Pathology residency.

[Farah Khan]

Hi...

If anyone has an opinion/experience to share about Pathology residency (esp Michigan programs) that would be most helpful.

Thanks... hope to get a few replies.

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[Firebird]

Pathology is typically a five year program with one year being optional. By that I mean it can be like a transitional year, or it can be straight pathology. I think most choose it to be path.

It's a very lifestyle-friendly residency, with less call and fewer hours than others. I'm not in medical school yet, so I am not sure what the average hours per week is...maybe Great Pumpkin can help us with that.

There's a variety of routes to take as a pathologist, but I won't get into that as I'm not exactly sure I understand them.

To sum up pathology, the lifestyle is good, but there's very little patient contact. So you've got to choose which you prefer.

 

[GreatPumpkin]

Well, I don't know much about Mich. programs, but like Firebird said, path has a very good lifestyle. I am in my second month of my surgical path rotation with is considered the toughest rotation during residency. I am working 12 to 14 hours a day Monday thru Friday, and 1/2 day every third Sat. On other rotations hours are usually 8 to 5. Sometimes longer depending on what is going on.

There is no call while on Surg path. On other rotations you take Surgical Call and Clinical Path call for a week at a time every couple of months or so. Call is from home. And, very rarely does the pathologist have to come to the hospital, most things are handled over the phone. Emergency frozen sections, weekend autopsies, and emergency aphoresis is about the only reason to have to come in.

Path residents are expected to study outside of work alot more than others. And, we get a lot more time in conferences and with attendings.

There is some patient contact during fine needle aspiration proceedures, aphoresis, blood bank, and bone marrow biopsies. But, there is plenty of contact with staff and other docs. The clinical path arm of pathology requires a lot of people management.


Any of the large university programs in path are probably fine. You should consider going to a program near where you would like to work in the future. Most jobs are found through word of mouth and contacts.

If you have any specific questions ask away, I try to check the board every night. Or email me.

 

[Farah Khan]

Thank you for a prompt reply Firebird.

Rob, thank you as well for a detailed reply. It was heartening to read your post. At present I am trying to find an observership/externship in Path since all my senior electives were in clinical specialties. Being an FMG I feel that I need a US LoR plus I really do want a feel of Patho for a month or so and don't not want to go into it half-blind (even though my heart and mind are pretty much set on it.)

As far as rep goes, I think the University of Michigan programs might take the lead, here in Michigan. However, the Wayne State University and Henry Ford programs also see to have a good bunch of full-time facutly in every field, good Board passing rate etc.

Another reason why I wanted to do an observership was that before entering a five-year residency program, a feel of the program and peers would be good. However, at present all the available programs say that they don't have a policy for offering observerships. So at present, Patho is not giving me a warm feel because I'm desperately trying to break in.

Well I'll keep trying till the interviews... otherwise I'll just have to realy on word-of-mouth and my impression duing the interviews (hopefully I'll get a few!) to make my final decision.

I may have specific questions for you in the future and will be sure to get in touch with you.

Thanks again.

-Farah.

 

[Farah Khan]

I just read my post... sorry for all the typos!

 

[Firebird]

Ok...I guess I'll ask a few more questions...

You said there's some patient contact. About how many patients would you see in week as a practicing pathologist? And how many pathologists does a hospital (urban, suburban and rural) typically employ? Is pathology a job that you probably would have to relocate for? One last thing...if the state you would be living in only does autopsies in the capitol city, what type of moonlighting opportunities would there be for other areas?

 

[Ludy]

Great Pumpkin,
I also have a question for you. I'm interested in path and I just finished a short rotation in surg path. I really loved it, but I keep hearing bad things about the job market, which makes me somewhat hesistant to apply. I've read several articles about how residencies continue to train too many pathologists despite the surplus because the hospital makes so much money off of the cheap labor, and that private practice groups are working more hours rather than hiring as their workload increases because their reimbursements have gone down. Even Iserson's Getting Into a Residency (2000 edition) says "many recent pathology graduates have had difficulty finding desirable positions." It also says 45% had difficulty finding a job they preferred and 19% were unemployed at graduation. However, I know that with the large IMG representation in path, that may affect the numbers and the job market might be better for U.S. medical graduates.

What's your opinion? You must have talked to residents as you were interviewing at various places, and of course at your current institution. What's your general feel for the job market? Also, is it necessary to do a fellowship now to find a job?

For Firebird...
the residents I worked with RARELY (if ever)see patients. I didn't see any while I was there with them, although it was just surgical pathology and autopsy. It's possible CP has more patient contact, and of course it depends on the hospital. Fine needle aspirations and bone marrow procedures are done by other departments here. There is plenty of interaction, however, with surgeons, infectious disease specialists, and attendings in lots of other areas concerning patient care and diagnosis. It certainly isn't an isolated job in the basement or anything.
Our path dept. had about 35 attendings, but I'm not sure how many of them are primarily research-based.

