Thanks to you all

[Jerms]

I was so psyched to pursue training in pathology until perusing this forum for the last 6 months. The persistent honest negativity has finally taken its toll. Evidently a "career in pathology" is really just a euphemism for "the fast track to slitting my wrists and jumping into a hot bath" based upon the attitudes toward the field I've been reading. It's a real bummer that the field has been looking so bad lately and, arguably, for quite some time now. But as much as I'd like to say that by my NOT pursuing pathology the field will become less competitive, let's face it, some other bright eyed "uninformed" future low-paid (or unemployed) pathologist will fill the would've-been empty residency spot.

Please don't take this post as a sarcasm as I truly am grateful for what I've learned from everyone's posts. However, I am now left contemplating what I want to be when I grow up since pathology is evidently a steaming pile of orangutan poo.

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[medfield12]

I was so psyched to pursue training in pathology until perusing this forum for the last 6 months. The persistent honest negativity has finally taken its toll. Evidently a "career in pathology" is really just a euphemism for "the fast track to slitting my wrists and jumping into a hot bath" based upon the attitudes toward the field I've been reading. It's a real bummer that the field has been looking so bad lately and, arguably, for quite some time now. But as much as I'd like to say that by my NOT pursuing pathology the field will become less competitive, let's face it, some other bright eyed "uninformed" future low-paid (or unemployed) pathologist will fill the would've-been empty residency spot.

Please don't take this post as a sarcasm as I truly am grateful for what I've learned from everyone's posts. However, I am now left contemplating what I want to be when I grow up since pathology is evidently a steaming pile of orangutan poo.

Just like there are still bright eyed "uninformed" future unemployed lawyers going to law school.

 

[pathstudent]

I was so psyched to pursue training in pathology until perusing this forum for the last 6 months. The persistent honest negativity has finally taken its toll. Evidently a "career in pathology" is really just a euphemism for "the fast track to slitting my wrists and jumping into a hot bath" based upon the attitudes toward the field I've been reading. It's a real bummer that the field has been looking so bad lately and, arguably, for quite some time now. But as much as I'd like to say that by my NOT pursuing pathology the field will become less competitive, let's face it, some other bright eyed "uninformed" future low-paid (or unemployed) pathologist will fill the would've-been empty residency spot.

Please don't take this post as a sarcasm as I truly am grateful for what I've learned from everyone's posts. However, I am now left contemplating what I want to be when I grow up since pathology is evidently a steaming pile of orangutan poo.

Don't give up on pathology just yet. Just make sure you have the right personality for it. If academics work for you, there are buku jobs. Heck the whole six years I spent in residency and fellowship my institution had a renal Pathology opening that they couldn't fill.

If you are interested in private practice, you just have to be willing to kowtow to administrators who only care about "productivity", be able to ask how high when surgeons say jump, and be willing to split half your diminishing professional fee with clinicians.

 

[Enkidu]

Don't give up on pathology just yet. Just make sure you have the right personality for it. If academics work for you, there are buku jobs. Heck the whole six years I spent in residency and fellowship my institution had a renal Pathology opening that they couldn't fill.

If you are interested in private practice, you just have to be willing to kowtow to administrators who only care about "productivity", be able to ask how high when surgeons say jump, and be willing to split half your diminishing professional fee with clinicians.

Why is academia not desirable to many pathologists?

 

[pathstudent]

Why is academia not desirable to many pathologists?

I think it is. Most people I knew considered it strongly. The university environement is inately exciting. The ony things that might put people off is that it is a bit of a ladder climb and some people don't like writing journal articles and such. And there is the issue that average starting and max salary are a bit lower likely due to the fact that community practices are run leaner with less overhead.

But it is also true that university work has become more like community in that you got to work your butt off signing stuff out. The days are done when you can just sit in your office and write papers and get paid a comfortable salary.

Btw, in my prior message I was being facetious.

 

[2121115]

Why is academia not desirable to many pathologists?

Awkward personalities. Mismanagement. Inefficiency. And very low pay.

 

[gbwillner]

I was so psyched to pursue training in pathology until perusing this forum for the last 6 months. The persistent honest negativity has finally taken its toll. Evidently a "career in pathology" is really just a euphemism for "the fast track to slitting my wrists and jumping into a hot bath" based upon the attitudes toward the field I've been reading. It's a real bummer that the field has been looking so bad lately and, arguably, for quite some time now. But as much as I'd like to say that by my NOT pursuing pathology the field will become less competitive, let's face it, some other bright eyed "uninformed" future low-paid (or unemployed) pathologist will fill the would've-been empty residency spot.

