Switching from IM to pathology

[LymphoBlast]

---

Members don't see this ad.

Hi guys

I am a PGY-1 IM resident, not happy with my choice. I should have listened to my heart when I was applying for residency and considered pathology, but I thought I could not give up the clinical side of medicine. I want to switch to pathology and do CP only. I have a background in clinical pathology. I was a medical technologist for a few years before starting medical school and really enjoyed working in the lab. so, I have a few questions, and would greatly appreciate your input..

How is the job market for clinical pathology? I know a lot of departments in the lab are run by Ph'D, so what kind of positions can you get as a clinical pathologist?
Do you really have to do AP/CP to be more competitive in getting a position later on, because I am not really interested in the AP side?
Is it too late to apply this year and get interview invites?
Is it possible to find an open spot outside the match? Please let me know if you know any open spots (I am an AMG, with slightly above average step scores, did above average in medical school, and in a good standing at my program)

Thanks

 

[deleted314957]

this has been beaten into the ground here, but with GREAT EXCEPTION, you are best served by doing an AP/CP program. you have so many more options and it is a minimal additional time commitment and CP is certainly not a very challenging portion of residency. think hard about this.

 

[Ombret]

CP-only jobs are really only found in academic settings. CP-only pathologists usually have significant research components to their job. This is a function of the kind of person who does CP only (research superstar really just trying to get back to the bench), coupled with the fact that the professional component of the payment for the amount of CP testing that one person can supervise is not large enough to cover that person's whole salary. The exceptions would be blood bank and, in places where hemepath is controlled by CP, hemepath. These are the CP subspecialties with enough "meat" to keep a physician gainfully employed in a variety of practice settings. Finally, there is no reason why a CP physician could not go into some other CP subspecialty, but as you correctly mention, the majority of your peers will be PhDs so you may suffer some existential crises as you go along. If you are creative, you may be able to craft some kind of career you are not thinking of right now, but it is a bit of a leap of faith to go into CP only without a definite plan because your job options are limited.

 

[KeratinPearls]

Hi guys

I am a PGY-1 IM resident, not happy with my choice. I should have listened to my heart when I was applying for residency and considered pathology, but I thought I could not give up the clinical side of medicine. I want to switch to pathology and do CP only. I have a background in clinical pathology. I was a medical technologist for a few years before starting medical school and really enjoyed working in the lab. so, I have a few questions, and would greatly appreciate your input..

How is the job market for clinical pathology? I know a lot of departments in the lab are run by Ph'D, so what kind of positions can you get as a clinical pathologist?
Do you really have to do AP/CP to be more competitive in getting a position later on, because I am not really interested in the AP side?
Is it too late to apply this year and get interview invites?
Is it possible to find an open spot outside the match? Please let me know if you know any open spots (I am an AMG, with slightly above average step scores, did above average in medical school, and in a good standing at my program)

Thanks

Not too late if you apply now. The longer you wait, the less invites you will get. You have to ask yourself if you are truly interested in AP since a lot of the hard work in residency will be in AP and if you don't like it, you may end up hating your life (I dont know how much you are NOT interested in it).

As an AMG, you are at an advantage. If you want to focus on CP, you need to be at a large academic center. The smaller programs will have crappy CP training I would guess. I wouldnt apply to those programs if you are interested in CP (plus CP only positions are only at larger programs).

What part of CP are you interested in? If you like heme and molecular that is in demand. Heme alone I think is in demand. I think you can get a pretty nice job in heme in both private or academics.

Mikesheree is right. To be the best candidate for private jobs you should be AP/CP certified but that really depends if you can endure AP training. If you are CP only, your future options will also depend on what part of CP you are interested in.

 

[DIce3]

The demand for general internists is huge and internal medicine subspecialists is large. The demand for pathologists of all flavors except forensics is very suboptimal. If there is any possible way you might be happy in any part of internal medicine, stay with internal medicine at all costs. Internal medicine blasts pathology economically and politically. This is a black and white issue. Consider these options: internal medicine in a research lab, or academic coagulation consults, or coumadin clinic doctor, or nursing home doctor, or ARNP clinic supervisor at an Indian Health Clinic, or VA disability doctor. There are many options after a three year internal medicine residency besides the standard traditional vs hospitalist vs medicine subspecialist.

 

[Tissue issue]

Hi guys

I am a PGY-1 IM resident, not happy with my choice. I should have listened to my heart when I was applying for residency and considered pathology, but I thought I could not give up the clinical side of medicine. I want to switch to pathology and do CP only. I have a background in clinical pathology. I was a medical technologist for a few years before starting medical school and really enjoyed working in the lab. so, I have a few questions, and would greatly appreciate your input..

