pathology job: invitation, interview, offer and contract

[sleeping beauty]

can anyone provide any information about the timeline of both academic and private practice from invitation, interview, offering and signing contract? Thanks.

it seems the process starts late this year. most of of the job searchers I know haven't received invitation yet.

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[yaah]

Private practice jobs don't have set timelines.

It is based on when the group needs someone. Some are known about 1-2 years in advance so they can plan a hire, others can be sudden because someone leaves, dies, whatever. Private practice jobs do not all start on July 1. Many places don't have a lengthy process. They want to hire someone and have them start within a couple of months.

Academics might be a bit different but the timeline is still based on the institutional needs, not the residency calendar.

 

[2121115]

can anyone provide any information about the timeline of both academic and private practice from invitation, interview, offering and signing contract? Thanks.

it seems the process starts late this year. most of of the job searchers I know haven't received invitation yet.

If it is January and they haven't had initial contact yet, then that is scary. They are 5 months from having no way to pay the bills.

 

[schrute]

If it is January and they haven't had initial contact yet, then that is scary. They are 5 months from having no way to pay the bills.

I suspect this year may be a bit different than the past few: HUGE reimbursement cuts (RE the 88305 slash...yes there are always cuts but this year was pretty significant and may have caused some PPs to rethink their hiring plans, especially large groups that own their own lab); the 'fiscal cliff' / looming tax hikes that were bound to come in January, the ACA starting to hit the fan and ACOs becoming part of the lexicon may have scared some...

That being said, it is a variable spectrum depending on family & spouse considerations that impact who applies/interviews where & when.

I had 4 PP interviews (3 in person, 1 phone), spanning October through just before Christmas, and another invite I turned down as I had already signed with a group. Like yaah said, group dynamics/needs are widely variable from job to job and ultimately determine what happens & when...half the PP jobs I looked at (including the group I joined) were personal connections & not advertised, the other half were national postings.

A fellow fellow has had 2 PP interviews, signed with the second.

Another fellow secured an academic gig early December.

Other fellows I know are still searching and either haven't had any interview offers yet or haven't really seriously looked or have limitations to their search (eg. geography).

Most of the fellows / residents I've known the past few years have gotten jobs either mid-Dec through March.

 

[pathstudent]

My group won't hire anyone right out of residency or fellowship. The timeline is based on when the job needs to be filled.

 

[LADoc00]

Yup, I would say around 1/2 of applicants typically dont know where they are going even 4 weeks out from graduation. If you are dependent on working to pay your bills you might have to consider moving back in with mom or taking a crap job as an interim plan (as I did).

 

[2121115]

Yup, I would say around 1/2 of applicants typically dont know where they are going even 4 weeks out from graduation. If you are dependent on working to pay your bills you might have to consider moving back in with mom or taking a crap job as an interim plan (as I did).

4 weeks?!?!?!?!?

That would scare me to death.

My job was lined up in September of fellowship year.

 

[yaah]

Yup, I would say around 1/2 of applicants typically dont know where they are going even 4 weeks out from graduation. If you are dependent on working to pay your bills you might have to consider moving back in with mom or taking a crap job as an interim plan (as I did).

I think 1/2 is a serious overestimation.

 

[BU Pathology]

I think 1/2 is a serious overestimation.

I agree. Out of the dozens of residents and fellows with whom I work the vast majority have positions locked down by early spring. I also do not know a single unemployed pathologist who recently completed training. When I ask residency and fellowship directors at the national meetings, they also do not know a single unemployed pathologist.

This information is provided to medical students considering a career in pathology so that they are not scared by internet rumors.

 

[LNsquasher]

Yes, while technically there may be few unemployed pathologists, I know several who are chronically underemployed. For example they are kept on as a temporary junior faculty at their training institution for a fellow's salary while taking most of the call for the department; they will never be promoted or made permanent faculty despite their abusive job. Others have done a series of fellowships due to not finding a job, such as three years (!) of surg path fellowship at the same place. Saying there aren't many unemployed pathologists is trying to gloss over the very real problem of underemployment.