Please don't take this post as a sarcasm as I truly am grateful for what I've learned from everyone's posts. However, I am now left contemplating what I want to be when I grow up since pathology is evidently a steaming pile of orangutan poo.

The cuts are going to affect all medical specialties... Some worse than others. Also, I would add that the viewpoints in these threads are not representative of all pathologists. Or most. Or anything more than a few. It tends to be the same 10 people or so biatching in every thread.

If you are interested in pathology, GO TALK TO PATHOLOGISTS in your program/community. Don't rely on hearsay and whining of disaffected internet trolls. Not that they don't have a point (they often do), but you are really getting one side of a story.

 

[rollwithit]

When you are on your residency interviews and you are inevitably asked "why did you choose specialty X", make sure you tell them your first love was pathology, but some anonymous Internet forum posters scared you out of it. They will be totally understanding. All other specialties lead to instant riches and no stress. You should hop on that story line. Good luck.

 

[Thrombus]

You are making a wise decision. I myself should have listened to the two attendings that had been out in the private world that were practicing at my academic institution at the time. They said they couldn't recommend anyone going into pathology and that was a decade or so ago. However my academic "mentors" told me differently. Now of course it is much worse. There may be a few jobs in the next year or two as those who banked away money get out of the field as the gravy train comes to an end, but this will severely swing the other way as overall groups will contract as reimbursements decline. The pathology workforce will grossly decline as pathologists work harder, become more efficient, reimbursements decline. Meanwhile, many of us in the field now will work until we are 75 or longer contracting the field further in decades to come.

Hopefully the government pulls the plug on the subsidized resident labor to academia soon and academia feels the same market pressures we do so they will stop the training mill, doing a great disservice to the field!!!!

Do we really think academic departments need 200K or more per resident plus all the free work the resident does???? Lets get those academics back to the gross room and into the powerpoint tumor conference drills!

 

[rollwithit]

You are making a wise decision. I myself should have listened to the two attendings that had been out in the private world that were practicing at my academic institution at the time. They said they couldn't recommend anyone going into pathology and that was a decade or so ago. However my academic "mentors" told me differently. Now of course it is much worse. There may be a few jobs in the next year or two as those who banked away money get out of the field as the gravy train comes to an end, but this will severely swing the other way as overall groups will contract as reimbursements decline. The pathology workforce will grossly decline as pathologists work harder, become more efficient, reimbursements decline. Meanwhile, many of us in the field now will work until we are 75 or longer contracting the field further in decades to come.

Hopefully the government pulls the plug on the subsidized resident labor to academia soon and academia feels the same market pressures we do so they will stop the training mill, doing a great disservice to the field!!!!

Do we really think academic departments need 200K or more per resident plus all the free work the resident does???? Lets get those academics back to the gross room and into the powerpoint tumor conference drills!

How can you honestly call it a wise decision until the OP offers Plan B? A blanket statement of "going into pathology is unwise" is, well, unwise.

Also, if you had listened to those two attendings, what would have been your Plan B? Just curious.

 

[mlw03]

Awkward personalities. Mismanagement. Inefficiency. And very low pay.

Agree this is why academia struggles to get and keep good pathologists. Along with the silly politics and publishing requirements.

I find this thread interesting. To the OP I would say that you have to make the best decision for you. Knowing what's going to be best for you for the next 30 years or so isn't easy. To those that would criticize him/her, why? These are very tough choices and for someone with geographic restrictions, pathology is a very tough sell. You may enjoy your work, but what if your spouse has a niche job? Or you need/want to be near family? Would anyone here argue with the statement that pathology is one of the most geographically restricting fields?

 

[Thrombus]

How can you honestly call it a wise decision until the OP offers Plan B? A blanket statement of "going into pathology is unwise" is, well, unwise.

Also, if you had listened to those two attendings, what would have been your Plan B? Just curious.

Medicine has many other plan B's.

Surgery, Uro, Onc, GI, Renal, Derm, Plastics even F.P. doing a lot of derm is a great gig! You are the pointman/pointwoman, control your autonomy, and can practice where you want without the fear of being undercut due to this ridiculous oversupply!!! In fact, you will likely get signing bonus's of significant figures that can approach 7 figures if you are flexible in location!!!

Radiology and Anesth. are other much more viable alternatives superior to path although they have some of the same issues in terms of autonomy.

