Radiology vs. Pathology

[NoSurgeon]

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I am a first-year med student trying to decide whether to do summer research in diagnostic radiology or in pathology (these are the specialties that have been suggested to me by doctors who know me). I had been thinking of this summer as a nice way to investigate a specialty, until I talked to a radiologist at my school a few days ago. He told me that his field was very competitive, and that if I wanted to match I would definitely need to do research in the rad department.

So now I'm trying to decide which specialty I'm more likely to like. I know I'm not going to pick my profession as an MS-1, but in light of the above conversation it seems prudent to give this some thought. There seem to be some obvious similarities: emphasis on visual analysis, relatively little patient contact (which I probably prefer), decent lifestyle compared to some other specialties.

But beyond the basics, I'm pretty uncertain, and the doctors I know disagree. The one pathologist I know claims that pathology is more intellectual than radiology, because pathologists have to identify problems more specifically than radiologists do (radiologists, according to the pathologist, merely have to say that there is or is not a problem). He also says that radiology is threatened by teleradiology and self-referal, and that radiologists "can't see the writing on the wall." He says that if I want to do neuroradiology I should go into neurology and read my own MRIs.

The two radiologists I know say that path is for people who couldn't match in radiology. They say that radiology offers better pay and greater security/autonomy, because pathologists are totally at the mercy of the hospital. Radiologists (according to the radiologists!) can always work for a private imaging center if the hospital starts abusing them. They assure me that they find their work challenging and stimulating.

If you have ideas or opinions about the differences between these fields, I would love to hear anything you have to say. First and foremost, I want to pick a field that I enjoy, and that I will continue to enjoy. Salary and job security are important but secondary.

I don't know if it matters, but in case knowing a little bit about me might be helpful, here is a brief summary. I was a philosophy major in undergrad. I did well (Princeton with honors), but the work was nothing like med school, so it's probably irrelevant. I would consider myself an intellectual, but definitely am not a "gunner," so I don't know how well I'll do on the board exams. In my spare time, which I value, I read fiction and non-fiction, and cook.

Sincere thanks for taking the time to read this.






I saw the angel in the marble and carved until I set him free. -- Michelangelo

 

[poutsara]

first of all, pick the research environment where you will be most productive in (yield most data, abstract(s), paper(s)). if both opportunites are equal, then i'd go with the radiology research because it is harder to get into rads so it can only help.

 

[radrad]

Radiology and pathology are both excellent fields, for the right person. I suggest you give both fields a try. For the purpose of career decision-making, you don't need a long elective, but you need a clinical elective that lets you participate rather than just observe. For radiology this means simulating the resident experience the best you can. I suggest you find someone who will let you read films on your own while looking things up in a radiology book, come up with a differential diagnosis on your own (and no problem if it is usually/always completely wrong), then discuss the case with a resident/staff radiologist. If you take your time and learn as you work through a small number of cases, a resident/staff radiologist should be happy to talk about the cases with you. See if you can join a resident on-call, even just for an hour. These experiences will teach you more than looking over someone's shoulder, just observing.

Similarly for pathology, try to read a case on your own while using a reference text before the staff/resident runs through it with you.

In terms of research, pathology and radiology are so closely related that I think strong research in either area is beneficial for application to both fields. You could certainly find someone who is doing a study that includes both radiologists and pathologists. I agree with the previous poster that once you are taking the time to do some research, you should have it published, and present it at your school, and present it at a professional meeting.

If you truly try a variety of specialties, your decision will not be difficult.

 

[NoSurgeon]

Thank you both for your helpful replies. I haven't talked to pathology yet. The radiologist I talked to said the most likely project would be for me to write up a case report or two (to be submitted for publication). What do you think about this?

 

[Docxter]

I am a first-year med student trying to decide whether to do summer research in diagnostic radiology or in pathology (these are the specialties that have been suggested to me by doctors who know me). I had been thinking of this summer as a nice way to investigate a specialty, until I talked to a radiologist at my school a few days ago. He told me that his field was very competitive, and that if I wanted to match I would definitely need to do research in the rad department.

Yes, radiology is very competitive and research will help your application. Obviously, radiology research will help more than non-radiology research. Is it mandatory? No. But when you're the program director and going over applications and when the majority of the applicants are AOA, have excellent letters, stellar boards scores, many with PhDs, a lot of related extracurricular activities, etc., who do you think he'll give the limited interview spots to? The one with 7 radiology publications/presentations or the one without any?

So now I'm trying to decide which specialty I'm more likely to like. I know I'm not going to pick my profession as an MS-1, but in light of the above conversation it seems prudent to give this some thought. There seem to be some obvious similarities: emphasis on visual analysis, relatively little patient contact (which I probably prefer), decent lifestyle compared to some other specialties.

This is where you're wrong. Pathology and radiology are very very different. Radiology has much more patient contact than you would think. The lifestyles are not comparable either. For radiology, you have to do a clinical internship year, which may be cush, or may be tough. You will take a lot of very tough and intyense nightcall in the hospital in radiology, but not in path. The night call will be very intense, and as far as I have personally experienced and heard from most people who have done tough IM or surgical internships, more intense that an IM or surgery nightcall.

