Subspecialties of Pathology?

[Lys Ile Glu Leu]

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[mlw03]

Thing is, if they're so important, why aren't they reimbursed?

The reasons you are mentioning sound like they have more to do with research than with direct patient care, and you don't need a physician to do research. Why don't PhDs just do medical autopsies for 75k a year?

You guys are not making a distinction between forensic and medical autopsies. They are totally separate entities, done for totally different reasons. Those of us who like autopsy pathology generally practice forensic pathology, while most medical autopsies are done by people whose main job is surgical pathology.

As to why medical autopsies aren't reimbursed, it's probably like people said - insurance companies aren't interested in paying for procedures on the deceased, who are no longer paying premiums.

 

[yaah]

eg =/= ie

http://theoatmeal.com/comics/ie

I thought of Get Shorty

http://www.youtube.com/watch?v=D_PL8ouEAus

 

[gbwillner]

Thing is, if they're so important, why aren't they reimbursed?

The reasons you are mentioning sound like they have more to do with research than with direct patient care, and you don't need a physician to do research. Why don't PhDs just do medical autopsies for 75k a year?

Wow- those are some pretty naive questions for someone who is an attending...

Autopsies are not reimbursed by INSURANCE COMPANIES because their duty to the patient is over since they are deceased. That does not mean you don't get paid to do autopsies as a pathologist. The HOSPITAL reimburses the pathologist for their time, and there are always some pathologists (primarily who are 80/20 research) whose entire clinical responsibility is to do medical autopsies. They are essential for patient care- for the hospital, not necessarily (but sometimes) for the one individual patient.

 

[twentyone]

And Pedi bx's aren't usually that much smaller than adult bx's. You still need tissue to make a diagnosis, whether it's for a kid or an adult.

Yeah, that was a joke. I said the same thing to an internal medicine colleague of mine when I was halfway through my pedi fellowship.

 

[BrainPathology]

I never really said I don't like gross pathology, it's just that it would be my least favorite of all the things that pathology entails, of which I don't know that much about outside of my limited experience. I can handle the messy stuff. I'm a grad student, and I have taught an anatomy lab for the last few years. I've alot of experience with human cadavers, so I don't think the grossing would bother me. I'd just prefer the microscopic anatomy stuff. I think I'd actually like clinical pathology too because I have a strong chemistry background. I'm just really interested in the more visual analysis stuff, which is why I'm interested in pathology and radiology. Thanks for your help though. I'm not trying to sound cocky or entitled. I don't know what set that other guy off. I'm not trying to be spoon fed either. If somebody is willing to take a moment to have a conversation with me on here than I'm thankful. I'd prefer that than digging through threads. If not than fine, don't say anything.

If you're really thinking of pathology the very first thing I'd do is limit your exposure to this forum. That's the advice I'm giving every one of my residents. Just like good jobs aren't advertised in a traditional way, good information seems to be given out in some other way than on this board a lot of the time. The same people over and over again will try to tell you that the specialty is over, the end isn't just near but has already passed us by (and of course all of these same people are still practicing pathology - wonder why). From the interests you listed you will easily find something in pathology that you'll love and that you can be good at. IF you don't let the pervasive WE'RE ALL DOOMED tone of this particular forum to infect your personality and make it dreadful to work with you you'll have no trouble finding work. Some of the newer people complaining about the job market, through personal experience, have no business working at a gas station let alone a microscope and have the charm and morals of a serial killer.

I do come on here occasionally to see if much has changed.. it hasn't yet. Maybe someday. There are gems here that you'll pick out if you do decide on pathology and develop enough confidence in the specialty to be immune to any fear mongering that goes on here. But while actually picking your specialty I'd pretty much be ready to ignore any advice you get from here (including mine as I admit it's possible I'm the only pathologist in the entire world who loves my work, my job, my colleagues and my prospects for continued happiness).

 

[caffeinegirl]

+1 Brain Pathology

I am more of a lurker since the forum tone turned sour. You're not the only happy pathologist.

 

[yaah]

+1 also

The internet can be a good thing because it allows for sharing of knowledge and understanding, and seeing how others do things. But it also allows for the dissemination of counterfactual information in a wide variety of areas. Do a search for pretty much anything controversial, and weird or unfounded opinions tend to dominate (because they are the loudest and most certain).

One thing I learned long ago about the internet is to pretty much ignore opinions when people start getting "100% certain" and dismissing other opinions without evidence. You don't know where other opinions are coming from - they could be valid but they also might not be. The problem is that people tend to seek confirmatory opinions and treat dissenting opinions as the ones that are "biased" or "naive." And for some reason people need to "win" arguments by shutting alternative opinions down, as if it really matters.