A blanket statement of going into path is unwise is becoming a creed my friend unless we can get demand for our services back. With the current market forces and absolute denial by academia, who depend on subsidized resident labor (this screws the whole thing up IMO) and with academia having a much louder voice that is heard in terms of politics and public policy, this is unlikely to happen.

Very wise decision to leave pathology for the OP! I wish I would have made this decision a decade or so ago despite the fact that I enjoy the medical aspects of pathology extremely!!!!

 

[lipomas]

This is so idiotic. Anyone who would choose their future 30+ year career based on the random semi-informed musings of anonymous internet posters deserves whatever negative happens to them in the future. Do you read all the posts or just the negative ones? Do you stop and think about what the motivation behind each post might be? Do you wonder if any of it is hyperbole? Go. Run from pathology. Go be an investment banker I hear they make lots of money and never get fired and work 30 hours a week.

Medicine has many other plan B's.

Surgery, Uro, Onc, GI, Renal, Derm, Plastics even F.P. doing a lot of derm is a great gig! You are the pointman/pointwoman, control your autonomy, and can practice where you want without the fear of being undercut due to this ridiculous oversupply!!! In fact, you will likely get signing bonus's of significant figures that can approach 7 figures if you are flexible in location!!!

Radiology and Anesth. are other much more viable alternatives superior to path although they have some of the same issues in terms of autonomy.

OMG my sides hurt from laughing at the lunacy of this (not the fact that there are different options, but the fact that the different options are so much better). This is truly spoken by someone who probably never exits their own bubble of an office and never actually has a conversation with another type of clinician unless it involves the phrase, "what did the biopsy show?"

Great gig? HA! Have you met any small group private practice urologists or gastroenterologists? They are big time stressed. Groups keep consolidating and stealing business, they need to consolidate and work harder (i.e. LOSS OF AUTONOMY) to keep up. You might get a bit of a signing bonus but it isn't going to come without strings attached. You seriously included oncology in this? Do you even know any oncologists that aren't employed by a hospital or large multispecialty group? Because of how reimbursement is structured they can lose money by practicing independently these days. And they all work longer hours. I know a urologist who started his career as a hospital employee for two years to get some experience, then joined a fairly small private group. Now it is on him to expand their 2 new offices. He spends 2 hours a day in the car and about 12 hours a day in the office or the OR. And his income is dependent on how well he does with this. You want that job instead?

Where does this myth of the "other clinicians have it so much better" come from? Are you just kind of imagining what things must be like? Or are you reading out of a 1980s textbook?

Go ahead, become a gastroenterologist and get your 7 figure signing bonus, work 3 days a week, and set up your own schedule.

 

[path24]

Considering gis and uros are basically employing pathologists....not really a stretch at all. We can't even keep our own fees.

 

[tkim]

buku jobs

"beaucoup"

Use in sentence:

"Now what we have here Little Yellow Sister, is a magnificent specimen of pure Alabama Blacksnake, but ain't too goddamn beaucoup."

 

[Silent Cool]

"beaucoup"

Use in sentence:

"Now what we have here Little Yellow Sister, is a magnificent specimen of pure Alabama Blacksnake, but ain't too goddamn beaucoup."

LOL, how about:

"Uros and GIs are making beaucoup de bucks. You should do that instead of Path."

 

[vashisdead]

Just like OP, I am seriously considering a career in pathology, but I can't help but to be discouraged when I peruse this forum and find this overwhelming negativity. Of course, you have to take everything with a grain of salt and understand that there are different points of views to everything, but still... to see all these "flee pathology" comments and even threads is very dissapointing.

What I would like to ask to all of you out there in the trenches is not to limit your comments to discourage, but to explain what can all of us who are truly interested in following a career in pathology do to change the field. What do we look for in our training? How can we participate? I've read that the solution lies in reducing the spots offered for residencies and fellowships, and also limiting the spots available to IMG's. Is that a really the solution? How do you expect AMG's to be really psyched about a career in pathology if this is one of the main places they come to look for information?

I've also read that we should not listen to people here and go to attendings in the "real world" for information. Most of us are so worried about getting a residency in a good program and good fellowships that make us competitive that we fail to see what happens AFTER we finish our training. What sort of questions should we ask to get the full picture? Is there a book we can read?

Honestly, I feel that the work of pathologist is crucial to the work of the vast majority of specialites and as such, cannot be replaced (but maybe I am being naive?), but to read how the field has become subservient to other specialities (sometimes with more than questionable ethics) is just sad.

