should I switch?

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i am 1st year resident in patholgy in a mid tier university based program. I chose pathology because I like pathology (although not crave for), and I appreciate the lifestyle. However, with more and more negative sign and information about the future pathology's job market, and recent change of my spouse's work (not in medical field), he is restricted to big city areas, I am thinking if I should switch to other specialty. I like IM. I didn't choose it last year mainly because I more like the lifestyle of pathology. However, if I end up no job after say 4 years training +1 year fellowship, or a job in some rural areas without my family around, I would go suffer the years in IM residency.
It is not because I don't like pathology or the current program. Actually, it is a solid program. However, as long as I am thinking about the future career and family issue, I become worried and am not able to focus on my studies these days. Should I change my specialty?
I'm prepared somebody kicks my butt on this awkard issue. But I sincerely appciate your opinions.

 

[2121115]

As you might expect, my reply is that you can only answer this one for yourself. I will say this though, if you are in an urban area it will be easier to find a job in internal medicine than pathology. However, if there is an academic center there, you may be able to find an instructor position or if you publish a lot during residency maybe a assistant prof position. These will likely pay the same (for assistant prof) or lower (instructor) and each have a similar lifestyle to a general medicine attending job. The lifestyle difference will exist only during residency, afterward the hours will be similar.

It all boils down to what you want to do. Why did you choose pathology in the first place? Many of us (like myself) knew beforehand about the job situation and chose pathology anyway because we like it and can't imagine doing anything else. I take it nobody told you about this while you were in medical school. Let us know what you decide.

 

[Patho2009]

You are the only one on earth who can answer this question. No one can predict the future of Pathology five years from now. I don't agree that you leave the field just because the jobs are few. If you really like pathology, I would say stay . If you don't feel that you are " attached" to pathology because you are "suffering" from any of the negative sides I mentioned below, I would say switch to another field.

There are both positive and negative sides of Pathology and regretfully the negative ones are more. The positive sides are the fact that it is less stressful than other areas (usually described as easy life!)..no emergency calls..no dealing with patients and doing everyday morning rounds and follow-ups....no "tiring" clinical responsibilities...In my training, I met PGY-2 surgery resident who came to our program ..when i confronted him about the reason of switching from surgery to Pathology, he answered clearly that he is looking for "easy life" and explained to me how surgery took all his life.

The negative sides are the fact that you might find yourself turned out to be a "lab person" sitting on the microscope in your office all the days ...takes a relatively longer time in training (4 + 1 or 2 years for fellowships..and after that you might not feel very confident!! Refer to the previous posts on this forum that shows that MOST of the training programs in Pathology do not prepare the trainees for the real life practice)...can be very challenging on frozen sections and difficult cases.. the jobs are sparse (relatively speaking, compared with primary care specialties)...mainly MORPHOLOGY and therefore depends on your "eye experience" which comes only after years of practice..very broad field, which explains the fact that you don't feel very confident...research oriented field and it requires excessive reading...Go over this forum and you will see much more complaints and negative things.

From my own experience, I struggled with the interest in Pathology in my first and second years when grossing and doing autopsies was very intense..but I became attached to it afterwards when I obtained the confidence in my diagnostic skills and realized the significance of this field in patient care. Therefore, becareful that you might get interested only later in your training when you start getting familiar with the field.

However, from time to time, I regret going through this field whenever I meet two of my close friends who went to IM and family practice and had been hired before they finished their training. ..They both started practicing after three years of training when I was just in the middle of the road !!!!!!!!!!!!!!

It is a well-known fact that the job opportunities of primary care specialties are much more than those of Pathology and this will never change. As said before, this should not be the discouraging factor. If you miss the clinical side of medicine and you want to go for practice after a short period of training, then go out now before it is too late (go for FM or IM..they are both in demand). If you are enjoying what you are doing, just stay and you will enjoy it more with time.

Your story reminded me with a friend from Canada I accidentally met. He went to pathology training. He told me that he regreted doing so. He switched to family practice. This is because the need for practitioners in FM in Canada is so severe to the extent the job is guaranteed and secured with any salary or location you like! They beg their students to go for FM..
He told me that life taught him that he should -sometimes- be realistic, not emotional..think with his brain, not heart. Go with what you see and experience in life, not with what you like. His words still ringing in my ears.
I also met TWO attendings, one in radiology and the other in IM..they both did and completed a residency in Pathology and then did a residency in radiology and IM..Crazy, isn't it?


