Sometimes being a pathologist is bad for mental health?

[PATHDOCNYCNJ]

Depression and Suicidality in Pathology and Laboratory Medicine: We Should Be Concerned

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[PATHDOCNYCNJ]

I saw this article in my Doximity account. Being a resident is easier now than back in my day, where you cut meat till midnight, took the garbage to the main hallway due to lack of ancillary services, and spent all morning organizing slides and paperwork for the dozen specialty pathologists, tracked down said pathologists throughout the day then served as their secretary then went back to cutting meat. Maybe you’d pick up a diagnostic Pearl from attending as you glanced into the microscope while furiously transcribing attending’s verbiage.

 

[Unty]

Sure doesn’t help when you work under lunatic attending pathologists who yell at residents, staff and fellow colleagues. Some pathologists are the ones you would never want taking care of your family members let alone speak to them.

From my experience it’s personality issues and sometimes cultural as well.

 

[SunBakedTrash]

Much is also self-selection. People go into medicine, hate everything clinical, get pushed into pathology, still hate it and then feel trapped. There is no doubt many pathologists are jackasses, and academics contains many of these types on a power trip. Still I actively discourage people from choosing pathology as a backup or for the perceived easy lifestyle. Pathology can be very stressful and isn’t for most people.

 

[Unty]

Much is also self-selection. People go into medicine, hate everything clinical, get pushed into pathology, still hate it and then feel trapped. There is no doubt many pathologists are jackasses, and academics contains many of these types on a power trip. Still I actively discourage people from choosing pathology as a backup or for the perceived easy lifestyle. Pathology can be very stressful and isn’t for most people.

Agree. Also I think some people with mental health issues tend to go into Pathology because they feel that it’s one of the fields that allows them to have the least patient contact or people contact and still allows them to be a physician.

I mean if I’m bipolar, I wouldn’t last long in internal medicine because patients and colleagues would notice.

I know one resident who literally didn’t talk to anyone in residency. They ended up leaving medicine and enrolling in a graduate PhD program, which was probably best for them.

 

[shikimate]

If I work at Toronto General Hospital I'd be pretty depressed too. You get paid 375K, same as every other pathologist in Ontario. If you are a young attending at TGH pretty much you're a bottom feeder and they work you to the bones.
Hard to live well in downtown Toronto on that salary. Marginal tax rate on salary is 53%. 2BR condo in downtown Toronto cost 1 million dollars. Stabbing and car jacking everyday. Homeless people every street corner. Street smell like cesspool every morning.

 

[Unty]

If I work at Toronto General Hospital I'd be pretty depressed too. You get paid 375K, same as every other pathologist in Ontario. If you are a young attending at TGH pretty much you're a bottom feeder and they work you to the bones.
Hard to live well in downtown Toronto on that salary. Marginal tax rate on salary is 53%. 2BR condo in downtown Toronto cost 1 million dollars. Stabbing and car jacking everyday. Homeless people every street corner. Street smell like cesspool every morning.

So your take home is like 177,000 a year? That’s crap

 

[mike-sheree]

I saw this article in my Doximity account. Being a resident is easier now than back in my day, where you cut meat till midnight, took the garbage to the main hallway due to lack of ancillary services, and spent all morning organizing slides and paperwork for the dozen specialty pathologists, tracked down said pathologists throughout the day then served as their secretary then went back to cutting meat. Maybe you’d pick up a diagnostic Pearl from attending as you glanced into the microscope while furiously transcribing attending’s verbiage.

Wow, that’s depressing. I thank god that did not happen to me. was this supposed to be a decent place or were you and all your colleagues blindsided by this crap?

 

[shikimate]

So your take home is like 177,000 a year? That’s crap

While the highest marginal personal income tax rate is 53%, the overall average tax rate for 375K of personal income is about 42% (per EY calculator for 2023). Therefore your take home pay would be about 215K (this assumes you are not incorporated, and ignores source deductions etc).

 

[pathres9999]

I agree with article in that I think burnout and depression is a much more pressing concern than what seems on the surface (although the surface doesn’t look great). I believe the biggest problem is the lack of action and urgency to address this. Serious work needs to be done to correct this field and set it towards the right trajectory. This is hard to do if leadership isn’t aggressively championing these ideals.