The internet is great for sharing interesting things or finding out factual information (or how few facts there are about certain things). One thing it is definitely bad for is advice, particularly evidence and fact-based advice. You can find it, but you have to have a certain amount of knowledge before you can even start processing it and acting on it.

 

[BU Pathology]

If you're really thinking of pathology the very first thing I'd do is limit your exposure to this forum. That's the advice I'm giving every one of my residents. Just like good jobs aren't advertised in a traditional way, good information seems to be given out in some other way than on this board a lot of the time. The same people over and over again will try to tell you that the specialty is over, the end isn't just near but has already passed us by (and of course all of these same people are still practicing pathology - wonder why). From the interests you listed you will easily find something in pathology that you'll love and that you can be good at. IF you don't let the pervasive WE'RE ALL DOOMED tone of this particular forum to infect your personality and make it dreadful to work with you you'll have no trouble finding work. Some of the newer people complaining about the job market, through personal experience, have no business working at a gas station let alone a microscope and have the charm and morals of a serial killer.

I do come on here occasionally to see if much has changed.. it hasn't yet. Maybe someday. There are gems here that you'll pick out if you do decide on pathology and develop enough confidence in the specialty to be immune to any fear mongering that goes on here. But while actually picking your specialty I'd pretty much be ready to ignore any advice you get from here (including mine as I admit it's possible I'm the only pathologist in the entire world who loves my work, my job, my colleagues and my prospects for continued happiness).

+1 also
My job is intellectually challenging, on an hourly basis. It is actually difficult to imagine ever leaving this profession and all of the personal and professional rewards that it offers.

 

[deleted314957]

+1 also
My job is intellectually challenging, on an hourly basis. It is actually difficult to imagine ever leaving this profession and all of the personal and professional rewards that it offers.

I'll second that.

 

[mlw03]

Yeah, I'll jump on the content pathologist bandwagon. No doom or gloom in FP. We have the ultimate job security, salaries are going up across North America, and there's increasing recognition by the media and governments that we do important work. Our problem is recruiting enough young pathologists into the field.

 

[lipomas]

Content here too.

I hate that the internet makes every argument into a binary proposition. Take the job market stuff: Either the job market SUCKS or it is AWESOME. Note that very few people say it is awesome, they say it isn't as bad as people say on here or it depends on multiple factors or it's only bad for weaker candidates. That is translated into "AWESOME" by the "SUCKS" people, who then tar and feather the poster and say anyone who doesn't agree that it SUCKS is delusional, corrupt, whatever. So they make it seem like there is some huge argument when there really isn't. There is just complexity. The main argument is from people who are at the far extreme vs everyone else. The best thing to do would be to be like chemistry testing and eliminate the outliers since they don't have any reflection of reality, and focus on the other trends. That would be FAR more educational and productive as a discussion. But instead we're left with "IT SUCKS IT SUCKS IT SUCKS THAT'S ALL THERE IS TO SAY ABOUT IT." It is unbelievable to me that pathologists of all people can't understand the concept of complexity.

 

[mlw03]

Nicely put.

Content here too.

I hate that the internet makes every argument into a binary proposition. Take the job market stuff: Either the job market SUCKS or it is AWESOME. Note that very few people say it is awesome, they say it isn't as bad as people say on here or it depends on multiple factors or it's only bad for weaker candidates. That is translated into "AWESOME" by the "SUCKS" people, who then tar and feather the poster and say anyone who doesn't agree that it SUCKS is delusional, corrupt, whatever. So they make it seem like there is some huge argument when there really isn't. There is just complexity. The main argument is from people who are at the far extreme vs everyone else. The best thing to do would be to be like chemistry testing and eliminate the outliers since they don't have any reflection of reality, and focus on the other trends. That would be FAR more educational and productive as a discussion. But instead we're left with "IT SUCKS IT SUCKS IT SUCKS THAT'S ALL THERE IS TO SAY ABOUT IT." It is unbelievable to me that pathologists of all people can't understand the concept of complexity.

 

[malchik]

I think Brain Pathology and others are overstating the degree of negative sentiment on this forum about the field. There are really only a few posters who are saying this. Yes they are there and are given to hyperbole. They repeat it so frequently that their small number makes their attitude appear more pervasive on this board than it actually is. There are a lot of people on here with nuanced opinions about things including the job market.

