by holding positions which cannot be attacked.
Now imagine a different set up where the local medical center's lab director, chief surgical pathologist is also the FP for the county or city. You have 2 power poles or "columns" with which to protect your interests: LE and hospital admin. In many communities, the hospital is THE no. 1 employer and is very gingerly dealt with by local politicians.

The Clever Combatant imposes his will on the enemy.
Then you have a wide net of private and/or public physician friends you simply dont have a pure FP. A third column of defense and influence. In many communities, this third column represents a massive store of wealth in the form of property, history and lineage in the community. The so-called "rock column."

He is skillful in defense when his opponent does not know where to attack.
Now lets talk the about the guy, the dude, the Pathologist. He (or she) is making as a dual-professional 3-4 times (or more!) what a pure FP can bring down. He owns a large house or even several in the community. He donates to the local churches, local schools and local politicians. He is greasing the palms of power with the extra cash not merely spending it on overpriced autos and flashy women. This purchased influence becomes the 4th column. You are using extra cash to put the police chief and his family, the sheriff, the hospital admin etc up at your vacation place/timeshare in Breckenridge or Miami or San Diego. You are donating to political re-election campaigns, hosting fundraisers, having your non-working spouse (because you pull down so much bank) operate the backside of the columns at the local country club, gym, spa, PTA meetings. You are setting up a scholarship programs for the kids of younger deputies, who you invite over for BBQs in the Summer and Holiday parties in the Winter.

Knowing the time and place of the battle, you may concentrate forces from the greatest distances in order to fight.

 

[Ziehl-Neelsen]

HaHaHaHaHa. The pathologist as the The Art of War reading local Don who pulls the levers of power in his small town. You have a vivid imagination.

I can see it now...

The supplicant is shown into LADoc00's office by his histotech/caporegime. LADoc00 looks up from his case of sinus histiocytosis with massive lymphadenopathy...

Good. Someday, and that day may never come, I'll call upon you to do a service for me. But until that day, accept this justice as a gift on my daughter's wedding day.

 

[LADoc00]

And I didn't know this was going down: http://www.foxnews.com/us/2016/03/1...-resigns-after-2-years-over-body-backlog.html

A 2010 county audit of the coroner’s office projected it could run into physician shortages in the coming years that would result in autopsy backlogs, caused by expected retirements and the slow rate of filling positions.

“By the year 2014, the agency is likely to experience a severe shortage of physicians, which could threaten the agency’s ability to meet the [National Association of Medical Examiners] standard of 250 autopsies per physician per year and may result in autopsy backlogs and loss of the ... accreditation,” the auditors wrote.

I would like a yearly salary of 2 million U.S.....(gasps from local politicians and police)......Im sorry, Im not done yet. I would also like a fully equipped Land Rover Sentinel and a paid team of 4 Tier One Operators for my own personal SMU. (would probably go 1xAF CRO, 1xSEAL, 1xUSMC CSO MARSOC and one Delta guy, then ball around LA in a blacked out Sentinel like I owned it)

And if I leave this room for you to deliberate this offer further, the price goes up 10%.

Thank you.

 

[deleted314957]

This kind of nonsense has been going on for ages in various and sundry jurisdictions in this country. Usually it is a big metro center but not always. This is one reason I did a forensic fellowship about 30 years ago-as a backup in case the more traditional hospital-type pp pathway did not pan out. ALL of these county supervisors and their ilk will squeeze a nickel until the bull s****. Then this happens. Nothing new under the sun.

 

[LADoc00]

This kind of nonsense has been going on for ages in various and sundry jurisdictions in this country. Usually it is a big metro center but not always. This is one reason I did a forensic fellowship about 30 years ago-as a backup in case the more traditional hospital-type pp pathway did not pan out. ALL of these county supervisors and their ilk will squeeze a nickel until the bull s****. Then this happens. Nothing new under the sun.

Did you ever fall back on it in your career? Was it ever a power lever arm for you when you get into negotiations with hospitals, admin etc?
thanks.

 

[deleted314957]

Nope. But it was actually integral to me landing my pp job (long story) and subsequent partnership after I left the military. While in pp I only did part time FP as a M.E. for my first 2 years of employment while an associate.

 

[LADoc00]

Nope. But it was actually integral to me landing my pp job (long story) and subsequent partnership after I left the military. While in pp I only did part time FP as a M.E. for my first 2 years of employment while an associate.

A year in a FP fellowship is a long time when you are already putting in too long but it maybe worth it. I wish undergrad education could be condensed down to 24 months or less. I dont relish the next generation starting life with 300K in education debt and a 30 year mortgage at age 35. Certainly for women this is doubly rough due to the biological clock issue and marketability on the singles scene.