Welcome back. Only your fifth post in over seven years and we joined at around the same time and you’re an M2? Guess that MD/PhD route really does put you through the ringer...
Your question referenced three of the biggest factors when it comes to people deciding their careers: 1. Interest in a certain field/doing what you like 2. Salary/benefits 3. Geography. I’d add 4. Collegiality of job environment/co-workers as rounding out the top four. As you stated, it seems like #3 is the most important to you. Geographic flexibility directly correlates with marketability. The more different types of places that are willing to hire you based on your skill-set, the more options you have, which equates to having a broader variety of places to choose from. And do not buy into that half-baked, fictional mantra,”If you’re great at what you do, then you can go anywhere”…b.s. The world is not your oyster and there’s no pot of gold at the end of the rainbow. There may be some truth to this statement, but how many of us are “great”? We’re not all 1%ers who are going to strike it rich. Some of us have to pound the pavement and most of us fall within 2-3 standard deviations of the bell curve. In this line of work competency is expected at the very least and then some degree of sociability (though not much). Anything beyond that you gotta earn and isn’t guaranteed.
The next question to ask yourself is do you want to go the academic route or not? Huge difference in what I would recommend if you want to be marketable in the academic vs private world. But let’s say you’re indifferent. I’ve said this before, and I still stand by Forensics. There’s around 500 FP’s in the country which is only about 10 per state. That kind of shortage makes puts Forensics in a class of its own. Many counties don’t have a medical examiner as they ship out their posts; but, there are still population centers large enough to accommodate their own FP as there are so few in existence. But, if you’re like 99% of people who pursue pathology, I’m assuming you have no desire to go into Forensics.
Should you go the private route, I would recommend the boarded subspecialties: Cyto, Derm, Heme before anything else. Some groups or private labs (and universities, but we’re talking private in this case) may advertise for GI, GU, GYN, breast, etc. but since these are not boarded, there are different ideas on what the definition of “expertise” in these fields are outside of having done a fellowship in them. And I know of some groups who scoff at some of these fellowships because their members push more glass per year in that organ system than a lot of academic-types.
If you choose academics, then it’s a lot more wide open as they are large institutions to begin with and could use a variety of pathologists from all kinds of backgrounds even in the non-boarded fields compared to your average 200 bed community hospital. This is because at the ivory towers, workloads are often subdivided into various organ systems and these big centers want to have their own experts. In addition, they may need such experts to head the department in research in those areas. So if you have an interest in Heme, there would certainly be opportunities there (more than Micro) and many other fields as well; but, certainly some more so than others. Having said that, my recommendation to have academic flexibility are the rare boarded subspecialties: Neuro, Peds, Molecular, BB/TM. These subspecialties don’t mint a whole lot of grads per year and most of them tend to cluster in academia anyway. I’m sure there are places that could find some use for you as an immunopathologist, or something else just as obscure, but we’re talking marketability, right?
As far as geographic options, do you want to live in a rural, suburban, or major metropolitan area? If it’s rural, then Podunk County Hospital in Mississippi isn’t going to have any use for being a board-certified Molecular Geneticist. I know of someone who did this (though their job was in very rural West Virginia) and their fellowship training essentially went to waste. But if you want to go bright lights, big city, the academic-oriented fellowships mentioned above might give you a better chance of moving to that city because sometimes private groups in such areas can be a tough shell to crack e.g. partnership track positions in places like San Fran, Chicago, etc.
Keep in mind pedigree matters. You could theoretically have a successful career doing residency at the University of Puerto Rico compared to Stanford. But in terms of opening doors and marketability, you know which place will improve your odds.
Not to dissuade you from pathology, but if geographic flexibility is of the utmost importance regardless of interest, salary, etc., then, you may want to consider a different field altogether as this is something pathology cannot compete with compared to most other specialties. In summation, you’re mileage may vary. I gave an overview, but that doesn’t mean there are exceptions as to what types of opportunities can exist with certain subspecialties and where they are. You have to go out there and discover them for yourself and perhaps find something that may exceed your expectations. Best of luck.