Why do people go into each subspecialty?

[BlondeDocteur]

I'm just curious what attracts people to each subspecialty field within path. What do people who go into cytology like about cyto? Hemepath? Each surg path subspecialty? Transfusion med? Micro / clinical chem? Forensics? Peds? Genetics? Et al?

Are there stereotypes associated with each field? Are some of them way more lucrative than others (dermpath, GI, heme?)

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[deleted314957]

I'm just curious what attracts people to each subspecialty field within path. What do people who go into cytology like about cyto? Hemepath? Each surg path subspecialty? Transfusion med? Micro / clinical chem? Forensics? Peds? Genetics? Et al?

Are there stereotypes associated with each field? Are some of them way more lucrative than others (dermpath, GI, heme?)

I took forensics because 1)it did not increase my military obligation if I took it right out of residency (I believe this has since changed),2) I was able to do it with Maryland med examiner office/AFIP and 3) it pretty much insured employment in a worst case situation

 

[gbwillner]

I'm just curious what attracts people to each subspecialty field within path. What do people who go into cytology like about cyto? Hemepath? Each surg path subspecialty? Transfusion med? Micro / clinical chem? Forensics? Peds? Genetics? Et al?

Are there stereotypes associated with each field? Are some of them way more lucrative than others (dermpath, GI, heme?)

Here is your answer:

1. People go into cytology because they have terrible diagnostic skills and like a subspecialty where they can just narrow it down to "malignant" or "not malignant" or "maybe, I'm not sure; defer to a real pathologist". They are also touchy about their lack of skill- see Cellpathology's post below.

2. People go into Hemepath because either they heard 10 years ago that it was a hot field with lots of job prospects and then fell into a coma, or because they like a field that changes on a monthly basis for almost no particular reason. The latter tend to be the people who also like doing 3 fellowships just for fun.

3. People go into transfusion medicine because either they did clinical medicine and found it too challenging with too much clinical variety, or they accidently did a CP-only residency by checking the wrong box on their residency application and found this was the only actual way to get a subsequent job.

4. People go into Micro or Clinical Chemistry because they completed residency in another country and didn't want to do it all over again here. They saw this opportunity perhaps slightly more appealing than being a taxi cab driver. Others likely to go this path are those that completed a relevant PhD and would rather blow their brains out rather than living to write R01s to support their meager salaries.

5. People go into Forensics because they know that no one wants to do it and thus they would have a job after residency. They are pretty sure they would be otherwise unemployable. People in this field have the social grace of a carrot.

6. Peds. See above.

7. People go into molecular/genetic pathology because they heard that one day we will all be replaced by robots, computers, and sequencers and it's better to be on the side of the winners. They basically have the moral fiber of Lex Luthor in Superman II.

Did I miss anything?

 

[Pollux]

Did I miss anything?

People go into Surg path subspecialties because they want to be real pathologists.

 

[BlondeDocteur]

Did I miss anything?

Stereotypes.

 

[mlw03]

I can't tell if you're serious or kidding, but #5 is not accurate, at least not entirely. The part about not a lot of people wanting to do it - that's accurate. Every FP I know does it because they like the work and/or hate pushing glass. While the job security is true (and is looking good in the future... NAME meeting hotel gives out a lot of AARP discounts), pay in the US is crap (as low as low 100s). Anyone who did FP and didn't like the work would burn out... too physically and emotionally draining. Any of you autopsy a 160 kg woman or an infant who had the **** beaten out of them in the last few months?

The better answer to who does FP is: People who like being pathologists, enjoy working with their hands every day, are not huge fans of microscopy, and like working with cops, lawyers, and other non-doctors (one of the best parts of my job, IMO). We also are people who like putting the whole story (examination, tox, scene, and history) together to make the most reasonable diagnosis (notice I didn't say right, as it's often impossible to know what's "right" in many cases).

Here is your answer:

1. People go into cytology because they have terrible diagnostic skills and like a subspecialty where they can just narrow it down to "malignant" or "not malignant" or "maybe, I'm not sure; defer to a real pathologist"

2. People go into Hemepath because either they heard 10 years ago that it was a hot field with lots of job prospects and then fell into a coma, or because they like a field that changes on a monthly basis for almost no particular reason. The latter tend to be the people who also like doing 3 fellowships just for fun.

