Pathology vs. Internal Medicine

[rebuilteva]

Hi everyone,

I'm a M4 at a US medical school who's on the fence between pathology and internal medicine. My Step 1 score is 235, Step 2CK score is pending, have 1 clerkship honor, 2 preclerkship honors. Overall leaning more towards pathology, but I have yet to take a pathology elective, although I have one scheduled in the near future. Was wondering if anyone could help tip the decision in favor of pathology, or try to talk me out of doing pathology / tell me that it's a terrible idea to even consider doing pathology in 2022.

Much appreciated.

---

Members don't see this ad.

 

[DoctorInQuotations]

There's some people on here that will say you're completely and utterly insane to consider pathology, but I don't think that's true.

I was on the fence between IM and path, and was considering hospitalist-type medicine but encountered some burnt out community practice hospitalists which put me off of IM. I had similar stats to you; you should be able to match at a top-tier path residency no problem. As long as you don't mind being flexible for your first job out of training (doing academics for a couple years before going into community practice and/or being geographically flexible), I think that going to a top-tier residency should at least open up a road to a successful career.

For context: I'm fresh out of training and just started my first job. I could have gone into academics at my home institution but wasn't interested in that. I wasn't able to find a community practice position in the city of my choice, but ended up in same geographic region I wanted to be and overall happy with what I landed. All my co-residents from my graduating class seem to be doing well and seem to be happy with the jobs they got too. With that said, I don't think that pathology is the land of milk and honey and there's concerning things happening in the field (corporate buyouts, lab consolidation, continuously decreasing compensation), but the alternative of burning out in ~10 years in IM seemed a whole bunch worse.

 

[KeratinPearls]

Internal medicine sucks. Dealing with all sorts of bullsh%t. Anything is better than that.

40 hours a week of work. No call and no weekends can be had in Pathology with a decent income.

 

[mike-sheree]

headaches, i’m dizzy, backaches, positive review of systems big time. hypertension, type II dm, chronic vascular dz and obesity. Have fun.

 

[M&L]

EDIT: DURING residency . Hahaha . No pun intended

I am personally going for pathology . There are so many opportunities now with a lot of older pathologists retiring . And the 50 hours a weeks/no nights/ 2 days off a week dying residency doesn’t hurt Hahshs

 

[Alteran]

IM is only worth it if you're looking at doing one of the subspecialties (cardio, pulmonary, GI, etc.). Otherwise you'll be a glorified social worker. Though, it doesn't seem to be so bad these days because every internist has an army of PAs doing all the routine work.

 

[KeratinPearls]

I am personally going for pathology . There are so many opportunities now with a lot of older pathologists retiring . And the 50 hours a weeks/no nights/ 2 days off a week dying residency doesn’t hurt Hahshs

My residency had crappy CP training. We had no blood bank calls. Most of us just spent the mornings in the respective labs observing technicians on our first or second months of the rotation. We didn’t do sh$t on our rotations and several of us unsurprisingly failed CP lol!!!

It was a mini vacation. Undoubtedly the easiest residency in all of medicine since we just sat around socializing with other residents on CP! LOL.

 

[M&L]

My residency had crappy CP training. We had no blood bank calls. Most of us just spent the mornings in the respective labs observing technicians on our first or second months of the rotation. We didn’t do sh$t on our rotations and several of us unsurprisingly failed CP lol!!!

It was a mini vacation. Undoubtedly the easiest residency in all of medicine since we just sat around socializing with other residents on CP! LOL.

Yeah my mentor told me to make sure CP program is good . She helped me make a list Hahshs

 

[Dave CX]

IM is only worth it if you're looking at doing one of the subspecialties (cardio, pulmonary, GI, etc.). Otherwise you'll be a glorified social worker. Though, it doesn't seem to be so bad these days because every internist has an army of PAs doing all the routine work.

I agree entirely. I would vote IM if he goes into med onc which is exploding with greatness. My older oncology buddies are actually happier now that they were 20 yrs ago, which is super rare in medicine. Actually being able to cure people occasionally who would have been pushing up daisies even 5 yrs ago.

 

[LADoc00]

IM has play if you are going to shoot for a top end fellowship like GI.

GI is in insane demand, perhaps the most of any specialty atm.

I know GI folks working PT, no call making as much or more than Ortho, like in the 750K range.

JUST IM is a total ****show unless you spin to cosmetics boutique practice. Wellness spa medicine.