Overall, if you feel "scared" from job availability, you can switch , otherwise stay.

 

[yaah]

Do you want to do pathology or do you want to live in a specific city? You might be able to do both, you might not. But what happens if you switch to IM and you can't get a job you like in the right place? What if the only jobs are doing things you don't want to focus on? Would you be ok with this because it was still a job? What about in pathology? Is any job ok or just ones that have specific characteristics? You shouldn't base very important decisions (your career is likely to be 30+ years of practice) on too much speculation (and rumor-mongering!).

And also, when you say "near a big city" that basically describes tons of places where there would be opportunities. If you need to live within the city limits of a city of more than 1 million people, that's different. If you need to be within 45 minutes drive of any such place, you are highly likely to find something that you would be happy with.

 

[exPCM]

Go the CAP website and actually look at the dismal number of job postings. Go to pathologyoutlines.com and do the same.
Don't believe the rumors that most jobs are not advertised and that the job market is hunky dory. There are many rumor mongerers who want to paint a bright shiny face on the dismal pathology job market.

 

[yaah]

Most (many) jobs are not advertised, that is the truth. Of the 8-10 jobs I considered, some of them very peripherally, only one was advertised.

 

[exPCM]

Most (many) jobs are not advertised, that is the truth. Of the 8-10 jobs I considered, some of them very peripherally, only one was advertised.

Your experience is anecdotal - can you actually post any data that supports your contention that most pathology jobs are not advertised?

Other specialties posts hundreds of job advertisements. Why would pathology have a double hush hush super secret job market unlike any other specialty?

 

[yaah]

Your experience is anecdotal - can you actually post any data that supports your contention that most pathology jobs are not advertised?

Other specialties posts hundreds of job advertisements. Why would pathology have a double hush hush super secret job market unlike any other specialty?

My experience is not the only one I know of, I have met numerous residents and attendings who say the same thing. At what point during the continued hearing of, "The best jobs are not advertised" do you start to realize it might be true? Some groups also target their advertisements or work with specific recruiters - thus, general job postings may not get a lot of the advertisements, but they are still there.

As to why it is, I have talked to several people who run pathology groups about this specific point. Advertising leads to a flourish of unqualified candidates who flood the group with applications - many of whom are already in jobs but want to move somewhere else. The best groups often have very low turnover and only hire new pathologists every 5-10 years. They can know about pending openings years in advance, and start to look for someone then. Pathology is by its nature a smaller field - there are far fewer graduates each year entering the job market than some other specialties, so groups can often afford to be selective. It's not quite like anesthesia where every hospital has dozens of anesthesiologists on staff. Many hospitals only have a couple of pathologists.

I also know that other specialties can behave the same way. While there may be tons of ER job postings, for example, oftentimes the "best" opportunities are not advertised.

 

[Torsed]

Funny how people get cold feet. I'd eat a bullet and try to at least pull the trigger twice before I left pathology. Can you imagine rounding the rest of your life and nurses harrassing you because "Ms. Jones' tummy hurts doctor...." and "Mr. Jackson's family wants to talk to you about his anal fistula care, so I gave them your home and cell numbers...."

I think if you bail out on pathology there would probably be no coming back, so you better make real sure before you make that leap.

I guess if the job market is as bad as some people make it out to be for pathology we should encourage people to quit. The one plus is I've met a lotta turd residents who will probably ensure that most of us will get jobs, at least there is the VA for them.

 

[pathman2]

