You raise an interesting point. I know there are some med schools (like iowa for one) that do a wonderful job of teaching path during the first couple of years, and wind up with a higher # of grads going into it as a career. At UMass, I am the only one in my class in the last 3 years to choose path as a career. I don't necessarily think this is for any reasons in particular. They do a good job of teaching it at umass as well, which is part of the reason I ended up getting interested in it. There are more people at my school who have a primary care mindset, however. The school really doesn't discourage any one career in particular at all. They do provide some encouragements towards primary care fields (more opportunities, vocal support, loans) but it is all optional. I didn't feel hindered at all by the school. In fact, they were pleased.
I also don't think that med schools would decide not to admit someone based on their expressed preference of a certain field. They know that most people change their minds many times during the course of med school in terms of which field they want to enter, and they would be pretty silly to not admit someone just because they expressed an interest in pathology. More likely, they would be ranking someone lower if they expressed only an interest in pathology, refused to consider other fields, and perhaps badmouthed internists during the interview. But they would also reject a potential pediatrician who did the same thing.
Every med school is going to have certain members of the community who have axes to grind about other specialties. So you will nearly always find someone who disagrees with your choice of specialty, whatever that may be, as well as finding those who support it. I really don't think you are going to be hurt by not going to a school with a great path reputation. This is more important, I would think, for students who wouldn't have realized that path could be a great career, and would just automatically dismiss it. These people might benefit from being at a school like Iowa with great teaching and more exposure to the field as a potential career. They might simply get lost in the shuffle of "which branch of IM do I choose?" If you start med school with an interest in finding out about path and pursuing it as a potential career, you should do alright at almost any competent med school. You're unlikely to get that much of a legup on the competition, because as I said, you're still just a med student. Even if you work with the world's expert, you're still just a med student. Your research experience in the world expert's lab is not really going to be "counted" for more than someone who had an equal level of research in a relative unknown's lab.
(all the smilies I could think to represent sarcasm).
