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scienceguy19

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why does starting salary in pathology have to be so low compared to other specialties with similar duration of training?

cardiologists, GI doctors, heme onc doctors, general surgeons, radiologists, anesthesiologists, even family medicine docs (only 3 years of residency) are doing better than us now... even pathologist assistants make more than some pathologists in academia...

I can't think of anyone lower with at least 5 years (including fellowship) of post-graduate training.

What's the root cause? Lack of respect? Too many pathologists? Or too many of us are pushovers?

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1) Poor lobbying
2) Poor marketing
3) Oversupply of trainees
 
Where are you getting this "so low compared to other specialties" data? I haven't seen any of that as it relates to starting salary. It does seem like academic pathology salaries start a bit lower than comparable fields, but not really private ones. I also really don't see anywhere that backs up your assertion that pathologists are not making as much as family med docs or new heme oncs.

There are fields with similar or longer training that get paid much less than pathologists. OFten these are internal med fields like rheum or ID or endocrine. And at our institution, I don't really think the starting pay for pathologists is any less than comparable training length fields.
 
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I think he probably refers to the few pathologists who are accepting a much lower pay due to the poor job market.

The problem lies in oversupply of trainees. The increasing demand in pathology is probably not catching up with the number of new trainees flooding the market
 
why does starting salary in pathology have to be so low compared to other specialties with similar duration of training?

It doesn’t have to be low, here’s how:

1. Get into residency at a respectable program. Preferably not Eastern Kentucky State or somewhere else that might shut down in 5 yrs.
2. Do a fellowship in something marketable, not Cardiothoracic, Immunopathology, etc.
3. Pass boards
4. Make friends/connections i.e. network, without showing signs of serious personality disorders
5. Speak English clearly

Most people have a problem with steps 3-5. But after that…Voila! You’ve got it made. You can thank me later when you’ve paid off your new Jaguar F-type in the first year and are hosting summer parties using an Artisan outdoor pizza oven.
 
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This does not work if the demand for pathology is less than the number of trainees flooding the market every year. Finance101

It doesn’t have to be low, here’s how:

1. Get into residency at a respectable program. Preferably not Eastern Kentucky State or somewhere else that might shut down in 5 yrs.
2. Do a fellowship in something marketable, not Cardiothoracic, Immunopathology, etc.
3. Pass boards
4. Make friends/connections i.e. network, without showing signs of serious personality disorders
5. Speak English clearly

Most people have a problem with steps 3-5. But after that…Voila! You’ve got it made. You can thank me later when you’ve paid off your new Jaguar F-type in the first year and are hosting summer parties using an Artisan outdoor pizza oven.
 
To quote a previous post:
The microeconomic basics of supply and demand do not seem to apply to health care.
That said, medicine has moved away from microeconomics and has been going towards macroeconomics and population based metrics.
I am sure pathology will continue to fail as a specialty regardless of which business / economic model prevails.
 
It doesn’t have to be low, here’s how:

1. Get into residency at a respectable program. Preferably not Eastern Kentucky State or somewhere else that might shut down in 5 yrs.
2. Do a fellowship in something marketable, not Cardiothoracic, Immunopathology, etc.
3. Pass boards
4. Make friends/connections i.e. network, without showing signs of serious personality disorders
5. Speak English clearly

Most people have a problem with steps 3-5. But after that…Voila! You’ve got it made. You can thank me later when you’ve paid off your new Jaguar F-type in the first year and are hosting summer parties using an Artisan outdoor pizza oven.

Just interested, what fellowships would you say are particularly marketable right now?

I'm an MD/PhD student that just finished defending my dissertation and is about to start M3 rotations. Path is something I'm really interested in, but it always seems like such a downer when I check these forums. My research was focused on antibody responses to viral infections so right now I'm primarily interested in medical micro or an oncology-related field (hemepath, etc.). While I'd like to get involved with clinical trials and diagnostics, I don't think I'll go the basic science research route. I have some hobbies that I like outside of medicine, and I find that to be a successful researcher you need to make grant writing your primary hobby.

Salary isn't a major concern for me, but being able to live somewhere I like definitely is. So, I want to ensure I have a subspecialty that allows me some flexibility in location.
 
Just interested, what fellowships would you say are particularly marketable right now?

I'm an MD/PhD student that just finished defending my dissertation and is about to start M3 rotations. Path is something I'm really interested in, but it always seems like such a downer when I check these forums. My research was focused on antibody responses to viral infections so right now I'm primarily interested in medical micro or an oncology-related field (hemepath, etc.). While I'd like to get involved with clinical trials and diagnostics, I don't think I'll go the basic science research route. I have some hobbies that I like outside of medicine, and I find that to be a successful researcher you need to make grant writing your primary hobby.