Come on, guys! Rescue the field! Instead of looking at us as competition, train us right now when we are in school so that we are in the field we can help in whatever changes are for the better for the field. Don't let it die, damn it! I don't want to be a plastic surgeon or GI or GU. I want to be a pathologist. A good one. One that has a positive impact in the field, as I am sure a lot of us who come to this forum are.

Anyway, I hope this long comment (sorry!) does not fall on deaf ears... or blind eyes? I don't know.

Sincerely,
an overly enthusiastic, probably naive, hopefully future pathologist over-dosed on caffeine

 

[mlw03]

I listen to a lot of Marketplace on NPR, and while that doesn't make me any economist by any means, I do think I've learned a bit about economic principles shaping FREE markets and how that effects labor markets. Simply put, I strongly agree that problems have to come from the top. Pathology in the US is NOT a free market. Imagine you want to sell coffee. You see Starbucks making money and figure there's room in the market for competition. You get some capital and open your shop. Relatively straightforward process. Pathology is not like that. You can't just be a pathologist because you want to, rather you need specific training. And once you have that training, you can't do anything else in medicine. And you need a job because you have loans and debt and such. So you take whatever job you may be able to find, dragging down wages for all because the buyer of pathology services follows economic principes for themselves.

I've said this before, but I think it's worth repeating that this is game theory in practice. The people making the decisions about the number of training slots have no incentive to lower the number of trainees. Rather, they have disincentive, as trainees often do things to make their lives better, ie grossing relatively cheaply and research which advances their careers (because we all know the key to curing all cancer is to know if a rhapadapaoma is positive for DOG1 or not).

 

[rollwithit]

I listen to a lot of Marketplace on NPR, and while that doesn't make me any economist by any means, I do think I've learned a bit about economic principles shaping FREE markets and how that effects labor markets. Simply put, I strongly agree that problems have to come from the top. Pathology in the US is NOT a free market. Imagine you want to sell coffee. You see Starbucks making money and figure there's room in the market for competition. You get some capital and open your shop. Relatively straightforward process. Pathology is not like that. You can't just be a pathologist because you want to, rather you need specific training. And once you have that training, you can't do anything else in medicine. And you need a job because you have loans and debt and such. So you take whatever job you may be able to find, dragging down wages for all because the buyer of pathology services follows economic principes for themselves.

I've said this before, but I think it's worth repeating that this is game theory in practice. The people making the decisions about the number of training slots have no incentive to lower the number of trainees. Rather, they have disincentive, as trainees often do things to make their lives better, ie grossing relatively cheaply and research which advances their careers (because we all know the key to curing all cancer is to know if a rhapadapaoma is positive for DOG1 or not).

You actually need to argue for a LESS free market for self-interested purposes. Pathology is inherently easier for the consumers to price shop. Since a lot of it is not urgent and you actually don't need the patient to be there (forensics excluded..hah), you can remove a part of the patient, overnight it, and someone can read it in virtually any part of the country.

Patients don't have that luxury when they actually need to see and talk to a person. That being the case, the market for many of a pathologist's services is vastly expanded, competition goes up, and reimbursement goes down. Having a readily available supply of trained pathologists is obviously going to make the market even more competitive as you now can pay your employees less due to excess labor supply or, if you are the decision maker in a practice or hospital, pay yourself less so you can remain competitive.

That actually is representative of a more free market than much of medicine. That's bad for pathologists, but not necessarily bad for patients - assuming quality of care is high. You need to argue for less of a free market - one that restricts the quantity of service providers. Unless you can prove that quality of service is going down, you aren't going to get the the folks that train pathologist to cut back and you aren't going to get the folks that license pathologists to that process any more difficult either. They haven't acted on their own to control labor supply to this point, so there's no reason to expect they will do it now unless all this cheap labor are terrible diagnosticians and ruining the field's reputation.

 

[Substance]

That actually is representative of a more free market than much of medicine. That's bad for pathologists, but not necessarily bad for patients - assuming quality of care is high. You need to argue for less of a free market - one that restricts the quantity of service providers. Unless you can prove that quality of service is going down, you aren't going to get the the folks that train pathologist to cut back and you aren't going to get the folks that license pathologists to that process any more difficult either. They haven't acted on their own to control labor supply to this point, so there's no reason to expect they will do it now unless all this cheap labor are terrible diagnosticians and ruining the field's reputation.

