Should I skip my fellowship to take this job?

[Path2020]

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Hi everyone, I could use some advice from people out there in the real world.

I'm currently a 4th year AP/CP resident, slated to do a GI fellowship next year.

I've been approached by a former attending to skip my fellowship and work with him at a corporate lab in our city reading biopsies and paps. I would be directly supervised for 6 months, during which my salary would be in the low $200s k; this would increase to $300s k after I became independent. I would also receive benefits and at least 6 weeks of vacation per year. Obviously no frozens, call, or autopsies. The pathologists there now work ~3-5 hours per day and seem to love it.

This sounds like a sweet gig, and it would mean that my spouse would not have to find a new job. But is it career suicide? I have no interest in academics, but would it be impossible if I needed to find another job in the future?

Thanks in advance.

 

[Unty]

Go get a job if you think you will be happy there. Forget the fellowship. Ask the people there about job security. If there’s job security start working and get signout experience. Sounds like a good gig and you got the job by word of Mouth, which seems like how jobs get filled. Don’t waste another year being someone’s minion.

If you want to do corporate you will just be looking at mucosal gi biopsies anyways and doing a fellowship looking at liver biopsies will be a waste of time.

There are others who would love to get that job if you don’t so consider yourself lucky.

 

[tiredguy]

Independent sign out experience may be more valuable than a one-year fellowship. Eliminating the need to find two jobs in the same city later on is also a pretty big incentive.

 

[Dro133]

300k for 3-5 hours of work per day? Are there really jobs like this out there?

 

[gbwillner]

On one hand, you should be careful when selecting jobs and make sure it is a good fit and that you will be happy with it.

On the other hand, from a financial and career development perspective, this is a no brainer. Take the job. 200k vs. 50k on a non-boarded fellowship year? A year of real experience? Learning about real world professional life?

 

[Unty]

On one hand, you should be careful when selecting jobs and make sure it is a good fit and that you will be happy with it.

On the other hand, from a financial and career development perspective, this is a no brainer. Take the job. 200k vs. 50k on a non-boarded fellowship year? A year of real experience? Learning about real world professional life?

Yup make sure you enjoy working with the people there and they will help you out and support you as you become more and more independent.

 

[deleted314957]

Hi everyone, I could use some advice from people out there in the real world.

I'm currently a 4th year AP/CP resident, slated to do a GI fellowship next year.

I've been approached by a former attending to skip my fellowship and work with him at a corporate lab in our city reading biopsies and paps. I would be directly supervised for 6 months, during which my salary would be in the low $200s k; this would increase to $300s k after I became independent. I would also receive benefits and at least 6 weeks of vacation per year. Obviously no frozens, call, or autopsies. The pathologists there now work ~3-5 hours per day and seem to love it.

This sounds like a sweet gig, and it would mean that my spouse would not have to find a new job. But is it career suicide? I have no interest in academics, but would it be impossible if I needed to find another job in the future?

Thanks in advance.

You take that job as fast as you can. That is the object. Believe me, if you like GI path, you can become very accomplished at it without a fellowship. The JOB and the EXPERIENCE are key.

 

[Dave CX]

I cant advise you because the family situation only you understand, but please be aware that with this job, you will miss the opportunity to consolidate much of you have learned in residency. General path in a hospital is better to start out, but this does sound like a good opportunity.

 

[BU Pathology]

Is anyone else struck by the irony of this post directly above the post about the tight job market?

 

[deleted314957]

Is anyone else struck by the irony of this post directly above the post about the tight job market?

Not at all. As I have explicitly stated before, folks get jobs. This particular resident appears to have gotten a “word-of-mouth” job from an acquaintance. Anecdotally, it seems this is the route to the most desirable jobs. Unfortunately, our field lacks the vigorous recruiting and geographic flexibility most primary care and surgical fields offer. Good for him. He appears to have had a much easier time than most of his cohort. I am not struck by the irony, but rather by his good fortune.

Just out of curiosity, have you asked your former residents [ (after they have completed their fellowship(s) ], how their job search went? I imagine very few ( apart from those entering academia) said they had their choice of two, three, or more desirable positions.

 

[Med Director New England]

Is anyone else struck by the irony of this post directly above the post about the tight job market?

Not at all
Likely the original poster is posing this question b/c he/she has concern if they pass on the job offer and do the fellowship the job may not be avail after completion of the fellowship. If the area they are looking to live/work in is a tough market for path this is a valid concern, esp if they don’t have interest in academia.

2020 - this far in advance the GI fellowship can easily find a replacement for you if you decide the job is better for you. So don’t let this hold you back. You know better than anyone here the specs of the job and your family situation - so you gotta decide for yourself what is best.

For what it is worth I would not look unfavorably on an applicant for hospital based private practice (I’m guessing this would be more ideal for you) who spent a few years doing independent sign out of outpatient biopsies.

 

[Granular]

This needs to be kept in perspective. They are recruiting a fresh graduate, so $200K with an apparent commitment to increase to $300K seems like a lot (it is to me). However, the OP might be signing out $900K of biopsies, so the compensation might not look as good if you are coming from another practice environment and understanding billing, exploitation, etc.

