Rads vs. Path

[caedmon]

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I am an MS III struggling trying to decide which way to go. Rads or Path. I was hoping you guys could comment on some on some of my thoughts or just help out. When I tell people these are two fields I'm interested in they're like, "those are totally different" but in my opinion they are very similar.

1. Both are diagnostically oriented
2. Both are critical to a patient's management
3. Both are visually oriented to some extent (Rads > Path)
4. Both have good lifestyle

And of course there are some major differences.

Dark room vs. lab
reading films vs. lab type work etc. etc. etc

Again, I am only MS III and haven't had much experience in either, but of course time to declare has come and gone without rotations in either. I've tried to take the initiative to look at any films or path specimens and discuss results with the docs whenever possible. From this limited experience, I think I'd be very happy in either field. I'd appreciate any added thoughts, comments, or persuasion.

Oh yeah, rumor of rads outsourcing also scares me a little.

Thanks in advance

 

[augmel]

Hi,
I'm only a MSIII as well but I have done a rotation in Path. The impression I got was that rads is more fun if you are clinically inclined and like talking to other clinicians. Path seems to be more about dx of ever more obscure tumors and focus on basic science. Autopsy seemed pretty clinical but I was surprised by how the rest of what the pathologist does seems so separate from what is going on in the rest of the hospital. I'm sure others will disagree but that is the impression I got.

 

[Brian Pavlovitz]

I bet some of our more seasoned visitors would be able to help out more, but I'll give you my impressions.

I can't speak for Radiology, but the Pathologists that I used to work with were always talking about cases with fellow clinicians (regarding staging, modes of treatment, etc.). In fact, there were many instances where a group of them (a few residents and the attending) would be at the multi-head scope with the Pathologist showing the case. It seems that there is a lot of "teaching" that goes on in Pathology. I would assume this would depend on the laboratory (hospital vs. private lab).

Hope this helps a little--anyone else with thoughts?

Good luck to you!

--Brian

 

[yaah]

I am not a huge fan of radiology, but I can see why it is attractive for some. I actually have an MS IV sister (we're not twins, though) who will be going into this. Both specialties include procedures, if that is important. Pathologists do FNA, Bone marrow bx, and some clinical path issues. Radiologists are gaining an increasing amount of procedures as technology improves. A lot of surgeries are being replaced by radiologic procedures, and radiologists are actually doing many procedures once done mostly by others (chest tubes, Central lines, LPs, etc). My problem with radiology is that you don't always make an accurate diagnosis. The most accurate scans can suggest diagnoses, but you usually still need tissue. It depends on where you are more fascinated - do you want to see the possibilities of a lung infiltrate, or do you want to know what it is?

The fields are similar superficially only. I think a good multi-disciplinary hospital conference will demonstrate a lot of truths about what fields are like.
(1)Medcine presents the patient, describes the history, presents the differential diagnosis, etc.
(2)Radiology provides information on what this is likely to be and likely not to be.
(3) Medicine continues to refine diagnosis possibilities, consults others, tries various treatments.
(4) Surgery maybe gets involved and cuts something out, or someone else does a biopsy
(5) Pathology tells you what exactly the diagnosis is, what the history of this disease is, other features.
(6) Treatment is further defined
(7) Either the patient lives and things end, or the patient dies and pathology decides the ultimate cause of death and course of disease.

So I look at these conferences, and where do I want to be? I certainly don't want to be the surgeon. I like what the medicine person does. I enjoy meeting the patient, deciding on which tests to order, deciphering the clinical history, and making my differential. But I don't like the fact that I am dependent on so many others. The radiologist's job is interesting but hasn't decided much. I want to be the pathologist. Knowing all of these different possibilities and being able to decide which of them is the most correct. I miss the fact that I can't form a relationship with the patient and follow their whole course, but like that I can see what is going on at a cellular level, or even a smaller level.

Pathologists do have lots of contact with clinicians, and they do a lot of teaching around the hospital, as well as being responsible for a large portion of med school teaching, whicn radiologists aren't really involved in unless they have a special area of expertise. Clinical pathologists run the labs, establish new tests, guidelines, and also make difficult diagnoses when it comes to transfusion issues, chemistry, micro, cytogenetic, and hematology.

The roles of each will become more defined as the years go on and imaging becomes more accurate and diagnosis at the molecular level becomes more important. Lifestyle I guess is similar, but if you want to be a good radiologist or pathologist, you will have to work hard.

