Questions about Ocular Pathology

[pathogeN7]

Hi everyone,

I'm a rising M3 who is extremely interested in both the fields of Ophtho and Pathology. Ocular Pathology seemed like the perfect marriage. However, there's not a whole lot of information I can find, so I was wondering if anyone could answer some questions.

1. I've heard anecdotally that it is such a small, niche field that it is quite hard to find a job. Is that true? Does it differ if you enter from an Ophthalmology residency compared to a Pathology residency? Is there any difference in compensation depending on which residency you enter from?

2. Are you viewed by your peers as an Ophthalmologist or a Pathologist?

3. If you enter Ocular Path after doing an Ophtho residency, are you still able to do generally able to do procedures like an Ophthalmologist would do? Or are you basically expected to read microscope slides 100% of the time?

Thanks for any help! I posted over on the Pathology forum], but let's just say there's some snarky Pathologists over there.

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[Bronze Medal]

Hi everyone,

I'm a rising M3 who is extremely interested in both the fields of Ophtho and Pathology. Ocular Pathology seemed like the perfect marriage. However, there's not a whole lot of information I can find, so I was wondering if anyone could answer some questions.

1. I've heard anecdotally that it is such a small, niche field that it is quite hard to find a job. Is that true? Does it differ if you enter from an Ophthalmology residency compared to a Pathology residency? Is there any difference in compensation depending on which residency you enter from?

2. Are you viewed by your peers as an Ophthalmologist or a Pathologist?

3. If you enter Ocular Path after doing an Ophtho residency, are you still able to do generally able to do procedures like an Ophthalmologist would do? Or are you basically expected to read microscope slides 100% of the time?

Thanks for any help! I posted over on the Pathology forum], but let's just say there's some snarky Pathologists over there.

1) Yes, this is probably true and you will have to find an academic job. However, from a prestige/reputation/education perspective I think there are many departments that would find it attractive to have an ocular pathologist on faculty. However, it is unlikely that you will be busy enough to do purely ocular pathology.

2) I think this depends on whether your practice is completely pathology or partially clinical ophthalmology.

3) I know of an ocular pathologist who still does comprehensive ophthalmology and cataract surgery at an academic center. So it’s possible.

 

[salami bahama]

Unless you're the next Ralph Eagle, it will be difficult to practice full-time ophthalmic pathology. I do think you would be able to get a job at an academic center as most centers do not have an ophthalmic pathology trained specialist. Probably most larger metropolitan areas can really only support one ophthalmic pathologist would be my semi-educated guess. I agree with the above that the next important decision for you to make is whether you would rather do full-time pathology (and be in a position to receive all the eye specimens) or do part-time ophthalmology. I would encourage you to pursue ophthalmic pathology as we definitely need good ocular pathologists, but my personal experience would say that very, very few ophthalmology residents are interested in pursuing ophthalmic pathology. SF Match is the match system that ophthalmology residencies use and most fellowships to match applicants to programs. I looked at the SF Match data, and it only listed one position available in 2018 and 2019. I'm assuming this means that the list of programs you'll find below accept people outside of the match? You could reach out to them and see if they only take ophthalmology trained residents vs pathology trained, how their selection process works, and if they even have a trainee every year. I wouldn't be surprised if those programs didn't all fill each year (my [again, semi-educated] guess is only 1-5 ophthalmology residents max are going into path each year across the country).

This article below may be helpful. It has some details about how to become an ophthalmic pathologist from either the pathology side or the ophthalmology side:

Selective Pathology Fellowships: Diverse, Innovative, and Valuable Subspecialty Training | Archives of Pathology & Laboratory Medicine

www.archivesofpathology.org

These two sites have lists of where you could do your training:

Fellowship Training « AAOOP

Programs in Compliance | Association of University Professors of Ophthalmology Fellowship Compliance Committee (click ophthalmic pathology)

If you do pursue an ophthalmology residency, please know that ophthalmic pathology is a very, very small part of the residency. The microscopes you spend the most time with will be the slit lamp in clinic or the scope in the OR, not a pathology microscope. Ophthalmology is competitive, so it can be difficult to guarantee where you'll match, but it'd obviously be nice to match at a program with an ophthalmic pathologist that residents can rotate with (usually a small part of the residency, maybe a couple weeks in total). So if you choose the ophthalmology route, I would hope you enjoy seeing patients and doing surgery.

I'd recommend doing electives in both ophthalmology and pathology to get a feel for both. I'd try and get connected to an ophthalmic pathologist to see what it's really like. The average ophthalmology attending/resident may not know a lot about the specifics.

 

[Fascia Lata]

So Dr. Sander Dubovy at Bascom Palmer completed both ophthalmology and pathology full residencies, as well as fellowships in ophthalmic pathology and medical retina. My understanding (I could be wrong) is that the reason he did a full pathology residency is that as a pathologist with pathology residency training you can bill more for your service/time? - not sure.

I think ophthalmic pathology is fascinating. I know a few who completed the fellowship but who also practiced some other form of ophthalmology sub-specialty (rather than comprehensive ophthalmology) - mainly ophthalmic oncology (more relevant) and oculoplastics (can be relevant).

Contrary to the prevailing discouraging tone in the thread you posted in the pathology forum, I think you can make a successful and relatively lucrative career out of ophthalmic pathology IF you combine it with something else, be it general path or some ophthalmology subspecialty. It just comes down to whether you like patient interaction in ophthalmology, enjoy a particular subspecialty in ophthalmology that is relevant to ocular path, and can withstand a residency of mostly irrelevant content (as an ophthalmology resident you will be seeing patients who have infections, dry eyes, cataracts, glaucoma, retinal disease...etc - conditions that would require treatment by medications, laser, or surgery, and most of which have little relevance to ocular path). If you don’t think you would like the bread and butter of ophthalmology, a path residency will probably be more suited.