The thing is, it happened in Canada. Back when you couldn't get anyone to go into path, hospitals were accepting people with credentials that were not up to snuff to do the work. That has resulted in myriad diagnostic disasters that were felt only years after the fact, due to the insidious nature of cancer and forensic misdiagnoses. So all of this cheap labor may very well be producing terrible diagnosticians. Path in Canada is suffering from a terrible reputation due to this kind of stuff. I read once that path should separate itself from forensics and change its name to diagnostic oncology or something sexy, to attract funding and to attract people who want to avoid corpses.

 

[Thrombus]

You actually need to argue for a LESS free market for self-interested purposes. Pathology is inherently easier for the consumers to price shop. Since a lot of it is not urgent and you actually don't need the patient to be there (forensics excluded..hah), you can remove a part of the patient, overnight it, and someone can read it in virtually any part of the country.

Patients don't have that luxury when they actually need to see and talk to a person. That being the case, the market for many of a pathologist's services is vastly expanded, competition goes up, and reimbursement goes down. Having a readily available supply of trained pathologists is obviously going to make the market even more competitive as you now can pay your employees less due to excess labor supply or, if you are the decision maker in a practice or hospital, pay yourself less so you can remain competitive.

That actually is representative of a more free market than much of medicine. That's bad for pathologists, but not necessarily bad for patients - assuming quality of care is high. You need to argue for less of a free market - one that restricts the quantity of service providers. Unless you can prove that quality of service is going down, you aren't going to get the the folks that train pathologist to cut back and you aren't going to get the folks that license pathologists to that process any more difficult either. They haven't acted on their own to control labor supply to this point, so there's no reason to expect they will do it now unless all this cheap labor are terrible diagnosticians and ruining the field's reputation.

The free market is not the problem. The problem is that academia is subsidized by the feds to have residents. If we took away this subsidy, our problems would wane as the oversupply issue resolved.

 

[Substance]

The free market is not the problem. The problem is that academia is subsidized by the feds to have residents. If we took away this subsidy, our problems would wane as the oversupply issue resolved.

Call your congressmen and tell them that the overabundance of residency positions are an extreme waste of public money that could be better put towards the war or something. Get lobbyists and be loud. I bet each of you on this damn board could scrounge together a few thou each to employ some lobbyists.

 

[rollwithit]

The free market is not the problem. The problem is that academia is subsidized by the feds to have residents. If we took away this subsidy, our problems would wane as the oversupply issue resolved.

That's an over-simplified point of view. All specialties have subsidized training and academics with a self-interest in cheap labor. Seeing that the reimbursements for a good chunk of pathologists' livelihood was just slashed in half, I seriously doubt they have the political clout to lobby for a disproportionate amount of GME funding for training purposes.

 

[Unty]

The free market is not the problem. The problem is that academia is subsidized by the feds to have residents. If we took away this subsidy, our problems would wane as the oversupply issue resolved.

I dont think there will ever be a cut in residency positions just because of the job market. I just cant see our society (or whoever is in charge) going to a program and saying "Hey we have an oversupply of residents, we are going to close your residency program down."

However if you were going to close any program down, I think programs with low board pass rates should be targeted.

 

[Jerms]

Plain and simple, I am going into medicine because, first and foremost, I expect to get a job. Sure, I would guess that we all pursued medicine because it quenches some lame thirst for "understanding the human body in health and disease" and to "rid the world of ferris wheel power outages" (that was only partly facetious because being stuck on a ferris wheel would really blow) but let's be honest, fighting for a job in Juneau, Alaska doesn't make it onto anyone's bucket list. None of us would've been comfortable pursuing medicine if we felt like we were gonna be in low demand at the end of an ungodly amount of training.

I know someone is thinking "sure bro, but you gotta do what makes you feel at one with the cosmos by following yer true calling". Personally, I don't buy this bologna of "doing what makes you feel complete and aligns your qi" because I did ten years of full-time factory work before going back to school and I would've gladly done it the rest of my working days had it paid the bills (I don't expect everyone to share this sentiment, just my personal feelings). Doing a bit of blue collar work was pretty eye-opening.
Anything will become repetitive after a few years; I just want to find some repetitive thing that is at least tolerable, will pay the bills AND be in high demand. I'm not concerned about 7-figure bonuses and chugging bottles of Cristal, I just want to feel like I've got choices when I'm finished and it sounds as if pathology cannot guarantee that.

