rural general path

[pathologic]

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Members do not see this ad.

I am interested in looking for employment with AP/CP training and no fellowship. My long term goal is small town general pathology. Is it possible in todays job market to find a job straight out of residency? I would be willing to go to an under served area even an Indian Reservation to gain real world experience. How can i go about looking for opportunities right out of residency?

 

[2121115]

Hard to do but it can be done. Need real connections and good timing.

 

[BamaAlum]

It can definitely be done. I am starting July 1st with no fellowship in a "rural" practice (community with a population of 45,000, 1 hour away from metro area with 2 million +) that covers 9 community hospitals with about 22,000 surgicals. I do have the aforementioned "connections," as a family member of mine is the sole owner of the practice. However, another guy without fellowship training is joining at the same time as I am with very little connection to the practice.

It is increasingly difficult to do this and some would say a little risky as a fellowship would ultimately make you more marketable if you were to change jobs in the future. You have to find a unique situation. In my case the practice is in the middle of massive retirement and all of the senior pathologists are leaving practically at the same time. I would recommend having a backup fellowship plan if it doesn't work out. Even I had one and I had a job waiting for me from day one.

 

[levels x3]

I took a job immediately post residency as well without a fellowship. 5 person group, suburban area of perhaps 250,000 population. While not a family connection like BamaAlum, I had a connection in the sense that I rotated with this group as a medical student. I also grew up in the town and so was seen as a sort of "native son done well coming back to town". As much as it pains me to say so, and it's a real indictment of our profession and its job market, I don't know that it's possible to do this without some sort of "connection". If you can make it work, though, it's highly preferable to a surg. path. fellowship...which is a complete waste of time (I know someone is going to argue this point, but I don't care). Unless you're doing the equivalent of soft tissue with Weiss or GI with Odze; do something boarded...

However, if I had to do it all over again, I'm not sure I would do the same thing. While it's working out well for me so far, I sometimes wonder if it would be good to have something else in my back pocket. Think about what else you like within AP/CP. For me, that would be TMS. I would be very happy if I only did BB/TMS for the rest of my career. So I'm gradually working my way into that area within my group (with some heme/coag thrown in), but I wonder sometimes if I should have spent one extra year doing that fellowship. Think not just about your first job, but what you might do for a second. Experience is good...but board certification helps too.

 

[Art]

It can definitely be done. I am starting July 1st with no fellowship in a "rural" practice (community with a population of 45,000, 1 hour away from metro area with 2 million +) that covers 9 community hospitals with about 22,000 surgicals. I do have the aforementioned "connections," as a family member of mine is the sole owner of the practice. However, another guy without fellowship training is joining at the same time as I am with very little connection to the practice.

It is increasingly difficult to do this and some would say a little risky as a fellowship would ultimately make you more marketable if you were to change jobs in the future. You have to find a unique situation. In my case the practice is in the middle of massive retirement and all of the senior pathologists are leaving practically at the same time. I would recommend having a backup fellowship plan if it doesn't work out. Even I had one and I had a job waiting for me from day one.

Interesting that this group is in the middle of massive retirement. Will there be multiple jobs opening up within the next few months? How would a young, hard-working pathology fellow find out about these positions?

 

[2121115]

It can definitely be done. I am starting July 1st with no fellowship in a "rural" practice (community with a population of 45,000, 1 hour away from metro area with 2 million +) that covers 9 community hospitals with about 22,000 surgicals. I do have the aforementioned "connections," as a family member of mine is the sole owner of the practice.

Nice. I am SO jealous right now. 👍

 

[dwil75]

Interesting that this group is in the middle of massive retirement. Will there be multiple jobs opening up within the next few months? How would a young, hard-working pathology fellow find out about these positions?

👍 Agreed. Care to PM? We are also interested in rural. Husband is from a tiny town (3000) and wants to live and practice in the country. We're finding it a tough road without connections, however.

To the OP - agree with everything written. Connections would be the way to go, perhaps with a touch (or more) of luck. I hope it works out for you.

