what's the catch

[docdoc]

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I am a second year student trying to decide what to do for the next 30 years. What's the deal? Path provides above average salary, below average work hours, very limited call, and the ability to avoid most of the hospital BS but is not competitive at all. What am I missing that is keeping people from stampeding to path?

 

[stormjen]

Supposed poor job market (but improving), little respect since they aren't "real doctors", autopsies, little to no patient contact, staring into a microscope for hours . . .

So it doesn't appeal to everybody.

 

[yaah]

I am a second year student trying to decide what to do for the next 30 years. What's the deal? Path provides above average salary, below average work hours, very limited call, and the ability to avoid most of the hospital BS but is not competitive at all. What am I missing that is keeping people from stampeding to path?

The supposed job market problems are not even as big an issue as many say.

I think the main deal with why more people aren't choosing it is that they simply don't consider it. People go to med school with their own ideals of what a doctor is and what kind of career they need to have. Their own patients, operating, whatever. People are so absorbed with the concept of clinical medicine that tunnel vision develops and they somehow feel they might be cheating themselves if they don't pursue it. Perhaps that last point takes it a bit far, but you get my point. People want to be orthopedic surgeons because they see how "exciting" it is (I think it's boring!). Their impression of pathology, unfortunately, is either of a boring cloistered lab rat or someone who has no contact with life and the hospital, all untrue stereotypes. Pathology just isn't cool for some reason. I would say though that it is becoming very popular, there seems to be a great deal more interest over the past few application cycles.

I don't know. Great field. Like I said you are constantly learning and doing things, and you learn all about disease and medicine without having to worry about a lot of peripheral issues.

 

[b&ierstiefel]

The supposed job market problems are not even as big an issue as many say.

I think the main deal with why more people aren't choosing it is that they simply don't consider it. People go to med school with their own ideals of what a doctor is and what kind of career they need to have. Their own patients, operating, whatever. People are so absorbed with the concept of clinical medicine that tunnel vision develops and they somehow feel they might be cheating themselves if they don't pursue it. Perhaps that last point takes it a bit far, but you get my point. People want to be orthopedic surgeons because they see how "exciting" it is (I think it's boring!). Their impression of pathology, unfortunately, is either of a boring cloistered lab rat or someone who has no contact with life and the hospital, all untrue stereotypes. Pathology just isn't cool for some reason. I would say though that it is becoming very popular, there seems to be a great deal more interest over the past few application cycles.

I don't know. Great field. Like I said you are constantly learning and doing things, and you learn all about disease and medicine without having to worry about a lot of peripheral issues.

I agree totally with the above. Pathology is great since you get to study why diseases progress the way they do and what they're all about. You get to see so many diseases in action in a given week whether it be by looking at a bunch of biopsy/surgical specimen slides and by doing autopsies.
Pathologists look at fecal leukocytes, fecal ova and parasites, etc. Pathologists get to examine all sorts of blood dyscrasias, weird cancers, and all sorts of other cool stuff. Without all the hospital BS and paperwork! What more can you ask for? Totally a great field.

People don't respect pathologists? We don't need it...we get enough satisfaction from what we do.

People don't think pathologists are cool? WTF! How can it not be cool when cool mofo's like Matte, yaah, DoctorB, etc. go into the field? Medicine has warped the fragile little minds of many.

For all those doing their path rotations now, I hope you all are having a blast! I look forward to living the dream next month. Peace.

 

[Fermata]

They are afraid of the manjuice.

The pathologist's libido goes unmatched.

 

[bente]

Some applicants are intimidated by pathologist's massive pecs and shoulder girdle. When they ripple their six pack, students scramble for the exits.

 

[yaah]

Some applicants are intimidated by pathologist's massive pecs and shoulder girdle. When they ripple their six pack, students scramble for the exits.

Yeah, you know, some people talk about how it's tough to get a job when you finish residency (which isn't really true, by the way, but let's pretend it is for the purposes of this). In actuality, you can get any job you want, because there is an unwritten code amongst pathologists that you are allowed to challenge anyone in hand to hand combat for their seat at the scope. You throw down a rubber glove and issue a challenge. Chairmen of pathology departments are the ultimate. They get challenged all the time but no one ever beats them. It's not just strength though, it's also quickness and attention to soft spots. All the feeble minded and weak bodied individuals had best choose a different specialty, unless you want to work at it.

 

[bente]

there is an unwritten code amongst pathologists that you are allowed to challenge anyone in hand to hand combat for their seat at the scope. You throw down a rubber glove and issue a challenge. Chairmen of pathology departments are the ultimate. They get challenged all the time but no one ever beats them. It's not just strength though, it's also quickness and attention to soft spots. .

