To those who were considering radiology....

Discussion in 'Pathology' started by tchantel21, Jun 19, 2008.

  1. tchantel21

    tchantel21 tchantel21

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    I'm trying to plan my fourth year and in need of a bit of advice.I know doing electives in both would be ideal, and that's my plan, but I want to have some idea what is likely to suit me so I can schedule that elective first and get good letters early on.

    To anyone who debated between radiology and pathology (and obviously chose pathology) what lead you to chose pathology? Now that you've begun residency, is it what you expected?

    Also, I know quality of life during residency sucks by definition, but do you feel like you are any better off than a radiology resident in that respect? For instance, I know radiology call is pretty stressful. What is "beeper call" like for path residents?

    How competitive is dermpath? How hard is it to get a dermpath fellowship coming from a community path program?

    Thanks all! Sorry for the litany of questions here.
     
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  3. yaah

    yaah Boring
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    Based on your posts it seems like your goal will be $$$. No offense, but if you're trying to decide between radiology and dermpath and your primary differentiating factor is stress level, etc, that's going to be most people's conclusion.

    We have had lots of threads on "path vs rads", here is one but there are others - try the search function. The way things are currently, it would be hard to get a dermpath fellowship from a community program. However, there are quite a few dermpath fellowships associated with private labs or with community programs, and if you distinguish yourself in some way (via away rotation or whatever) you would have as good a shot as anyone.

    Personally, I liked pathology but didn't like radiology. I can never understand the dilemma between the two. They have different ways of looking at things and your day is a lot different.
     
  4. trent05

    trent05 Member

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    I agree with Yaah. I think for you radiology is the better fit. With no judgement of you motivations for either field, rads is probably easier to get than dermpath. If you are considering both you can probably at least get rads somewhere. So get rads in the match and be done with it. Then you can focus on learning your specialty and not trying to get a competitive fellowship. If your goals are $, lifestyle, and working somewhere other than the sticks then in IMHO Rads>DP. Check out pathology in a elective or something but I think rads is what you are looking for.
     
  5. tchantel21

    tchantel21 tchantel21

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    Thanks for the advice! I'm a single mom so lifestyle in BOTH in residency and practice come into play for me. It'd definitely be nice to have one less hoop to jump through (obtaining a super-competitive fellowship). I will schedule a path elective but you're right...I think I will probably lean toward rads. Thanks again :)
     
  6. 106174

    106174 Junior Member

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    Hmmm... I really do not know why people think that Dermpath is the ticket to making the most money in Pathology. A friend of mine is finishing his Dermpath fellowship and will start a job making barely over 200K (just signing out Derm). Meanwhile, another friend who is finishing a GU fellowship is starting a job at 315K (just signing out GU). If you ask me, if your goal is to make the most money, I think GI and GU are the way to go.
     
  7. Unty

    Unty New Member

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    I would also agree with BigD. All three can make good money if you have your own biz and have a nice group of clinician friends who are willing to send you biopsies. :soexcited: Once that happens, welcome to Fantasy Island friends.

    [​IMG]
     
  8. Patrick O

    Patrick O Member

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    Big, what part of the country offered just over $200? TX area?
     
  9. Patrick O

    Patrick O Member

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    Big, although I agree with you about the fact that one will likely make more money in GI/GU, you and I both know that Derm is much more fun to sign out.
     
  10. levels x3

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    The type of job and the specific job are far more important than whether or not you do dermpath or GI or anything else as regards money and lifestyle. You can make a lot of money with derm, or not a lot. Private group vs. hospital employee vs. academics...These are the questions to ask yourself. Excepting the outlier experts in their fields with busy consult services (a la Phil Leboit in derm) you're likely better off as a partner in a private group with an appropriate pathologist to volume ratio doing something you enjoy. This will also be more important in determining lifestyle as you could be doing derm/GI/GU working long hours just as easily as not.

    Generally however, as born out by work-hour surveys, pathologists work fewer hours than radiologists. Call also tends to be easier. You'd be making a mistake to assume that radiology is the better lifestyle field. Ask an interventional radiologist what their life is like, what call is like, and how much they enjoy the turf wars with vascular surgeons and cardiologists.

    Ultimately, I completely disagree with the idea that dermpath is the only way make money and have a good lifestyle within pathology. This notion is apparent all over this forum and it's total nonsense.
     