Of course you should switch. I have been in Pathology for 15 years, and if I could get a job doing anything else I would. There is a HUGE oversupply of Pathologists (probably twice as many pathologists as are needed), thanks to the CAP refusing to close residencies. Add to this the fact that there are only two large national labs (Quest and Labcore), you will probably wind up working as a Pathotron for one of them, (if you can ever get a job outside of Timbuktu). How many cervical biopsies can you see before your brain shrinks to the size of a prune?
Pathologists long ago sold-out their profession, and are currently under the thumb of administrators and insurance companies. Besides, it's called SURGICAL pathology for a reason. If you want to spend the rest of your life kissing the butts of surgeons to send business (i.e. their biopsies) your way, and stroking their enormous egos, have at it, but it's a miserable existence. Don't kid yourself, most people in the hospital have to be reminded that Pathologists have a medical degree.
DO NOT listen to anyone in academia, as they only have their self-interest at heart. And under no circumstance spend any time doing Clinical Pathology. This field is a joke, and can be best viewed as house-arrest. No one will ever pay you a dime to be a clinical pathologist, and at best you will have wasted two years of your life being in the way of overworked lab techs. Sure it's fun reading about blood-groups for a while, but can you honestly look yourself in the mirror and feel like you are earning your pay?
And don't get me started on frozen sections. Sure, the surgeon will go in at 2 AM to do a procedure, but he is after all getting big bucks for his time. You can't get a plumber to come to your house for what you will probably be reimbused for sitting around at night waiting for your precious specimen to arrive. AND autopsies should be banned. No one pays for them either, so they come out of the department's overhead if they are not private. And unless it's a medical-legal case, no one reads the final report either. So they are just skeevy busy-work I guess.
Quit drinking the kool-aid, and listen to the internal revulsion you are feeling. Take a year off if you have to, as they obviously did a good job programming you in Med School. My advise would be to complete just the AP portion of your training, and go into something else. The Anatomic Pathology training will give you an edge over other candidates. And again, under no circumstances, spend any time in Clinical Pathology. There are a ton of Internal Medicine jobs, and you might consider looking at the packages hospitals give hospitalists and nocturnalists. They are pretty good. Just suck it up and spend a year starting Foley's and NG tubes as an Intern. Good luck. You have been warned.
P.S. Check out www.PathologyOutlines.com for latest info in Pathology.

 

[Patho2009]

OMG!!!!!!!!!!!..pathman2..your view of pathology is too gloomy ..It killed me!

I partially agree with you that there is a dark side of the field but you have made it so dismal!!

It seems that you have been unfortunate with your job or you entered this field without having (or at least developing during training) a genuine interest in it. The result will be grieving, crying and suffering for the rest of one's life...

It really depends on luck..like other things in life....Some pathologists who are stuck in community based hospitals or private labs will be used and their life will be hell, as you described...others might enjoy an easy life and a lot of money ..

Although I suffered from the things you said (and may be more) as a resident/fellow in training..I guess the suffering can be larger as an attending (like in your situation) or can be less!!!!!!..

Other fields are not easy either.. Therefore, I always try to focus on the "shiny" parts of this field rather than being preoccupied with the dark sides. Maybe I am crazy...

I know very well what you mean in every word you said. I cannot argue with words coming from a person with fifteen years experience!!!!!!.
Because I am still a fellow, I think it is more suitable for attendings..like you.. to respond.


You really made me feel down....BUT I WILL CONTINUE BECAUSE I ENJOY THIS FIELD..AT LEAST THE SHINY PART OF IT..

 

[raider]

My opinions:

Surgical pathology is by far the best medical field ever. I love looking at slides, gathering subtle clues and coming up with a diagnosis that is the SINGLE MOST IMPORTANT aspect of patient care. I love the fact I am walking in the shadow of giants like ewing, stout, lauren ackerman etc.

THERE IS NO BETTER/SMARTER PHYSICIAN THAN AN EXCELLENT SURGICAL PATHOLOGIST. SUCH AN INDIVIDUAL HAS CERTAIN CHARACTERISTICS THAT MAKE HIM SUITED TO THE THE ROLE OF "DIAGNOSTICIAN" INCLUDING BUT NOT LIMITED TO A HIGH LEVEL OF INTELLIGENCE, EXCELLENT VISUAL MEMORY, A PHILOSOPHICAL PERSPECTIVE, A LOVE OF DETAIL ETC. AN EXCELLENT SURGICAL PATHOLOGIST HAS INNATE QUALITIES THAT ATTRACT HIM TO THE FIELD. ASK YOURSELF "DO I HAVE THESE QUALITIES? SURGICAL PATHOLOGY IS NOT A JOB IT IS A CALLING.

HOWEVER:


1. Losers come to pathology because of the "preceived " easy life style. Selfish programs use them as warm bodies to gross, transcribe etc. and then give them a diploma.

2. These posers survive by giving incomplete/worthless diagnoses, bothering their colleagues with numerous consults etc. However, clinicians soon find them out and laugh behind their backs.

4. These posers contribute to THE NEGATIVE IMAGE OF PATHOLOGISTS etc etc.

DO YOURSELF AND EVERYONE ELSE A HUGE FAVOUR

CHOOSE PATHOLOGY BECAUSE YOU LOVE IT FROM THE CORE OF YOUR HEART AND NOT BECAUSE OF FACTORS LIKE AN EASY LIFE STYLE. A LITTLE SECRET TO BE AN EXCELLENT SURGICAL PATHOLOGIST YOU HAVE TO READ A LOT MORE THAN ANY PHYSICIAN IN THE HOSPITAL PLUS YOU HAVE TO LOVE THE SCOPE AND LOOK AT A GAZILLION SLIDES BEFORE YOU START GETTING A HANG OF THE FIELD.