 

[pathstudent]

It can definitely be done. I am starting July 1st with no fellowship in a "rural" practice (community with a population of 45,000, 1 hour away from metro area with 2 million +) that covers 9 community hospitals with about 22,000 surgicals. I do have the aforementioned "connections," as a family member of mine is the sole owner of the practice. However, another guy without fellowship training is joining at the same time as I am with very little connection to the practice.

It is increasingly difficult to do this and some would say a little risky as a fellowship would ultimately make you more marketable if you were to change jobs in the future. You have to find a unique situation. In my case the practice is in the middle of massive retirement and all of the senior pathologists are leaving practically at the same time. I would recommend having a backup fellowship plan if it doesn't work out. Even I had one and I had a job waiting for me from day one.

That's awesome. The scenario where the partners own the group is increaingly rare. It is particularly awesome that your father owns the group by hisself I have read that the going rate for app or ameripath buying groups is 4x annual revenue. I bet he could sell the practice for 12-20 million. That's awesome that he hasn't. Maybe it has something to do with being rural. In any case it would be awesome if he just gave/sold the group to you when he is ready to retire. You are very lucky.

 

[path24]

7 YEARS POST RESIDENCY EXPERIENCE!!!!!!!!!

Rural Wyoming!! Only in pathology will you see an ad like this! Rural areas are begging for every kind of doctor, but of course pathologists. You just got to find something to do 7 years prior and this one is all yours.

AP/CP BOARD CERTIFIED PATHOLOGIST TO JOIN A SOLO RURAL PRACTICE IN THIS BEAUTIFUL MOUNTAIN COMMUNITY.
St. Johns Hospital is a 48 bed hospital with a CAP accredited laboratory. The hospital is staffed by knowledgeable physicians, has a progressive minded administration, and a sophisticated community. The pathologist should strive to provide the range of anatomic pathology services needed by the community. Candidates should have 7 YEARS POST RESIDENCY EXPERIENCE in an appropriate setting, and feel confident practicing alone. Diagnostic material includes needle core biopsies, FNA, and performance of bone marrow biopsy.

 

[lipomas]

I think every thread should come complete with its own generic and uninformative path24 comment about how the job market sucks, so that path24 no longer needs to log into the site to read messages. It could be a sort-of disclaimer. Every thread after it is started will automatically be assigned a reply post, on a rotating system to keep things reasonably fresh. All we would really need is four posts:

1) The job market sucks! Do we need more proof?
2) This is more evidence why people should avoid pathology as a career.
3) 50 job applicants for a mediocre job? This would never happen in another field!
4) This thread is unrelated to the job market at all but we should talk about the job market because it sucks.

I think this is a good proposal.

 

[levels x3]

I wouldn't want to practice alone with less than that amount of experience, nor would I want to hire someone for that kind of job with less than that.

Frankly I would never work without a partner...ever.

This is probably a 60 year-old pathologist who is finally deciding to "slow down" and so is looking for someone to cover during the soon to be 6 months of vacation he takes every year. Of course they're not going to be looking for someone fresh out of training. This isn't evidence of a poor job market. It's evidence of hospital administration and a pathologist being smart about wanting someone with an appropriate level of experience.

 

[Parts Unknown]

I wouldn't want to practice alone with less than that amount of experience, nor would I want to hire someone for that kind of job with less than that.

Frankly I would never work without a partner...ever.

This is probably a 60 year-old pathologist who is finally deciding to "slow down" and so is looking for someone to cover during the soon to be 6 months of vacation he takes every year. Of course they're not going to be looking for someone fresh out of training. This isn't evidence of a poor job market. It's evidence of hospital administration and a pathologist being smart about wanting someone with an appropriate level of experience.

My thoughts exactly. 👍

 

[deleted314957]

I agree completely with levelsx3. I am an "older" solo medical director pathologist in a suburban 170 bed community hospital and I guarantee you that someone fresh out a residency or fellowship could not do my job to the level that 30+ years experience has given me professionally or administratively.

 

[2121115]

I guarantee you that someone fresh out a residency or fellowship could not do my job to the level that 30+ years experience has given me professionally or administratively.

