Questions about a path residency

[lsuhockeyplayer]

Hey guys,

I am a MS3 and i have been doing quite a bit of thinking about residencies, like many of the people at my stage of training. First off i really have been interested since i started med school in oncology. Before you ask "why dont you go into a heme/onc" i have looked down that road and i know i couldn't handle the ups and downs that come with it. Additionally i have an intimate understanding of how tough it is to loose some one to cancer because i lost my mother to stage 4 astrocytoma last October. Dont misunderstand me i thought about heme/onc and even surgical onc but i dont think those fit as well as path does. The more that i research different specialties and sub specialties the more that i think pathology is a great fit. I really like the procedural stuff (which is why i looked at surgery), I also really like the fact that pathology is hands on you physically look at the tissues and make the diagnosis. Non of this differential bull ****ting like you do for days in internal medicine (sorry for that i am about a week away from finishing my internal medicine rotation nightmare). Which brings up my next point I also like the fact that you don't have an ass of an attending looking over your shoulder or trying to think of the next superfluous thing to pimp you on. You seem to have much more freedom (correct me if i am wrong on this). I also gather that patient contact is pretty much as little or as much as you want which is fine with me. I like the patient contact but some days i am completely fine to go with out it. Also

I guess what i am unclear on is what i should be expecting as a pathology resident and what do the specific sub specialties entail. Like i said earlier i am interested in oncology so which would be the best fit? Hemepath, surgical path, soft tissue path, or i even saw there is a new program in south Florida called oncology surgical path. Maybe i am completely off the mark on what i think pathology is or what the sub specialties include so could you guys enlighten me a little.

additionally i dont know if this is even an option but i would like to do research, that is of course if there is time to do research, on the side.

I know that was a ton of stuff but thanks for the opinions ahead of time

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[Arctic Char]

Hey guys,

I am a MS3 and i have been doing quite a bit of thinking about residencies, like many of the people at my stage of training. First off i really have been interested since i started med school in oncology. Before you ask "why dont you go into a heme/onc" i have looked down that road and i know i couldn't handle the ups and downs that come with it. Additionally i have an intimate understanding of how tough it is to loose some one to cancer because i lost my mother to stage 4 astrocytoma last October. Dont misunderstand me i thought about heme/onc and even surgical onc but i dont think those fit as well as path does. The more that i research different specialties and sub specialties the more that i think pathology is a great fit. I really like the procedural stuff (which is why i looked at surgery), I also really like the fact that pathology is hands on you physically look at the tissues and make the diagnosis. Non of this differential bull ****ting like you do for days in internal medicine (sorry for that i am about a week away from finishing my internal medicine rotation nightmare). Which brings up my next point I also like the fact that you don't have an ass of an attending looking over your shoulder or trying to think of the next superfluous thing to pimp you on. You seem to have much more freedom (correct me if i am wrong on this). I also gather that patient contact is pretty much as little or as much as you want which is fine with me. I like the patient contact but some days i am completely fine to go with out it. Also

I guess what i am unclear on is what i should be expecting as a pathology resident and what do the specific sub specialties entail. Like i said earlier i am interested in oncology so which would be the best fit? Hemepath, surgical path, soft tissue path, or i even saw there is a new program in south Florida called oncology surgical path. Maybe i am completely off the mark on what i think pathology is or what the sub specialties include so could you guys enlighten me a little.

additionally i dont know if this is even an option but i would like to do research, that is of course if there is time to do research, on the side.

I know that was a ton of stuff but thanks for the opinions ahead of time

path may indeed be something you would enjoy and thrive in. the best way to figure that out - as well as gain insight into the realities of the field and the day-today work of it - is to get as much exposure as possible. i started into path when i was at your stage in the game, during internal medicine. from that point on, i tried to attend sign out as frequently as possible with various attending and subspecialty pathologists. personally, i just got more and more excited about it as time went on and i gained more insight into the field and the human biology we were looking at. since that time i have done as many path electives as possible into 4th year, and it has only expanded my appreciation of the field, and has better prepared me to make the decision to apply for residency in path. so just try to get your hands as dirty (or bloody?) as possible in the upcoming year and things will be more clear to you, i promise.

about attendings - you will find p***ks and pimping in any field. but, i am pleased to report that i have not experienced any blatantly unpleasant attendings or residents in my experience so far (which, admittedly, is little).

path seems to have a large representation of physician scientists - compared to other fields - and research options are available and encouraged depending on what program you choose for residency (some are research heavy, others not so much. there is more info about this i think in the FAQs).

i think thats about the best i can offer at the moment. there are plenty of other great folks on here that can perhaps answer more questions for you.