LITMUS TEST:
ASK YOURSELF WILL I BE HAPPY LOOKING AT SLIDES/MAKING DIAGNOSES EVEN IF I AM AWAY FROM MY SPOUSE, IN A SMALL TOWN FULL OF HILLBILLIES, WITH INCOMPETENT COLLEAGUES AND MANY ARROGANT/DUMB PHYSICIANS (WHO MAKE MORE $$THAN ME) AND THINK OF ME AS A "GLORIFIED TECHNICIAN". IF THE ANSWER IS YES, CONGRATS YOU ARE A SURGICAL PATHOLOGIST AND A WORTHY ENTRY TO THE FIELD. WELCOME AND MAY THE FORCE BE WITH YOU!!!!!!!!!!

 

[Pathwrath]

I chose pathology because I like pathology (although not crave for), and I appreciate the lifestyle. However, with more and more negative sign and information about the future pathology's job market, and recent change of my spouse's work (not in medical field), he is restricted to big city areas, I am thinking if I should switch to other specialty. I like IM. I didn't choose it last year mainly because I more like the lifestyle of pathology.

Geographic restriction is a real problem. Even the people on this board who minimize pathologist oversupply/job crisis will concede that you can't reliably pick where you'll end up no matter how good you are. How they can simultaneously hold both opinions is beyond me, but that topic has been beaten into the ground on other threads.

It sounds like lifestyle issues are more important to you than professional satisfaction. If you would be content with a low-paid, low-prestige, low-security position in a big city if it comes to it, then I think you should stay in path.

I know a lot of high-powered residents who down-shifted after having kids or whatnot, and they are now quite content with their modest careers.

 

[earmuff]

Of course you should switch. I have been in Pathology for 15 years, and if I could get a job doing anything else I would. There is a HUGE oversupply of Pathologists (probably twice as many pathologists as are needed), thanks to the CAP refusing to close residencies. Add to this the fact that there are only two large national labs (Quest and Labcore), you will probably wind up working as a Pathotron for one of them, (if you can ever get a job outside of Timbuktu). How many cervical biopsies can you see before your brain shrinks to the size of a prune?
Pathologists long ago sold-out their profession, and are currently under the thumb of administrators and insurance companies. Besides, it's called SURGICAL pathology for a reason. If you want to spend the rest of your life kissing the butts of surgeons to send business (i.e. their biopsies) your way, and stroking their enormous egos, have at it, but it's a miserable existence. Don't kid yourself, most people in the hospital have to be reminded that Pathologists have a medical degree.
DO NOT listen to anyone in academia, as they only have their self-interest at heart. And under no circumstance spend any time doing Clinical Pathology. This field is a joke, and can be best viewed as house-arrest. No one will ever pay you a dime to be a clinical pathologist, and at best you will have wasted two years of your life being in the way of overworked lab techs. Sure it's fun reading about blood-groups for a while, but can you honestly look yourself in the mirror and feel like you are earning your pay?
And don't get me started on frozen sections. Sure, the surgeon will go in at 2 AM to do a procedure, but he is after all getting big bucks for his time. You can't get a plumber to come to your house for what you will probably be reimbused for sitting around at night waiting for your precious specimen to arrive. AND autopsies should be banned. No one pays for them either, so they come out of the department's overhead if they are not private. And unless it's a medical-legal case, no one reads the final report either. So they are just skeevy busy-work I guess.
Quit drinking the kool-aid, and listen to the internal revulsion you are feeling. Take a year off if you have to, as they obviously did a good job programming you in Med School. My advise would be to complete just the AP portion of your training, and go into something else. The Anatomic Pathology training will give you an edge over other candidates. And again, under no circumstances, spend any time in Clinical Pathology. There are a ton of Internal Medicine jobs, and you might consider looking at the packages hospitals give hospitalists and nocturnalists. They are pretty good. Just suck it up and spend a year starting Foley's and NG tubes as an Intern. Good luck. You have been warned.
P.S. Check out www.PathologyOutlines.com for latest info in Pathology.

