I'm probably in the minority, but I wouldn't trust a fresh pathology graduate without a fellowship. There is simply too much to learn in 4 years if you do AP/CP. There is just so much more information today than 20 years ago. So, my point is, I don't think it's unreasonable for a pathologist to do at least 1 fellowship before becoming competitive for a job.
Verification, license, boards, make me think...Do I really want this?
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I'm probably in the minority, but I wouldn't trust a fresh pathology graduate without a fellowship. There is simply too much to learn in 4 years if you do AP/CP. There is just so much more information today than 20 years ago. So, my point is, I don't think it's unreasonable for a pathologist to do at least 1 fellowship before becoming competitive for a job.
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Well, I wouldn't trust a new pathology grad with a fellowship either. Training programs are too inadequate for real world practice.
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To the OP, I feel your pain and can definitely relate to your predicament. I'm also a 4th year resident who is having some serious doubts about their future in and of the field in general of pathology. I do agree with many on here that it is probably way too early for you to expect job offers in the field, but that, in and of itself, is part of the problem to me and I'm sure to you. I, like you, don't see being a pathologist as the end-all-be-all of living and I'm sure this magnifies the job market issues for you.
You see your friends who went to medical school spend half the time in training come out with 100x the job prospects and nearly always equal or better pay. When your peers enter their last year of residency it is always with a sense of hope and accomplishment; they are either certain they will find a decent job or have a fellowship lined up where they know they will actually be practicing in the field--nearly all obtaining said job before being board certified. To top it off, most are actively recruited for positions or can count on just about any hospital in the US to need one of their specialty and don't have to rely on the monolithic Pathology Outlines job board to know of job openings.
We now face a final year of residency where you've finished 4 years of training and know you are unemployable in your field. You "accept" that you will be doing at least one fellowship in something you may not even like or don't even know if you'll be practicing it for the sole purpose of being "marketable." You then are faced with the dilemma of whether you should set up a second fellowship (in something you probably don't care about) just so that you aren't faced with the situation where you must scramble into whatever mediocre fellowships are left in (likely) another city if you can't get a job. It is hard to not become discouraged when this scenario is more than even a rare occurrence these days.
Basically, I'm agreeing with you that you have many reasons to be upset/frustrated with your current position. Now, what to do? I agree with a few others on here that your career counselors sound worthless. Continuing to push forward in the defined path is by far the trajectory that requires the least amount of non-linear effort and creativity from their part. Will you find a job? I think almost certainly you and most pathology residents will. What is becoming harder to predict is will it be worth it? Is the possibility of doing 3 fellowships to get there worth it to you? Is going into academia for a few years worth it? Is moving many times over the course of a couple years worth it? Is taking a crappy job to get experience worth it? It's doubtful you would have to do all of these, but increasingly likely you would have to do one to get that "dream job." And with the contraction in partnership gigs and decreasing reimbursement, those aren't multiplying.
If this doesn't sound worth it, you probably need to start working on "Plan B" ASAP. The longer you go down the traditional pathology route, the harder it will be to break away and less financially sound it will be. That could entail another residency or going the non-clinical route and leaving medicine. Just know that these routes are not easy and pathology is definitely one of the harder fields to re-enter after a non-clinical stent because you can't just moonlight every odd Saturday and keep your skills fresh like many other fields. It sounds like you wouldn't miss pathology so that would likely not be an issue for you. Also know that making a non-clinical transition will likely come with a moderate to significant pay cut compared to a private practice pathologist--at least initially (and with the way things are going, maybe not for long). The earlier you do this the better as you can relate your starting salary to a resident/fellow salary and it will look much better for those initial years.
Good luck to you.
You see your friends who went to medical school spend half the time in training come out with 100x the job prospects and nearly always equal or better pay. When your peers enter their last year of residency it is always with a sense of hope and accomplishment; they are either certain they will find a decent job or have a fellowship lined up where they know they will actually be practicing in the field--nearly all obtaining said job before being board certified. To top it off, most are actively recruited for positions or can count on just about any hospital in the US to need one of their specialty and don't have to rely on the monolithic Pathology Outlines job board to know of job openings.