3. People go into transfusion medicine because either they did clinical medicine and found it too challenging with too much clinical variety, or they accidently did a CP-only residency by checking the wrong box on their residency application and found this was the only actual way to get a subsequent job.

4. People go into Micro or Clinical Chemistry because they completed residency in another country and didn't want to do it again. Or they did a PhD and would rather shoot themselves than live to write R01s to support their meager salaries.

5. People go into Forensics because they know that no one wants to do it and thus they would have a job after residency. They are pretty sure they would be otherwise unemployable.

6. Peds. See above.

7. People go into molecular/genetic pathology because they heard that one day we will all be replaced by robots, computers, and sequencers and it's better to be on the side of the winners.

Did I miss anything?

 

[Substance]

I can't tell if you're serious or kidding, but #5 is not accurate, at least not entirely. The part about not a lot of people wanting to do it - that's accurate. Every FP I know does it because they like the work and/or hate pushing glass. While the job security is true (and is looking good in the future... NAME meeting hotel gives out a lot of AARP discounts), pay in the US is crap (as low as low 100s). Anyone who did FP and didn't like the work would burn out... too physically and emotionally draining. Any of you autopsy a 160 kg woman or an infant who had the **** beaten out of them in the last few months?

The better answer to who does FP is: People who like being pathologists, enjoy working with their hands every day, are not huge fans of microscopy, and like working with cops, lawyers, and other non-doctors (one of the best parts of my job, IMO). We also are people who like putting the whole story (examination, tox, scene, and history) together to make the most reasonable diagnosis (notice I didn't say right, as it's often impossible to know what's "right" in many cases).

Why is the pay so horrible in America? Who would do that kind of job for sub-family-doctor pay? I mean, sure pediatrics also gets paid that horribly, but at least they can go around saying they cure children and there's a certain amount of pride that goes along with that.

 

[mlw03]

As LADoc would probably say, because it can be. By that I mean crap pay is offered, yet someone takes the job and does it. I probably would have, had I not gotten an offer up north (not one of the horrific ones, but 160 is pretty good for FP). Salaries have crept up a bit of late, as the job market has gotten even tighter. thename.org and aafs.org are where FP jobs in the US and Canada get posted (those that aren't filled via word of mouth), if folks are ever curious to see what's out there in that market.

Why is the pay so horrible in America? Who would do that kind of job for sub-family-doctor pay? I mean, sure pediatrics also gets paid that horribly, but at least they can go around saying they cure children and there's a certain amount of pride that goes along with that.

 

[gbwillner]

I can't tell if you're serious or kidding, but #5 is not accurate, at least not entirely. The part about not a lot of people wanting to do it - that's accurate.

So you've just proven my point... who would hire someone who lacks the ability to sense when a post is entirely tongue-in-cheek? No one. Better stick to FP until you burn out in seven years because you only interact with dead people and they haunt your dreams every night to the point of madness. Or switch to Peds.

Here are some more subspecialty fellowship types....

8. Surgical pathology- People go into surgical pathology fellowship because they based their residency choice on whether or not a beach was within walking distance or how much time they would have to take up water polo. Now they realize they are unemployable because they suck at surgical pathology, and hope that by doing this fellowship at a "top institution" future employers will ignore what a failure the rest of their lives have been.

9. Dermpath- People who go into dermpath are the type-A personality a-holes that everyone hates in residency. They probably only went into path because their Step 1 scores and clinical grades weren't good enough to land a ROAD specialty, and now they take out their frustrations on those lesser cretins they are forced to share space with. They pride themselves in having the ability to convince others that looking at skin biopsies is actually interesting, and that they aren't just in it because it's lucrative.

10. Neuropath- People who go into neuro are typically the biggest nerds in medicine. This is in part because they are passionate about a field that basically no one cares at all about. They are not infrequently given atomic wedgies in the women's lavatory. Their work is divided between being the neurosurgeon's b**ch for frozens at any given notice, only to receive a minuscule amount of tissue with which to make a diagnosis, debating extremely rare brain tumors, and looking at 3 week old brains from dead people for no real purpose. They are pretty worthless overall, which is why if they vanished one day no one would notice for at least a week.