-AC

p.s. i'm sorry that you lost your mother. very respectfully - remember that astrocytomas are not staged, they are graded. grade 4 is what you meant to say. again, i don't mean to open a wound, just making a correction for future reference

 

[lsuhockeyplayer]

Arctic Char,

Thanks for the info, a lot of what you said was what i hoped for. In fact i went to talk with a pathologist this morning and she echoed a lot of the comments you made. For the most part i wanted to make sure that i am on the right path (no pun intended ). Also I actually just signed up for a rotation in pathology that will begin as i start my 4th year.

about attendings - you will find p***ks and pimping in any field. but, i am pleased to report that i have not experienced any blatantly unpleasant attendings or residents in my experience so far (which, admittedly, is little).

I kind of figured that this would be the case, I know that regardless it has got to be less painful then internal medicine or surgery for that matter

p.s. i'm sorry that you lost your mother. very respectfully - remember that astrocytomas are not staged, they are graded. grade 4 is what you meant to say. again, i don't mean to open a wound, just making a correction for future reference

thank you for your condolences and i completely forgot that fact about stage/grading, thanks for correcting me.

 

[Nilf]

Hey guys,

I am a MS3 and i have been doing quite a bit of thinking about residencies, like many of the people at my stage of training. First off i really have been interested since i started med school in oncology. Before you ask "why dont you go into a heme/onc" i have looked down that road and i know i couldn't handle the ups and downs that come with it. Additionally i have an intimate understanding of how tough it is to loose some one to cancer because i lost my mother to stage 4 astrocytoma last October. Dont misunderstand me i thought about heme/onc and even surgical onc but i dont think those fit as well as path does. The more that i research different specialties and sub specialties the more that i think pathology is a great fit. I really like the procedural stuff (which is why i looked at surgery), I also really like the fact that pathology is hands on you physically look at the tissues and make the diagnosis. Non of this differential bull ****ting like you do for days in internal medicine (sorry for that i am about a week away from finishing my internal medicine rotation nightmare). Which brings up my next point I also like the fact that you don't have an ass of an attending looking over your shoulder or trying to think of the next superfluous thing to pimp you on. You seem to have much more freedom (correct me if i am wrong on this). I also gather that patient contact is pretty much as little or as much as you want which is fine with me. I like the patient contact but some days i am completely fine to go with out it. Also

I guess what i am unclear on is what i should be expecting as a pathology resident and what do the specific sub specialties entail. Like i said earlier i am interested in oncology so which would be the best fit? Hemepath, surgical path, soft tissue path, or i even saw there is a new program in south Florida called oncology surgical path. Maybe i am completely off the mark on what i think pathology is or what the sub specialties include so could you guys enlighten me a little.

additionally i dont know if this is even an option but i would like to do research, that is of course if there is time to do research, on the side.

I know that was a ton of stuff but thanks for the opinions ahead of time

I'm sorry about your loss.

If you are seriously considering path, you should do a rotation at your department, or if path is not strong at your medschool, rotate at one of the renown programs. There is not substitute for that.

Like everything in life, pathology has pros and cons, and it's not for everyone. Expect to work hard, be overwhelmed with the material, and YES there will be pimping. Yes you will pull 16 hour workdays occasionally, depending where you go. Patient contact is very limited to nonexistent. Benchwork or clinical research opportunities are there. Overall, it takes 4-5 years of 60+ hours/week to become a competent pathologist. Some mature faster than others.

I cannot adequately describe the entire field here: suffice to say, different subspecialties are quite dissimilar: fulltime bloodbanker has completely different set of responsibilities than a dermatopathologist or medical examiner. Then there are jacks-of-all-trades who can do it all.

 

[mlw03]

i generally agree with the comments others have made. do a rotation in general surg path as a MS4 early in the academic year to be sure you know what you're getting yourself into. one thing i wanted to comment on is about differential diagnoses. while it's not like it is in IM, there is a bit of it in pathology, especially for the poorly differentiated tumors. sometimes we'll stain the hell out of something and still can't come up with a great way to classify it. from a clinical standpoint this usually doesn't matter because as a group, these tumors behave aggressively no matter what we precisely call them. but there is an element of thinking about "what else could this be" when looking at a case. i personally think the mindset is somewhat similar to IM, although the day to day practice is obviously quite different.

best of luck to you as you figure out what path (no pun intended) you'd like to pursue.

