Logos' said:
I agree Andy, in retrospect fast-track IM/subspecialty is the way to go if you want 100% research and a decent back-up
but then again you have to like IM at least a little bit, so that option was never on the table for me.
I met a few surg path folks while interviewing who had R01s and who uniformly told me how incredibly difficult it was to compete scientifically and keep their head above water diagnostically.
And I will quote the above to segue into answering the "Why fast-track IM/subspecialty?" Doing surgical pathology as a researcher is a BIG distraction. Sure, there are the challenges of keeping your diagnostic acumen in tip-top shape. But let's look at the early career of a scientist in pathology because this is the make-or-break time for these folks...let's say you are hired as junior research faculty...rest assured, you will still be doing a fair share of signout responsibilities. Why? Because you're the department's bitch. Now, you don't have 20 years of experience at this so you're not all that great to begin with...and imagine not being able to sign out cases immediately due to the fact that you're hedging on a diagnosis and you need impox to help you out. Then you have to wait another day. What if more sections need to be submitted? Extra levels? Even more impox? It could take days to sign out these cases and you have to keep going back to revisit these issues. When you're a lab investigator, these things become very distracting. Some of our junior faculty in our department, who have research interests, cannot pursue them because they are slammed with signout responsibilities. Imagine trying to run a lab when you have to sign out one week (or god forbid, two weeks) every month. And when you have cases that drag out...the clinical issues become very distracting. Then you get emails or pages from the clinicians and have to answer to them. Again, another distraction.
Now, my PhD thesis adviser was a nephrologist. He only had to do clinic one half day per week. He said that it's pretty easy to see 10-15 patients in one morning. Appointments frequently involve tweaking doses of meds or whatever. Then, you have to dictate the H&P's or progress notes but then you're done (unless you have to consult people). But this is the key issue. When you consult someone, you're basically turfing your problem issues to someone else. Then the consulted person will get back to you. That's not a distraction. In pathology, YOU as the attending have to keep the gears moving. The specimens and slides go nowhere without your constant supervision. Having to be anally retentive about signing out cases quickly and efficiently (so that clinicians don't pester you and that you can put these cases behind you) is distracting.
Basically, for a person who is wholeheartedly interested in research (and wants to make more money cuz PhD's get paid **** compared to MDs), clinical duties are a distraction. IM/subspecialty does allow you to better minimize these distractions. (CP only too though
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Plus, there are more research jobs in IM departments than pathology departments. IM departments just tend to be bigger.
Also, the backup job options in pathology are harder to get than in internal medicine. Let's say you absolutely fail in your postdoc and you are board certified in medicine. Well f*ck, you can drop all of it and just open up your clinic in some podunk town...and make good money! In pathology, it's not like you can just simply open up your own lab. You have to go somewhere that is already established and is willing to hire or has an opening!
I was always cognizant of these IM versus pathology issues from talking to my thesis adviser. He strongly suggested that I go into fast track IM. And that was my plan until I got a Pass in my medicine rotation and realized that my alma mater would be the best place I would be able to match at (and I would rather be caught dead rather than matching at Michigan for IM). Hence, I settled for pathology where I could write my own ticket and go wherever I wanted to go. There, I've said it. And I am completely sober now.
One mentioned that he relied significantly on his colleagues who specialized in diagnostics and all of them supported the AP/CP route if you have any interest in surg path. AP only, with subspecialty training, imo is more of a path toward diagnostics in an academic setting with collaborative translational research projects.
I totally absolutely agree with you. This is what I have concluded during my first several months here. And I have absolutely no desire to do these "translational" research projects. Hence, there lies the problem...now I am half-heartedly entertaining the option of doing the basic minimum AP training and running to postdoc and putting all my eggs in one basket and forgoing any back-up plans.
One of the nice things about UCSF is that you can switch between any combination of AP, CP or AP/CP with little difficulty.
Yeah, this was one thing I really liked about your institution. This switch business really isn't easy at many places. Here at the Brigham, everyone does two years of AP so basically you have 1-2 years to decide whether you want to tack on CP training or not.
Hope all is well for you Logos'. Glad you stopped by and I hope you're enjoying SF!