 

[gbwillner]

Yes, while technically there may be few unemployed pathologists, I know several who are chronically underemployed. For example they are kept on as a temporary junior faculty at their training institution for a fellow's salary while taking most of the call for the department; they will never be promoted or made permanent faculty despite their abusive job. Others have done a series of fellowships due to not finding a job, such as three years (!) of surg path fellowship at the same place. Saying there aren't many unemployed pathologists is trying to gloss over the very real problem of underemployment.

That sucks. I've never seen that happen at my institution. Clinical staff that stay as instructor do so temporarily only- usually they are looking for a PP job to open up, and the institution lets them work as instructor till they find a spot. Now research faculty is a different matter...

 

[mlw03]

I also will chime and say that the folks I know have mostly secured jobs late fall through early spring of their terminal fellowship year. I've known only 1 person out of around 15 who didn't have something lined up by the completion of their terminal fellowship, and he did subsequently find work after passing the board exam.

 

[path24]

Sadly the stay on staff or how about a blood bank fellowship (whats one more fellowship? ) options are not as uncommon as they should be. Good people/pathologists that can't get work after training.

The underemployment of practicing pathologists is crazy. Know lots of pathologists that sit at work and watch the stock market...nothing else to do.

I have never met a residency director/department chair be honest about the pathology job market either.

Don't risk your families well being, being able to payback your student loans...etc (lots of personal stress). Major oversupply in pathology, not worth it.

 

[gbwillner]

Sadly the stay on staff or how about a blood bank fellowship (whats one more fellowship? ) options are not as uncommon as they should be. Good people/pathologists that can't get work after training.

The underemployment of practicing pathologists is crazy. Know lots of pathologists that sit at work and watch the stock market...nothing else to do.

I have never met a residency director/department chair be honest about the pathology job market either.

Don't risk your families well being, being able to payback your student loans...etc (lots of personal stress). Major oversupply in pathology, not worth it.

WTF????

How does a thread about timing your entry into practice (after training) morph so rapidly into another "don't go into path" BS tirade???? I love how eloquently transform your point to do it.

Your points, in sequential order:

1. Stay on staff (work) and
2. Fellowship options (work) are NOT uncommon
3. There should be fewer options...
4. Good pathologists can't get work
5. Pathologists are underemployed
6. Directors are liars
7. Don't go into pathology.

Who is the intended audience of your post? Clearly no one in this thread.

 

[lipomas]

Sadly the stay on staff or how about a blood bank fellowship (whats one more fellowship? ) options are not as uncommon as they should be. Good people/pathologists that can't get work after training.

Define "good."

Thought experiment: What percent of pathology residency graduates do you think do not warrant a job when they finish? i.e., they are poor diagnosticians, dangerous attitudes (overconfident, etc), poor communication skills, unethical behavior history. (typically most of the above)

I would say, unfortunately, that that number is NOT zero percent. I would go as high as 10% actually in my experience having encountered a wide range of pathologists all over the country. But the majority of these people do have jobs. I went to an excellent residency program (probably at least top 15-20 around the country) and I would say one out of five of the people who finished there by the time I graduated I would not want to work with and I wouldn't really trust their performance in the real world. But I do have high standards. Probably only about 1 in 10 did not deserve a job, and these people were good researchers so they could end up doing that. What if they weren't good researchers (which poor pathologists usually aren't)?

What percentage fail the boards? That is not zero percent either. I think this was zero percent at my training program, given multiple attempts of course.

While these two categories overlap to some degree they don't always, so now what percent are we at? 15%?

Now, how many of the people from my training program are unemployed? zero. My residency program did have at least 4 washouts though. 1 left medicine due to legal difficulties, 3 switched to another field. None of them did this because they were worried about the job market.

How many people have jobs who cannot pass the boards?

I know this is difficult to think about but it is a real problem. Residency programs will work hard to get someone finished with training without taking the step to prevent a dangerous pathologist from graduating.

Has anyone on here seriously met a quality pathologist (this means someone who you would hire to work with you in a private group, for example, such that their performance impacts everyone's impression of you) who has serious trouble finding a job? I have met quite a few who can't find a great job right away and have to settle by moving far away or doing an extra fellowship or something, but that's pretty much the extent of it. Some take bad jobs for various reasons, usually they end up figuring that out and leave after a couple of years for something they like.