11. GI/GU/GYN/Breast/Renal/soft tissue/thoracic/head&neck- people who do these fellowships are masochists who actually enjoy indentured servitude. They plead for residency programs to do additional years of residency and in the end receive absolutely nothing for it, other than the joy of being a scut monkey. People who do these fellowships often do more than one, or even do them indefinitely because the real world is "scary".

12. 2 fellowships- people who do 2 fellowships are sheep. They are controlled by group-think, and tend to enjoy reality television. They are told that "everyone does it" which is sufficient for them to do a four year residency (at least one year of which will be a complete g*ddam waste of time) and then an additional 2 years without questioning it or even applying for a job. They are basically cannon-fodder.

13. 3 fellowships. People who complete 3 fellowships are totally unemployable for one reason or another, who have the mistaken belief that by simply doing another fellowship they will gain the attention of an employer who did not think them qualified for a job after 2 subspecialty fellowships. They tend to blame "the man" for their failings and not the fact that everyone can sense their homicidal tendencies.

 

[coroner]

I vehemently dispute #8: I trained far from the beach where we had cold winters, so I was more concerned about taking the day off from a CP rotation to go snowboarding...

 

[path24]

You jump on the subspec merry go round because a pathology residency can't get you a job. Doing multiple fellowships with the hopes of finding employment somewhere in the US. It keeps going and going....how many times will you go round till you get a job...2...3....or do you jump off with no job? Academics keeps selling and adding tickets, while collecting money, free labor, and singing/laughing about an upcoming shortage. And the line just keeps growing.

 

[Cellpathology]

Here is your answer:

1. People go into cytology because they have terrible diagnostic skills and like a subspecialty where they can just narrow it down to "malignant" or "not malignant" or "maybe, I'm not sure; defer to a real pathologist"

2. People go into Hemepath because either they heard 10 years ago that it was a hot field with lots of job prospects and then fell into a coma, or because they like a field that changes on a monthly basis for almost no particular reason. The latter tend to be the people who also like doing 3 fellowships just for fun.

3. People go into transfusion medicine because either they did clinical medicine and found it too challenging with too much clinical variety, or they accidently did a CP-only residency by checking the wrong box on their residency application and found this was the only actual way to get a subsequent job.

4. People go into Micro or Clinical Chemistry because they completed residency in another country and didn't want to do it again. Or they did a PhD and would rather shoot themselves than live to write R01s to support their meager salaries.

5. People go into Forensics because they know that no one wants to do it and thus they would have a job after residency. They are pretty sure they would be otherwise unemployable.

6. Peds. See above.

7. People go into molecular/genetic pathology because they heard that one day we will all be replaced by robots, computers, and sequencers and it's better to be on the side of the winners.

Did I miss anything?

#1 poorly thought out considering that the majority of people that go into cytology also continue to practice surgical pathology..... I am not biased at all :/

 

[yaah]

I'm just curious what attracts people to each subspecialty field within path. What do people who go into cytology like about cyto? Hemepath? Each surg path subspecialty? Transfusion med? Micro / clinical chem? Forensics? Peds? Genetics? Et al?

Are there stereotypes associated with each field? Are some of them way more lucrative than others (dermpath, GI, heme?)

Everybody has their own specific reasons. You can start to cluster some by stereotypes but the ultimate reason is typically that they like it and/or they have a talent for it. Sometimes initial considerations of subspecialties may happen for stereotypical reasons but the final decision usually comes down to desire. Except for the subset who are doing it because they think it makes them more competitive (I actually have met a lot of people who did cytopath for this reason, and some of them actually dislike cytopath).

You don't have to do fellowships to practice in certain areas. But a lot of times big groups want someone with subspecialty training to lead certain sections like cyto or heme.