Even after graduation, radiologists work much longer hours. See the official stats: http://forums.studentdoctor.net/showthread.php?t=101722

But beyond the basics, I'm pretty uncertain, and the doctors I know disagree. The one pathologist I know claims that pathology is more intellectual than radiology, because pathologists have to identify problems more specifically than radiologists do (radiologists, according to the pathologist, merely have to say that there is or is not a problem). He also says that radiology is threatened by teleradiology and self-referal, and that radiologists "can't see the writing on the wall." He says that if I want to do neuroradiology I should go into neurology and read my own MRIs.

Your pathologist is totally clueless to say the very least. Don't get advice from him/her about radiology, since you're being misinformed. Only get advice about pathology from him/her.

See my post here: http://forums.studentdoctor.net/showthread.php?t=103421

Radiology has become a major central player in the day to day care of patients. Many times radiologist make a very specific diagnosis and these cases never get to a biopsy. Pathologists are biased with sampling error since they only get the ones that actually make it to biopsy/surgical pathology. The number of specific diagnoses that can be made with imaging continues to increase, decreasing the need for tissue sampling. A good example is in the case of adrenal masses. Imaging can provide a specific diagnosis of adrenal adenoma in the majority of cases, so the biopsy rate has gone significantly down compared to 10-15 years ago. Not that surgical pathology will go away, because it won't, but the trend is towards making specific imaging diagnoses, obviating the need for biopsy. Many imaging findings have differential diagnoses and are not specific enough to allow a noninvasive diagnosis; hence cytology or pathology to the rescue. Pathology can be nonspecific too. Also, pathology is not ALWAYS the final word. Pathologsists are notably inaccurate in diagnosis of certain osseous tumors, some interstitial pneumonitides, and also lower grade chondrosarcomas. We see it all the time in our monthly pulmonary and bone tumor conferences. Even in the breast, pathologists are sometimes inaccurate. Atypical ductal hyperplasia is treated like cancer, because it is a well-known fact that pathologists miss DCIS in these cases in up to 30% of cases. Biopsy an area of healing fracture, and many pathologists will call it an osteosarcoma. What are you going to do? Listen to the pathologist and amputate the leg? No, you correlate it with the patient's other info. There are many more examples that I can give that pathology is NOT the final word.

The two radiologists I know say that path is for people who couldn't match in radiology. They say that radiology offers better pay and greater security/autonomy, because pathologists are totally at the mercy of the hospital. Radiologists (according to the radiologists!) can always work for a private imaging center if the hospital starts abusing them. They assure me that they find their work challenging and stimulating.

They are wrong about the first part. Most pathologists go into pathology because they like it. They are right about the very stimulating and challenging work in radiology.

I don't know if it matters, but in case knowing a little bit about me might be helpful, here is a brief summary. I was a philosophy major in undergrad. I did well (Princeton with honors), but the work was nothing like med school, so it's probably irrelevant. I would consider myself an intellectual, but definitely am not a "gunner," so I don't know how well I'll do on the board exams. In my spare time, which I value, I read fiction and non-fiction, and cook. .

Well, you will have more time for your "hobbies" during your path residency than your radiology residency. After graduation, your free time will depend on what type of job you want to take (private-practice, academic, full-time, part-time, partner, employee).

[/QUOTE]

 

[RADRULES]

Radiology >> every other field of medicine

 

[SoCalRULES!!!!!]

[to the original poster...you would have to be crazy to go into path if you can get into radiology. Community practice radiologists have not problem making 800 K on up. Path is more like 200K. C'mon. Could path be that much more interesting that you would be willing to give up 600K?

 

[NoSurgeon]

"Community practice radiologists have not problem making 800 K on up. Path is more like 200K. C'mon. Could path be that much more interesting that you would be willing to give up 600K?"

Well, I don't know yet. But my question is, do you think the extremely high rad salaries will last? It seems like Medicare just has to declare, "Okay, now we're going to pay you a lot less than we've been paying," the private insurance companies will quickly follow, and that will be that.

 

[Docxter]

"Community practice radiologists have not problem making 800 K on up. Path is more like 200K. C'mon. Could path be that much more interesting that you would be willing to give up 600K?"

Well, I don't know yet. But my question is, do you think the extremely high rad salaries will last? It seems like Medicare just has to declare, "Okay, now we're going to pay you a lot less than we've been paying," the private insurance companies will quickly follow, and that will be that.

Radiology salaries are not actually "extremely high" compared to many other specialties. They are pretty good, but commensurate with many other specialists. The above mentioned 800k is probably in the top 1% of rads income and the vast majority of radiologists can't even dream of such a salary. Take a look here:

http://www.allied-physicians.com/salary-surveys/physicians/

And will the salaries last? Maybe, maybe not. Reimbursement may go down, but it won't be limited to rads.

 

[doc05]

do the rads research. pretty much any US grad can land a top path residency with only average grades, but it takes a lot more to get rads, and research will help.