 

[governaitor]

Puhhhlllleassssseeeee,

Path is a million times more important and interesting than radiology.

You didn't just take a year long course in radiology in med school did ya?

Radiologists can't really diagnose anything. Even stupid surgical stuff like appendicitis. A radioligist can call it appendicitis, but a pathologist will tell you exactly what it is whether regular old fecalith appendicitis or strange infection or malignancy.

 

[bucasiabeach]

Actually, I had planned to do Radiology, but when I did my transitional year, I had really bad role models in Radiology. They sat around and hedged on everything.

Well..... if you think it may be this get a bone scan, etc........

I could'nt stand it any longer by the end of my internship. Pathologists were far better role models, better engaged and integrated with the clinical teams and far more interesting. It was always interesting during a medicine rotation to go down to path and look at some unexpected finding on pleural effusion, etc....

If you graduate from an accredited residency program not on probation, and study hard, then you will get a job. Every field moves in cyclical nature, so it would be foolish to not enter a field, because the outlook will be different by the time you finish training including fellowship in 5-6 years. Look at Anesthesia for example. Path is a good field, however if the trainee is not good or devoted then he will not get a job.

 

[caedmon]

Thanks for the input everyone.

Yaah, once again you provide great insight, much appreciated.

Bucasiabeach, your viewpoint and experience is very helpful.

Any additional input is always welcome.

 

[Goober]

Originally posted by yaah

The fields are similar superficially only. I think a good multi-disciplinary hospital conference will demonstrate a lot of truths about what fields are like.
(1)Medcine presents the patient, describes the history, presents the differential diagnosis, etc.
(2)Radiology provides information on what this is likely to be and likely not to be.
(3) Medicine continues to refine diagnosis possibilities, consults others, tries various treatments.
(4) Surgery maybe gets involved and cuts something out, or someone else does a biopsy
(5) Pathology tells you what exactly the diagnosis is, what the history of this disease is, other features.
(6) Treatment is further defined
(7) Either the patient lives and things end, or the patient dies and pathology decides the ultimate cause of death and course of disease.

So I look at these conferences, and where do I want to be? I certainly don't want to be the surgeon. I like what the medicine person does. I enjoy meeting the patient, deciding on which tests to order, deciphering the clinical history, and making my differential. But I don't like the fact that I am dependent on so many others. The radiologist's job is interesting but hasn't decided much. I want to be the pathologist. Knowing all of these different possibilities and being able to decide which of them is the most correct. I miss the fact that I can't form a relationship with the patient and follow their whole course, but like that I can see what is going on at a cellular level, or even a smaller level.

Pathologists do have lots of contact with clinicians, and they do a lot of teaching around the hospital, as well as being responsible for a large portion of med school teaching, whicn radiologists aren't really involved in unless they have a special area of expertise. Clinical pathologists run the labs, establish new tests, guidelines, and also make difficult diagnoses when it comes to transfusion issues, chemistry, micro, cytogenetic, and hematology.

The roles of each will become more defined as the years go on and imaging becomes more accurate and diagnosis at the molecular level becomes more important. Lifestyle I guess is similar, but if you want to be a good radiologist or pathologist, you will have to work hard.

Interesting perspective but I would clarify some of your points.

1. First not all patients that come to a hospital end up going to biopsy. In fact I would say it is a minority. All patients have radiology done on them in a hospital. Pathology is not always the final answer 😛 BTW if you have seen some of path reports I get back, pathologists hedge too. Nothing in medicine is always clear cut.

2. Radiologists have constant interactions with clinicians. I would say I talk to a clinician at least a dozen times a day to go over scans. Radiologists also have a fair amount patient interactions- tons of GI, interventional, imaged guided biopsies of all types. The interactions are short and you don't develop and relationship with a patient, but some of us consider that a bonus.

3. Lifestyles- radiology unfortunately is much more demanding. ER utilization of imaging has exploded. Everybody who walks though the door gets scanned it seems. 15-20 years ago you would get a few calls at night. Now if you even at just a moderately busy ER you won't get any sleep. The flipside is that the compensation for rads is much higher than path probably on the order of twice as much.

 

[yaah]

You're right of course, it is only the minority of patients that receive a biopsy - biopsies have to be justified by demonstrating that it will alter treatment or provide information that can't be gathered anywhere else. But there are lots of other tests - cytogenetics, hematology, chemistry,etc.

