Procedures?

[Deucedano]

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Im a MSIII and I rotated through pathology earlier in the year and I loved it. I am a very visual person and prefer to diagnose rather than treat disease. However, I just finished OBGYN and I really enjoyed all the short procedures and surgeries they did. I know pathologists can do their own bone marrows and FNA, but it seems (based on reading forums) that many pathologists dont do them as much as they did in the past.

I really like pathology, but I want to be able to get up and do things at least for some part of the day. I dont think I could sit at my scope all day long cranking through slides. Is there enough opportunity to mix up my day with bone marrows or FNAs assuming I have the proper training and qualifications?

 

[KeratinPearls]

Im a MSIII and I rotated through pathology earlier in the year and I loved it. I am a very visual person and prefer to diagnose rather than treat disease. However, I just finished OBGYN and I really enjoyed all the short procedures and surgeries they did. I know pathologists can do their own bone marrows and FNA, but it seems (based on reading forums) that many pathologists dont do them as much as they did in the past.

I really like pathology, but I want to be able to get up and do things at least for some part of the day. I dont think I could sit at my scope all day long cranking through slides. Is there enough opportunity to mix up my day with bone marrows or FNAs assuming I have the proper training and qualifications?

A majority of your work is going to be sitting down looking at slides most of the day. Yeah, you can do FNAs but you dont do them everyday. Some days you may get a few some days nothing and then you will be looking at paps, non-gyns after the cytotech has looked at them. I dont know how it is in the community setting. You can always get up and get a cup of coffee...it's not like you will be chained to your chair the whole day. If you definitely need to do procedures everyday and love procedures, yes pathology has FNAs, but it really isnt a procedure oriented field. You really have to enjoy looking into a microscope.

I dont mind procedures at all but FNAs are really a different beast. You stick a needle in a patient's node or whatever and they are grimacing in pain...not my cup of tea..but if I got to do it ill do it.

 

[yaah]

I don't know man, I move around a lot. Just because I don't do procedures doesn't mean I don't move around. Have to go to different labs, frozens, whatever. Don't overestimate the importance of doing procedures - some people get excited about them as med students before they realize how tedious and repetitive they are.

 

[KCShaw]

Depends on your institution, but for the most part pathologists have released the grip they once had on certain procedures (or quietly allowed other specialties to take them, and generally charge for them). That's not to say I wouldn't personally rather have a surgeon or interventional radiologist or whatever, who spends much of their time sticking sharp things into living people, vs a pathologist who spends the vast majority of their time looking down a microscope, stabbing me. Also not to say that taking them back and performing them in an organized, financially beneficial way might not be a good move for pathology in general. But anyway.

Most career choices are a tradeoff. Yaah makes a good point that procedures, especially "minor" ones, eventually can become repetitive and tedious -- and take away from time spent cranking through multiple billable slides & cases vs one procedure you may spend half an hour or an hour trudging around to deal with, to be fiscal about it. I remember a brief time when it was cool to take blood and put in peripheral lines. You may also go through a phase when you enjoy interacting with patients. Eventually you'll have to really decide what's most important to you.

 

[Autopsy101]

I had similar thoughts before I entered pathology residency. There are opportunities to interact with patients and do procedures, but it is not usually on a daily basis. I have the same feelings about looking at slides all day. What I have found that I really enjoy which takes the place of doing the procedure is going for "immediate reads". The pathologist comes to the bedside of the patient having the procedure (endoscopic ultrasound guided FNA (transbronchial or pancreatic), radiologist guided procedure, or bronchoscopy). You can see the patient before the procedure if you want and talk to them about their history, and then watch on the screen as the endoscopist or radiologist does the procedure. It is almost like doing it, it gets you out of your office for awhile and out into the hospital wards, allows for limited patient contact, and really makes the clinicians happy. There are some drawbacks to that because it is not well reimbursed for the amount of time it takes away from your regular slide work, and it can be stressful if the clinicians you are working with don't understand the limitations of what can be done with immediate reads. However, I work in a community hospital, and I have the opportunity to go on immediate reads for procedures at least 2-8 times per day when I am on cytology rotation. In contrast, I probably do 1-4 FNA procedures every month.