 

[bigfrank]

Radiology salaries are not actually "extremely high" compared to many other specialties. They are pretty good, but commensurate with many other specialists. The above mentioned 800k is probably in the top 1% of rads income and the vast majority of radiologists can't even dream of such a salary. Take a look here:

http://www.allied-physicians.com/salary-surveys/physicians/

And will the salaries last? Maybe, maybe not. Reimbursement may go down, but it won't be limited to rads.

I'd certainly take self-reported salary surveys with a grain of salt. I have heard (which you can also take with a grain of salt) that many of the traditionally higher-paying specialties, especially Plastics, Derm, and Rads, tend to UNDERreport actual salaries, for obvious reasons (reimbursement issues, etc.).

 

[SoCalRULES!!!!!]

^ That's for sure.

My friend's mom is pulling a 1/2 million working 3 days a week. One of our family friends is an attending and she gets letters from all over random spots in the country promising her 800K to start. Some of the places seem obscure, at least to me, like Virginia or South Dakota. She has shown us one of the letters when we have been to her house as it came that day. I have no idea what she makes in academics as typically it is much lower but she wouldn't leave LA and the laid back academic career suits her fine with raising kids and stuff (plus her husband is a very successful entertainment lawyer which obviates the need for a high salary).

 

[azcomdiddy]

^ That's for sure.

My friend's mom is pulling a 1/2 million working 3 days a week. One of our family friends is an attending and she gets letters from all over random spots in the country promising her 800K to start. Some of the places seem obscure, at least to me, like Virginia or South Dakota. She has shown us one of the letters when we have been to her house as it came that day. I have no idea what she makes in academics as typically it is much lower but she wouldn't leave LA and the laid back academic career suits her fine with raising kids and stuff (plus her husband is a very successful entertainment lawyer which obviates the need for a high salary).

You can't make half a million a year in radiology working in Phoenix let alone the much more saturated and managed care crazy SO CAL. I'm calling b.s. on that. Besides, you seem to exaggerate and provide misleading information in nearly all of your posts so I wouldn't be suprised if your friend's mom is pull closer to 200K working 3 days per week.

 

[Docxter]

I'd certainly take self-reported salary surveys with a grain of salt. I have heard (which you can also take with a grain of salt) that many of the traditionally higher-paying specialties, especially Plastics, Derm, and Rads, tend to UNDERreport actual salaries, for obvious reasons (reimbursement issues, etc.).

I do take what you say with a "large" grain of salt. While I do agree that salaries may be underreported, I don't see a networked conspiracy that all members of a certain specialty underreport their salaries while other specialties don't, as you purport that you "have heard". In the grand scheme of things and in big numbers, the reported salaries will be relatively accurate with respect to each other, even though they may all be somewhat undereported. The sum of information in a couple of salary surveys is the closest you will come to the reality and the one I referenced does match the info me and my resident colleagues have gathered and experienced in looking for radiology jobs.

 

[bigfrank]

The sum of information in a couple of salary surveys is the closest you will come to the reality and the one I referenced does match the info me and my resident colleagues have gathered and experienced in looking for radiology jobs.

This may be true. I am speaking to residents who prefer to go to less urban areas, and even some RURAL areas. Their salary offers have been astronomical by any standard.

Are the jobs to which you are referring in more metropolitan areas?

Thanks Docxter.

 

[novacek88]

This may be true. I am speaking to residents who prefer to go to less urban areas, and even some RURAL areas. Their salary offers have been astronomical by any standard.

Are the jobs to which you are referring in more metropolitan areas?

Thanks Docxter.

If you are basing income potential based on less urban and rural areas then of course they are going to be higher than what is reported in a salary survey. Internists in rural areas can make 500-700K as they perform stress tests and colonoscopies which would be handled by a cardiologist and a GI doc in a metropolitan area. It's no secret that these less dense areas are hurting for specialists which is why they will pay these astronomical salaries. This is why these rural hospitals will pay thousands of dollars in recruitment fees to find them a physician who wil be willing to come to the area. It's supply and demand. Rural areas are not paying outrageous salaries out of charity. There is a HUGE tradeoff with practicing in these areas which is why these places have a tough time recruiting physicians in the first place. It's usually these rural and less urban areas that are forced to employing headhunters to fll their positions. Others will disagree with me and that is certainly their right. I'm not going to bash small town life because it has it's merits [all 800K merits 🙂] But just realize that radiologists are not the only ones who experience a far greater income potential in rural and less urban areas. Every field is going to experience a surge in income potential in these areas.

Anyway, I think if you are content with living in a less dense area, then you are really lucky because you will be paid quite well to live in your desired setting. 👍

 

[bigfrank]

Anyway, I think if you are content with living in a less dense area, then you are really lucky because you will be paid quite well to live in your desired setting. 👍

That's the plan! Thank you very much for your answer.

 

[novacek88]

That's the plan! Thank you very much for your answer.

Based on your posts in the past, you seem like a pretty sharp guy so I can see you doing quite well. Good luck my man