Amazing... Another "new" attending who spouts the same rhetoric as the dream team of doomsayers

 

[exPCM]

Amazing... Another "new" attending who spouts the same rhetoric as the dream team of doomsayers

Just another clueless idealistic resident who cannot recognize the real "rhetoric" spewed out by residency program faculty who want to keep their pipeline of cheap resident labor flowing. FYI, pointing out the truth is not doomsaying. Do you see these repeated job market discussions going on in any other forum here besides the pathology section? Why do you think that is?

I have seen major resident/student proponents on this board of the "there are good jobs out there for good residents" get less vociferous over time about trying to discount the opinions of the attendings who post here about pathology in the real world. It seems as these residents transition into practice they get a better perspective on the reality of private practice pathology.

 

[earmuff]

Just another clueless idealistic resident who cannot recognize the real "rhetoric" spewed out by residency program faculty who want to keep their pipeline of cheap resident labor flowing. FYI, pointing out the truth is not doomsaying. Do you see these repeated job market discussions going on in any other forum here besides the pathology section? Why do you think that is?

I have seen major resident/student proponents on this board of the "there are good jobs out there for good residents" get less vociferous over time about trying to discount the opinions of the attendings who post here about pathology in the real world. It seems as these residents transition into practice they get a better perspective on the reality of private practice pathology.

I'm just sick of your propaganda. Sure, you may be right, but I don't care to read your chicken little scratch anymore.

 

[exPCM]

I'm just sick of your propaganda. Sure, you may be right, but I don't care to read your chicken little scratch anymore.

If you don't want to read my posts then please don't read them.

In the words of Colonel Nathan Jessup (played by Jack Nicholson) is it that "you can't handle the truth"?

If you don't want to read what I say how about this from a veteran pathologist in Nashville, TN:

"Eventually most pathology will be practiced in large groups. The big
cancer type staging cases will be done for hospitals, most likely by
hospital based pathologists working out of a central lab. The small
biopsies will be done by large outpatient oriented labs. As in any
business, there will be niches, but consolidation will continue for some
time. Unless someone is just really fascinated by pathology to the
exclusion of other fields or has an unusually entrepreneurial nature, I
couldn't recommend training in it because there's a high risk of not finding
a satisfying job."

One other negative which is rarely/never discussed is the "mobility"
issue. Clinician can pack up and move their practices, rather easily,
especially if they have a speciality that hospitals want. Indeed, they
often get paid to do so. Pathologists, on the other hand generally look for
the job opening, and then also have to decide if they want to move there.
Rather hard to do with family, schools etc., so often they stay where they
are and accept less than optimal working conditions."

Dave Yates
Nashville, TN
http://www.mailman.srv.ualberta.ca/pipermail/patho-l/2008-March/030115.html

Or how about another veteran pathologist in Wichita KS:

"A residency in dermatology, followed by dermatopathology training, is a rewarding
career path for a bright medical student who likes pathology. (S)he can practice
both derm and dermpath, or just one. This gives them a lot of flexibility, much more
than in most other fields. I realize that derm residencies are highly sought after,
so this is only realistic for the brighter students."

Dwight Oxley, MD
Wichita Kansas USA

http://www.mailman.srv.ualberta.ca/pipermail/patho-l/2008-March/030118.html

 

[mrjames]

I regret to enter into pathology field but it is too late for me to switch. What should we do? Any positive suggestions?

 

[Psychopathology]

ASK YOURSELF WILL I BE HAPPY LOOKING AT SLIDES/MAKING DIAGNOSES EVEN IF I AM AWAY FROM MY SPOUSE, IN A SMALL TOWN FULL OF HILLBILLIES, WITH INCOMPETENT COLLEAGUES AND MANY ARROGANT/DUMB PHYSICIANS (WHO MAKE MORE $$THAN ME) AND THINK OF ME AS A "GLORIFIED TECHNICIAN".

It's tough being a resident. We need to focus on learning how to function as pathologists and develop a high degree of proficiency and knowledge in a relatively short amount of time, but we cannot expect dream jobs to fall into our laps or pretend that the problems plaguing our profession do not exist. We do not have much time or experience to contribute to a discussion of the job market, but one way or another we will soon be facing it.

 

[Patho2009]

You are absolutely right...Well-said, Psychopathology






"We need to focus on learning how to function as pathologists"

 

[Psychopathology]

maybe I'll look back at those thoughts some day and laugh or cringe, but given a limited perspective, I'm concerned for what the future holds and trying to make sense out of what no two people here fully agree upon.