    #9 levels x3, Jun 23, 2008
    Last edited: Jun 23, 2008
  11. yaah

    yaah Boring
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    One problem with derm that a lot of people aren't that aware of (and perhaps I am overblowing, correct me if I'm wrong) is that a lot of dermpath is seemingly being consolidated into a few large mega lab corporations (dermpath diagnostics, among others). Their practice is pure dermpath. They have small groups in various locations, with quite a few big names in the field on staff somewhere or as consultants. These big names likely make big money. Others make considerably less, with pay almost surely dependent on how much you sign out. I don't know the full extent of these practices though, I might be somewhat misinformed. Dermpath fellowships (these labs also have a rapidly increasing pool of fellowship spots) are also increasing substantially, so the "monetary" advantage to dermpath will likely diminish compared to recent times. That's not to say a lot of general private practice places don't still see dermpath, but it seems to be diminishing. It's like what's happening with GI and GU in some areas also. Specialty labs are plucking the low hanging fruit.

    I also strongly disagree that dermpath is the fast and easy way to more money than other areas. I have had in the past month or so two unsolicited private practice feelers, neither one knew or cared what fellowship I was doing.
     
  12. t3705

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    nevermind
     
    #11 t3705, Jun 23, 2008
    Last edited: Jun 23, 2008
  13. 106174

    106174 Junior Member

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    I agree --- I do think that the continued increase in the number of Dermpath fellowship spots will hurt the field down the road. It will become less competitive (actually, at the rate Dermpath fellowship spots are rising in number, I would not be surprised if GI and GU were now harder to get into) and the market will get so saturated that it will mirror the current state of Pathology (way more Pathologists for the number of jobs available).

    As for the income --- it might actually be better to make less than 250K. If the polls hold true until November, Obama will win the Presidency and under his plan, the government will take close to 50% of the hard earned money of those making >250K.
     
  14. Gut Shot

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    Link.
     
  15. yaah

    yaah Boring
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    The number of GI fellowship spots is exploding too. A lot of them are unadvertised so it may not be obvious (since they aren't generally acgme accredited). I was surprised in talking to people at USCAP, there are lots of academic path departments who have "GI" fellowships that I did not know had one. I think a lot of places that have surg path fellows will often allow at least one of them to focus on GI for their electives and possibly call their fellowship a "GI" fellowship. Similar with GU, although less common in my experience. There are also private labs who are starting GI and GU biopsy fellowships.

    And as far as Obama's plan taking $$$, I am not that familiar with it, but whenever they propose taking 50% of income over $250,000, it means the income in excess of $250,000 only, thus if you make $251,000 you only pay the 50% on the $1000. That is what was true in the decades before Reagan when the marginal income tax rate was in excess of 70%. But tax policies vary.
     
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  17. Pingu

    Pingu The Imelda Marcos of Path

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    This is again why it is SO important to educate yourself about business and the tax code. A significant amount of your income tax liability can be reduced if you know what you are doing. Some of the wealthiest people in this country pay a miniscule percentage of their income in taxes. You don't need to be uber-wealthy to benefit from the same laws and tax code they do. You just need a good accountant (not H&R Block, but someone who will sit down with you and explain things when you need it), some motivation, and some decent organizational skills (yes, you have to save receipts).

    If you have been intelligent enough to pick pathology as your career, then you are intelligent enough to understand the tax code. Granted, the wording is as convoluted as many of our textbooks, but it is eventually understandable. You will save money...in some cases lots and lots of money. Also, if you are fortunate enough to become a partner, there is an insane amount of deductions for business owners. That is one of the many added benefits of partnership!
     
  18. Pingu

    Pingu The Imelda Marcos of Path

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    Oh, and as for radiology, I have recently heard that GE is laying off a number of employees in their medical branch, citing dismal sales of imaging equipment. The era of radiologists minting their own gold doubloons may soon be over.

    Some choice quotes from the article I read:

    “The layoff is a response to the market,” McKaig said. “This is basically one of the toughest years ever for our diagnostic imaging business, which is based here.’

    McKaig said implementation of the federal Deficit Reduction Act had an impact on the diagnostic imaging business because it lowered federal reimbursement for certain diagnostic imaging procedures.

    “In addition, governments, insurance companies and legislators are taking actions aimed at reducing the amount spent on diagnostic imaging,” McKaig said.