 

[Unty]

I agree with article in that I think burnout and depression is a much more pressing concern than what seems on the surface (although the surface doesn’t look great). I believe the biggest problem is the lack of action and urgency to address this. Serious work needs to be done to correct this field and set it towards the right trajectory. This is hard to do if leadership isn’t aggressively championing these ideals.

Burnout moreso as an attending. On some rotations in residency, residents barely work or not at all (think CP lol).

 

[pathres9999]

Burnout moreso as an attending. On some rotations in residency, residents barely work or not at all (think CP lol).

I would consider burnout possible even if you aren't overworked. If you aren't doing meaningful work it can also be distressing (an interesting read is with David Graeber)

 

[HeyDalaron]

Burnout is what happens when you do too much work that isn't appreciated or that you sacrifice too much to do.

The concentration on heavy workload as the main driver of burnout is not accurate. I think most doctors are fine with heavy workloads provided the rewards are sufficient.

I recall reading an article a few years ago about burnout in pathology. A few reasons they outlined included never seeing tangible results of your work, never achieving the feeling of mastery, and a loss of autonomy.

 

[Unty]

Burnout is what happens when you do too much work that isn't appreciated or that you sacrifice too much to do.

The concentration on heavy workload as the main driver of burnout is not accurate. I think most doctors are fine with heavy workloads provided the rewards are sufficient.

I recall reading an article a few years ago about burnout in pathology. A few reasons they outlined included never seeing tangible results of your work, never achieving the feeling of mastery, and a loss of autonomy.

Not true. I was on surgpath for 5 months straight. I was getting burned out. There were days during the rotation I was able to relax but I was doing the same thing (3 day cycle) everyday. Hell it got so bad I became irritable and lost it once my attending yelled at me. I was there previewing until 10 pm at night and there were days I had to get back to work early for tumor board.

I started to stop caring. I had a pile of surgicals to preview and I just had no motivation to do it at all.

If you gave me a week or two to do something else during those 5 months, to re energize I would be fine. Sometimes you just need a little break. I tried to tough it out as long as I could but it started to affect my work, health and I became irritable.

 

[mike-sheree]

I would be hesitant to hire any pathology resident/fellow who implied they were overworked of facing burnout from the “pressures “ of a pathology residency/fellowship.
Really, they have had zero real responsibility in the way of being any type of final arbiter. Maybe they are stressed trying to impress staff/peers but, please.

 

[shikimate]

Not getting support and help is a big reason for burnout. If you are in a busy residency or practice but have peers that you can talk to, help you when needed, encourage you, and other members of the lab who try to make your life easier, then time will fly and you won't feel like it's a grind.

But imagine you have a low workload, but have nobody to show slides to, have nobody to ask questions, everyone else in the department treat you like a nobody, then that low workload is still going to feel like a mountain. Not to mention that pathology residency is learning a mountain of information. If we tell McKee to learn medical renal/transplant pathology or tell Odze to study for neuropath in a toxic environment (aka McKee can't have all the fun hosting FB groups and posting his retirement pictures), don't you think they'd struggle too?

 

[WEBB PINKERTON]

Only for city pathologists. Rural ones don't have mental health issues.

 

[HeyDalaron]

Not true. I was on surgpath for 5 months straight. I was getting burned out. There were days during the rotation I was able to relax but I was doing the same thing (3 day cycle) everyday. Hell it got so bad I became irritable and lost it once my attending yelled at me. I was there previewing until 10 pm at night and there were days I had to get back to work early for tumor board.

I started to stop caring. I had a pile of surgicals to preview and I just had no motivation to do it at all.

If you gave me a week or two to do something else during those 5 months, to re energize I would be fine. Sometimes you just need a little break. I tried to tough it out as long as I could but it started to affect my work, health and I became irritable.

I bet you were being paid nothing and being treated like a peon too.

Change the scenario to you having respectful interactions with colleagues and getting paid a radiologist's income, and you'd probably not be so burned out.

 

[Unty]

Only for city pathologists. Rural ones don't have mental health issues.

Lol I’d probably need Prozac and a loaded gun if I lived in the back country but to each his own.

 

[mike-sheree]

Having done the surgery route I can assure you NOBODY is overworked in pathology. 36 on and 12 off is challenging.