How is the job market for clinical pathology? I know a lot of departments in the lab are run by Ph'D, so what kind of positions can you get as a clinical pathologist?
Do you really have to do AP/CP to be more competitive in getting a position later on, because I am not really interested in the AP side?
Is it too late to apply this year and get interview invites?
Is it possible to find an open spot outside the match? Please let me know if you know any open spots (I am an AMG, with slightly above average step scores, did above average in medical school, and in a good standing at my program)

Thanks

May I ask why you're thinking clinical pathology instead of an internal medicine subspecialty (heme/onc, i.d.)?

 

[NuckingFuts]

The demand for general internists is huge and internal medicine subspecialists is large. The demand for pathologists of all flavors except forensics is very suboptimal. If there is any possible way you might be happy in any part of internal medicine, stay with internal medicine at all costs. Internal medicine blasts pathology economically and politically. This is a black and white issue. Consider these options: internal medicine in a research lab, or academic coagulation consults, or coumadin clinic doctor, or nursing home doctor, or ARNP clinic supervisor at an Indian Health Clinic, or VA disability doctor. There are many options after a three year internal medicine residency besides the standard traditional vs hospitalist vs medicine subspecialist.

Although I agree with much of what you're saying, I'd emphasize to the OP to pursue the route that he/she is passionate about.

 

[Enkidu]

Internal medicine blasts pathology economically

Is this true? Doesn't seem like it.

But in any case, internal medicine sucks. If all we had to base out career decisions on was economics and "political power", that would be one thing, but most people want to follow their interests and passions first. That's why we have teachers, for instance, and pathology is also in some way a teaching profession.

If pathologists couldn't pay back their loans, that would be one thing, but they enjoy relatively good hours and high pay compared to other specialties. The job market is an issue, but of course job markets change.

 

[DIce3]

To explain my above statement: Economics and politics are critical to one's happiness; we are not talking about acquiring power or making millions per year but rather survival. Unfortunately, the 1980s and early 1990s are over. Life in the private world is harsh. A hospital administration views an internist/subspecialist with 2500 outpatients under roof differently than a contracted service provider. A pathology contract can be dropped with little thought, forcing the pathologist to move to a new city. An internist can start practice in any city at any time. A pathologist just can't. Again economics and politics of 2012... it is not good.. but it is the current state of things.

 

[pathstudent]

Although I agree with much of what you're saying, I'd emphasize to the OP to pursue the route that he/she is passionate about.

I'd be passionate about being in a big indie rock band or working for one and spending my time on the road traveling to Coachella, Lollapalooza, bumpershoots, and all the big European and American festivals. But instead I settle for being a physician which I genuinely enjoy and it provides long-term stability for my family.

To the OP, get informed and weigh all factors when making a career decision.

 

[Thrombus]

I'd be passionate about being in a big indie rock band or working for one and spending my time on the road traveling to Coachella, Lollapalooza, bumpershoots, and all the big European and American festivals. But instead I settle for being a physician which I genuinely enjoy and it provides long-term stability for my family.

To the OP, get informed and weigh all factors when making a career decision.

I am passionate about the NFL. I am thinking about quitting medicine and trying out. Enkidu any opinions?

Maybe I could play fantasy football fulltime if this doesn't work out? (this career option is about as secure as pathology)😡😱😱😱👎thumbdown

 

[Enkidu]

I am passionate about the NFL. I am thinking about quitting medicine and trying out. Enkidu any opinions?

Maybe I could play fantasy football fulltime if this doesn't work out? (this career option is about as secure as pathology)😡😱😱😱👎thumbdown

I think the OP has a little better shot at being a pathologist than you do at being a professional football player, but then again I haven't seen you in person.

Based on your post I imagine that you're typing this message at a public library with your dirty fingerless gloves, getting ready for another rough night on the streets, because if you are actually a practicing pathologist making more money than the average general internist then your comment would be quite silly.

 

[LymphoBlast]

Not too late if you apply now. The longer you wait, the less invites you will get. You have to ask yourself if you are truly interested in AP since a lot of the hard work in residency will be in AP and if you don't like it, you may end up hating your life (I dont know how much you are NOT interested in it).

As an AMG, you are at an advantage. If you want to focus on CP, you need to be at a large academic center. The smaller programs will have crappy CP training I would guess. I wouldnt apply to those programs if you are interested in CP (plus CP only positions are only at larger programs).

What part of CP are you interested in? If you like heme and molecular that is in demand. Heme alone I think is in demand. I think you can get a pretty nice job in heme in both private or academics.

Mikesheree is right. To be the best candidate for private jobs you should be AP/CP certified but that really depends if you can endure AP training. If you are CP only, your future options will also depend on what part of CP you are interested in.