Taking care of actual patients for government and commercial insurance with chronic diseases in a office based IM practice is the equivalent of drinking Clorox bleach and having unprotected sex with homeless people. You will die young, divorced, sick and broke.

LET ME BE 100% HONEST: A straight IM physician has a higher suicide rate than a US Navy SEAL who has 5+ combat deployments under his belt.
F--K THAT.

 

[Dave CX]

I work for a GI group. For years they fight over the same few candidates with other GI practices.

 

[Med Director New England]

Hi everyone,

I'm a M4 at a US medical school who's on the fence between pathology and internal medicine. My Step 1 score is 235, Step 2CK score is pending, have 1 clerkship honor, 2 preclerkship honors. Overall leaning more towards pathology, but I have yet to take a pathology elective, although I have one scheduled in the near future. Was wondering if anyone could help tip the decision in favor of pathology, or try to talk me out of doing pathology / tell me that it's a terrible idea to even consider doing pathology in 2022.

Much appreciated.

If you are not sure between these 2 (quite different specialties), safer to do IM.

You can go so many directions after IM (as others have pointed out ^^) via fellowship to find whatever lifestyle / work setting you like.

But if you spend some time in path and discover you like it it than by all means. It is a great field.

 

[caffeinegirl]

To the OP - I hope you understand the selection bias of posting in a pathology forum - you are going to get more pro-pathology replies than in other forums. I wouldn't choose a career without actually spending time doing/shadowing/interning in it.

 

[Spikebd]

Hi everyone,

I'm a M4 at a US medical school who's on the fence between pathology and internal medicine. My Step 1 score is 235, Step 2CK score is pending, have 1 clerkship honor, 2 preclerkship honors. Overall leaning more towards pathology, but I have yet to take a pathology elective, although I have one scheduled in the near future. Was wondering if anyone could help tip the decision in favor of pathology, or try to talk me out of doing pathology / tell me that it's a terrible idea to even consider doing pathology in 2022.

Much appreciated.

It’s not a terrible idea to consider pathology in 2022. Anatomic pathology is cool because no other specialty really knows what we look for under the scope (even grossing will teach you a lot!). We see real diseases, which is satisfying in some ways because it makes the work feel meaningful. Making life-changing diagnoses on biopsies is a tremendous responsibility, and the amount of knowledge of each organ systems pathology we have to learn is really a lot of work. That helps protect us from mid-level encroachment, which is nice in todays medical environment. Clinical pathology is really cool and can lead to careers in biotech, which could be interesting. Blood banking, molecular, hemepath, and maybe bioinformatics are all good choices right now. Microbiology and chemistry is interesting but is sort of PhD driven these days.

The Lifestyle in residency is pretty good, but you certainly need to spend time reading outside of work. It’s not a residency you can drop into and be passable at like family medicine, etc. and the skills take time to develop. That means there will be growing pains and you’ll often feel foolish at around-the-scopes. Another thing to note is that you don’t really get a lot of autonomy aside from the gross room as a resident. Sure you can fill in synoptics and write up IHCs on each case along with a diagnostic comment, but many attendings have their own idiosyncrasies in how they sign out that it can sometimes feel random (almost always on benign entities).

The consolidation of lab medicine is certainly something to be aware of, but nobody knows how the future will unfold. As of today there are still pathologists practicing in private hospitals and not just academia & corporate labs. It would be great if that continues.

 

[Spikebd]

To the OP - I hope you understand the selection bias of posting in a pathology forum - you are going to get more pro-pathology replies than in other forums. I wouldn't choose a career without actually spending time doing/shadowing/interning in it.

Sound advice. Listen to people you trust, but it is your decision in the end

 

[airpods]

To the OP - I hope you understand the selection bias of posting in a pathology forum - you are going to get more pro-pathology replies than in other forums. I wouldn't choose a career without actually spending time doing/shadowing/interning in it.

This form is usually very negative about pathology. Path seems to be improving!

 

[mike-sheree]

Anecdotally, the job opportunities do seem more numerous than recent years but pay trajectory has been, and continues to be, on a downward slope for the same amount of effort and time expended. Also, attractive PP opportunities seem to get less and less.
Jobs in a corporate/ v.c. setting seem to be available in many locations. Academia is- - - academia.

 

[KeratinPearls]

This form is usually very negative about pathology. Path seems to be improving!

Yeah when I hear people say pathology is a great field on this forum something does not seem right lol!

 

[voxveritatisetlucis]

AP at McMaster is the worst in Ontario, maybe in Canada. A lot of problems!

Ok