 

[Unty]

When you are in training for 6-7 years and get paid 250K in high cost of living areas of the country and get told by senior pathologists that you aren’t worth 250,000 but are only worth a bag of cheetohs and 3 Oreos, wouldn’t you have mental health issues?

Pathology is the only field in medicine where you do as much training as neurosurgery and make as much as primary care coming out of training LOL.

Even better… if you got to go to the sticks (rural Ohio) to get a higher paying job, wouldn’t you want to blow your brains out?

You, a few deers, trees, one McDs, corn fields (if you live in the Midwest), your neighbors are all hillbillies. Just give me a double barreled shotgun already.

 

[coroner]

When you are in training for 6-7 years and get paid 250K in high cost of living areas of the country and get told by senior pathologists that you aren’t worth 250,000 but are only worth a bag of cheetohs and 3 Oreos, wouldn’t you have mental health issues?

This is due to the "haves" vs "have nots" in our field which is becoming less and less common with large health care conglomerates swallowing up former private practices. This isn't as bad as it sounds on the surface, depending on one's situation. Less fat cats squeezing junior pathologists. On the other hand, if you have risen to the top in pp, it's likely a downgrade from autonomy and income.

Even better… you got to go to the sticks (rural Ohio) to get a higher paying job, wouldn’t you want to blow your brains out?

I have interviewed and/or visited these impoverished, coal-mining, opioid epidemic rampant parts of rural OH, WV, and KY. To each their own: some dream to live on 10 acres of land and don't mind being a half hour from the nearest grocery store. Others want to live in the penthouse of luxury highrise with access to Michelin-starred restaurants, pro sports teams, and discotechs open until 3AM. The rural areas obviously have docs working there, pathologists included. And, they have to be higher paying in order to recruit physicians..."money talks and b.s. jerks off, baby"👶

Isn't this is about when Webb chimes in to start a tree-cutting business or tattoo removal parlor in the styx...?

 

[hurrycane]

some dream to live on 10 acres of land and don't mind being a half hour from the nearest grocery store. Others want to live in the penthouse of luxury highrise with access to Michelin-starred restaurants, pro sports teams, and discotechs open until 3AM

I see how the former is possible for a pathologist. The latter on the other hand…. What penthouse or luxury high rise are you talking about on an urban path salary in a high COL urban area? Two bedroom maybe?

 

[Unty]

This is due to the "haves" vs "have nots" in our field which is becoming less and less common with large health care conglomerates swallowing up former private practices. This isn't as bad as it sounds on the surface, depending on one's situation. Less fat cats squeezing junior pathologists. On the other hand, if you have risen to the top in pp, it's likely a downgrade from autonomy and income.


I have interviewed and/or visited these impoverished, coal-mining, opioid epidemic rampant parts of rural OH, WV, and KY. To each their own: some dream to live on 10 acres of land and don't mind being a half hour from the nearest grocery store. Others want to live in the penthouse of luxury highrise with access to Michelin-starred restaurants, pro sports teams, and discotechs open until 3AM. The rural areas obviously have docs working there, pathologists included. And, they have to be higher paying in order to recruit physicians..."money talks and b.s. jerks off, baby"👶

Isn't this is about when Webb chimes in to start a tree-cutting business or tattoo removal parlor in the styx...?

Talked with another colleague today. 5-6 years of training and 235-240k starting in big city with a limited number of jobs to choose from.

You wonder why pathologists have mental health issues.

Years of cleaning colons during autopsies and acting like a professional secretary for attendings. You’re a gross monkey for 3- 5 years.

Senior people exploit young pathologists in this field. You are worth a snickers bar to employers in this field.

You wonder why US grads don’t apply to Pathology. When you are selling a product that is basically garbage, what competitive US grad wants a piece of it?

Go to radiology, anesthesiology where once you graduate, your employers pay you more than a snickers bar and actually think your worth more than a pile of steaming feces. And there are plenty of jobs in big cities.

Good strong fields you come out valued and get paid like you are valued. In pathology, you get out of training and people pay you 200K because that’s what employers think you are worth.

Radiology and anesthesiology trainees come out of training and are able to hit the ground running and get paid high starting salaries. In pathology, you train, for 5-6 years and employers still think you aren’t even worth a higher starting salary because you can’t sign out crap.