Back to studying.

 

[Pathwrath]

If you don't want to read my posts then please don't read them.

In the words of Colonel Nathan Jessup (played by Jack Nicholson) is it that "you can't handle the truth"?

If you don't want to read what I say how about this from a veteran pathologist in Nashville, TN:

"Eventually most pathology will be practiced in large groups. The big
cancer type staging cases will be done for hospitals, most likely by
hospital based pathologists working out of a central lab. The small
biopsies will be done by large outpatient oriented labs. As in any
business, there will be niches, but consolidation will continue for some
time. Unless someone is just really fascinated by pathology to the
exclusion of other fields or has an unusually entrepreneurial nature, I
couldn't recommend training in it because there's a high risk of not finding
a satisfying job."

One other negative which is rarely/never discussed is the "mobility"
issue. Clinician can pack up and move their practices, rather easily,
especially if they have a speciality that hospitals want. Indeed, they
often get paid to do so. Pathologists, on the other hand generally look for
the job opening, and then also have to decide if they want to move there.
Rather hard to do with family, schools etc., so often they stay where they
are and accept less than optimal working conditions."

Dave Yates
Nashville, TN
http://www.mailman.srv.ualberta.ca/pipermail/patho-l/2008-March/030115.html

Or how about another veteran pathologist in Wichita KS:

"A residency in dermatology, followed by dermatopathology training, is a rewarding
career path for a bright medical student who likes pathology. (S)he can practice
both derm and dermpath, or just one. This gives them a lot of flexibility, much more
than in most other fields. I realize that derm residencies are highly sought after,
so this is only realistic for the brighter students."

Dwight Oxley, MD
Wichita Kansas USA

http://www.mailman.srv.ualberta.ca/pipermail/patho-l/2008-March/030118.html

Careful, exPCM. Earmuff will be accusing you of creating internet sockpuppets that transcend space and time.

 

[pathman2]

My there are a lot of doubters out there. The best biopsy rate I can find is 6,000 biopsies/100,000 population/year (reasonable), which for a US population of 300 million means there are 18 million biopsies/year. Figuring that an average pathologist can read 5,000 about cases/year means only 3,600 set of eyes are needed. Even with PAP's and the like, considering that there are about 15,000 US pathologists,there are TOO MANY PATHOLOGISTS, PERIOD. END OF ARGUMENT. LET'S MOVE ON.

The dirty little secret is that the bigger, agressive labs like Quest and Labcorp siphon off the more profitable smaller outpatient biopsies like cervix, colon, prostate, etc, and leave the larger, more labor-intensive specimens like colon resections and (my personal favorite) Whipple resections for the Hospital based pathologists to schlep around with. As this Walmart approach to the profession escalates, hospital-based pathologists will be losing revenue to competing outside labs, and the guys stuck in Quest and Labcorps will be swamped with ditzels. And everyone will be fighting for the chance to sign-out a gallbladder. As a Pathologist, you will have little say in the matter. The specimens, your bread and butter, will wind up where the Surgical Group or Insurance Company decides. How's that for security?

I could go on to lambaste the CAP, but I think I've made my point.

 

[Patho2009]

Thanks pathman2..

you gave us a grim picture......It's too late for me and I have to move on...you made me feel down!

 

[yaah]

I think it would help everyone to realize that almost every branch of medicine (with the exception of the cosmetic ones) is not what it used to be, and is facing dire changes. Private groups in all specialties are going away and being replaced by hospital based practice ("employees"). Incomes are going down across the board. What people on this forum tend to do, unfortunately, is to ignore difficulties in other specialties while magnifying difficulties in pathology, to make it seem as though pathology is somehow different or off on its own island. The points about relative lack of jobs are more pertinent to pathology specifically, but in other fields as well advertised jobs are not always the best, and people flee their first job after a couple of years when they realize it isn't as rewarding as they though. It is true that there are some fields which can offer more autonomy than pathology in carving out your career, but to suggest somehow that surgeons and procedural-based fields have it made because they are the ones doing to procedures is hugely disingenuous. You can talk to a lot of hospitalists who absolutely hate their jobs, and surgeons who wish they never went to med school to begin with.

And also, small hospitals are disappearing across the country as they are absorbed by conglomerates. As these hospitals are absorbed, physician jobs go away or change. This affects far more than the pathologists.

But there are too many pathologists - I have never disputed that. That does not mean, however, that people interested in pathology and who perform well should not go into pathology.

