Why do you think AMGs avoid pathology? Why did you go into it?

[jupiterianvibe]

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I am trying to figure out why AMGs avoid pathology as a career.

I also want to find out why pathology was chosen as a career by those practicing it.

Share your reasons here.

 

[coroner]

I’ll bite even though you just joined SDN today…

Obviously that’s not the case as myself, most of my colleagues, a fair number of posters on here, and at least half or more of practicing pathologists are AMG’s. So, it becomes a matter of semantics and what is your definition of “avoid”.

If you're inquiring why is there such a high percentage of IMG’s in pathology relative to other specialties. There are a number of reasons, but the best answer is that it is not that competitive and less competitive specialties attract/accept more IMG’s i.e. competitiveness of specialties directly correlates with a higher proportion of AMG’s. Other people will probably chirp in that pathologists don’t have to speak with pts.; therefore, it’s convenient if English is not their first language. But, that has less to do with it than the main reason I just stated.

On the other hand if you want to know why don't as many AMG's "seemingly" don't want to go into pathology in general, that's another question. This is probably due to lack of exposure in medical school as pathology is an elective. So without making a significant, impact on med students, it can be more challenging to generate the spark of interest for one to pursue it as a career. Another reason is the lack of patient contact which pathology has the least of compared to any clinical field of medicine. Med students typically fantasize about living a life that's glamorized by Hollywood on shows like 'ER' and 'Grey's Anatomy', running codes, and performing life-saving procedures, and making buku bucks, not being 'Dr. G Medical Examiner' or sitting behind a microscope. Therefore it isn't perceived to be sexy compared to other specialties. Laboratory-based medicine like the laboratory isn't often recognized by many in health care despite the essential role it plays.

 

[stickyshift]

I like being the first guy in the world to really know what's wrong with the patient.

 

[alpinebrook]

I agree with what Coroner said. Pathology is less competitive, but it's not the only field that's "less competitive", and thus not the only field you will see foreigners in (just an example -- where I went to med school and did rotations in internal medicine, the place was swarming with IMGs).

My medical school provided almost NO exposure to pathology as a specialty. It has to occur to you, on your own, that you might like it, and then you must pursue it in order to really find out for sure. I think most students get hung up on the glorified, sexy images of being a surgeon, etc. (as stated above), so they never think to look beyond that. I would definitely bet that more people would be interested in pathology if only they had proper exposure to it (i.e., met some really dynamic pathologists who are awesome teachers and have passion for their specialty -- I am extremely lucky that I met some!).

The other thing to keep in mind is supply and demand. We simply don't need as many pathologists as we do internists, pediatricians, and surgeons. Pathology is a smaller field to begin with.

As for the patient care thing, that is another factor obviously. I still struggle a little bit with the idea of not having patients express their appreciation to me. I'm currently doing an elective in radiation oncology, and I'll have to admit, it is nice meeting some of the patients -- they can be really friendly and charming, and make you feel good about yourself. But I should know that I'm a good person, and not need constant external validation. I also have to remind myself of the thousand other reasons I ultimately won't miss patient care. As a pathologist, I can still put to use all the things I learned in medical school about being sensitive and a good listener... I'll still be surrounded by people all the time (especially during residency / in an academic setting). I'll have a whole lifetime of developing relationships and being a good person (the "good doctor")! Long story short, there's no reason the "people skills" I worked on in med school will go to waste, not if I let them.

Just some of my thoughts.

 

[icpshootyz]

I'm an AMG, and in our practice only two out of our 14 pathologists are FMGs. I think one reason a good number of FMGs choose something like pathology is because of the language barrier. Simply put you don't need to speak perfect English to sign out path cases. Much harder to be a clinician and have your patients have no idea what you're saying.
For me, the only reason I went to med school was to do pathology, specifically forensic pathology. I never had any interest in being a clinician, like at all. I'm not sure I'd be in medicine if I wasn't doing pathology. I did a post-sophomore fellowship during med school to get more exposure to path, and during that I realized that I didn't really find forensics as interesting as I thought I would, but I did fall in love with dermpath, so that's what I do today. Path is funny - we're like the only field of medicine where the other fields actually have very little idea about what we do all day, or what our job actually entails. We all rotate through just about every other field, but path is an elective that few people ever choose, and when residents from other specialties choose a path elective it's usually just to have the easy schedule and to take vacations. You'd think surgeons and surgical specialties would have at least some time in path as part of their training, but they really don't. Trying to explain what a cassette is or why I can't give a wet read on a path specimen they just sent down in formalin always makes me laugh. I sort of like it this way, it gives us an aura of mystery. Sure, I suppose it would be nice if path received more credit and attracted more talented AMGs. But for the hours I work, the very low stress level while at work, the flexible schedule, and the pay, I have very few complaints.

 

[Torsed]

See my comment here:

http://forums.studentdoctor.net/threads/why-a-dramatic-increase-in-burnout.1181768/

 

[LADoc00]

AMGs avoid it because AMGs pattern off the "cool residents" they encounter during their educational process. Path residents have been, with some exceptions, largely a group of people you would never want to be left alone in room with. FMGs meanwhile operate in perpetual survival mode and take what they can get, creating a failed feedback loop for Path as a specialty.

