Torn between Rads vs Path

[GMO2003]

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I've been trying to decide between these two similar yet very different specialties. I have the pros and cons list in my mind practically memorized. Radiology, although more competitive at this time due to higher potential income has always been a choice for me. I'm not going to delude myself into thinking that I'm the ideal applicant either. I'm finishing up my internship year with 2 electives back to back. Rads and Path. I am hoping that I can confirm my decision by then. I was hoping others on this board can share how they came to the conclusion that Rads or Path was for them.

 

[Doctor B.]

I always thought rads was cool but it was way too competitive for me. I was a just-above-average medical student and, while if I applied to every program in the country I might have gotten in, I felt like my chances were better to get in to path. Of course, that was 2 years ago and path seems to have gotten a bit more competitive since then (but not as competitive as rads). Also, I loathed the idea of a transitional year; path not requiring one was very appealing. In addition, for some reason, path seemed more fun. Everything was in color and you didn't sit in a dark room all day. Overall, though, I just liked pathology more after rotating in it. My gut said that was the field for me and I followed it. No regrets so far.

 

[pathdawg]

Path and Rads are really more similar to one another than different. I went through the same choice. I rotated in both and I simply enjoyed pathology more. Hopefully, when you rotate, the light will go on for one or the other. I personally found path more intellectually challenging, but that was only my personal opinion. Radiology is pretty cool too (not to mention more lucrative).

 

[HotSteamingTurd]

Ditto...I considered radiology when talking to some of my friends who are going into that field...and I considered going into rads for about 2 hours...then switched back to path. Some of the reasons are:

1. No intern/transitional year. After med school, I'm done doing floor work.
2. Interest in basic science research - granted some radiologists do research but it's mainly clinical. Pathologists do tons of excellent basic science (and so do Internal Med docs but see 1.)
3. My main interest in medicine is understanding pathophysiology and mechanisms underlying disease processes, especially at the cellular and tissue level. Rads doesn't do that for me.
4. Can't stand dark rooms...too depressing. Plus black and white pictures in dark rooms...even more depressing.
5. Never thought I was talented in radiology...CT scans own me.
6. Pathology not as competitive (but that's not one of the big reasons why I'm going into it).

I'll say this though...one advice from an attending was, "pick a field where you will see yourself enjoying to work with the people around you." I have to say that radiologists and pathologists are cool, awesome, happy folks.

 

[pathdawg]

I'll jump on the rads wagon and say, yes, I considered it too. It's a unique mixture of biomedicine, physics, and art appreciation. Obviously I chose pathology, an equally unique combination of biomedicine, meat cutting, and art appreciation.

I love that you mentioned art appreciation. I tell my students all of the time that pathology is similar to art history. Both fields involve looking at a picture and interpreting very fine and minute details. Think about it. We look at this picture (slide) and can derive from that how a disease process will biologically behave. Its really kinda kewl when you think about in those terms.

 

[yaah]

Well, I guess maybe count me as the only one who never even considered radiology. Don't like it at all. They are similar in some ways, I grant you, but I don't think they are that similar.

I wasn't really turned off by radiology being competitive. While it is nice that pathology residencies are not as hard to get, that is not really a factor in my decisionmaking. I just don't like the lifestyle of a radiologist. Sitting in a dark room, squinting at images, seeing things but never being that sure what they actually represent. I know, many radiologists say they can make an exact diagnosis on many scans, but I just don't think it's the same. They certainly help out clinicians a lot, don't get me wrong there. Very vital. Radiologists also have to learn to do too many procedures, a turnoff for me, which is only going to increase. Plus that whole prelim year garbage.

It's hard to explain. Especially when I am hungry. I just don't like it. Pathology has the attraction of seeing things at a cellular level. I think it sort of comes down to what type of person you are. Radiologists will insist until they are blue in the face that what they do is more challenging, more intellectually stimulating, more clinically relevant, and more subtle. Pathologists will insist equally vehemently the same things, only that pathology is the superior field. So who knows.