Thanks for the reply. I am interested in Hempath and transfusion medicine.As far as AP, I am not interested in it that much, and it is one of the reasonsthat I decided to do IM instead of pathology. My plan was to do Hem/Onc later.

 

[LymphoBlast]

May I ask why you're thinking clinical pathology instead of an internal medicine subspecialty (heme/onc, i.d.)?

The reason, is that in IM, you spend about 70-80% of your time documenting and solving social problems, there is a high level of non-compliance with patients, lots of patients are narcotic seekers and will fight to get them at any cost, residency is tough with lots of calls.

 

[KeratinPearls]

Thanks for the reply. I am interested in Hempath and transfusion medicine.As far as AP, I am not interested in it that much, and it is one of the reasonsthat I decided to do IM instead of pathology. My plan was to do Hem/Onc later.

Most of the heme ppl Ive met are AP/CP certified. You need to be AP/CP certified for most private practice positions however. I think if you are CP only, you are restricting yourself to academics or some reference lab jobs (not sure about the latter though).

You have to careful with choosing AP. You will be doing months of autopsies as well as surgical pathology (both are long hours). Also, cytopathology is a part of AP as well (looking at paps, doing FNAs, etc).

 

[NuckingFuts]

I'd be passionate about being in a big indie rock band or working for one and spending my time on the road traveling to Coachella, Lollapalooza, bumpershoots, and all the big European and American festivals. But instead I settle for being a physician which I genuinely enjoy and it provides long-term stability for my family.

 

[todds]

The reason, is that in IM, you spend about 70-80% of your time documenting and solving social problems, there is a high level of non-compliance with patients, lots of patients are narcotic seekers and will fight to get them at any cost, residency is tough with lots of calls.

seems like you want to consider switching IM residencies rather than specialties. That should not be what most of your time consists of if your hospital has a good enough support network.

Also consider that if you are a PGY-1, what are PGY-2 and PGY-3 life like? Ultimately, I think one of the best options might consider doing Hematology alone, and then there are some fellowships that will take you for Hemepath after doing Hematology.

Ive looked into this myself as I was interested in both medicine and pathology. You would probably have more options as others have alluded to, and you would a more interesting candidate for academic jobs in Hematology deaprtments as well with the dual training.

 

[LymphoBlast]

Is it possible to go into a Transfusion Medicine fellowship right out of IM residency? I heard some programs will allow that, but how competitive will you be compared to someone with CP or AP/CP training.

 

[KeratinPearls]

seems like you want to consider switching IM residencies rather than specialties. That should not be what most of your time consists of if your hospital has a good enough support network.

Also consider that if you are a PGY-1, what are PGY-2 and PGY-3 life like? Ultimately, I think one of the best options might consider doing Hematology alone, and then there are some fellowships that will take you for Hemepath after doing Hematology.

Ive looked into this myself as I was interested in both medicine and pathology. You would probably have more options as others have alluded to, and you would a more interesting candidate for academic jobs in Hematology deaprtments as well with the dual training.

Interesting I have never met a hematologist/oncologist who did a hemepath fellowship? I didn't know that was possible. One of the attendings in my residency was just that however.

 

[mlw03]

Interesting I have never met a hematologist/oncologist who did a hemepath fellowship? I didn't know that was possible. One of the attendings in my residency was just that however.

I was told this occurred some back in the day. Where I did residency, a few of the older attendings would like to come in and pretend they were hematopathologists. They certainly knew a bit, but pathologists they were not.

To the OP - I don't know how common this is in current practice. I'd suggest checking the ABP eligibility requirements to see if this is still a legit route to become BE-in hemepath (I honestly don't know). Then you'd also need to see if there are any programs that would allow it. I think the big jump will be with immunostains - without a path background, it'll take some time to get comfortable, especially with the non-heme ones. I suppose your decision comes down to choice. Do you want to be a diagnostician or a treater? Both are important, it's just a matter of preference.

 

[lipomas]

Is it possible to go into a Transfusion Medicine fellowship right out of IM residency? I heard some programs will allow that, but how competitive will you be compared to someone with CP or AP/CP training.

Yes you can. Will you be competitive? Depends what for. No pathology group in their right mind would hire you since all you can do from their end is blood bank. A hospital could conceivably hire you but you would have to do IM stuff also. You could theoretically get a job in a very high volume center or blood center but even there the director often has to do other things.

If you're asking whether you would be competitive for the fellowship itself, probably. BB is not a very competitive fellowship and positions often go unfilled.

I have no idea why someone in your position would do CP only. The only people who do CP only are those who mostly do research and can also help with part of the lab. Some can make a career out of running a lab but it has to be huge and busy and it is hard to break into something like that right out of fellowship. I know of a handful of individuals who work outside of academia with CP-only training. All of them did either hemepath or molecular, and they end up working for a megalab or megaplace.