    Here's a link to the story:

    http://www.jsonline.com/story/index.aspx?id=764498
     
  19. yaah

    yaah Boring
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    Indeed. All I meant was that I was not sure about Obama's plan, and that a lot of people have mistaken assumptions about tax burdens. Personally though, I think the tax codes are unnecessarily convoluted. But there have to be loopholes for congresspeople and their friends to take advantage of, so the rest of us will probably have to suffer until the end of time.

    I'm sure this has been posted previously, but I presume that the number of partnerships out there is steadily decreasing with increasing mega lab takeover of practices as well as sleazy business practices? Seems to me like a lot of graduating residents are getting jobs as salaried employees, similar to academics but paid more.

    I expected the cash cow that is diagnostic radiology wouldn't last long at the levels it has been recently - kind of like the cash cow that was flow cytometry a few years ago.
     
  20. PathLessChosen

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  21. 106174

    106174 Junior Member

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    Yep! Exactly --- "Robin Hood" economics. Bad for the entrepreneurs and businesses, small and big alike, who keep the economy afloat and who actually give jobs to people.

    But I will stop now before I get carried away. Politics should never be discussed...
     
  22. Gut Shot

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  23. eddieberetta

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    Well you may want to reconsider path then.

    Radiology is not a lifestyle residency anymore. When you are on call you will be BUSY, up all night reading scans. In places where the volume has become unmanageable, they have switched to blocks of night and evening shifts, which effectively results in more frequent call, spread out. Call is typically around 1 in 5 or 1 week in 4 nightfloat. Althought it is not physically demanding, call is stressful, especially early on, and exhausting. My colleagues who have switched in from surgery all say they get less sleep on call in rads, which jives with my intern experience. During the day you will be busy most of the time. In the evenings (like in path) you will have to READ a lot, more that you ever did in med school. My friends in path have time during the day to read around cases and study -- in radiology this is becoming now very rare. In path, at least in my program, "call" consists of carrying a pager that never rings exc to arange the odd autopsy for the next morning. Path residents never have to maka a "call" until they are done training -- in radiology you will be clearing c-spine films on day 1!

    Once you are done, you may find it harder than you think to get the type of radiology job you may be hoping for. As indications for imaging at night creep up the community hospitals also have to support a lot of after hrs imaging.

    A job with a great lifestyle is possible in radiology, but it is not a gaurantee, and my come with a pay cut. In pathology, the income is lower but the lifestyle is guaranteed.

    But in the end, you will be better served pursuing a specialty that interests you, 5 years is a long time to invest.
     
  24. yaah

    yaah Boring
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    Are you a pathologist?

    I don't know what you're talking about, "guaranteed lifestyle." There are graduated residents here who entered private practice and were surprised at how much they actually worked - one left his first job because he was working 14 hours a day, every day. Your comment, "A job with a great lifestyle is possible but is not a guarantee" could also apply to path.

    And while our call is benign compared to some other specialties it isn't that innocuous. I get pages all night when I'm on call. I also have to make many many clinical decisions without attending input during my training. I'm sure there are some programs (i know of a couple) where the residents do nothing their entire residency, but that is not true for many. On many of my rotations I have no time to read during the day either. Many of our rotations are also often basically 6 days a week (not including call).

    If you are in pathology residency, then what you are describing is not representative. If you are not in pathology residency, then stop claiming expertise.

    Part of the problem is that people with very little experience in the field claim expertise on things such as lifestyle that belong to other fields. Some are med students whose only experience is an observer rotation or heresay, others are people in other fields whose only experience is observer rotations or interaction in tumor boards or whatever. When an "outsider" relates their views on a specialty they are not in, generally they are selective in which parts of it they choose to highlight for the purposes of describing it to others. Personally, if someone asks me whether the lifestyle is better in path, radiology, or ER, I would be able to comment on path but have to defer on the other two. I know a few radiologists and some work hard, some don't work so hard. Jobs vary.

    There really aren't any great "lifestyle" jobs in residency training, no matter which field you are in. All will be full time, at least 8-5 (but probably more), with call responsibilities frequently. Once you become an attending, you can create whatever lifestlye you want in any specialty, but you are going to have to compromise SOMETHING (whether that's salary, benefits, autonomy, whatever) no matter which field you pick. Unless of course you happen to get really lucky.
     
  25. djmd

    djmd an Antediluvian

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    Fox news has all the "evidence" you could want...