You never sign out cases in training, have no sort of autonomy in training or even worse are poorly trained. Then you come out looking for a job and of course employers are going to pay you $h&t.

There are some crap trainees and graduates out there. I know that. These folks are probably truly worth 200K or less but then again why would any practice even consider or hire these people?

 

[macrocyte]

Talked with another colleague today. 5-6 years of training and 235-240k starting in big city with a limited number of jobs to choose from.

You wonder why pathologists have mental health issues.

Years of cleaning colons during autopsies and acting like a professional secretary for attendings. You’re a gross monkey for 3- 5 years.

Senior people exploit young pathologists in this field. You are worth a snickers bar to employers in this field.

You wonder why US grads don’t apply to Pathology. When you are selling a product that is basically garbage, what competitive US grad wants a piece of it?

Go to radiology, anesthesiology where once you graduate, your employers pay you more than a snickers bar and actually think your worth more than a pile of steaming feces. And there are plenty of jobs in big cities.

Good strong fields you come out valued and get paid like you are valued. In pathology, you get out of training and people pay you 200K because that’s what employers think you are worth.

Radiology and anesthesiology trainees come out of training and are able to hit the ground running and get paid high starting salaries. In pathology, you train, for 5-6 years and employers still think you aren’t even worth a higher starting salary because you can’t sign out crap.

You never sign out cases in training, have no sort of autonomy in training or even worse are poorly trained. Then you come out looking for a job and of course employers are going to pay you $h&t.

There are some crap trainees and graduates out there. I know that. These folks are probably truly worth 200K or less but then again why would any practice even consider or hire these people?

View attachment 377010

100% true. This has been the case for decades and it all comes down to supply and demand. For the first time there is a glimmer of hope for the field. It is getting difficult to hire pathologists for the corporate owned jobs and the partnership jobs in more rural towns. Practices in need of pathologists that are having trouble filling spots (often because salary is way too low but was previously enough to fill spots) are utilizing locums. Locums rates going up now and eventually practices will need to increase full time salaries to finally fill that spot. I think it takes time for the process to occur. Hopefully we will start to see more actual salary quotes on job ads. For every other specialty job ads without some sort of indication of salary are typically looked at as suspect and a potential waste of time. Once we see lots of salary quotes in the job ads, the companies not quoting salaries will be forced to follow along or go unfilled. Then we have the competition and the bids increase. Maybe over the next 2-3 years we will see this.

 

[Unty]

“There are currently ~1,000 pathologist job openings in the United States, but only about 450 new pathologists are entering the workforce each year according to Rich Cornell, Founder & President of the Life Sciences recruiting firm Santé Consulting (Ellisville, MO). The pandemic led many pathologists on the bubble of retirement (age 55-65) to retire early, while pathology case volumes have surged since lockdowns ended, notes Cornell.

Cornell founded Santé Consulting in 2008. Santé is focused exclusively on the recruitment of pathologists, PhDs, and laboratory executives and directors. Over the course his career, Cornell has negotiated more than 1,000 physician and PhD employment agreements. Below we summarize his views on the current pathologist job market.”

Although this is likely true, jobs are still limited regionally but nationwide jobs are plentiful from my experience. I know some places still offering low pay (200-240) and hopefully they stay unfilled.

Most grads need visa sponsorship as well since they are foreign grads which further makes it hard to find people but then again some practices still offering salaries in the 200-250 range despite the current supply demand imbalance.

 

[coroner]

What penthouse or luxury high rise are you talking about on an urban path salary in a high COL urban area? Two bedroom maybe?

It was just hyperbole contrasting the urban vs rural lifestyle. Obviously not: an academic pathologist at Mt. Sinai can't afford to live on Billionaires' row in Central Park, Manhattan.

You wonder why US grads don’t apply to Pathology. When you are selling a product that is basically garbage, what competitive US grad wants a piece of it?

Go to radiology, anesthesiology where once you graduate, your employers pay you more than a snickers bar and actually think your worth more than a pile of steaming feces. And there are plenty of jobs in big cities.

Good strong fields you come out valued and get paid like you are valued. In pathology, you get out of training and people pay you 200K because that’s what employers think you are worth.