 

[Humpy]

There is a vocal group on this forum that constantly posts about the terrible job market but that has not been representative of my experience or that of my colleagues. Everyone from my program has found a good (or great) job after residency and about a third have done so without a fellowship (including myself). No one has left the program unemployed or significantly underemployed. The spots available are more limited than many fields of medicine but this seems to be more a matter of needing fewer pathologists to cover a larger area than many of the specialties we are compared to. The jobs are out there but you do need to make an effort to find them. I love what I do and have always had the respect of the local clinicians/surgeons. I am valued as an integral member of the medical staff and can't imagine anything other than that. If you are actively involved with the basics like tumor board, clinical committees, and active involvement with clinicians to show how you can contribute to patient care, then respect for what you do becomes a given.

 

[Enkidu]

I think Brain Pathology and others are overstating the degree of negative sentiment on this forum about the field. There are really only a few posters who are saying this. Yes they are there and are given to hyperbole. They repeat it so frequently that their small number makes their attitude appear more pervasive on this board than it actually is. There are a lot of people on here with nuanced opinions about things including the job market.

Well - I think that literally every thread posted here devolves into complaints about the job market. I think that it would be nice to maintain a job market sticky where this stuff can go and keep non-job market related threads on topic. I've seen something like this in other forums - Anesthesiology actually created an entirely new forum devoted to midlevel anesthesia providers to keep a place for people to vent about that stuff, if they want to, but not let it be the only thing that students read when they come to the forum looking for insight into the field.

As for the number of people who are negative about the job market, I also think it's a minority, but those sentiments are pervasive. This is the one place that every medical student comes when they're thinking about pathology - and it's probably succeeds in convincing 90% of them that there are no jobs available and that the field is heading off a cliff. That's probably not a good way to attract good students to this field.

 

[icpshootyz]

. . .This is the one place that every medical student comes when they're thinking about pathology - and it's probably succeeds in convincing 90% of them that there are no jobs available and that the field is heading off a cliff. That's probably not a good way to attract good students to this field.

But, it also probably scares them away from the field, leaving more jobs for those complaining about the job market! (although from the sound of it most people on here have jobs, so I don't really see what most of the complaining is about anyway)

I'll chime in - perfectly happy with my job. Landed the 1 job I interviewed for, great private group, great hours/vacation/CME time, quick partner track. Hope to be here for my career. And there's no other field in medicine that interests me in the least, so this is the career for me.

 

[Enkidu]

But, it also probably scares them away from the field, leaving more jobs for those complaining about the job market! (although from the sound of it most people on here have jobs, so I don't really see what most of the complaining is about anyway)

I'll chime in - perfectly happy with my job. Landed the 1 job I interviewed for, great private group, great hours/vacation/CME time, quick partner track. Hope to be here for my career. And there's no other field in medicine that interests me in the least, so this is the career for me.

Yeah - to my knowledge there is no unemployed pathologist on this forum, nor is there any unemployed pathologist that I've ever met or even heard of outside this forum.

Probably pathology, as a field, would do better to attract good students than to scare them away.

 

[wholeheartedly]

This forum can definitely be a downer for ppl interested.

This thread, however, has actually turned into a pretty good one, so thanks for that.

 

[KCShaw]

Yes, the reasons for doing autopsies haven't changed much since The Beginning. But some people have been lulled into a sense of complacency, and feel that since we know a lot and can view innards to some extent using radiation and magnets, there is no more to be gained by them despite repeated publications to the contrary. I'm not poo pooing imaging, but there's still a lot of false +/- and in many instances it only leads to a broad differential or perhaps narrowing the clinical differential. All tools have their place.

No, insurance companies and the government don't define what is useful to medicine. Unfortunately they have become a sort of dangerously semi-educated control mechanism with short term profiteering &/or political goals which may not parallel the needs or future of quality medicine.

There was a lot more to this thread, but by the time I finished reading/catching up that was all I could remember I wanted to talk about. Heh.

 

[the alchemist]

Autopsies are an essential component of public health. They pick up homicides that could have been missed, poisonings/overdoses, infectious disease outbreaks, and medical errors. Just because a doctor makes a diagnosis does not mean that it is correct. Autopsies can provide answers to physicians and families, as well as the public.

Autopsies and health care in general, are not just about the living. We had a case with widely metastatic cancer and a family with multiple members with a history of various cancers. They wanted to know the primary cancer to help them in terms of surveillance. We also had a patient who dropped dead without an apparent reason and found a huge saddle embolus that completely blocked the pulmonary artery and even extended into the lung bilaterally. The family found comfort in knowing the reason and that there wasn't anything they didn't do that could've saved their loved one to assuage any guilt they had. So besides the other noted reasons given previously, even though I don't really jump for joy when I get an autopsy, I believe that you can get good info, esp for the surviving family members, that is both pertinent and useful, even in helping them make decisions about their own health care.