 

[cjw0918]

I signed my contract for my first job May 28 with Jun 30 being my last day of fellowship #2. I really thought I was going to be unemployed. I was also geographically limited to one city. Scary times indeed.

 

[icpshootyz]

I signed my contract before Christmas during my fellowship year, but I was earlier than others I knew.

 

[LaBelleVN]

I started a preliminary search 1.5 years prior to my start date by sending cold emails to various groups in my geographic area of interest. I went to visit 5 places last May, before even starting my current fellowship. After 2 months into my fellowship, I re-contacted one of the places and came back for a more formal interview in early October. I had a phone conversation to negotiate my salary etc after Thanksgiving. My contract was mailed out after the holidays and I had Jane Pine Wood review it. The contract was revised and I will be signing it this week. I'll be joining a private pathology group.

 

[pathdoc68]

Interesting, CAP's attorney, huh? How much does something like that cost? How receptive were your future employers to changes negotiated. What kinds of provsions did you negotiate, eg. non-compete, tail, etc.

 

[LaBelleVN]

Interesting, CAP's attorney, huh? How much does something like that cost? How receptive were your future employers to changes negotiated. What kinds of provsions did you negotiate, eg. non-compete, tail, etc.

My good friend & colleague recommended her to me. She charges $625/hour (hefty) and it took her 0.8 hours to complete my contract review. The end result was $500 for 4 pages of recommendations, mostly changes in verbal lingo etc. She did address my concerns about case loads and whether what was agreed upon verbally should be addressed in the contract. In the end, it was more so for my peace of mind since my group did not want to write out in detail my job description because they haven't done that for anyone else. Luckily, I don't have a non-compete and I do get tail end insurance. This is my first job so maybe I went a bit overboard with hiring a lawyer who specializes in healthcare contracts, particular pathology.

 

[deleted314957]

My good friend & colleague recommended her to me. She charges $625/hour (hefty) and it took her 0.8 hours to complete my contract review. The end result was $500 for 4 pages of recommendations, mostly changes in verbal lingo etc. She did address my concerns about case loads and whether what was agreed upon verbally should be addressed in the contract. In the end, it was more so for my peace of mind since my group did not want to write out in detail my job description because they haven't done that for anyone else. Luckily, I don't have a non-compete and I do get tail end insurance. This is my first job so maybe I went a bit overboard with hiring a lawyer who specializes in healthcare contracts, particular pathology.

You were wise--probably about the best $500 bucks you have/will ever spend.

 

[Ruination]

There is no rhyme or reason to this process. Everything is completely random and luck has a lot to do with the opportunities you will be presented with.

For example:
-- I started applying to (mainly) advertised positions in September.
-- In November/early December several word of mouth jobs in community practice came open and I interviewed at all of them in December. Each of these places has told me that they will make a decision as soon as the end of this month, no later than early February.
--An academic job that I was interested in just came open in December and I am scheduled to interview shortly with a final decision to be made in mid-February.
-- I was invited to interview for a different academic job in October, interviewed at in December, and they will make a decision sometime in February.

In my 5+ years of training (even in several "drought" job years), I have never seen another fellow go past the beginning of May without something lined up for July or shortly thereafter.

 

[vistaril]

the most troubling sign to me(if I were an applying med student) is that at least 1 fellowship seems to be the standard/minimum, 2 very frequent, and 3 not unheard of....

there is no other field in medicine where this is the case, and there has to be some reason for it. Seems like a lot of neurologists are doing some sort of fellowship now, but it's generally easy to get a job and work as a generalist neurologist if you don't.

It either speaks to a very poor job market or very substandard training in general residency.

 

[icpshootyz]

Vistaril, your psychiatry resident input isn't exactly needed in this forum. Thanks, but no thanks. If we need your guidance in careers in pathology, we'll call you, don't call us.

 

[2121115]

the most troubling sign to me(if I were an applying med student) is that at least 1 fellowship seems to be the standard/minimum, 2 very frequent, and 3 not unheard of....

there is no other field in medicine where this is the case...

Actually radiology is the exact same way.

You seem to "know" a lot about pathology for a psych resident married to a GI fellow.

Troll.

 

[vistaril]

Actually radiology is the exact same way.

You seem to "know" a lot about pathology for a psych resident married to a GI fellow.

