I keep reading from different sources that medical students do not know what pathologists do, that medical schools do not expose students enough to pathology, etc., as a way to explain recruitment difficulties. Although this is partly true, the same argument could be applied to a certain extent to specialties like nuclear medicine, PM&R, medical biochemistry, public health, medical genetics, radiation oncology, etc., where there are no dedicated mandatory rotations during clerkship. I believe the interest for most of these specialties is higher than for pathology. The problems with recruitment in pathology are not geographic (the problem is worldwide) and is an oooold issue. It has "always" been like that. Some things may need to be said out and loud and sometimes you have to call a spade a spade: most people did not go to medical school to spend hours a day looking at slides through a microscope for the rest of their working lives. Live with that and stop asking where the problem is! No matter how interesting the microscopic findings may be, most medical students would simply see it like that, just interesting, crucial, important findings, etc., that can be used for patient management, BUT, and a big BUT, from there to building a career specifically on this field...not so sure. The dynamics of the daily practice in pathology is not for everyone, and like reeeeeally not for everyone. You must be comfortable sitting in strenuous, movement-limiting positions, adopting postures that are not ergonomic, being more sedentary (you know this), being more socially isolated during the working hours (yeah talking to colleagues etc., come on, you know this is not the reality of most of your day behind the scope keeping silently in focus and using those OCD traits you need to have, or to develop). You know not everybody is obsessed with nuclear, membranous, cytoplasmic details, counting mitosis, etc., with endless tumor classification systems and books (a big part of pathology is cancer diagnosis, thus limiting the variety of the job unless you are in a community practice). Not everybody enjoys going through rounds 1, 2, and 3 of immunohistochemistry tests which will delay signing reports and then dealing with impatient clinicians/surgeons, learning by heart genetic mutations, translocations for every cancer where applicable, grossing specimens, doing autopsies, breathing formaldehyde or xylene, managing lab issues, developing musculoskeletal health problems, and more, for the rest of their lives. Unfortunately, pathologists do not usually get positive feedback from clinicians or other colleagues (or patients) for making a difficult diagnosis that took days to make, and that can be hard to accept. You certainly get negative feedback if mistakes are made. Some clinicians and surgeons imagine pathology is like a machine where you enter a specimen on one side, press a button, and a diagnosis magically comes out on the other side. The lack of respect, the lack of autonomy (you can work on your speed/accuracy but no control over volume) can make some feel like they are prisoners, slaves, servants to other specialties. I am not going to talk about the positive aspects of pathology as a career because that is what you can easily read about in many sites on the internet. I am just tired some people keep avoiding talking about some real issues that are inherent to the practice of pathology and are not site-specific. It's the elephant in the room.
A move towards digitization of path images is a move in the right direction. Get rid of microscopes as a regular diagnostic tool for your health's sake! Invest in pathology image analysis software and technologies. Also, make patient contact and procedures more accessible to pathologists who are interested in having some of that (like ultrasound-guided FNA performed by pathologists). The solution is somewhere in that direction, but I bet you will always have a majority of students thinking that looking at tissues all day (as important and critical as it is) is not what they find most motivating for a job. I think macro-anatomy, and something dynamic (where you can see movement), like a process, is more interesting for a human being to imagine than focusing on individual cells and sub-cellular details. People, just simply understand that pathology is not for everyone in medicine, where from the very beginning there is a selection bias when you admit people who are dreaming of becoming super heroes. My two brutally honest cents.