 

[yaah]

There's less and less exposure to it these days in med school. The local med school where I am I don't think even has labs anymore. They keep increasing time for touchy feely stuff and things like that. So I don't know how people even learn about the field and what is in it. They still get lectures, but do they even go to lectures anymore anyway?

Research-interested people will always be an important pipeline for pathology.

 

[KeratinPearls]

Speaking from my own experience, Ive met FMGs who apply to Pathology as a "backup" to internal medicine. I knew of a resident who jumped ship from a path residency after a year to go into internal medicine. I even had one person admit it during his interview. There are several who were urologists or surgeons in their country and applied for Pathology because it's a field they can get into and especially with language issues. Its kinda sad really that people apply to Pathology as a backup.

 

[gbwillner]

I agree with some of the sentiments here. There is little exposure to pathology in medical school, and this is likely greatly contributing to lack of understanding or interest on the part of the average physician. At my medical school, before we could enter the clinics we had to take and pass a qualifying exam. If you did not pass you could not move on to your clinical rotations, except of course for pathology (until you retook and passed the test). It was automatically assumed that everyone who did a path rotation was therefore someone who failed this exam. There was no requirement that you did any rotation in this field, so for most people, that's all they ever knew about it.
Regarding IMGs and other specialties- path is not a super-competitive specialty like RadOnc or neurosurgery, but it is more competitive than IM, Peds, Neuro, and some others. While it may be a backup for some (lower quality) applicants, the reverse is also true. There have been more IMGs (as a % and overall) in those other fields than pathology in the last decade or so. While the communication issues are valid, more IMGs flock to IM and Peds than to Path.
At my institution I have known only one resident (out of ~100) who has left Path to go into IM. I have known more than a dozen who have left IM, Surg, GYN, and other fields (including Derm and Optho) to go into Path.

 

[pathapcp]

During my interview I met a surgery resident at home country interviewing for pathology residency.... Seemed like back up..
Agree with gbwillner.. I think pathology is more competetive. There are fewer spots compared to IM, Peds and candidates apply to this branch for backup. So for candidates who are interested in pathology as first choice it gets tougher!!

 

[VenuSN]

So... many IMGs have language issues. What about the PDs? How come they accept such candidates? How do the applicants stand out then in their interviews or in their personal statements? The problem here is less the IMGs and more those who accept them as their residents. Language issues should be unacceptable. Besides, English is a relatively easy language to learn. People should try German for a change. Or Russian.

Sent from my LG-H815 using Tapatalk

 

[VenuSN]

During my interview I met a surgery resident at home country interviewing for pathology residency.... Seemed like back up..
Agree with gbwillner.. I think pathology is more competetive. There are fewer spots compared to IM, Peds and candidates apply to this branch for backup. So for candidates who are interested in pathology as first choice it gets tougher!!

If PDs would be more selective and would search more for IMGs applying for Pathology as their first choice they'd have few problems in "smelling" candidates who want this specialty as a back-up.

 

[Thrombus]

Most pds don't care. They just want the cash from the Feds and any warm body will do.

 

[mlw03]

I wanted to be (and now am) a forensic pathologist. Pathology residency is the route by which that happens at present, so I tolerated 3 years of mostly surg path as a means to an end. If a straight FP track existed in the US, that's what I'd have done.

 

[alpinebrook]

So... many IMGs have language issues. What about the PDs? How come they accept such candidates? How do the applicants stand out then in their interviews or in their personal statements? The problem here is less the IMGs and more those who accept them as their residents. Language issues should be unacceptable. Besides, English is a relatively easy language to learn. People should try German for a change. Or Russian.

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I don't think the PDs are necessarily "accepting" candidates who can barely speak English. I'm guessing that the less competitive programs go very far down their rank list and end up with "such candidates" whereas the more competitive programs have far more AMGs. So then in this case, the said PDs appear to prefer having residents with poor language skills to having unmatched spots / no residents at all... (?)

 

[coroner]

It has next to nothing to do with language ability as I said. Path is not competitive. It's more competitive than FM, IM, PM/OM, Peds, Psych, Neuro, Nuc Med and PM&R, but that's about it. So again: Less competitive = Easier for IMG's to get accepted = higher proportion of people with another 1st language besides English. It's correlation, not causation.

 

[gbwillner]

It has next to nothing to do with language ability as I said. Path is not competitive. It's more competitive than FM, IM, PM/OM, Peds, Psych, Neuro, and PM&R, but that's about it. So again: Less competitive = Easier for IMG's to get accepted = higher proportion of people with another 1st language besides English. It's correlation, not causation.

Another thing I have noticed is that many of the IMG applicants have already completed Path residency in their home country and simply want to move to the US. When considering applicants, who would you rather have? A low-quality AMG, or maybe an IMG who has 10 years experience in the field? I am not saying they are the majority by any means, but they are definitely out there and I have known several.

While I disagree with Thrombus that academic programs just want Fed money, they do need someone to grind the meat. With this in mind, such IMG applicants are actually quite desirable, even if their communication skills are not as good as some of the AMG applicants.