 

[caffeinegirl]

What is it you liked about the procedures of OB/Gyn? The actual technical aspect or the patient contact??

I like the visual aspect of pathology both on the slide and at the grossing bench. In many geographic areas (ie, west coast), pathologists gross the big specimens. This breaks up my day from sitting at the scope, and also allows me to use a scalpel, knife, and bone saw without worrying about patient's vital signs. 🙂 And also makes my sign out easier when looking at the slides of the tissue I submitted.

If you want a setting pathology that isn't just at the scope, there are practices with active FNA clinics, transfusion services (with infusion centers), grossing, tumor boards, etc. And if you like working with the entire body..how about forensics?

I agree with yaah...my job is rarely just sitting at the scope and I like it that way. As for procedures...I would think a D&C would get pretty boring after the 100th time....

 

[Deucedano]

Thanks for all the responses. I can see what all of you are saying and yes those procedures would probably get pretty routine after a while. I think what I liked more was the variation in their day to day activities. I do really enjoy working with my hands, so working at a place where I could gross big cases would be enough to satisfy me there.

One of the big reasons I like pathology is the breadth of the specialty and I would like to practice a little piece of everything. I also think I might be in the minority who really likes clinical pathology. I know most private practice pathology is AP, but would there be a place in private practice for someone to do 1/2 AP and 1/2 CP or more CP than most pathologists do.

The bottom line is Im afraid if I have to sit all day and crank through slides I will get bored. Dont get me wrong, I enjoy the microscope and tissue diagnosis, but I just dont want it to become routine. Regardless, Im almost positive I will end up in pathology. While I enjoyed the procedures and surgeries, the time one needs to spend in clinic to get those patients is more than a deterrent. Most days I am in the clinic I spend watching the clock and thinking please someone kill me now.

 

[KCShaw]

Well.. do enough of anything and, eventually, the majority of the time it will be routine. But as everyone has said, a lot of pathology jobs do or can involve more than sitting around getting hemorrhoids all day. Even if it's just swinging by the gross room to do something or offer an opinion/lay some demands, or handling frozen sections. And I think there are a reasonable number of positions where one can still mix in some regular CP.

If you're -really- concerned about being bored by routine, consider forensic path; autopsies keep your hands busy, postmortem testing can range from more or less typical histology/surg path to a range of CP related testing, tox, imaging, etc., while lawyers, families, law enforcement, and perpetrators never cease to amaze -- not always in a good way, but still. (Nevertheless, as with anything else, certain things will still become largely "routine.")

 

[Deucedano]

Well.. do enough of anything and, eventually, the majority of the time it will be routine. But as everyone has said, a lot of pathology jobs do or can involve more than sitting around getting hemorrhoids all day. Even if it's just swinging by the gross room to do something or offer an opinion/lay some demands, or handling frozen sections. And I think there are a reasonable number of positions where one can still mix in some regular CP.

Yes I agree about the routine and it will become routine at some point. I just dont want to be in a place where I dont feel challenged. My biggest problem is that I have narcolepsy/hypersomnia and sitting all day makes me want to go to sleep. I just want to be able to get up and do something intermittantly to keep myself awake (part of the reason I like procedures). Based on what all of you are saying, I can which makes me feel much better.

Caffienegirl if you dont mind me asking what state do you practice in?

 

[LADoc00]

Im a MSIII and I rotated through pathology earlier in the year and I loved it. I am a very visual person and prefer to diagnose rather than treat disease. However, I just finished OBGYN and I really enjoyed all the short procedures and surgeries they did. I know pathologists can do their own bone marrows and FNA, but it seems (based on reading forums) that many pathologists dont do them as much as they did in the past.

I really like pathology, but I want to be able to get up and do things at least for some part of the day. I dont think I could sit at my scope all day long cranking through slides. Is there enough opportunity to mix up my day with bone marrows or FNAs assuming I have the proper training and qualifications?

there are alot of jobs where you can do all procedures you want.

but for example, I dont sit at my scope all day. about 60% of my time is admin/biz etc.