Radiology and anesthesiology trainees come out of training and are able to hit the ground running and get paid high starting salaries. In pathology, you train, for 5-6 years and employers still think you aren’t even worth a higher starting salary because you can’t sign out crap.

There are a lot crappy jobs out there. But, there are also good jobs too where people are happy. As I said before, this is a field of "haves" and "have-nots", and I do think the disparity of the good vs crappy jobs is greater compared to other fields in medicine. For a lot of pathologists it takes time to find a good job which may require moving and going to a less geographically desirable place. Is it fair? "Fair" is a subjective matter. What someone is willing to tolerate and what seems fair is different for everyone.

Locums rates going up now and eventually practices will need to increase full time salaries to finally fill that spot. I think it takes time for the process to occur. Hopefully we will start to see more actual salary quotes on job ads. For every other specialty job ads without some sort of indication of salary are typically looked at as suspect and a potential waste of time. Once we see lots of salary quotes in the job ads, the companies not quoting salaries will be forced to follow along or go unfilled. Then we have the competition and the bids increase. Maybe over the next 2-3 years we will see this.

This is partially attributed to post-pandemic market changes i.e. inflation and more retirements (remember that cliff CAP always talked about?). Also, because of dwindling private practices compared to a decade or two ago, health care conglomerates and employed models at hospital systems have raised their base salaries when compared to junior/non-partner levels in private practice. And, as you mentioned, locums rates have gone up. I remember a decade ago it was about $900-1200/day. Now, agencies are paying b/w $1500-2200/day.

 

[Unty]

It was just hyperbole contrasting the urban vs rural lifestyle. Obviously not: an academic pathologist at Mt. Sinai can't afford to live on Billionaires' row in Central Park, Manhattan.


There are a lot crappy jobs out there. But, there are also good jobs too where people are happy. As I said before, this is a field of "haves" and "have-nots", and I do think the disparity of the good vs crappy jobs is greater compared to other fields in medicine. For a lot of pathologists it takes time to find a good job which may require moving and going to a less geographically desirable place. Is it fair? "Fair" is a subjective matter. What someone is willing to tolerate and what seems fair is different for everyone.


This is partially attributed to post-pandemic market changes i.e. inflation and more retirements (remember that cliff CAP always talked about?). Also, because of dwindling private practices compared to a decade or two ago, health care conglomerates and employed models at hospital systems have raised their base salaries when compared to junior/non-partner levels in private practice. And, as you mentioned, locums rates have gone up. I remember a decade ago it was about $900-1200/day. Now, agencies are paying b/w $1500-2200/day.

There’s a lot of crappy jobs—>Agree
This field is of haves and have nots->Agree

If you are a competitive US grad I don’t know why youd come into Pathology unless you are truly and sincerely interested in it.

 

[shikimate]

Just saw ad for pathologist assistant with "Salary range: $110,500.00 to $130,000.00 depending on experience and qualifications."

What's the qualification required in US? Master's degree? In Canada we have IMGs who are not certified but still work as PA but PA here make maybe 90K.
If an IMG can be paid 120K as PA then why bother doing 6 yr residency+fellowship just to make 240K.

 

[coroner]

What's the qualification required in US? Master's degree?

Yes

If an IMG can be paid 120K as PA then why bother doing 6 yr residency+fellowship just to make 240K.

Because, they will still come out ahead financially making double the income in the long run. On top of that, if they're an IMG, they went to school to be a physician. So, there's some personal pride/sense of accomplishment to fulfill that goal.

Let's take an IMG who chose to enter pathology residency instead of becoming a PA in your example. As a 6 yr resident/fellow, they're not making zero. For simple math, as a resident/fellow they would be earning ~60K/yr x 6 yrs = $360K total. As a PA, using your number they would earn 120K x 6 years = 720K over that same 6 yr period they would have been a trainee.

720 - 360K = 360K opportunity cost from being a resident/fellow vs becoming a PA. After that, the resident/fellow (using your salary number) will earn 240K/yr. As a practicing physician they will earn 120K more per year vs a PA x 3 years = 360K. So, their breakeven point is in only 3 years. Then, they have the rest of their career to come out ahead. Let's take an average career of 30 years for simplicity sake: (30 years - 3 years to breakeven = 27 years) x 120K more per year as a pathologist vs PA = 3.24 million dollars more over their lifetime.

