Was going into Path but changed my mind recently...

[Mamba824]

Hey guys,

I posted here a few months ago, essentially saying that I wanted to go into pathology and asked for opinions on the field. I'm a strong applicant (Step 1:250, 6 publications, all honors, AOA). I did 2 rotations in pathology, one at my home institution and one away at a top 5 academic program. I really enjoyed both rotations; however, I couldn't help but notice that the fellows were either scrambling for jobs, usually settling for academic jobs, or essentially moving to a different state, for low 200s salary. There's just so much negativity in this field, both on here and in general. Its such a shame because I truly love this specialty but after thinking about it for some time, I realized its just not worth it. 6 years of residency just to have to scramble for a mediocre 200k job that requires me to move to another state and put my family through that uncertainty? It just unfortunate. Some residents get lucky and that definitely made me optimistic. But in the end, its just not worth the risk. No matter how much I like this field, I have to be practical.

Ultimately, I chose a field (Radiology) that is a bit more clincially oriented, has a similar lifestyle (typically 8 am-5 or 6 pm, maybe even better depending on type of work), is more flexible with part time options and teleradiology, is procedural if you want it to be, and has a much better job market (rads fellows, in comparison, are getting jobs wherever they want at my institution, which is BARELY a TOP 50 program) with starting pay 350-450k. I'm not worried about outsourcing or AI and no one in radiology is. Outsourcing still requires a US MD to sign out the cases and AI will not make a drastic impact any time soon, at least not in my lifetime.

Don't mean to start anything or to say that pathology is a bad specialty. Just don't think its smart to go into this field. At least from what I have seen. Unless you are ok with an average paying job that might require you to live in a place you might not want to. Maybe this all changes in 6 years when I am an attending, who knows. For now, I have chosen to go with my brain and not with my heart.

Someone mentioned here a while ago that Pathology is losing good candidates. Well, unfortunately I'm sorry to say its lost another one.

Just wanted to give an update. Thanks.

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[Dro133]

In your last thread, you said:

"Every attending I've talked to (at my institution, at top academic programs and private practices) has told me that pathology is a wonderful specialty. None of them regret going into it. They all emphasized that the doom and gloom talk just isn't true and that the pay is very good (one attending at my institution mentioned average of 300K and someone in PP mentioned his salary is 500K). The fellows at my school all got good jobs with solid pay. The director at my school also emphasized that since I'll likely be able to go to a top residency program, I will have no problems finding a job in 6-7 years."

Today, you said:

"however, I couldn't help but notice that the fellows were either scrambling for jobs, usually settling for academic jobs, or essentially moving to a different state, for low 200s salary. There's just so much negativity in this field, both on here and in general."


Basically completely opposite sentiments. So, what gives?

 

[EMH Mark V]

200K vs 450K. Good on him - god speed.

 

[Mamba824]

In your last thread, you said:

"Every attending I've talked to (at my institution, at top academic programs and private practices) has told me that pathology is a wonderful specialty. None of them regret going into it. They all emphasized that the doom and gloom talk just isn't true and that the pay is very good (one attending at my institution mentioned average of 300K and someone in PP mentioned his salary is 500K). The fellows at my school all got good jobs with solid pay. The director at my school also emphasized that since I'll likely be able to go to a top residency program, I will have no problems finding a job in 6-7 years."

Today, you said:

"however, I couldn't help but notice that the fellows were either scrambling for jobs, usually settling for academic jobs, or essentially moving to a different state, for low 200s salary. There's just so much negativity in this field, both on here and in general."


Basically completely opposite sentiments. So, what gives?

The difference is I did rotations and saw for myself. Before I was just listening to academic attendings and regurgitating that on here. But they honestly are clueless. Like I said, I love path but you have to give up some things if you want it. You won't be making a ton of money and you prob won't live in an ideal location. If you are ok with that, then that's fine. Its a great speciality with lots of intellectual stimulation and good hours. But ultimately I want to have a say in where I work and live in general. When I saw fellows nervous about getting jobs near family or settling for fellowships, I knew it wasn't worth it.

 

[pathslides]

Path is great but you are right-You will give up either good pay or location to practice pathology. Based on the radiology forum, their job market is whack as well (less so compared to rads).

 

[Thrombus]

The difference is I did rotations and saw for myself. Before I was just listening to academic attendings and regurgitating that on here. But they honestly are clueless. Like I said, I love path but you have to give up some things if you want it. You won't be making a ton of money and you prob won't live in an ideal location. If you are ok with that, then that's fine. Its a great speciality with lots of intellectual stimulation and good hours. But ultimately I want to have a say in where I work and live in general. When I saw fellows nervous about getting jobs near family or settling for fellowships, I knew it wasn't worth it.