 

[lsuhockeyplayer]

while it's not like it is in IM, there is a bit of it in pathology, especially for the poorly differentiated tumors. sometimes we'll stain the hell out of something and still can't come up with a great way to classify it. from a clinical standpoint this usually doesn't matter because as a group, these tumors behave aggressively no matter what we precisely call them. but there is an element of thinking about "what else could this be" when looking at a case. i personally think the mindset is somewhat similar to IM, although the day to day practice is obviously quite different.

Dont get me wrong I know understand that there a differential thought process in path like any other field. The thing that i did not like about IM was the fact that you had to think of EVERYTHING to come up with a differential. I guess i could be like that in path as well but i think the final thing that draws me to path oppose to something like IM is the fact that it seems to be a lot more visual. That is you see the tissue and you put the story with what you see histologically (again correct me if i am wrong). I guess it is the visual aspect of it that is more appealing to me.

 

[DarksideAllstar]

Dont get me wrong I know understand that there a differential thought process in path like any other field. The thing that i did not like about IM was the fact that you had to think of EVERYTHING to come up with a differential. I guess i could be like that in path as well but i think the final thing that draws me to path oppose to something like IM is the fact that it seems to be a lot more visual. That is you see the tissue and you put the story with what you see histologically (again correct me if i am wrong). I guess it is the visual aspect of it that is more appealing to me.

The way that we formulate a DDx is a bit different than IM. In addition to what we see at the scope, we also have to take the patient's history, exam, and radiographic findings into account when formulating a DDx. It can be extremely frustrating at times, particularly when clinicians are breathing down your neck for a final Dx.

Pathology is not immune to the super A-hole attendings who pimp and relentlessly look over your shoulder to make sure you are doing what you are supposed. In fact, I think a clinical intern has much more autonomy than a 1st or 2nd year pathology resident. There is no question that a senior surgical resident or medicine resident has made many more important decisions over their training career than a pathology resident will have-- one of the main problems I see in pathology (because you don't get to actually make autonomous decisions until you get to fellowship or beyond, thus you are more likely to lack confidence when signing out as an attending).

Take everyone else's advice and do an early rotation in surgical pathology to see if you think you would like it, then go from there.

 

[mlw03]

Dont get me wrong I know understand that there a differential thought process in path like any other field. The thing that i did not like about IM was the fact that you had to think of EVERYTHING to come up with a differential. I guess i could be like that in path as well but i think the final thing that draws me to path oppose to something like IM is the fact that it seems to be a lot more visual. That is you see the tissue and you put the story with what you see histologically (again correct me if i am wrong). I guess it is the visual aspect of it that is more appealing to me.

you're not wrong - you do match the stories of tissue + clinical scenario. the nice thing about path is that getting the clinical info is generally less painful than in IM. no listening to stories for 20 minutes before getting the info you need. we can usually get the info we need from the electronic medical record. and in some cases, clinical context really isn't necessary beyond patient's age and gender. we're definitely a visual field. make sure you can tolerate and/or enjoy sitting in front of a microscope for 5 hours. you're asking the right questions for where you are in your training. keep at it, and take opportunities to go to pathology whenever you can. if your patient had a biopsy, go to path and ask to look at it with the resident or attending. unless super-busy, most of us like that.

 

[sweetymd]

make sure u do an in-depth rotation in path. i thought it would be amazing in theory also, but in practice its been a shock. dont getme wrong, there r people that love it...and more power to them, its a great field that couldnt be needed more. its just not my cup of tea and i would have never known that until i was elbow deep

 

[lsuhockeyplayer]

make sure u do an in-depth rotation in path. i thought it would be amazing in theory also, but in practice its been a shock. dont getme wrong, there r people that love it...and more power to them, its a great field that couldnt be needed more. its just not my cup of tea and i would have never known that until i was elbow deep

If you don't mind my asking what didn't you like about it?

Also i guess that applies to all of you on the board if you all had to list one or two things about path that you really did not like what would that be?

 

[Arctic Char]

If you don't mind my asking what didn't you like about it?

Also i guess that applies to all of you on the board if you all had to list one or two things about path that you really did not like what would that be?

i don't think running bowel is the most anticipated activity, to put it mildly. but it in no way affects the overwhelming balance of awesomeness of pathology as a whole.