I like radiologists, I just find the field stultifyingly dull. Is that a shadow? Is that a lesion or a vessel? Well, let's compare it to the previous. No previous? Well, let's repeat it. Still there? Let's get a cat scan. I find radiology to have even more pattern recognition than pathology. It gives me a headache too. Every chest xray and cat scan seems basically the same, you have to hunt for the differences. Every path slide, on the other hand, tells a story, has marvelous architecture, and tells you a lot about function and disease. You may have to hunt hard to find disease, but it seems more interesting to me than grading shades of gray. At least, I think so. Some would say all path slides look the same. WRONG! There's something to learn in every one, whether it is about structure, differing normal variants, or staining patterns.

I would probably be WRONG! to say that all chest xrays and cat scans are the same. Fine, I'm WRONG! Obviously, they are not.

Eventually they have to get a biopsy anyway for many things. That's the place I want to be.

 

[yaah]

Oh yeah, forgot to mention that people in both fields will say that their field is poised to be even more important in the age of increasing technological advances in medicine. My conclusion: Both will be important. Pick the one you like the most and where you can see yourself in 20 years.

Also, pathologists often have more of an opportunity to teach, if that is important to you.

p.s. For those who say radiology is more interesting and more intellectually challenging. I say:

 

[Molly Maquire]

From my limited experience thus far, it seems that a radiologist has to be more of a "medical detective" in that the patient's clinical history is much more important--that is to say, the same x-ray can mean different things depending on the patient's history. I guess they hedge so much because clinicians usually don't provide them with an adequate history.

With path, it seems that everything you need is right there on the slide. If that dosen't work, you just use different stains. For this reason, I think rads may be more intellectually challenging.

Also, it seems that even a purely diagnostic radiologist has much more patient contact than a pathologist.

I would be interested to hear any other thoughts on this. I am doing rotations in both next year, so I'll get more first hand info then.

 

[yaah]

With path, it seems that everything you need is right there on the slide. If that dosen't work, you just use different stains. For this reason, I think rads may be more intellectually challenging.

I would agree, except for the "more intellectually challenging" bit. Every branch of medicine is intellectually challenging. If you want, there is an infinite amount of information to learn, and you can always improve your skills. All fields also depend on intellect to certain extents. To be sure, you can get away with "routine" and doing repetitive tasks in almost any specialty, some more than others, so that some of the challenge and mental part are lessened.

It depends on the individually. I find pathology to be the most intellectually challenging field, but that's because it is what interests me and motivates me. I spent a month with a cardiologist who, for her, obviously thinks cardiology is the same way. And it was for her. She was so into it, thought so much about problems, used her intellect, that she was a fantastic doctor.

It's tough to make arguments about stuff like this, because it really isn't necessarily true for everyone. What applies to one person is unlikely to apply to many others. That's why, as I said, one needs to find the specialty that fits them the best. More than likely, it will not be the one that appeals just to their lifestyle, but the one that "pushes their buttons" in the right way.

That being said, an awful lot of people seem to like dermatology...

 

[Doctor B.]

With path, it seems that everything you need is right there on the slide. If that dosen't work, you just use different stains. For this reason, I think rads may be more intellectually challenging.

That's not entirely true. In certain areas, bone path and derm path to name a couple, clinical history is extremely important. The skin can only react in a limited number of ways. Without a clinical ddx, the pathologist often cannot make an exact diagnosis. With bone path, you need to correlate the findings with radiology. For example, the difference b/w a low grade chondrosarc and an enchondroma is often determined radiologically as they cannot be reliably distinguished on the slide. So clinical history is very important in path. Honestly, I think both fields are very intellectually challenging; we both have to know a lot about a lot.

 

[HotSteamingTurd]

Good point. In any case, it's convenient that path isn't competitive and all of us going into it will all match without problems. But that's gonna be the easy part; I expect learning path to be very study and labor intensive but I'm looking forward to it.