 

[Cellpathology]

Everybody has their own specific reasons. You can start to cluster some by stereotypes but the ultimate reason is typically that they like it and/or they have a talent for it. Sometimes initial considerations of subspecialties may happen for stereotypical reasons but the final decision usually comes down to desire. Except for the subset who are doing it because they think it makes them more competitive (I actually have met a lot of people who did cytopath for this reason, and some of them actually dislike cytopath).

You don't have to do fellowships to practice in certain areas. But a lot of times big groups want someone with subspecialty training to lead certain sections like cyto or heme.

Yes but you have to do fellowships to practice in MOST areas

 

[yaah]

Yes but you have to do fellowships to practice in MOST areas

Not sure about that (except for derm). It depends on the practice type, again. If you're at an academic center it's probably best (nearly required unless you do lots of research) if you have done a fellowship in your primary area, unless there are some other circumstances. Or in a large reference-type lab. But in regular practice not as much. I sign out lots of stuff without having done a fellowship in it.

 

[pathstudent]

I think a lot of it depends on who are the most charismatic members of the faculty where you are training.

 

[ItsSurgicallyComplicated]

So you've just proven my point... who would hire someone who lacks the ability to sense when a post is entirely tongue-in-cheek? No one. Better stick to FP until you burn out in seven years because you only interact with dead people and they haunt your dreams every night to the point of madness. Or switch to Peds.

Here are some more subspecialty fellowship types....

8. Surgical pathology- People go into surgical pathology fellowship because they based their residency choice on whether or not a beach was within walking distance or how much time they would have to take up water polo. Now they realize they are unemployable because they suck at surgical pathology, and hope that by doing this fellowship at a "top institution" future employers will ignore what a failure the rest of their lives have been.

9. Dermpath- People who go into dermpath are the type-A personality a-holes that everyone hates in residency. They probably only went into path because their Step 1 scores and clinical grades weren't good enough to land a ROAD specialty, and now they take out their frustrations on those lesser cretins they are forced to share space with. They pride themselves in having the ability to convince others that looking at skin biopsies is actually interesting, and that they aren't just in it because it's lucrative.

10. Neuropath- People who go into neuro are typically the biggest nerds in medicine. This is in part because they are passionate about a field that basically no one cares at all about. They are not infrequently given atomic wedgies in the women's lavatory. Their work is divided between being the neurosurgeon's b**ch for frozens at any given notice, only to receive a minuscule amount of tissue with which to make a diagnosis, debating extremely rare brain tumors, and looking at 3 week old brains from dead people for no real purpose. They are pretty worthless overall, which is why if they vanished one day no one would notice for at least a week.

11. GI/GU/GYN/Breast/Renal/soft tissue/thoracic/head&neck- people who do these fellowships are masochists who actually enjoy indentured servitude. They plead for residency programs to do additional years of residency and in the end receive absolutely nothing for it, other than the joy of being a scut monkey. People who do these fellowships often do more than one, or even do them indefinitely because the real world is "scary".

12. 2 fellowships- people who do 2 fellowships are sheep. They are controlled by group-think, and tend to enjoy reality television. They are told that "everyone does it" which is sufficient for them to do a four year residency (at least one year of which will be a complete g*ddam waste of time) and then an additional 2 years without questioning it or even applying for a job. They are basically cannon-fodder.

13. 3 fellowships. People who complete 3 fellowships are totally unemployable for one reason or another, who have the mistaken belief that by simply doing another fellowship they will gain the attention of an employer who did not think them qualified for a job after 2 subspecialty fellowships. They tend to blame "the man" for their failings and not the fact that everyone can sense their homicidal tendencies.

This is why it is always interesting to sit with the path attending at cafeteria and hear the rant.

 

[chooks]

@gbwillner: love it. keep it coming!

In all seriousness, I did hemepath as 1) I like it, 2) I appear to be good at it (from what I can tell and from what others tell me), 3) it is pretty high tech and 4) the diagnostic categories change every month!

Despite all the bells and whistles of molecular, flow, IHC, FISH, etc... morphology is still king (e.g. HRS cells, blasts, etc...) I like to look at pretty pictures as much as any other glass pusher. But also fun to talk about spectroscopy, Raman scattering, quantum efficiency, etc... too!