I remember interviewing many years ago for a fellowship at one of the premier places in the country. I asked the fellows if attendings there got them jobs. I got an enthusiastic “no, but...” and was shown the website that everyone already knows about listing jobs. I laughed my formerly naive ass off and went straight to the bar!! Been pissed off ever since about the LIES BIG ACADEMIA SPREADS SO THAT THEY CAN FILL THEIR COFFERS WITH GOVERNMENT HANDOUTS THAT TRAINEES PROVIDE!!!

 

[octopusprime]

Before I was just listening to academic attendings and regurgitating that on here. But they honestly are clueless.

bingo

 

[PathologyOptimist]

Hey guys,

I posted here a few months ago, essentially saying that I wanted to go into pathology and asked for opinions on the field. I'm a strong applicant (Step 1:250, 6 publications, all honors, AOA). I did 2 rotations in pathology, one at my home institution and one away at a top 5 academic program. I really enjoyed both rotations; however, I couldn't help but notice that the fellows were either scrambling for jobs, usually settling for academic jobs, or essentially moving to a different state, for low 200s salary. There's just so much negativity in this field, both on here and in general. Its such a shame because I truly love this specialty but after thinking about it for some time, I realized its just not worth it. 6 years of residency just to have to scramble for a mediocre 200k job that requires me to move to another state and put my family through that uncertainty? It just unfortunate. Some residents get lucky and that definitely made me optimistic. But in the end, its just not worth the risk. No matter how much I like this field, I have to be practical.

Ultimately, I chose a field (Radiology) that is a bit more clincially oriented, has a similar lifestyle (typically 8 am-5 or 6 pm, maybe even better depending on type of work), is more flexible with part time options and teleradiology, is procedural if you want it to be, and has a much better job market (rads fellows, in comparison, are getting jobs wherever they want at my institution, which is BARELY a TOP 50 program) with starting pay 350-450k. I'm not worried about outsourcing or AI and no one in radiology is. Outsourcing still requires a US MD to sign out the cases and AI will not make a drastic impact any time soon, at least not in my lifetime.

Don't mean to start anything or to say that pathology is a bad specialty. Just don't think its smart to go into this field. At least from what I have seen. Unless you are ok with an average paying job that might require you to live in a place you might not want to. Maybe this all changes in 6 years when I am an attending, who knows. For now, I have chosen to go with my brain and not with my heart.

Someone mentioned here a while ago that Pathology is losing good candidates. Well, unfortunately I'm sorry to say its lost another one.

Just wanted to give an update. Thanks.

According to the most recent Medscape survey, pathologists are averaging around $287K, $374K if self-employed. I personally know multiple pathologists who took jobs with partnership tracks and who are estimated to pull in earnings in that ballpark range. Pathology remains one of the better paid specialties per hour worked. We also have no intern year, which I value at priceless. I've additionally spoken to pathologists from groups who give each pathologist up to a week off a month PAID - one from California and I can't remember where the other guy was from. I'm not sure of the regularity at which that occurs, but I'm just saying it's there.

IMO specialties go in and out of vogue. The most popular and best paid specialties now, won't necessarily be that way in 10-20 years. If you enjoy rads, do rads. They'll have their own struggles in the future. But if you enjoy path, do path. The specialty ain't going anywhere, and anywhere from low $200K up is plenty of cash to do a specialty you enjoy, have typically light call, and rarely work weekends.

 

[Dro133]

The difference is I did rotations and saw for myself. Before I was just listening to academic attendings and regurgitating that on here. But they honestly are clueless. Like I said, I love path but you have to give up some things if you want it. You won't be making a ton of money and you prob won't live in an ideal location. If you are ok with that, then that's fine. Its a great speciality with lots of intellectual stimulation and good hours. But ultimately I want to have a say in where I work and live in general. When I saw fellows nervous about getting jobs near family or settling for fellowships, I knew it wasn't worth it.

Thanks for the reply. It sounds like you're interested in private practice, but have you heard anything from graduating residents/fellows about what the job climate is like for aspiring academics?

 

[Alteran]

Ultimately, I chose a field (Radiology) that is a bit more clincially oriented, has a similar lifestyle (typically 8 am-5 or 6 pm, maybe even better depending on type of work), is more flexible with part time options and teleradiology, is procedural if you want it to be, and has a much better job market (rads fellows, in comparison, are getting jobs wherever they want at my institution, which is BARELY a TOP 50 program) with starting pay 350-450k. I'm not worried about outsourcing or AI and no one in radiology is. Outsourcing still requires a US MD to sign out the cases and AI will not make a drastic impact any time soon, at least not in my lifetime.