To the OP: what is being provided in writing? Is the increase to $300K actually in print? Is there any relationship between compensation and productivity?

 

[cmz]

I would be hesitant about the job for a couple of reasons, including job security and limiting your scope to one area of practice; however, this is real world experience and a significant jump in salary. In the end, experience outweighs everything.

We also need to stop comparing the pathology job market with the primary care job market, especially with respect to recruitment. Pathology and primary care exist in two totally different worlds.

 

[Unty]

Is anyone else struck by the irony of this post directly above the post about the tight job market?

If you are referring to me, No I’m not. He got a job by word of mouth, which may have been never advertised.

Im not saying there are no jobs. There are jobs and from what I’m thinking after talking to other people Is that they are by word of mouth or a connection. If you don’t have a connection, you will never hear of the job unfortunately.

An online search shows jobs scattered throughout the country but don’t expect an abundance of jobs.

My belief is that There are more jobs than from what I’m seeing online which are filled by what I described above.

Just because one person comes online and says they got a job offer from a connection does not refute that it’s a tight job market out there, moreso in particular regions of the country.

The same argument can be said that I mentioned the job market is tight from a recruiter and that may not represent the job market overall. I’ve actually have been told the job market is tight by a few people (2 recruiters and a pathologist) in the past month. I’ve also been told there are no jobs by a pathologist in a particular state in the NE.

To the original poster, Sorry to disrupt this thread.

 

[WEBB PINKERTON]

I'd skip the fellowship and take the job. Can't beat experience and the spouse will be happy. Win win.

But I wouldn't view the place as anything long term. Places like you are describing are getting more and more rare. Years ago there were lots of places doing skins and Paps in my area. Now those labs are on the endangered list.

 

[mark-ER]

Yep, agree with above. If needed, you can get a fellowship later; I knew an attending at an academic institution, who went back to get a boarded fellowship in after 10+ years in practice. Gives you a chance to do a couple of years of backdoor roth rollovers, if nothing else.

 

[octopusprime]

Is anyone else struck by the irony of this post directly above the post about the tight job market?

Oh my GOD someone posted a thread about a potential job! That is clear evidence the "tight job market" thread is a complete non sequitur.
ironic? maybe. meaningless? completely.

 

[Path2020]

Thank you all for your responses so far; this is exactly the kind of insight I was looking for. I've talked to current fellows and recent grads but that kind of feels like the blind leading the blind.

Just out of curiosity, have you asked your former residents [ (after they have completed their fellowship(s) ], how their job search went? I imagine very few ( apart from those entering academia) said they had their choice of two, three, or more desirable positions.

To be fair, I think the job market is pretty good in our area. Almost all of our recent fellows have gotten jobs that they liked (usually after 2 fellowships though). I can think of two from last year who did not get jobs and are doing other things now.

Likely the original poster is posing this question b/c he/she has concern if they pass on the job offer and do the fellowship the job may not be avail after completion of the fellowship. If the area they are looking to live/work in is a tough market for path this is a valid concern, esp if they don’t have interest in academia.

They told me the job would not be there in a year. They said that they really need someone now but that they're willing to wait until I finish residency because I have a good eye, good work ethic, and am a normal person. How much of that is true, I don't know.

To the OP: what is being provided in writing? Is the increase to $300K actually in print? Is there any relationship between compensation and productivity?

I have nothing in writing yet, but these are good things to keep in mind for when I meet with them again.

I would be hesitant about the job for a couple of reasons, including job security and limiting your scope to one area of practice; however, this is real world experience and a significant jump in salary. In the end, experience outweighs everything.

This is what I'm worried about, and I don't know if my hesitation is the answer I'm looking for. This lab has been around for <5 years. They tell me that business is booming and that they are expanding, but it's risky. They could go under or I could get fired, and I'd be left with no job and no fellowship. And a bunch of burned bridges at my home institution. I'm torn.

 

[MetroPath]

Thank you all for your responses so far; this is exactly the kind of insight I was looking for. I've talked to current fellows and recent grads but that kind of feels like the blind leading the blind.



To be fair, I think the job market is pretty good in our area. Almost all of our recent fellows have gotten jobs that they liked (usually after 2 fellowships though). I can think of two from last year who did not get jobs and are doing other things now.



They told me the job would not be there in a year. They said that they really need someone now but that they're willing to wait until I finish residency because I have a good eye, good work ethic, and am a normal person. How much of that is true, I don't know.



I have nothing in writing yet, but these are good things to keep in mind for when I meet with them again.



This is what I'm worried about, and I don't know if my hesitation is the answer I'm looking for. This lab has been around for <5 years. They tell me that business is booming and that they are expanding, but it's risky. They could go under or I could get fired, and I'd be left with no job and no fellowship. And a bunch of burned bridges at my home institution. I'm torn.

How did the fellows obtain their jobs if I may ask?