    He isn't going to raise the tax rate to 50% for people over 250k.
     
  26. yaah

    yaah Boring
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  27. djmd

    djmd an Antediluvian

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    Man I love that math....
    You pay 6.25% in FICA (Social Security) and your employer pays 6.25%.

    If your salary is 100k you still pay 6.25% FICA. Regardless of what other BS this article is tacking on. (But they call it 12.5% from here on)

    So the funds you make over 250k are taxed at 33-35% (BEFORE deductions), he will add FICA back on to that (6.25%) plus a proposed 4.5% increase (which I have NOT heard specifically starting at 250k).

    So really the taxes on money over 250K are taxed at 43.75-45.75% (Again BEFORE deductions).

    Of course if we want to count FICA in "50% tax" then you better add 6.25% to the tax levels that everyone under 200k pays. Oh wait we better add 12.5% right?

    Ironically, that very ridiculous exercise proves the logic of increasing the tax rate on say 1Mil annual incomes.
    Because people who make 75k are really paying their tax rate + 6.25% Where as everyone who make more than 100k stops paying FICA. So once they make more than 100k per year their paycheck gets bigger because FICA stops coming out.

    Thus demonstrating how the tax bases of this country is skewed to favor the rich.

    Just in case that doesn't make sense
    IF you want to see what happens to the Tax rate when you include FICA (and I am only counting the part you pay, no the part you don't pay if you want to make it like their stupid 50% then add 12.5% to the exist tax rate.

    10% $8,025 WITH FICA 16.25%

    15% $8,026 – $32,550 21.25%

    25% $32,551 – $78,850 31.25%

    28% $78,851 – $164,550 34.25% to 102k then 28%

    33% $164,551 – $357,700 33%

    35% $357,701+ 35%

    So if you count FICA, people who make 100k to 75k are paying the same tax rate as people to make more than 357k.
    And people who make 32k-78k are paying the same rate as people who make 160k-357k.
     
    #25 djmd, Jun 25, 2008
    Last edited: Jun 25, 2008
  28. yaah

    yaah Boring
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    All I know is that what a presidential candidate says about tax plans is basically worthless apart from "I would raise taxes" or "I want to make a tax cut a priority." Everything else will get chewed up and spit out by 8 million committees and lobbyists and come out totally different anyway. I've stopped paying attention to specifics in any candidate's speeches. Because they don't mean squat. The generalities are important.
     
  29. levels x3

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    Boy has this thread been side-tracked. Who would have thought a path vs. rads question would become a discussion of tax policy and the upcoming elections. I'm not saying I mind but these are some serious topics for a diversion.

    I want to redivert (I made up that word) back to a less heady topic; something Yaah said about private practice, partnership goups being gobbled up by megalabs. I've heard this fear/impression/assumption before, but can anyone support this with data? I haven't observed this myself and know people (myself included) who have recently joined or will soon join smallish (3-5 pathologists) private groups that are stable and thriving. I have seen the very small 1-2 pathologist practices closing however, but not because of megalabs. It seems to be more that these very small practices aren't making any money for their very small hospitals that also aren't making any money and so when they retire they aren't replaced. Or when the bankrupt small hospital receives a purchase offer from a larger hospital nearby, they take it and the 1-2 pathologists either leave or are absorbed.

    One thing to remember about these 3-5 pathologist groups at 200 or so bed hospitals, is that they probably make the hospital a good amount of money on part A billing. The hospital then basically ensures a specimen load for the pathologists to get their part B billing on. Does this constitute a kickback under Stark law? Probably not in most cases, but even if it did, to my knowledge nobody has ever been prosecuted under that law. So it becomes a reasonable mutualistic relationship with the right sized hospital, group, and patient population.

    One last thing that could relate to either the tax/election discussion or the megalab that ate New Jersey discussion is a quote that I think is attributed to Scott Adams (the creator of Dilbert). Paraphrasing: "I am deeply suspicious of anyone who holds a strong opinion about a complex issue".
     
  30. eddieberetta

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    Nah I'm a radiologist. I have a few friends who did path and I have spoken to them a lot.

    I was not trying to say that path is easy by any stretch. Obviously the work during the day can be very busy. I was just talking about the stresses of call being less of a factor in path, which I think is relevant for a single mom.
     