 

[GreatPumpkin]

Firebird,
----About how many patients would you see in week as a practicing pathologist?

Alot of that would depend on the type of practice and if you want to specialize. There are path docs that see patients everyday in my residency. The cytopath docs do Fine Needle Aspirations every day. And, the Hematopath docs perform bone marrows everyday as well. But, this is not the kind of patient contact you experience in FP or IM. Very proceedure oriented and short. Path is not the specialty for you if you crave close patient contact.

----- And how many pathologists does a hospital (urban, suburban and rural) typically employ?

These are kind of a guess, but not to far off.
Urban- 10-15
Suburban- 5-7
Rural- hospital I worked at prior to med school, had 3. It was definately rural.

Many path docs are part of large multi-hospital groups as well.

-----Is pathology a job that you probably would have to relocate for?

Yes, but usually jobs are in the geographic area you train.


-----One last thing...if the state you would be living in only does autopsies in the capitol city, what type of moonlighting opportunities would there be for other areas?

Normally, each county has a Medical Examiner even if the forensic autopsies are handled in a central location. But, you can also moonlight in the gross room for other hospitals. There is nothing really to stop you from moonlighting in primary care if a place is in real need.

 

[Farah Khan]

Thank you for your thorough replies Great Pumpkin.

I was wondering how you went about (or how you feel one should go about) deciding how to rank a program just by interviewing there (by that I mean not having worked there)? Any known red flags to look out for etc...??

And is it really true that Patho is a field for the "good ol' boys"... being a woman and a foreigner on top of that, I hope my academic credentials alone are looked at wile entering a residency and thereafter a job.

Well, I am not going for Pathology for monetary reasons alone, but I am curious about how the field will reimburse eventually. I realize that it is hard to predict since the salary would depend on the location and academic vs private... but do you have any average figures in mind?

Hope to hear from you soon.

Thanks again.

-Farah.

 

[GreatPumpkin]

GP20

----I'm interested in path and I just finished a short rotation in surg path. I really loved it, but I keep hearing bad things about the job market, which makes me somewhat hesistant to apply. I've read several articles about how residencies continue to train too many pathologists despite the surplus because the hospital makes so much money off of the cheap labor, and that private practice groups are working more hours rather than hiring as their workload increases because their reimbursements have gone down. Even Iserson's Getting Into a Residency (2000 edition) says "many recent pathology graduates have had difficulty finding desirable positions." It also says 45% had difficulty finding a job they preferred and 19% were unemployed at graduation. However, I know that with the large IMG representation in path, that may affect the numbers and the job market might be better for U.S. medical graduates.

That last sentence really sums it up. And, all the figures people are quoting are from a 1996 study, the job market is changing quickly. All of the residents I have talked to have said there is no problem now. And, all the residents from my program have found jobs right away. The cyto fellow we have now said he had multiple offers and the the job market is good right now. So just pick what you want to spend your life doing, the job will come. Even if 19% were unemployed at residency end, half of those probably only wanted to live in Cali or New York or some "special place". And, I have been told many times if you are a US grad you will be golden when it comes time to find a job. It is true that groups held off hiring when the reimbursement slowed, but there comes a point that the job market will explode for path.

------Also, is it necessary to do a fellowship now to find a job?

No, but many residents do because of interest and wanting to improve there CV even more. Many use it is a year to get ready for the board.

There is talk that path may switch back to a 4 year residency, we will see.

I encourage anyone who is interested in path to do a rotation in Surg path and some clinical path. These are really completely different jobs, make sure you like or can tolerate both if you are interested in private practice.

 

[GreatPumpkin]

Farah Khan

----I was wondering how you went about (or how you feel one should go about) deciding how to rank a program just by interviewing there (by that I mean not having worked there)? Any known red flags to look out for etc...??

Try to make sure the residents are happy. That is the biggest thing. I hear stories of programs just using the residents as cheap slave labor, pumping out the cases. Make sure they have lots of formal teaching conferences, that is one big clue.


----And is it really true that Patho is a field for the "good ol' boys"... being a woman and a foreigner on top of that, I hope my academic credentials alone are looked at wile entering a residency and thereafter a job.

It is somewhat a good ol' boy network, especially in private groups. Academics is less so. Lots of foreigners and women are finding jobs in path, you might just have to try a little harder and be willing to go further. The foriegn graduates that speak poor, broken or english or with a very heavy accent have a much harder time. That may be unfair, but path is a specialty that requires good communication. And, unfortunately for me spelling and grammer.


----Well, I am not going for Pathology for monetary reasons alone, but I am curious about how the field will reimburse eventually. I realize that it is hard to predict since the salary would depend on the location and academic vs private... but do you have any average figures in mind?

I expect to start 150,000ish with partner in 3 or 4 years. Then will jump to over 200,000. Academics is low 100s. Forensics also low 100s if you work for state or local gov.