Amazing but true. The first time I heard wailing from the hospital basement, I rushed down, shocked to see a young martial artist lying on the floor with nunchucks stuffed in his mouth. Smiling slying at the scope was a 60ish grey-haired man who simply told me, 'Go on your way, there's nothing to see here.'

 

[b&ierstiefel]

Amazing but true. The first time I heard wailing from the hospital basement, I rushed down, shocked to see a young martial artist lying on the floor with nunchucks stuffed in his mouth. Smiling slying at the scope was a 60ish grey-haired man who simply told me, 'Go on your way, there's nothing to see here.'

I swear...path chairs must be trained as ninjas. Sometimes they flip out and cut people's heads off too (for more info go to www.realultimatepower.net).

 

[desmangt]

That ninja site might be the most hilarious thing I have ever seen!

 

[joedogma]

I love it when people tell me that they think that pathology is boring and how great and interesting clinical medicine is. I tell them how I saw more pathology in one afternoon sign-out session than I did the prior four weeks on a medicine rotation but they don't listen...they still think that CHF and Diabetes are "interesting" cases...

 

[b&ierstiefel]

I love it when people tell me that they think that pathology is boring and how great and interesting clinical medicine is. I tell them how I saw more pathology in one afternoon sign-out session than I did the prior four weeks on a medicine rotation but they don't listen...they still think that CHF and Diabetes are "interesting" cases...

Amen to that joe! What's really boring is endocrine clinic or hypertension clinic where 90% of your patients have diabetes/essential hypertension and it's all about adjusting med doses.

 

[DrBloodmoney]

I am a second year student trying to decide what to do for the next 30 years. What's the deal? Path provides above average salary, below average work hours, very limited call, and the ability to avoid most of the hospital BS but is not competitive at all. What am I missing that is keeping people from stampeding to path?

You also forgot to add, less ridiculous paperwork, less annoying nursing staff, less annoying patients, less diabetes/ alcoholism/ heart disease/ smoking. But you have to give up patient care.

 

[deschutes]

Well... it still is patient care. We don't sit around looking at slides merely for fun - although we enjoy it so much it's just silly for me to be arguing against the fact that we do fun for work 😀 And that's the best thing about path! I've never seen people as fired up about insulin sliding-scales and Arava regimes as they are about a really good stain.

No one ever says "That's a fantastic dose of vancomycin!"
But just think of the times you've heard "Isn't that a beautiful silver/PAS/Trichrome?"

 

[yaah]

Trichromes are always beautiful. You can stain a blood clot or a mucus plug with trichome and I reckon it would be a work of art. I think I might start collecting them.

Direct patient care isn't all it's cracked up to be. When people are sick or anxious, they lose a lot of their likeability. Pathologists do provide patient care, they just don't often do it face to face. But you interact with clinicians a lot and provide important services, so you are certainly just as vital to the mission of medicine.

I like a lot of patients too. That doesn't mean I need to make it my career.

 

[deschutes]

I like meeting people. I like seeing patients. But I don't have a need to see sick people feel better to feel like my life is worth living.

I also like knowing things inside out. I like knowing exactly what happens to the specimen before the slides end up on the tray. That way I can actually troubleshoot, should something go wrong in the process.

Versus....

Dr: "Okay sir, we're going to start you on the Clinda for 10 days."
Pt: "Is that the yellow pill?"
Dr: "I don't know. The pharmacist will tell you."

 

[pbp4]

I agree about with most of the reasons path is a great field but be careful on the paperwork front. Pathology is one of the most highly government regulated fields in medicine and we all know what comes with government...Aside from that -what other speciality can you kick someones ass for a job?
-p

 

[deschutes]

what other speciality can you kick someones ass for a job?

...kick someone's ass? Do you mean other physicians?

 

[Doctor B.]

I love realultimatepower! I think alot of folks are turned off to path b/c they don't like autopsies/microscopes/lack of patientcare/not being perceived as a real doctor. The same issues we all dealt with when decided on pathology. As for paperwork, NO DISCHARGE SUMMARIES OR H AND P'S! Beautiful.

 

[Foxxy Cleopatra]

Let me tell you, from a surgery resident's point of view, I don't know why people aren't flocking towards path.

With all of the:

A. Social issues you have to deal with regarding patient care (trying to get a chronically ill 85 -year-old placed, finding a nursing home, but then having the family get p.o'd b/c they want to take her home so they can still cash in on her checks, etc, etc,)

B. The hours (I slept through dinner with friends last night because I was post-call and up all night for, yep, the 3rd time in the last 8 days)

and

C. The specimens are pretty darn interesting. We just did a distal SBR/ R. hemicolectomy on a Crohn's patient and I was fascinated with the specimen- creeping fat, a stricture, just like the books in medical school said.