Of course that is true for any job.

 

[deleted314957]

I should refine my comment- I overstated the obvious.

Someone fresh out of residency COULD NOT do my job adequately solo. They would be fine with a more seasoned partner assuming they have the 3 "A's" of pathology---Affability, Availibility and Ability.

 

[macrocyte]

Unless you're doing the equivalent of soft tissue with Weiss or GI with Odze; do something boarded...

I have to disagree with this statement (in terms of private practice). Boarded vs non-boarded is not important. It's all about the area of training. If the subspecialty is boarded then of course you need the certificated. IMO non-boarded GI or GU at any academic center would be more marketable than a heme or cyto fellowship performed anywhere. At the same time soft tissue with Weiss would not be as marketable as a boarded hemepath fellowship performed at the smallest most unknown program. Remember if you are AP/CP boarded you can read any biopsy and perform any test that someone with subspeciaty boards.

 

[levels x3]

Macrocyte makes a good point. We would probably agree if we got into it, but I didn't intend to get into a nuanced discussion there. I was really referring to generic general surg. path fellowships at random community programs (that's why I mentioned Weiss and Odze...perhaps Weiss was a poor choice). I stand corrected.

 

[path24]

Couple of thoughts....

Individuals from my program have went solo right after training without any issues that I am aware of. They have been there for years.

Funny how other doctors can practice solo after training but not a pathologist. Administration: Go ahead and operate young newly trained physician, but hold on to that specimen your taking out. We need to make sure its going to a pathologist that has a decade of experience. I guess the specimens are a bigger concern then the patients. Maybe a lot pathology training programs are crap? You can train a surgeon in 5 years, but not a pathologist?

For those looking to go solo after training, apparently you are not good enough according to some posts.

I guess some attendings on here, don't have the confidence, abilities, came from a poor program, or whatever so they can't practice solo. Sad. I can see maybe getting a year or two under your belt and then going for it.

I would say my post is very relevant.....a rural job advertisement that wants 7 years exp, in a thread about getting a rural job right after training.

 

[2121115]

Couple of thoughts....

Individuals from my program have went solo right after training without any issues that I am aware of. They have been there for years.

Funny how other doctors can practice solo after training but not a pathologist. Administration: Go ahead and operate young newly trained physician, but hold on to that specimen your taking out. We need to make sure its going to a pathologist that has a decade of experience. I guess the specimens are a bigger concern then the patients. Maybe a lot pathology training programs are crap? You can train a surgeon in 5 years, but not a pathologist?

For those looking to go solo after training, apparently you are not good enough according to some posts.

I guess some attendings on here, don't have the confidence, abilities, came from a poor program, or whatever so they can't practice solo. Sad. I can see maybe getting a year or two under your belt and then going for it.

I would say my post is very relevant.....a rural job advertisement that wants 7 years exp, in a thread about getting a rural job right after training.

I actually agree with some of this post, although not the inflammatory portion. People can independently operate on patients after 5 years of training but it takes longer to train someone to sign out chronic gastritis? I see that as an indictment of pathology residency training. Pathology training is SO out of touch with the reality of pathology practice, yet every suggestion to address this (CAP white paper, etc) advocates stuff like doing more autopsies (WTF?).

 

[JPR22]

Perhaps extending residency another year (or more) might better prepare residents so they could practice independently. That being said, one unqualified solo pathologist could cause alot of harm.

 

[2121115]

That being said, one unqualified solo pathologist could cause alot of harm.

This can be said for any physician though.

 

[Ruination]

I actually agree with some of this post, although not the inflammatory portion. People can independently operate on patients after 5 years of training but it takes longer to train someone to sign out chronic gastritis? I see that as an indictment of pathology residency training. Pathology training is SO out of touch with the reality of pathology practice, yet every suggestion to address this (CAP white paper, etc) advocates stuff like doing more autopsies (WTF?).