You very intelligently evaluated the opportunity cost of choosing pathology vs. other options, and its not always a monetary price that's being evaluated. I consider myself one of the lucky few in pathology who has a good private practice and secure job (baring anything super drastic of course). But for most candidates that pathology as a field would like to have, they can at some level do the math and figure out that there really isn't any other specialty where (1) it takes at least 6 months to find a job - quality and location are no guarantee, (2) job security is shaky at best as I sit from my position and watch some well established groups in my region fall apart because of contract and payor "renegotiation", and (3) other specialties have every opportunity and right to rip you off and you have practically zero recourse.

The academics will tell you that you that there are jobs out there, which is not a lie. But, you'll certainly have to be flexible in ways that no other specialty will have to be and that in of its self is too big an opportunity cost for most desirable applicants.

As a disclaimer, I don't want the following to be misconstrued as anti-IMG, but I'll let the numbers speak for themselves. From the NRMP itself, the 2018 pathology match was 220 US seniors and 568 IMGs who got into a training program in the US. I would only venture to say that for a US medical school graduate who has ~$200K debt, the opportunity cost of a pathology residency is too high compared to other specialties whereas they are acceptable to certain IMGs with no medical school debt. I say "certain" because only 1.5% of IMGs applied to pathology...so maybe there's something they also know as well.

 

[octopusprime]

According to the most recent Medscape survey, pathologists are averaging around $287K, $374K if self-employed. I personally know multiple pathologists who took jobs with partnership tracks and who are estimated to pull in earnings in that ballpark range. Pathology remains one of the better paid specialties per hour worked. We also have no intern year, which I value at priceless. I've additionally spoken to pathologists from groups who give each pathologist up to a week off a month PAID - one from California and I can't remember where the other guy was from. I'm not sure of the regularity at which that occurs, but I'm just saying it's there.

IMO specialties go in and out of vogue. The most popular and best paid specialties now, won't necessarily be that way in 10-20 years. If you enjoy rads, do rads. They'll have their own struggles in the future. But if you enjoy path, do path. The specialty ain't going anywhere, and anywhere from low $200K up is plenty of cash to do a specialty you enjoy, have typically light call, and rarely work weekends.

"According to the most recent medscape survey..." --lmfao.

"...anywhere from low $200K up is plenty of cash to do a specialty you enjoy"...also lmfao.
I would say that's about as myopic, asinine and ignorant as it gets, but what's the point.
Dude...you do realize where the 200k comes from, right?
If I made only $200k based on the actual work I did, I'd have enough time to have a full second career...$200k for a full-time avg case load pathologist is a beyond insulting because that full-time avg case load pathologist is generating SEVERAL TIMES that in revenue.

The reason the profession is in the state it is in is because a huge percentage of the field has Stockholm syndrome.
Just mind boggling.

 

[octopusprime]

Low 200 is great if you...
a.) don't have $200-400k in med school debt
b.) have a max home budget of $250k
c.) don't have to pay malpractice, life, disability, and health insurance
d.) don't have any children
e.) have someone else maxing your 401k, 529s, IRAs, HSAs, etc.
f.) live in an area that has a low cost of living [which is out of your control because per your caveat #1, you can't be geographically restricted]
g.) are happy driving a '92 Honda civic or minivan until you pay off a.) and b.)
h.) like to go camping at KOAs
i.) jeez i could go on

 

[LADoc00]

Low 200 is great if you...
a.) don't have $200-400k in med school debt
b.) have a max home budget of $250k
c.) don't have to pay malpractice, life, disability, and health insurance
d.) don't have any children
e.) have someone else maxing your 401k, 529s, IRAs, HSAs, etc.
f.) live in an area that has a low cost of living [which is out of your control because per your caveat #1, you can't be geographically restricted]
g.) are happy driving a '92 Honda civic or minivan until you pay off a.) and b.)
h.) like to go camping at KOAs
i.) jeez i could go on

I would get to lowest possible COLA geographic place I could find, rural Mississippi if needed. I would live at the absolutely bear minimum to maximize savings to the highest plausible level that I feel is sustainable. I would stay single and without kids, for sure. I would hit debt with everything I had but still save 50% of my take home in cash. And finally I would throw 95%+ of my waking brainpower into business or investment ideas to dig out from that situation. Hard for sure, but very possible. Personally I would relish the challenge of being dropped proverbially "naked in the woods with just a microscope" scenario at this point in my career.

 

[dukeresident]

I would get to lowest possible COLA geographic place I could find, rural Mississippi if needed. I would live at the absolutely bear minimum to maximize savings to the highest plausible level that I feel is sustainable. I would stay single and without kids, for sure. I would hit debt with everything I had but still save 50% of my take home in cash. And finally I would throw 95%+ of my waking brainpower into business or investment ideas to dig out from that situation. Hard for sure, but very possible. Personally I would relish the challenge of being dropped proverbially "naked in the woods with just a microscope" scenario at this point in my career.

As a current pathology resident my conclusion is that pathology sucks in terms of getting a decent job.