Oh yeah, before I forget, don't NOT do pathology (if you otherwise like it) because of percieved lack of respect. Patients, families, and colleagues don't exactly idealize, respect, heck, for that matter, even listen to you for the most part. There's not much shining glory over here.

D. Look at this forums- these people are great! The pathologists are one of the few groups on here that are cordial, forthcoming with their interests/identity, fun, and have respectful, collegial discussions with one another.

Hmmm, I just gave a pretty good pitch for the pathologists. And I'm not even one...

 

[Su4n2]

FC, why not jump ship?

 

[yaah]

Thanks for the input, much appreciated from a different perspective.

And I think you are right about other specialties not really being any more respected. I think what we mostly complain about are all the med students and new residents who don't really know what path is and instead of learning about it, they badmouth it or criticize it for perceived "drawbacks" like lack of patient contact.

All branches of medicine are losing respect from the public. With the rise of the internet and the increasing prevalence of malpractice attorneys and so-called "advice," patients are now expecting, in many cases, perfect outcomes. If anything goes wrong, it absolutely has to be someone's fault. They believe this because there is no shortage of individuals who will tell them this. "You were wronged," etc. People are trying to sue doctors and hospitals when known common side effects or adverse events (i.e. a bleeding event after being given TPA, or abdominal infection following a gastric bypass) happen despite full disclosure of the risks. It's a shame.

 

[deschutes]

Foxxy - thanks for a catchy post!

I almost feel unqualified to comment being "only" a 3rd/final year MS who has not done a surgery rotation. 😀 But disclaimer aside:

I know many reasons for NOT going into surgery - but then I have to ask, why does someone go into surgery? Not being sarcastic, just curious.

Some years ago as a newbie med student in another part of the world, I picked up Iserson's and read that something like 30% of practising physicians said that if they had known then what they knew now about their jobs, they would not have gone into medicine.

I was young(er) then and very very new, and this Very Large Unhappy Figure stunned me. What had I gotten myself into?

Some years have gone by since, and I've had a chance to experience the context in which that statement was written. It seems there are people out there whose smartness becomes its own trap and in simplistic terms, causes them to lose sight of what makes them happy.

I like medicine - I'm in it for the long-term. I cannot and do not want to do q4 call for the rest of my life, though I have immense respect for those who do.
Path for me is both Internal Medicine and Surgery - you get to cut, and you get to make the diagnosis.
I'm still interested in seeing what Surgery is about - even as I know that I will hate the hours.

~
The last part of yaah's post re: perfect outcomes was interesting.

Again, harking back to my "Third World"/equatorial background - in my experience, people here are often horrified to hear about end-stage malaria and dengue fever and elephantiasis.
But we don't have diabetes and anorexia and crazy peanut allergies in the numbers that one sees in this part of the world.

("Don't eat peanuts? Don't eat wheat? What DO you eat?")

Healthcare in developing countries frequently does not achieve "optimal" outcome, for major reasons known to us all - but perhaps there is another dimension to it, which is that patient populations are coming at their disease treatment from a viewpoint of being okay with not being entirely well. (One could carry elephantiasis for years despite it being so awfully disfiguring.)

Or perhaps that it is even more essential than that - that in a less layered (I don't really like the words "material" or "superficial") society, people are more familiar and comfortable with the idea of their own mortality, that death is not such a very alien thing.

I realize I am almost over-encompassing. But maybe some of you will see what I am trying to get at.

 

[Doctor B.]

Thanks for the nice post Foxxy! Sounds like you like path; you should consider it.

 

[b&ierstiefel]

Thanks for the nice post Foxxy! Sounds like you like path; you should consider it.

Yeah Foxxy, if you're not too far into surgery training, you could switch to path 🙂

Foxxy has seen the light-tah! Amen Alleluia! She has been saved-dah!

 

[Foxxy Cleopatra]

Heh, I speak only the truth. And I could probably used being saved 😉

Yaah, I agree. I can imagine that some people that look at path from the outside (be it student, resident, layperson) may give you guys grief. It's unfortunate because (speaking from the viewpoint of someone in clinical medicine for a few years,) pathology is an integrated and crucial part of the diagnostic process. In other words, pathologists are very much "real" doctors in my opinion. I guess it's the black-cloud stereotype of the field, much like the one that all general surgeons do all day are fix hernias and look at rectums!

Oh yeah, the cover-your-as$ aspect of medicine (which affects my life every day) secondary to the med mal in this country... well, let's just say that it makes "smell of poo" more appealing!

Deschutes, no offense taken- I often ask myself the same question- why in the world did I do this to myself? I don't have a good answer. I thought I loved operating (in other words, the opportunity to fix things) more than anything else, but residency has made me put that into question. Operating is gratifying/interesting/fun, but IMO, you must love it above all else or you will start to resent the sacrifices of surgery (of which at times I am guilty.)