 

[Parts Unknown]

Warning, musings ahead.

I have heard there are approximately 13,000 pathologists in the country. Assume a completely even age distribution and that everyone works full time. Now assume everyone works for exactly 30 years and then retires.

13,000/30 = 433 pathologists retire each year.

Now start adjusting the length of career:

13,000/25 = 520
13,000/35 = 371

Total PGY-1 pathology training spots offered in the match last year: 522

On the plus side, the age distribution of pathologists is reportedly far from even. Also, as the population grows and ages, specimen volume is increasing year by year.

US population in 1978: 222,585,000
US population in 2008: 303,824,640
Percent increase: 36.5
Current median U.S. age: 37.9 (highest ever)

On the down side, pathologists tend to retire pretty old. There is also the issue of reimbursement. If an 88305 paid $1,000 the field could accommodate a lot of people, but the scraps of meat have been getting progressively smaller.

 

[exPCM]

Warning, musings ahead.

I have heard there are approximately 13,000 pathologists in the country. Assume a completely even age distribution and that everyone works full time. Now assume everyone works for exactly 30 years and then retires.

13,000/30 = 433 pathologists retire each year.

Now start adjusting the length of career:

13,000/25 = 520
13,000/35 = 371

Total PGY-1 pathology training spots offered in the match last year: 522

On the plus side, the age distribution of pathologists is reportedly far from even. Also, as the population grows and ages, specimen volume is increasing year by year.

US population in 1978: 222,585,000
US population in 2008: 303,824,640
Percent increase: 36.5
Current median U.S. age: 37.9 (highest ever)

On the down side, pathologists tend to retire pretty old. There is also the issue of reimbursement. If an 88305 paid $1,000 the field could accommodate a lot of people, but the scraps of meat have been getting progressively smaller.

The total number of spots in the match is not the figure to look at since there are quite a few spots given outside the match.

The ACGME reports 2312 AP/CP pathology residents in 2007-08 which equals 578 per year.

http://www.acgme.org/adspublic/

The number of CAP junior members (does include some fellows) is even higher:
http://www.cap.org/apps/docs/pathology_residents/pdf/rf_delegate_positions.pdf

The 13000 pathologist number may be okay.
The ASCP says: There are approximately 13,000 to 14,000 board certified pathologists in the United States who practice their specialty in community, university, and government hospitals and clinics, in independent laboratories, or in private offices, clinics, and other health care
facilities.
https://www.chicago.ascp.org/careerLinks/pdf/howManyPathologists.pdf

The fact remains that serious workforce planning in pathology is lacking and many pathologists are putting off retirement.
http://forums.studentdoctor.net/showthread.php?t=569561&highlight=retire

And pathman2 has an excellent point about the number of eyes needed being much less with pathologists signing out 5000+ cases per year. In my group each pathologist is actually signing out over 6000 cases per year. Compare this to 20 years ago when the average pathologist was signing out 2000-3000 cases/year.

CarisDx says they have 20 GI pathologists signing out more than 5000 cases per week. This comes out to >1000 cases/pathologist per month or >12000 cases/pathologist per year. So as these megalabs suck up more and more specimens the need for pathologists will go down.
http://www.pathologypartners.com/pages/focusNL/giFocusNL/07_05_GI_FocusNL.pdf

 

[lipomas]

Your experience is anecdotal - can you actually post any data that supports your contention that most pathology jobs are not advertised?

Other specialties posts hundreds of job advertisements. Why would pathology have a double hush hush super secret job market unlike any other specialty?

Most jobs are not advertised (except for reference lab jobs and some groups who just can't find someone who speaks english adequately). My group never advertises when we need someone new, unless it is a targeted advertisement directed towards a specific interest. Another group I interviewed at said they don't advertise because they did once and they got 100 CVs, most of which had horrible grammar and spelling. Most of the private groups in other specialties in my hospital also do not advertise unless they can't find someone outside of other methods.

The points about reference lab jobs are semi-valid. These jobs often do suck, unless you are the type of person who likes them or you are very experienced and they hire you as an expert to recruit business their way. A resident colleague took a quest job and was slammed with cases. He got a good signing bonus and decent pay (I think $225 to start, not sure). Bailed after one year and took a job in a large private hospital.

Don't switch if you love pathology. Pathology is not the auto industry. If you're a hard worker and smart you will find a job. If you're that worried about working in a specific city then you might have a problem, but lord knows how much problem. Near any big city there are likely to be some openings. Depending on timing the current options might suck, but better ones might open up.