And you are right about pathologists hedging, it certainly does happen, but it isn't as common. You try making a diagnosis on the transbronchial biopsy that contains 5 viable cells! 😉. Since biopsy/surgery is not done lightly, pressure is on to make a diagnosis. Very few biopsies fit the textbook definition of what a disease should look like, either because treatments have already been done and transformed the cellular image of it, or it is at such an early stage that the changes seen are unclear.

I also wonder about this explosion of # of radiologic tests done - it's only going to become even more common, probably. Eventually there may even be scans that you pass through on your way into the hospital, who knows. Scans are also relatively painless and non-intrusive. But they still often raise more questions than they answer (unexpected findings, burden of disease not equal to symptoms).

I wanted to do a radiology elective during 4th year, but the way UMass' requirements work, radiology is not considered an elective with enough "direct patient contact or care" and thus I would not have gotten credit. I did an away path elective and another at UMass that I couldn't pass up, so the rest of my electives had to be consult services (I am really sick of consult services) and the like.

Thus, my impressions of radiology include:
1) Getting yelled at for trying to order a chest CT at 8pm
2) Listening to or reading reports that too often included "could represent atelectasis or possible infiltrate, malignancy cannot be excluded."
3) Having trouble with a chest film, and going to a radiologist and having them take me through it and explain what we were seeing
4) Having the radiologists be very nice and doing a couple of procedures (PICC lines, thoracentesis, etc) on difficult patients.

You're right, radiologists do often seem overworked and stressed out, I think people going into it for lifestyle might be in for a rude awakening. But then again, picking any field of medicine because of the lifestyle is like picking out which fast food chain serves the healthiest bacon double cheeseburger.

One other thing for the uninitiated - radiology requires a transitional/preliminary year, which pathology does not. BIG edge to path here!

 

[Galaxian]

I'd be interested to hear what radrules has to say about this one...

Anyways, I would be more inclined towards radiology. Looking at slides in that microscopes gives me a headache, and they move it around so much that I get carsick. That aside, there are no rotten odors in radiology, ya got the procedures in interventional, and they've got some pretty trickster technology at their disposal. Both have a great lifestyle and great pay, so you're a winner no matter what! Great choices...

 

[GreatPumpkin]

It has been my observation that as rads becomes more and more interventional, there are more and more surgical types going into it. That is not bad really, just that generally these folks are more uptight and type A++. So the calm laid back specialty that once was rads, may in fact become much more surgical like. Some thrive in that atmosphere, not I. This observation could just be happening in my hospital, but I doubt it.


I don't think path will ever have the pay that rads is seeing right now, but it is not doing bad. We only had one person leaving who was looking for private practice this coming year and she did not have much trouble getting an incredible job. She was a cyto fellow to which helped. The other person leaving is going academics and has multiple offers, but he has not decided which to take yet.

Rads and path have alot in common. Both are great choices. I would suggest just doing a few rotations in each and figuring out which you like the most.

Don't forget that path also generally includes the Clinical Path part as well, which is vastly different from rads or surgical path. I would make sure you at least can tolerate that part of path if you plan to do private practice.

 

[yaah]

Wow, radiology gives me the headache. But I can understand the arguments for wanting to be a radiologist. Go for it if you want, as long as you're not doing it for the money or the hours. Like I said, my sister wants to be a radiologist. It's a great field, just not for me. Neither one is "better" in general. Make sure you research it and find out what you're getting into, no matter what it is.

I know a few type A pathologists. Yikes. Put a type A pathologist and a type B pathologist on opposite sides of a two-headed scope, you've got some real entertainment. Particularly if there is a partial language barrier.

And let the type B person drive the scope.

 

[Whisker Barrel Cortex]

I think its really unfair how many people complain about radiologist's hedging. People expect that radiologic imaging can make a diagnosis in every case. Unfortunately it can't. The reason for the pneumonia or malignancy comment is that bronchoalveolar pneumonia looks EXACTLY like pneumonia. With our limited clinical history, we can't tell what it is.
Many things can look alike on imaging.

That being said, we also make many diagnoses that pathologists don't get to see. That is because we have determined that a finding is benign and needs no further work up. It happens many many times in radiology. Not a single abdominal CT I read all of last month was completely normal, yet only 20% had actual pathology.

 

[yaah]

Here you go folks here is the old thread with even more arguments.

See also:
http://forums.studentdoctor.net/showthread.php?t=103148

Now we can have two different threads active at the same time with the same title.

Cue the music!!!!!!!