  31. CameronFrye

    CameronFrye Senior Member

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    It sounds like your friends probably did residencies at low volume institutions with minimal responsibilities and likely suboptimal training. I've had plenty of nights where I dealt with very stressful calls that affected individual patients as well as the hospital system as a whole. I will soon be responsible for interpreting after hours frozens.

    If your point was that rads call is tougher than path call, fine, I will give you that. But to say that path residents never make stressful decisions in the middle of the night, that is absolute garbage.
     
  32. yaah

    yaah Boring
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    I agree. Picking a specialty because it has a "less busy" call schedule during residency is not really the way to go. Residency is only a few years. Path residents taking call have to get babysitters for their kids (if no one is home to watch them) when they are on call too, because they might have to go in at anytime. I'm on call tonight and I am getting paged almost exactly every 45 minutes. It's not stressful, but it's incredibly annoying because I can't sleep. Most of the pages tonight have been stupid (as in, "The cytogenetics media I have is expired, where do I get more?") but the next one might be a hemolyzing patient that no one knows what to do with.

    As far as the point above about megalabs - that was my question too - I have heard of labs buying private practice groups, but perhaps it isn't as much as the rumors say? Maybe they have focused on larger groups? Many groups also lose outpatient business to large labs, particularly GI, GU, dermpath stuff.

    That is an interesting quote as well, I would perhaps modify it to include that I am suspicious of anyone who holds a strong or a simplistic opinion on a complex issue. Part of the problem with politicians - they distill complex issues into simple dichotomies. You know, like

    Q: What do you think about free trade?
    A: It's evil!
    Q: Care to modify your statement?
    A: No.
     
  33. eddieberetta

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    I agree this is not the optmal reason for picking a specialty, but the OP is in a challenging situation (single parent) and stated they need to optimize lifestyle in and out of residency, and income.

    Want to stress that I am not trying to say pathology is easy or that pathologists are not hard working. And I am certain that making the final tissue diagnosis, with its attendant implications, can be very stressful and high stakes.

    But...

    I do not think it is unreasonable to say that lifestyle in residency is, on average, likely to be better in pathology than radiology, and call has a lot to do with that. Our rads residents are in-house at all sites -- none of our path residents are in house (they may come in next day for autopsy) . Are you in house on call?!?! The heavier demands of call now carry into private practice rad jobs, unless you set up a clinic practice, which may mean a pay cut.

    Of course individual jobs vary. And of course, no residency is a peice of cake. Even if there is less call, there is still lots of reading and work to be done (and I'm sure there is a ton of reading in path).
     
  34. caffeinegirl

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    As someone who trained at a high volume institution, we are really up front with the demands that expected of residents. We routinely are handling difficult situations (such as during senior frozen section call, when the senior reads the frozens or during blood bank call, etc).

    As for the original poster, I understand the importance of having time for family. However, I also think that one should follow a career that one is interested and passionate about. Sure, at the end of residency you can decide how busy you want to be...a subspecialist in IM or a PI in a lab can have flexible hours as well, more so than a regimented pathologist in a private practice lab. As for during residency....you're a resident!! I'm under the school of thought that this is the only opportunity you have to learn as much as you can, to immerse yourself, and to really learn from the faculty above you.

    As for hours during residency, you can find programs in other specialties other than rads and path that will also have easier hours....even during IM the final year is mostly clinics, whereas my final year of path still had lots of call and tough AP rotations.

    As for dermpath..I don't see the competitiveness decreasing anytime soon..it's still ultra-difficult to get a spot. So, if you want to do dermpath, you're going to have to work hard during residency anyway. And I'm sure you know that dermpath fellowship isn't a walk in the park either..with 6 months of clinic AND still having to learn the dearth of path in the field, days can be much longer than 10 hours...and they frequently spill over into the weekend.
     
  35. caffeinegirl

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    I don't think this should be a rads vs path: which is easier? type of thread. Sure we may not have in-house call, but at least in high volume institutions, we also work 80 hour weeks routinely...so although you may be sleeping in your own bed, you rarely have time to do anything but sleep once you get home during these tough stretches.... but that isn't EVERY program.
     
  36. 106174

    106174 Junior Member

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    Hmmm... I wonder who said this (being facetious)...
     
  37. 106174

    106174 Junior Member

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    I am assuming what you meant to say was "wealth" and not "dearth..."
     
  38. caffeinegirl

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    pardon my post-boards non-caffeinated brain. of course you are right
     

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