 

[Pingu]

And pathman2 has an excellent point about the number of eyes needed being much less with pathologists signing out 5000+ cases per year. In my group each pathologist is actually signing out over 6000 cases per year. Compare this to 20 years ago when the average pathologist was signing out 2000-3000 cases/year.

CarisDx says they have 20 GI pathologists signing out more than 5000 cases per week. This comes out to >1000 cases/pathologist per month or >12000 cases/pathologist per year. So as these megalabs suck up more and more specimens the need for pathologists will go down.
http://www.pathologypartners.com/pag...GI_FocusNL.pdf

The math here and in the other posts in this thread makes a pretty strong point with regard to why the job market and compensation in pathology are not what they should be. Obviously, the number of cases looked at by pathologists has increased and while total specimen number may have also increased, it has not increased at the same rate.

I personally know of a lab where 4 pathologists sign out 50,000+ specimens a year. The post by exPCM (quoted above) states that each pathologist in that group signs out 6,000. Caris has their pathologists signing out 12,000+. If you need less eyes, then you need less pathologists. I don't have the numbers but I am pretty sure that we are training more pathologists than we were 20 years ago.

Personally, 6000 cases per year is definitely reasonable/doable. With 8 to 12 weeks of vacation, that works out to about 25-30 cases per day.

 

[yaah]

It really depends on the group though and the case distribution. Dermpaths can sign out in excess of 10,000 cases per year and it is a reasonable load. GI paths can sign out that many and it is reasonable. If you do mostly GU or breast or a lot of heme, it's a lot less. If you do everything, it is going to average out to where somewhere between 4000-6000 is reasonable. The increase in specimens over the years has been mostly in cases with small numbers of slides (except maybe for prostate biopsies). 20 years ago a higher percentage of your cases were large resection specimens.

However, I definitely agree that these figures do not mesh with compensation data, etc. And I also agree that I don't think regulatory agencies have done a very good job of melding the changing duties and caseloads of pathologists with future need for pathologists.

 

[Parts Unknown]

If you do mostly GU or breast or a lot of heme, it's a lot less.

Good point. I'm on track to do about 1,200 bone marrows this year with about 250 lymph node, 250 consults, and assorted miscellany, and it keeps me pretty darned busy.

Perhaps the question isn't specimen volume, but rather the 88305/88307/88309 ratio, with a nod to the number of specials, immunos, and frozens needed.

 

[Pingu]

However, I definitely agree that these figures do not mesh with compensation data, etc. And I also agree that I don't think regulatory agencies have done a very good job of melding the changing duties and caseloads of pathologists with future need for pathologists.

Good point. I'm on track to do about 1,200 bone marrows this year with about 250 lymph node, 250 consults, and assorted miscellany, and it keeps me pretty darned busy.

Perhaps the question isn't specimen volume, but rather the 88305/88307/88309 ratio, with a nod to the number of specials, immunos, and frozens needed.

All this is very true. I could definitely sign out 10,000 GIs or skins if that is all I did. Granted, after my 10th dysplastic nevus of the week, I would probably start wearing cardigans with kittens on them and muttering to myself, but that's why I didn't do derm.

Even so, I think there is a definite trend towards pathologists signing out more overall cases. Perhaps that's how we got our reputations as a cush specialty, because if I only had to sign out 2,000 to 3,000 cases a year I would probably be done well before 5 p.m (Note to Parts Unknown...this does not include heme, obviously). Even with stains and frozens, most pathologists in private practice are signing out more cases and that doesn't include the pathologists who work for corporate labs like Ameripath who have to sign out a huge volume every day regardless of the code. We have a surplus of pathologists and even if a group's volume increases, many times people just do more cases rather than hiring someone.

As for compensation, the average reimbursement for an 88305 is around $100 (If I'm wrong, sorry, I'm just a month out of residency and am still trying to figure out billing/reimbursement) and a typical GI or skin is billed as 88305, so even if those 10,000 cases only had one specimen and no stains, that works out to around 1 million per year. Clearly, someone is making money but it is obviously not the pathologists as I don't know many people bringing in anywhere near that, even at a partner level.

 

[yaah]

Our group defines signout by number of slides - so I see fewer cases than a GI person but we get the same number of slides. It doesn't often correlate that well (because it's easier to look at two slides of polyps than two slides of trans bronch or something like that) but it averages out ok I guess.