Well, I am one of those people who, after many rotations, did like both equally. Yes it is possible to like both and yes they have a lot of similarities. They are in no way "very different" and even if they were there is no reason you can't like both the same. I really struggled with the choice so I just applied and interviewed at both (last year). My thoughts on the two…
Overall job:
Radiology- Is something wrong? If so, where, how bad, and can you give us a decent idea about what it might be?
Pathology- We are pretty sure something is wrong and have a decent idea what it is..here is a chunk, can you tell us for sure what it is?
They are both mainly about visual diagnostics (I'm only considering AP, since CP blows monkey balls). Both will get to be involved with all the coolest cases in the hospital. With radiology you are more likely to see a lot of normals, with pathology you mainly only see normals when somebody "missed" the biopsy. In radiology you get to help make the initial diagnosis and track changes, whereas in pathology you get the fun and privilege of being the last word on what is wrong.
All clinicians think they are radiologists, but only dermatologists try it in pathology.
Environment:
Radiology- nice, quiet dimly lit room with the occasional physician stopping by. Get to have a nice computer to look at.
Pathology- nice, quiet well lit room with the VERY occasional physician stopping by. Spend your day behind the scope.
Both fields will let you avoid the general chaos that is floor medicine, the ED, clinic and the OR.
Technology:
Radiology- lots of high tech toys, always changing
Pathology- microscopes?
If you are a nerd and like lots of techy stuff, radiology is far and away superior. If anyone says to you, but, but..MOLECULAR PATHOLOGY, punch them in the face and tell them to go back to their lab while you read some more slides and actually do something that is useful outside of academics.
Colleagues:
Radiology- nerdy, nice, laid back
Pathology- geeky, nice, laid back
Both fields attract smart people who have lots of interests outside of medicine. The residents and attendings in both are far and away the happiest and nicest people you will meet in medicine.
Research/Academics:
Radiology- To do what I consider "worthwhile and cool research" you should probably have an advanced degree in engineering or physics. Very few programs really, really try to push you into academics.
Pathology- Probably the most research friendly field you can find. Best and easiest way to become a full-time researcher if that is your thing. Also, far superior to radiology if you want to teach at some point.
Tip: If you are on an interview at any of the "top" research programs and surrounded by md/phds who want to revolutionize the world with their molecular pathology, don't tell your interviewers that your ideal job involves working in private practice in close enough proximity to a medical school so you can hopefully teach too. They will look at you like you have two heads since you don't want to be a super duper molecular pathology researcher. You will also be forced to cancel all of your other "big name" pathology interviews since none of them really care to focus on training someone who doesn't want to be in academics.
Competitiveness:
Radiology- pretty competitive, but lots of spots
Pathology- not very competitive, if you are a good student you will have your choice of programs and can train with those top molecular pathologists if you so choose.
Lifestyle:
Radiology- Intern year stinks, rest of residency is 8-5 with the occasional nightfloat. In practice mainly 8-5ish. Can work more or less, take call or not take call depending on how much money you want/need. Intern year stinks. Every time you have to trudge down to the ED at 3am to admit yet another 78 y/o w/ chf, copd, ckd, in with chest pain and SOB, you will wish you had gone into pathology.
Pathology- pretty much 8-5 both during and after residency
Money/jobs:
Radiology- jobs aren't quite as plentiful as they were 4-5 years ago, but you can still more or less pick where you want to live and work and make a tidy sum of money. With so much money radiology is likely to be a big target for reimbursement cuts (even though nothing in radiology pays all that well...it is purely a volume thing).
Pathology- jobs not nearly as plentiful. Income varies widely as you have academics and people who join ubermegacorp path labs dragging down salaries. However, if you are okay with a little risk, have business sense, and are good at "politics" it is much easier to carve out your own practice from scratch and make the mega bucks then it is in radiology. In fact one of my highest ranked pathology programs was a little noname community program where they seemed excited to teach residents the business-side of pathology (they were well above all the "super duper big name research places" on my rank list).
So, at the end of the day, I really don't think you can go wrong with either field. You can always do what I did and just apply to both. Maybe you will make up your mind on the interview trail or maybe not. I ended up with a mixed match list and matched at my top choice which happened to be a radiology program. If I went down 1 more spot I would have been in pathology. rad=path>>>>> anything else in medicine. Good luck. If you have any questions feel free to pm me.