 

[yaah]

I would have a lot of questions. Mostly related to job security, as noted above. I doubt they are going to give you a guarantee but what you don't want to do is take this job and find out 6 months later that, oops, it's only a temporary thing or they're merging with someone else or selling the lab and that position will be eliminated. Or other people in the group are leaving and they haven't told anyone else yet. It strikes me as the kind of job offer someone might get if they were going to be left holding the bag. But that being said, it may also be a legit job and they honestly are in need of someone quicker. And if it's a private lab, are you going to be up for partnership at some point? Or are they all employees? Have to be somewhat wary of jobs with two tiers of practitioners (partners and non-partners).

In general, while it is true that sometimes groups need to add someone, to get the right person groups will also wait. If they are only working 3-5 hours a day, there is clearly some reserve there that they could use if they went an additional year while waiting for you to complete your fellowship (especially if your fellowship is something your job would be focused on).

There was also a comment above that "you can always do the fellowship later" - maybe, but it might not be easy to get a good spot. Fellowships don't typically accept a lot of post-training pathologists already in practice except under certain circumstances.

So just be careful! If you trust this guy and like working with him, and if you like the city you are in, it may be a great opportunity. Trust but verify, as the saying goes.

 

[cmz]

To me this sounds like a path mill job where the compensation may seem great but a lot of questions remain. I am betting that the prospects of partnership will never be on the table. You'll be a hired gun to execute a job. There's nothing wrong with that model, but, again, I would be concerned with long-term job security.

You'll have to do your own research, but I would look at their corporate structure, try to figure out who the company owners are, what type of clients are sending to the lab and if these clients have some sort of financial stake in this lab, etc etc. I would also look into the number and expertise of the support staff and see if its appropriate with respect to the current volume and potential future volume. What kind of AP LIS do they use? What is the quality of their AP lab machines?

On the career side, ask about potential compensation models. The work sounds nice and easy, but if they are paying you ~$300K, you better believe you're going to be pushing a lot of glass to cover your overhead and then some. Consider that the work performed by a seasoned pathologist may only take 3-5 hrs/day... how long will it take someone right out of AP/CP training? Do they offer RVU bonuses?

 

[Med Director New England]

Partnership, partnership..you kidding me.

you guys pathologist owned groups / true parternships are becoming like hens teeth. > 95% of all paths will be employed soon.

 

[Spikebd]

Partnership, partnership..you kidding me.

you guys pathologist owned groups / true parternships are becoming like hens teeth. > 95% of all paths will be employed soon.

If it’s hospital employed that’s probably far better than labcorp employed. It’s better to have 500 hospital systems around the country competing against each other for our services as compared to 4 SALT MINES like LabCorp or AMERIPATH. They’ll treat us like perpetual fellows- No partner, no say in management. Just a trained monkey pushing glass, trying to remain relevant long enough to have a career before they replace you with a AI algorithm. Don’t let them take $200,000 off the top from your professional component.

 

[MetroPath]

I have friends that look at 100 88305s everyday for Quest. They are happy and don’t care if someone else is skimming $$$$ off them. They work 8 hours a day. Good benefits I hear as well.

 

[Med Director New England]

If it’s hospital employed that’s probably far better than labcorp employed. It’s better to have 500 hospital systems around the country competing against each other for our services as compared to 4 SALT MINES like LabCorp or AMERIPATH. They’ll treat us like perpetual fellows- No partner, no say in management. Just a trained monkey pushing glass, trying to remain relevant long enough to have a career before they replace you with a AI algorithm. Don’t let them take $200,000 off the top from your professional component.

Why is employment by a hosp or large medical group better than being employed by a corporate lab?

 

[cmz]

I have friends that look at 100 88305s everyday for Quest. They are happy and don’t care if someone else is skimming $$$$ off them. They work 8 hours a day. Good benefits I hear as well.

That's called a job. They likely didn't bring in the clients. There's no skimming here.

 

[Dave CX]

I've been on both sides. PP partner in a hospital and glass pusher in GI office. The former felt like a career, the latter (current) is simply a job. I much prefer being a glass pushing monkey. I make more money and never deal with any BS.

 

[Torsed]

Hi everyone, I could use some advice from people out there in the real world.

I'm currently a 4th year AP/CP resident, slated to do a GI fellowship next year.

I've been approached by a former attending to skip my fellowship and work with him at a corporate lab in our city reading biopsies and paps. I would be directly supervised for 6 months, during which my salary would be in the low $200s k; this would increase to $300s k after I became independent. I would also receive benefits and at least 6 weeks of vacation per year. Obviously no frozens, call, or autopsies. The pathologists there now work ~3-5 hours per day and seem to love it.

This sounds like a sweet gig, and it would mean that my spouse would not have to find a new job. But is it career suicide? I have no interest in academics, but would it be impossible if I needed to find another job in the future?

Thanks in advance.

Make sure they aren’t defrauding big brother (CMS) in some weird way. Look at their CMS reimbursement for the last few years and you figure it out.

Those pay numbers don’t translate to 3 to 5 hours a day. I’d expect that duration to increase the second you sign on the dotted line. I’d work you at least 10 a day during weekdays.

I’m pro fellowship, but if you got bills you got bills. Guess the fellowships will always be there.

Everyone gets excited about no autopsies but if your group has a brain, they just send to the local med center. I know few who do autopsies in private practice. I sure as heck don’t.