 

[path or no path]

Plain and simple, I am going into medicine because, first and foremost, I expect to get a job. Sure, I would guess that we all pursued medicine because it quenches some lame thirst for "understanding the human body in health and disease" and to "rid the world of ferris wheel power outages" (that was only partly facetious because being stuck on a ferris wheel would really blow) but let's be honest, fighting for a job in Juneau, Alaska doesn't make it onto anyone's bucket list. None of us would've been comfortable pursuing medicine if we felt like we were gonna be in low demand at the end of an ungodly amount of training.

I know someone is thinking "sure bro, but you gotta do what makes you feel at one with the cosmos by following yer true calling". Personally, I don't buy this bologna of "doing what makes you feel complete and aligns your qi" because I did ten years of full-time factory work before going back to school and I would've gladly done it the rest of my working days had it paid the bills (I don't expect everyone to share this sentiment, just my personal feelings). Doing a bit of blue collar work was pretty eye-opening.
Anything will become repetitive after a few years; I just want to find some repetitive thing that is at least tolerable, will pay the bills AND be in high demand. I'm not concerned about 7-figure bonuses and chugging bottles of Cristal, I just want to feel like I've got choices when I'm finished and it sounds as if pathology cannot guarantee that.

Good post, I feel the exact same way

 

[Enkidu]

Plain and simple, I am going into medicine because, first and foremost, I expect to get a job. Sure, I would guess that we all pursued medicine because it quenches some lame thirst for "understanding the human body in health and disease" and to "rid the world of ferris wheel power outages" (that was only partly facetious because being stuck on a ferris wheel would really blow) but let's be honest, fighting for a job in Juneau, Alaska doesn't make it onto anyone's bucket list. None of us would've been comfortable pursuing medicine if we felt like we were gonna be in low demand at the end of an ungodly amount of training.

I know someone is thinking "sure bro, but you gotta do what makes you feel at one with the cosmos by following yer true calling". Personally, I don't buy this bologna of "doing what makes you feel complete and aligns your qi" because I did ten years of full-time factory work before going back to school and I would've gladly done it the rest of my working days had it paid the bills (I don't expect everyone to share this sentiment, just my personal feelings). Doing a bit of blue collar work was pretty eye-opening.
Anything will become repetitive after a few years; I just want to find some repetitive thing that is at least tolerable, will pay the bills AND be in high demand. I'm not concerned about 7-figure bonuses and chugging bottles of Cristal, I just want to feel like I've got choices when I'm finished and it sounds as if pathology cannot guarantee that.

Well - if you are equally fulfilled with every field, then pick the best lifestyle. Most people have a little more narrowed interests than that. Pathology is pretty unique, so most students interested in it would not generally be happy in surgery or internal medicine.

 

[DaSein77]

I'm on medicine now after a few months of path, research, studying, etc. So I had a good break from 3rd year and can see medicine from a fresh perspective. I can't believe I even considered it before. Path blows it away, in my opinion, for many reasons. What a big difference rotations make. I would suggest doing a path rotation and medicine near each in 4th year to directly compare. This is a big decision, choose wisely and not b/c of the job market only. I'd rather work as a pathologist in a crappy location than as an internist with the option of living anywhere.

 

[mlw03]

I'm on medicine now after a few months of path, research, studying, etc. So I had a good break from 3rd year and can see medicine from a fresh perspective. I can't believe I even considered it before. Path blows it away, in my opinion, for many reasons. What a big difference rotations make. I would suggest doing a path rotation and medicine near each in 4th year to directly compare. This is a big decision, choose wisely and not b/c of the job market only. I'd rather work as a pathologist in a crappy location than as an internist with the option of living anywhere.

Write down the time and place you said that. I have a few friends now saying the exact opposite. Life perspectives change with age (and marriage, kids, mortgages, etc). Hopefully your choice works well for you, but I don't think most med students know just how geographically restrictive a career in pathology may be.

 

[DaSein77]

Write down the time and place you said that. I have a few friends now saying the exact opposite. Life perspectives change with age (and marriage, kids, mortgages, etc). Hopefully your choice works well for you, but I don't think most med students know just how geographically restrictive a career in pathology may be.

Duly noted...you most certainly have a point and I'm not going to argue with that. I hope I have some options, of course, and there are a few places I wouldnt want to live in for more than a few years, but, I'm pretty flexible. I've lived in a lot of places and traveled everywhere. Moreover, you spend most of your waking life at work and at home on a couch, so I think work satisfaction trumps location if its a toss up between the two.