I agree. I think the biggest issue with pathology training is the lack of autonomy. Medicine and surgery residents probably make more autonomous and immediately important decisions during their intern year than most of us do in 4 yrs of AP/CP-- this is what makes them ready to go and practice fairly comfortably right after residency. Meanwhile, the only shot I have at looking at frozens and having the responsibility of signing them out is during my fellowship year? Something is amiss.

 

[levels x3]

I agree. I think the biggest issue with pathology training is the lack of autonomy. Medicine and surgery residents probably make more autonomous and immediately important decisions during their intern year than most of us do in 4 yrs of AP/CP-- this is what makes them ready to go and practice fairly comfortably right after residency. Meanwhile, the only shot I have at looking at frozens and having the responsibility of signing them out is during my fellowship year? Something is amiss.

This is the key point, aside from grossing and the occasional late night transfusion reaction, there is no autonomy. There is very little in a pathology residency that really prepares you for day to day sign out in a busy practice. It's not just the lack of autonomy either. Why are senior pathologists (generally) faster and more efficient? It's not because they're smarter and just "better". It's because they've seen everything a thousand times before. Scope time is amazingly important. An AP/CP resident spends more than a third of a 4-year residency away from the scope doing things like Chemistry and Micro. So yes, I completely agree with the sentiment expressed by many above that pathology residency doesn't do a great job preparing us to practice on our own. How to make residency better (drastically cut CP training) is another thread.

I would never argue that one can't go out and practice at all after a 4-year AP/CP residency. I did it and it's going fine. But I joined a group of senior partners that could help me make that transition from resident to fully independant pathologist. However, I don't care who you are or where you trained, a 4-year AP/CP residency (in my opinion) is inadequate preparation to practice "solo".

 

[dwil75]

I would say my post is very relevant.....a rural job advertisement that wants 7 years exp, in a thread about getting a rural job right after training.

I would say the proof would be in the pudding here...
How quickly will this job fill? Better yet - how many applicants will it get?

(I comment because we actually looked at this ad with hope when it came up- then sadly noted the solo factor/experience requirement - some of us 😳 would actually prefer to live in places like WY, although path24 has a point - not many would.)

 

[lipomas]

I would love to live in Wyoming. But I would not love to be in a solo practice. Personally I wouldn't want to be in a group with three or fewer. These groups can be prime targets for takeover but mainly it's because you're starting to get spread very thin. And people have to go on vacation! I would get very irritated if I was in solo practice at trying to find a competent locums coverage every time I wanted time off.

 

[Ruination]

I would love to live in Wyoming. But I would not love to be in a solo practice. Personally I wouldn't want to be in a group with three or fewer. These groups can be prime targets for takeover but mainly it's because you're starting to get spread very thin. And people have to go on vacation! I would get very irritated if I was in solo practice at trying to find a competent locums coverage every time I wanted time off.

I've met one pathologist (25+ years experience) who is in a solo practice, semi-rural area, who hires locums for a couple months/year so she can take vacation. She uses this one person exclusively.

 

[deschutes]

Added a post for a rural GP position in southern B.C. in the Open Positions 2010 thread. Cross-linking here.

http://forums.studentdoctor.net/showpost.php?p=9605168&postcount=20

 

[path24]

Rural town with 7+ years exp. pathology job lasted about a month and a half on the CAP site.....the strong pathology job market continues.

Pathologists will eventually just be "overglorified lab techs".

 

[Autopsy101]

It is possible to get a position straight out of residency. I was so lucky to be offered that. It is helpful to know the people who practice in the area where you want to work as early as possible in your training. The groups must also know that you are very flexible and willing to cover whatever lab or specimens that everyone else hates. The more you can take the angle that you are helpful to the group and willing to take on something to make their job more enjoyable, the better off you will be. However, it is good to look at the credentials of everyone in the group. In my situation, I am the only young pathologist without a fellowship, and sometimes I feel that I am not as respected or valued in my position as the others. This treatment comes from both the other pathologists as well as surgeons and oncologists that I work with. I sometimes wish that I had completed a fellowship and consider applying for one when I have an especially bad day. But I have great job satisfaction working with my residents and wouldn't trade my job for anything in spite of these circumstances.