I just had to comment on this thread because I have sat back and watched the pathologists at our tumor and path conferences- there is a very collegial and respectful way about them, and it seems to me to be a generalization of most people in pathology. I just find this (and the field in general) to be pretty interesting.

Maybe you guys will let me be an honorary member?

 

[b&ierstiefel]

I just had to comment on this thread because I have sat back and watched the pathologists at our tumor and path conferences- there is a very collegial and respectful way about them, and it seems to me to be a generalization of most people in pathology. I just find this (and the field in general) to be pretty interesting.

Maybe you guys will let me be an honorary member?

I was being facetious about the whole being saved thing.

I was always interested in pathology after the first 2 years of med school before doing my PhD work. However, I heard about some of those stereotypes that we have all alluded to in previous posts and threads. So the whole pathology possibility sat in the backburner for a while.

I really didn't entertain pathology until I realized that I definitely didn't want to go into IM (initially that was my plan since my Ph.D. mentor was a nephrologist in training and he was totally advising me to go the short-track medicine route). A few months after IM was over, I did my ob/gyn and surgery rotations. I was introduced to tumor board meetings where I got to talk to pathologists. And I got the same impression from them as you did. A very friendly, sociable, collegial type of people.

I remember one of the best pieces of advice I got was from a general surgeon with whom I had the pleasure to remove a pheochromocytoma. He told me, "go into a field where you will like what you do and enjoy working with the type of people in that field." Then I got to accompany the pheo specimen to the path lab where I got to hang out for talking to the pathologist as the specimen was being handled. This may not seem like a huge experience to some, but it was a very defining experience for me.

OK...that's the end of serious Andy talking. Now back to stupid Andy...

Poo is appealing you got that right! Long live poo!

P.S. Foxxy you got my vote for being an honorary member. Who else is with me?

 

[quant]

you have my vote foxy

quant
(though im still not a official member....im angling quite hard...andy is my mentor here... )

 

[b&ierstiefel]

andy is my mentor here

The force is strong in that one!

 

[Primate]

Funny how offhanded comments can sometimes carry so much weight. Although my PhD PI is a neuropathologist (and a relatively normal guy, to boot), I also put path on the back burner, I think largely because I couldn't stomach the idea of hanging around the "stereotypical" pathologist. Now, before anyone howls or groans, please note that I used quotes (man, just can't get enough of those "air quotes" when talking - that's sarcasm, for those who wondered).

Ahem. Back to the point.

It was during my surgical rotation that I started to think path might be a bit different then all the non-pathologists were portraying it. I had the good fortune to be on our busiest surgical service (well, let's say more of a mixed blessing - loved the experience and am glad our surg block is only a few months total) and working with the chief of GI surg. This guy was awesome, demanding, nice and funny as heII. He would hand carry bits and pieces up to path and go over stuff with the residents - he was quite complementary and the pathologists didn't have translucent skin and huge coffee saucer sized eyes like morelocks. Who knew.

Doing a rotation in surg-path clinched it. The residents were normal, had lives, and knew their $h1T cold. Some of the attendings may have fit a stereotype or two, but they were still decent people.

Long story short (too late), I almost convinced myself to go into Ophtho (great field, just REALLY not the right one for me) based on a lack of knowledge and some bad PR (public relations, not the PR you put on orders) in path.

What can I say but, "Whew."

"Best,"
"P"

 

[deschutes]

Operating is gratifying/interesting/fun, but IMO, you must love it above all else or you will start to resent the sacrifices of surgery (of which at times I am guilty.)

I would find it hard to not think of that as being normal.

I think of what a Peds senior said to me as I was struggling over an admission late one evening - "This is still just a job. We get it done and we go home."

...there is a very collegial and respectful way about (them), and it seems to me to be a generalization of most people in pathology.

See, I was naive enough on entering med school to think that all doctors were like that... 🙄

The psychiatrists I have met seem the way you describe, too.

Maybe you guys will let me be an honorary member?

I hereby pronounce you - 🙂 Friend of Path!

Friends of Path are always welcome, should you ever choose to join us 🙂 I am guessing that there is as strong a need for people like you in surgery as in path.

 

[PsychMD]

Hey, the mood in this Path forum is one of the best I've seen around in a long while! I'm actually thinking of switching careers into Path now, almost exclusively for having the excuse/opportunity to continue hanging around here with such friendly and optimistic younger colleagues! 🙂

 

[DrBloodmoney]

The atmosphere is a huge part of the reason why I got into path. I had direct experience with five path departments at teaching hospitals and two private groups and they were all similar. Great attitudes, everybody passing around cool cases. Getting home to see their families. Lots of travel photos on the walls and plenty of goofy hobbies that folks with some money and time can get into... seemed like just my place.