 

[Tiki]

Write down the time and place you said that. I have a few friends now saying the exact opposite. Life perspectives change with age (and marriage, kids, mortgages, etc). Hopefully your choice works well for you, but I don't think most med students know just how geographically restrictive a career in pathology may be.

Deleted because I was naive.

 

[mlw03]

Definitely may, not will. I know people in both groups, and I think the more niche you are, the more likely you are to struggle if you limit yourself geographically. For example, know a bright, personable girl who has cyto and derm fellowships, and is having no problem getting interview offers in the region of her choice. Also know an awkward guy who needed a few attempts to pass his boards, has cyto and surg path fellowships, and has struggled to find work anywhere. So the take home message, in my opinion, is for med students to simply know what they're signing up for. If the original poster wants flexibility and job security, s/he is probably better off doing IM than path.

 

[Johnny Sunshine]

This is so idiotic. Anyone who would choose their future 30+ year career based on the random semi-informed musings of anonymous internet posters deserves whatever negative happens to them in the future.

Not only based on these skewed internet posters. Also the attendings and current fellows at my institution, also at another public hospital system in another state, also at a private office in another state, and at a small public hospital in yet another state.

Although the postings on this board really play up the drama, fundamentally I'm not finding a whole lot of practicing pathologists who would disagree with the basic points here. And although contacts in 4 states is hardly an all-encompassing conglomerate from which to draw perspective, it's a lot better than just harking on this message board. Plus, if there were solid reasons to be optimistic, I would think I would have at least found a whiff of them. I haven't.

The most realistic scenario I can imagine for myself at the moment, which would be the most bearable (read: least painful) will be that after nearly as much training as a neurosurgeon I will wind up in a cubicle at a large corporate path lab in a city I would have never chosen as a desirable place to live, signing out slide cases like a madman. They will continue to up my workload while I'm under contract. If, when contract renewal comes up, I try to negotiate a more favorable working scenario, I will have very little leverage to use in my favor as there will be waves of nearly desperate young trainees available and willing to jump in if I decide to leave.

It's not all bad. I'll have a job. I'll pay my loans off eventually. I'll have enough income to be perhaps upper-middle class, live solid and well, and retire without much to worry about.

Assuming I don't slit my wrists in the process.

 

[pathstudent]

Pathology is totally awesome and if you have the right personality it is a very rewarding career. Everything seems so warm and rosy as med student or as a resident. The real world is totally different. It is brutal out there and pathology is a politically weak speciatly from a business perspective. And yes this matters.

In the upcoming system where a single bundled payment goes out from the Government or an insurace company, how do you think pathology will do? Who will command the greatest share, the ENT-Onc who brings the patient to the hospital, or the pathologist who just happens to be there and will read out the thryroid. Yes our job is fascinating. Yes it is essential. But you have to be willing to confront the brutal facts.

 

[Tissue issue]

Not only based on these skewed internet posters. Also the attendings and current fellows at my institution, also at another public hospital system in another state, also at a private office in another state, and at a small public hospital in yet another state.

Although the postings on this board really play up the drama, fundamentally I'm not finding a whole lot of practicing pathologists who would disagree with the basic points here. And although contacts in 4 states is hardly an all-encompassing conglomerate from which to draw perspective, it's a lot better than just harking on this message board. Plus, if there were solid reasons to be optimistic, I would think I would have at least found a whiff of them. I haven't.

The most realistic scenario I can imagine for myself at the moment, which would be the most bearable (read: least painful) will be that after nearly as much training as a neurosurgeon I will wind up in a cubicle at a large corporate path lab in a city I would have never chosen as a desirable place to live, signing out slide cases like a madman. They will continue to up my workload while I'm under contract. If, when contract renewal comes up, I try to negotiate a more favorable working scenario, I will have very little leverage to use in my favor as there will be waves of nearly desperate young trainees available and willing to jump in if I decide to leave.

It's not all bad. I'll have a job. I'll pay my loans off eventually. I'll have enough income to be perhaps upper-middle class, live solid and well, and retire without much to worry about.

Assuming I don't slit my wrists in the process.

You mentioned you were applying for fellowship. Which subspecialty?

 

[Johnny Sunshine]

You mentioned you were applying for fellowship. Which subspecialty?

I'm beginning with general surgical pathology, because it's what I enjoy the most and I want to become very solid with it. Afterwards, I could see myself enjoying cytopath or GI.