So, the better question is why bother going to PA school just to make 120K?

 

[Unty]

Yes

Because, they will still come out ahead financially making double the income in the long run. On top of that, if they're an IMG, they went to school to be a physician. So, there's some personal pride/sense of accomplishment to fulfill that goal.

Let's take an IMG who chose to enter pathology residency instead of becoming a PA in your example. As a 6 yr resident/fellow, they're not making zero. For simple math, as a resident/fellow they would making 60K/yr x 6 yrs = $360K total. As a PA, using your number they would earn 120K x 6 years = 720K over that same 6 yr period they would have been a trainee.

720 - 360K = 360K opportunity cost from being a resident/fellow vs becoming a PA. After that, the resident/fellow (using your salary number) will earn 240K/yr. As a practicing physician they will earn 120K more per year vs a PA x 3 years = 360K. So, their breakeven point is in only 3 years. Then, they have the rest of their career to come out ahead. Let's take an average career of 30 years for simplicity sake: (30 years - 3 years to breakeven = 27 years) x 120K more per year as a pathologist vs PA = 3.24 million dollars more over their lifetime.

So, the better question is why bother going to PA school just to make 120K?

It was just hyperbole contrasting the urban vs rural lifestyle. Obviously not: an academic pathologist at Mt. Sinai can't afford to live on Billionaires' row in Central Park, Manhattan.


There are a lot crappy jobs out there. But, there are also good jobs too where people are happy. As I said before, this is a field of "haves" and "have-nots", and I do think the disparity of the good vs crappy jobs is greater compared to other fields in medicine. For a lot of pathologists it takes time to find a good job which may require moving and going to a less geographically desirable place. Is it fair? "Fair" is a subjective matter. What someone is willing to tolerate and what seems fair is different for everyone.


This is partially attributed to post-pandemic market changes i.e. inflation and more retirements (remember that cliff CAP always talked about?). Also, because of dwindling private practices compared to a decade or two ago, health care conglomerates and employed models at hospital systems have raised their base salaries when compared to junior/non-partner levels in private practice. And, as you mentioned, locums rates have gone up. I remember a decade ago it was about $900-1200/day. Now, agencies are paying b/w $1500-2200/day.

LOL 1500-2000 a day is considered great for a pathologist. Just talked with an anesthesiologist buddy who is getting $450 an hour locums (10 hour shift per day). LOL I’m telling him I thought $1500 was good. In pathology, you got to take anything you can get!

I feel too embarrassed to tell him we used to get $700-$900 a day.

I get it comparison is a thief of joy but cmon now….

Pathology is garbage guys. Just be happy you got a better than crappy job market now.

 

[KeratinPearls]

I saw this article in my Doximity account. Being a resident is easier now than back in my day, where you cut meat till midnight, took the garbage to the main hallway due to lack of ancillary services, and spent all morning organizing slides and paperwork for the dozen specialty pathologists, tracked down said pathologists throughout the day then served as their secretary then went back to cutting meat. Maybe you’d pick up a diagnostic Pearl from attending as you glanced into the microscope while furiously transcribing attending’s verbiage.

My guy. ALL that stuff still happens in training programs today except for maybe taking out the garbage….but wouldn’t be surprised if that still happens today too…hahaha

 

[shikimate]

Good point, for an IMG it could still be worthwhile to find a residency in USA. Here, it is much harder for IMG to find residency, so many give up. The amount of years spent trying for residency might be better off studying to be PA. Maybe for undergrads/high school students, they might be more inclined to consider PA with the shorter training and attractive compensation.

 

[KeratinPearls]

Good point, for an IMG it could still be worthwhile to find a residency in USA. Here, it is much harder for IMG to find residency, so many give up. The amount of years spent trying for residency might be better off studying to be PA. Maybe for undergrads/high school students, they might be more inclined to consider PA with the shorter training and attractive compensation.

Everyone in pathology is an IMG here in the States. At least 50%. Some of the residents are good hard working and then there’s a bunch of lazy a$$es too. Why would you pass all your boards just to become a PA? Youre better off becoming a family doc.