Troll.

I wouldn't say it is the 'exact same' way....from everything I'm reading the radiology job market is tightening and groups are increasingly organizing in such a way that they have one body person, one msk person, one nucs person, one neuro person, etc....but in smaller towns/cities you don't have megagroups and thus there are still plenty of spots for general neurologists. Dont have the percentages, but there are clearly a lof of radiogy pgy-5s now who are going straight into practice.....many many more than path

 

[Euchromatin]

I wouldn't say it is the 'exact same' way....from everything I'm reading the radiology job market is tightening and groups are increasingly organizing in such a way that they have one body person, one msk person, one nucs person, one neuro person, etc....but in smaller towns/cities you don't have megagroups and thus there are still plenty of spots for general neurologists. Dont have the percentages, but there are clearly a lof of radiogy pgy-5s now who are going straight into practice.....many many more than path

Pathology used to be a 5 year residency (and, no, the first year was not a clinical internship or anything non-path related). It was changed to a 4 year residency in 2006 and one year fellowships became much more popular. This does not seem the least bit surprising to me.

 

[mlw03]

not sure why vistaril is chiming in here. you don't seem to have an educated opinion on this topic. i certainly wouldn't offer opinions on why things are they way they are in the psychiatry.

 

[Geork]

Finally had to join after long, long lurking.

I interviewed mostly private, so I'm not 100% sure about academics, but in general groups that know what they are doing are somewhat aware of the fellowship timelines.

Of course, they are more flexible than academic jobs, since there are no "deans" and other clown types like that, but in general if they are looking for someone out of training they tend to adhere to the same schedule.

I started 2 months into fellowship (cyto) and had interviews dates starting Nov. Offers came in Dec. I was in a big training program, MOST fellows had the same timeline. Don't underestimate how long it may take to get a license, frankly by Feb its kinda close. Not knowing where you're going to end up weeks before you finish fellowship is unlikely, as you will not have your license and credentialing finished in time to sign out. If you can't sign out you're not worth crap.

Regarding the chronic conversation about too few jobs. Yes ALL residents get "jobs" but underemployment is a massive understatement. There are too many training positions and we take too many poor candidates. I don't think anyone is "trolling" and we SHOULD be comparing ourselves to radiology, as its an apt apples to apples comparison. If anything our specialty is uniquely suited to be by far the most lucrative, competitive, and intellectually satisfying.

Now are there sweet, sweet completely private global bill, good payer mix, mostly outpt. jobs. Sure. Are they VERY rare in places people actually wanna live? Yup. Why? If there was INTENSE need to push glass a non-boarded non-fellowed resident would be slopped up in seconds to plug gaps in many groups. Is this the case? No. Someone responded up there that his group wouldn't hire someone out of training. Good groups in high demand places can do that (and its a good move!), but how can they possibly be so selective? Think about it.

I really don't mean to hijack the thread on my first post, but there are far too many poor trainees out there that should have not gotten a residency spot period. Of course most people on this forum will have fine great jobs, but we should not pretend that there isn't this vast pool of path resident and fellowship trained people who are simply not suited for real path work and should not have been let into the machine in the first place.

 

[scienceguy19]

I don't see how increasing the number of pathology residency positions fixes the problem of too many pathologists who are not qualified for the job.

 

[Geork]

Yeah maybe I was a bit too ranty and not actually clear, I'm one of the folks who is all for decreasing the number of residency positions.

 

[Geork]

yeah... and I also just caught up on some other threads and realized I was feeding a troll. Apologies, didnt realize office managers from IOP GI groups hung out here too! Cheers visatril

 

[Path or bust]

at least 1 fellowship seems to be the standard/minimum, 2 very frequent, and 3 not unheard of....


It either speaks to a very poor job market or very substandard training in general residency.

Wrong again. I am in private practice, straight from residency. AP/CP boarded.

 

[mlw03]

Wrong again. I am in private practice, straight from residency. AP/CP boarded.

You are by far the minority. I would venture less than 3% of graduates since 2005 have been able to gain employment straight out of residency with no fellowship. The comment that 1 fellowship is a minimum is accurate for the vast majority of pathologists in the US.