Salary isn't a major concern for me, but being able to live somewhere I like definitely is. So, I want to ensure I have a subspecialty that allows me some flexibility in location.

It will be difficult to select a specific place to live if you go into pathology.

I can't really think of any subspecialties that allow significant flexibility (significant as defined as being able to live in the city you want to live in while doing work at a rate that is not denigrating). Plenty of people in pathology either have to take huge paycuts to stay in metro locales or academia, or move far away to rural areas to get jobs that are adequately compensated. I've personally not witnessed anyone new have it both ways.

The ASCP survey has data regarding the job hunt for subspecialty trained pathologists. I cannot remember the results of it. Finding that will give you an idea on what potential options you may have, and what ones you should avoid.


All that being said, I would assume that training at a top-five program like MGH, UCSF etc. would certainly give you more flexibility. If you decide to stick with pathology, rank only top programs. You'll probably only regret going lower.
 
This is addressed to medical students who may be considering a career in pathology, to provide some objective information about starting salaries. Pathologists are paid pretty well, in most cases as well as or better than other disciplines

The graph below was created using the 25th percentile compensation in 2014 for an assistant professor in each discipline (typical starting salary). The data are expressed as the fraction of what an anesthesiologist would earn. Pathologists earn more than endocrinologists, nephrologists etc., but we do earn less than cardiologists or surgeons.

The major point of my recent posts is that objective data shows that pathologists' compensation is very good. Our compensation is not in the bottom of all medical specialties, despite what is posted on a recurring basis.


Other disciplines.jpg


Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine, Boston Medical Center
 
Just interested, what fellowships would you say are particularly marketable right now?

I'm an MD/PhD student that just finished defending my dissertation and is about to start M3 rotations. Path is something I'm really interested in, but it always seems like such a downer when I check these forums. My research was focused on antibody responses to viral infections so right now I'm primarily interested in medical micro or an oncology-related field (hemepath, etc.). While I'd like to get involved with clinical trials and diagnostics, I don't think I'll go the basic science research route. I have some hobbies that I like outside of medicine, and I find that to be a successful researcher you need to make grant writing your primary hobby.

Salary isn't a major concern for me, but being able to live somewhere I like definitely is. So, I want to ensure I have a subspecialty that allows me some flexibility in location.


If you don't want to do basic science or write grants DO NOT go into microbiology through Path. Micro labs can operate just fine with a PhD-lead attending. There are very few positions out there as well, so you will definitely have to move unless you are really lucky.

Hemepath is way more versatile. I would caution against doing it via CP-only residency. If you want to focus on oncology related fields, do AP. As others have stated, be prepared to move in Path.
 
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If you don't want to do basic science or write grants DO NOT go into microbiology through Path. Micro labs can operate just fine with a PhD-lead attending. There are very few positions out there as well, so you will definitely have to move unless you are really lucky.

Hemepath is way more versatile. I would caution against doing it via CP-only residency. If you want to focus on oncology related fields, do AP. As others have stated, be prepared to move in Path.

Thanks for the insight, I'm not against moving per se. I just know I can't do a city like NYC or Boston for the rest of my life.
 
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 (and as I recently learned Renal, although it's not boarded). 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 (although 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.
 
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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.

Thanks for the quality reply. There's actually someone in my program a year behind me who is finishing a PhD in forensic anthropology looking at skull fractures from blunt projectiles. I think I'm going to let him take the Forensics path.

It's good to hear your insight as most of the pathologists I have had access to are in academics. I haven't had the chance to meet any private practice pathologists yet, much less ones in a partnership located in a big city. Hopefully, I can find one of those to talk with soon...

I suppose it's worth remembering that I'm not choosing my subspeciality next year. There's still that whole residency thing which will give me some time to refine my professional focus. For the time being, it seems like attending the best AP/CP program I can get into would be the idea approach. That would give me wide subspeciality exposure, good networking opportunities, and that big-name appeal (I assume path is like most other specialities in that, whether you like it or not, attending a top-tier program gives you an advantage in certain employment situations.)

In summary, I'm just returning to medical school and having the normal 'What do I do with my life that'll *really* make me happy?' Gaining insight from this forum has been immensely helpful, but I suppose spending time in the labs and interacting with other pathologists is really the best approach.

Thanks again for everyone's constructive comments!
 
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