But honestly, beyond a general surg path fellowship any more would just be spinning my wheels, buying time until I could land a decent job. Hell, I'd jump at an AP-only job without fellowship starting next summer if I could find one (no luck on that yet), although I'm nervous that my current level of training is insufficient to get me through a career.

 

[Tissue issue]

I'm beginning with general surgical pathology, because it's what I enjoy the most and I want to become very solid with it. Afterwards, I could see myself enjoying cytopath or GI.

But honestly, beyond a general surg path fellowship any more would just be spinning my wheels, buying time until I could land a decent job. Hell, I'd jump at an AP-only job without fellowship starting next summer if I could find one (no luck on that yet), although I'm nervous that my current level of training is insufficient to get me through a career.

I'm offering advice only in an attempt to help. You should plan on doing a second fellowship after general surg path. You should be deciding right now whether that should be cyto or GI. Start researching/applying for that second fellowship. Do that second fellowship at the biggest name institution you possibly can. Bust your @#$ for the next two years. At that time you'll look markedly better to potential employers (private or academic). I'm not saying you'll have zillions of job offers, but you'll get a job. And I understand why you're bummed (believe me, I understand). But any hint (whether you realize it or not) of negative emotions at a job interview will get you tossed into the circular file. Hang in there dude.

 

[moonraker]

Pathology is totally awesome and if you have the right personality it is a very rewarding career. Everything seems so warm and rosy as med student or as a resident. The real world is totally different. It is brutal out there and pathology is a politically weak speciatly from a business perspective. And yes this matters.

In the upcoming system where a single bundled payment goes out from the Government or an insurace company, how do you think pathology will do? Who will command the greatest share, the ENT-Onc who brings the patient to the hospital, or the pathologist who just happens to be there and will read out the thryroid. Yes our job is fascinating. Yes it is essential. But you have to be willing to confront the brutal facts.

That is the unfortunate reality. Look, I love my job and I love doing what I can do to improve patient care. I feel fortunate to have my job and will do whatever I can to keep it as long as I can.

Ultimately, I feel that there is a clock out there and that clock is ticking. I just hope that when **** hits the fan, I'll be retired and/or dead.

Medicine is constantly changing and every specialty is fighting for a bigger piece of the pie. I'm just afraid that pathology doesn't have enough type-A personalities to maximize the size of our piece of the pie.

 

[Path or bust]

I'm just afraid that pathology doesn't have enough type-A personalities to maximize the size of our piece of the pie.

Pathology has plenty of type A personalities, but they get hammered out during residency. If you don't conform, you're out.

I think we have all witnessed this at some point, whether its through residents unified protesting or standing up for something. At one point we had a chairman tell us we would be "disadvantaged" if it persisted, despite 20+ resident unification. We were also told we should transfer if we had a problem with it. After all, they want a little slave who doesn't talk back or think. Lovely memories.

 

[KCShaw]

Had a similar issue just prior to starting medical school, and another similar issue during internship. The former was an eye-opening process, pretty much ending when the dean basically told us students that his hands were tied because the perp had tenure -- the best we could do is keep sending him written complaints and maybe someday it could go somewhere, otherwise if we openly lashed out the perp could make our lives more unpleasant than we could make his. I suspect he was truthful, although it didn't really matter. The latter was an attempt by a new CEO to slash intern and resident income (over there we got paid hourly, with overtime, and of course almost everyone had lots of unscheduled overtime) by stopping paid overtime without prior approval from his office (not just from our own clinical team). He eventually succumbed after a few days of 50+ of us repeatedly calling, sending dirty documentation suggesting we might sue, go on strike, involve the media, etc., had a meeting during which a horde hounded him from all sides, and after that we...understood one another. Had he said "well, fine, go sue, go on strike, call the media, and see what it gets you suckers," then I have no idea what would have happened -- evidently he knew it could be as bad or worse for him as for us, so he caved. But during that process I realized how much other interns/residents felt they had to lose -- I didn't have the same fear, and was able to push a lot of buttons because the worst case scenario was I left back for the U.S. a few months early. The locals worried about the next step in their training and ultimately their careers -- kinda like in elementary or high school when everyone is cowed by threats of something going on their "permanent record". Even if it ain't likely to be a problem, the threat and the fear does the job.

Point being, there comes a point where one has to put fear aside in order to be effective, but that can be very difficult to do. Especially if you're the only one sticking your neck out, or fear you might be.