 

[Path or bust]

You are by far the minority. I would venture less than 3% of graduates since 2005 have been able to gain employment straight out of residency with no fellowship. The comment that 1 fellowship is a minimum is accurate for the vast majority of pathologists in the US.

Yes but the poster didn't qualify that his statement was true for the vast majority of pathologists in the US. You did. Hence, my reply to his post and not yours.

 

[mlw03]

Yes but the poster didn't qualify that his statement was true for the vast majority of pathologists in the US. You did. Hence, my reply to his post and not yours.

Well, that's fine, but if we're trying to offer information to med students about what they can expect if they become pathologists, I think it's important to make sure the norm is known, along with exceptions. Happiness = reality/expectations. If most people expect to do 4 years of AP/CP and then get a private practice job for 250K, then there will be a lot of unhappy pathologists.

 

[Path or bust]

Well, that's fine, but if we're trying to offer information to med students about what they can expect if they become pathologists, I think it's important to make sure the norm is known, along with exceptions. Happiness = reality/expectations. If most people expect to do 4 years of AP/CP and then get a private practice job for 250K, then there will be a lot of unhappy pathologists.

I'm not offering information to med students nor do I really care. Like you, I agree its important to emphasize the norm and the exceptions. I believe the norm is clearly emphasized in every thread and almost every post on this forum. Nobody is debating that fact. 😕

 

[mlw03]

If you don't care why do you come on here and post? It can't be for the stimulating case discussion, since that rarely happens. I guess I just thought most people on here at least have some interest in the future of pathology in North America.

 

[Path or bust]

If you don't care why do you come on here and post? It can't be for the stimulating case discussion, since that rarely happens. I guess I just thought most people on here at least have some interest in the future of pathology in North America.

Perhaps you need to stop reading into posts more than what is actually written.

Not that I need to justify what I write or think or how I live my life, that is my own right. But, did I say anywhere in my post that I don't care about the future of pathology in North America? Some of us come on here to give a point of view and perspective and to share our experience. Sometimes we come to vent and share in our frustration. If someone finds it useful, great, if not thats fine too.

 

[scienceguy19]

So how's the job market this year? It's already halfway through the academic year.

Do most of the graduating pathology fellows have jobs lined up after graduation now?

 

[lipomas]

You are by far the minority. I would venture less than 3% of graduates since 2005 have been able to gain employment straight out of residency with no fellowship. The comment that 1 fellowship is a minimum is accurate for the vast majority of pathologists in the US.

I would venture that less than 3% even tried. It's just sort of assumed people do a fellowship, because that was what people did for many years when that extra year was essentially required.

 

[mlw03]

I would venture that less than 3% even tried. It's just sort of assumed people do a fellowship, because that was what people did for many years when that extra year was essentially required.

Probably, but I was being generous, since path or bust was offering his/her anecdotal experience that one can attain a job without fellowship. Yes, one can, but almost nobody does. That's the point I'm trying to make.

 

[yaah]

In my program I know of a few people who did no fellowship. Only one was a non-researcher. She took a private quest job somewhere, seemed like a decent but not great job.

 

[pbp4]

I was looking in 2009 and every year has it variables. but 2009, was the banking crisis. i remember an interview where a senior pathologist told me i should do another fellowship because his 401k was a 4k now and he had no intention of retiring (i presumed I was interviewing for his job).

Nevertheless, had 3 solid offers(PP) by December and signed mid month. I have to say - I was an active job seeker. My fellowship had a lot of consult work and if I had an interesting case or reason to call the contributor, I did. If the opportunity to tell them i was looking for a position came up, I did. I probably did this 100 times and only remember one person getting offended. I mean many just said they had nothing and knew of nothing but 2 of my 3 offers started this way. The job I took came from contacting a former chief resident. My point is if you are waiting for a recruiter, you will likely wait a while.

As for Academics, 3 interviews and all put on hiring freezes during the crisis- i could not wait them out- or I would not wait them out.

Looking at the other posts, I am often asked to look at incoming candidates for positions. In my world, a fellowship is required or significant experience outside residency. However, some of my partners do not feel the same. BUT, more then one is red flag and three is a non-starter- that screams of issues.

I did have two "offers" (they were not real solid just discussions) without fellowship but they were not very good offers.