 

[Ludy]

Great Pumpkin,
Thanks for your replies. Very encouraging. I have one other question... I know that autopsies are much less common than they used to be, and that they form only a small part of a job in private practice. I participated in two fetal autopsies during the few days I spent on the autopsy service, and it seemed pretty complex. I'm not sure that I would feel confident enough to look for congenital heart defects in 23-week-old fetuses after just a few months of autopsy training in residency, which may not include that many infants. Do community pathologists generally perform the fetal autopsies as well as the adult ones? Do you have any idea how often this would come up, say, in a month of practice? Thanks for your help.

 

[Firebird]

I checked out a few websites on path but they were very ambiguous as to what the difference is between anatomic, surgical, and clinical pathology. Could you explain that? Nothing too elaborate, just something so I have an idea.

You've been EXTREMELY helpful in the past couple days with this thread! I really appreciate it! So thanks a bunch!

 

[GreatPumpkin]

GP20
----Do community pathologists generally perform the fetal autopsies as well as the adult ones? Do you have any idea how often this would come up, say, in a month of practice? Thanks for your help.

I am not real sure. But, fetal autopsies are fairly rare even here at a very large university hospital. So no telling how many a group would get in a community setting. But, remember that when you go out into a group you usually have other path docs to help. Some of the smaller hospitals near to us send their autopsies to us, so their pathologists don't even have to do them. If you feel you need practice on autopsy just do a few months at the medical examiners office.

Firebird,

-----I checked out a few websites on path but they were very ambiguous as to what the difference is between anatomic, surgical, and clinical pathology. Could you explain that? Nothing too elaborate, just something so I have an idea.

check this page out
Path Faq

If this doesn't do it let me know. One thing I will say is that surgical path is a part of Anatomic Pathology, not a seperate component. You recieve board certification in AP and CP if you do the 5 year program.

 

[Firebird]

Another question or two popped in my head.

We've talked about the Path call schedule before. Everyone has said it's very benign, in that most pages can be dealt with over the phone.

Exactly what do they page you for? What do they ask and what do you tell them when you're paged on the path service? And for those calls that you have to go into the hospital for, would that be exclusively for an emergency frozen section?

What would constitute the need for an emergency frozen section?

 

[GreatPumpkin]

-----Exactly what do they page you for? What do they ask and what do you tell them when you're paged on the path service?

Clinical Path Call:
You name it, specific questions about lab tests, about blood products, what does this result mean, how do I draw blood for this test, and so on. Also, we go in if there is an emergency aphoresis. We go in and consent the patient for the proceedure and then make sure everything is going ok, then leave. This does not happen often. Maybe once every 3 months. But, the biggest call item is from clinicians trying to get the lab to accept mislabled or unlabled specimens. In which we usually have to say sorry, redraw the sample. Sometimes clincians try to argue with us, but it is the law. We cannot accept those type of samples or the lab would lose it's accredidation and the pathologist would specifically be liable for any mistakes no matter how much the clincian ensures to us it is the right sample. The only exception to this rule is if another specimen is IMPOSIBLE to get. Usually spinal fluid is about the only thing we will take.

Autopsy Call:
Monday thru Friday if clinitians call after hours to say they want an autopsy. We say great we will do it in the morning, get all the paperwork ready. On the weekend if it is prior to Noon and all the paperwork is ready (usually this is not the case), we go in and do the autopsy, after it gets done the next day.

Surgery Call:
Really the only thing is for frozen sections. Which happens most often in the early evenings with cases that are still going late. Once in a blue moon happens in the middle of the night or on weekends.


---What would constitute the need for an emergency frozen section?

Anything that needs immediate evaluation that may change the course of surgery. Normally the types of surgery that would require a frozen section are done during the week. Like cancer cases, ortho cases, breast, lung and neuro cases. But, sometimes a trauma victim will have a unexpected finding that requires investigation. Also sometimes emergency transplant things will require evaluation. But, sometimes we are called for things that are not really appropriate for frozen. And, if so the on-call attending will usually refuse it, and explain why to the requesting doc (if they won't take your word for it).

Of course for me, alot of this info is hearsay, I haven't had call yet. I have my first week of clinical call toward the end of September.

 

[madrigal08]

Does anyone know how difficult it is to get into the Indiana pathology program? What do they look for in terms of research, grades and board scores? Do they like students who do 4th year path electives at their school? Is their pathology program very good?

 

[knockoutMice]

Hi GreatPumpkin

Your posts have been really informative..thank you so much....

However I want some specific advice from you. I'm very much torn between path n peds

Did you ever face any dilemma between path n peds/IM if so how did you overcome it?

Can you give me any advice on how I can go about making my decision?

My experience in path is limited to Robbin's Pathologic Basis of Disease (the large edition) that book is all I know and all that I love about path....n I do love path a lot

Any help will be much appreciated.
Take Care

 

[yaah]

This is kind of an old thread. Great Pumpkin rarely visits the forums anymore. Oddly enough, we just had a "Peds vs Path" thread in the path forum

http://forums.studentdoctor.net/showthread.php?t=593830