We now face a final year of residency where you've finished 4 years of training and know you are unemployable in your field. You "accept" that you will be doing at least one fellowship in something you may not even like or don't even know if you'll be practicing it for the sole purpose of being "marketable." You then are faced with the dilemma of whether you should set up a second fellowship (in something you probably don't care about) just so that you aren't faced with the situation where you must scramble into whatever mediocre fellowships are left in (likely) another city if you can't get a job. It is hard to not become discouraged when this scenario is more than even a rare occurrence these days.
Basically, I'm agreeing with you that you have many reasons to be upset/frustrated with your current position. Now, what to do? I agree with a few others on here that your career counselors sound worthless. Continuing to push forward in the defined path is by far the trajectory that requires the least amount of non-linear effort and creativity from their part. Will you find a job? I think almost certainly you and most pathology residents will. What is becoming harder to predict is will it be worth it? Is the possibility of doing 3 fellowships to get there worth it to you? Is going into academia for a few years worth it? Is moving many times over the course of a couple years worth it? Is taking a crappy job to get experience worth it? It's doubtful you would have to do all of these, but increasingly likely you would have to do one to get that "dream job." And with the contraction in partnership gigs and decreasing reimbursement, those aren't multiplying.
If this doesn't sound worth it, you probably need to start working on "Plan B" ASAP. The longer you go down the traditional pathology route, the harder it will be to break away and less financially sound it will be. That could entail another residency or going the non-clinical route and leaving medicine. Just know that these routes are not easy and pathology is definitely one of the harder fields to re-enter after a non-clinical stent because you can't just moonlight every odd Saturday and keep your skills fresh like many other fields. It sounds like you wouldn't miss pathology so that would likely not be an issue for you. Also know that making a non-clinical transition will likely come with a moderate to significant pay cut compared to a private practice pathologist--at least initially (and with the way things are going, maybe not for long). The earlier you do this the better as you can relate your starting salary to a resident/fellow salary and it will look much better for those initial years.
Good luck to you.
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5 of the last 7 people hired in our group of >10 have been hired right out of fellowship. 4 did 1 fellowship, 1 did 2, both of which were complementary to their interests.
The point is not whether you trust someone right out of fellowship, it's whether you trust the person. Certainly, someone right out of training is a bit more of a wild card, you aren't sure whether they can hack it or handle the pressure and such. But to be honest you don't know that with someone 5 years out either. All you really know is that they are 5 years out. Groups that are dogmatic and refuse to hire anyone without any experience usually fall under one of two categories:
1) Those that have been burned by hiring a new grad, for whatever reason.
2) Those in smaller groups that have multiple different responsibilities and minimal time to train people in a lot of the CP issues and management issues that are important in the job.
The point is not whether you trust someone right out of fellowship, it's whether you trust the person. Certainly, someone right out of training is a bit more of a wild card, you aren't sure whether they can hack it or handle the pressure and such. But to be honest you don't know that with someone 5 years out either. All you really know is that they are 5 years out. Groups that are dogmatic and refuse to hire anyone without any experience usually fall under one of two categories:
1) Those that have been burned by hiring a new grad, for whatever reason.
2) Those in smaller groups that have multiple different responsibilities and minimal time to train people in a lot of the CP issues and management issues that are important in the job.
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While this is true to a certain extent, my impression is that experience is almost always a trump card due to the perceived risk of hiring a new graduate. If someone has been practicing (particularly in a competitive market) for 3-5 years and hasn't been run out of town yet, you can assume a general level of competency. Assuming the 3-5 years wasn't with 3-5 different groups, of course. If a person isn't cutting it, it doesn't take a group 3 years to encourage them to move on.
