Unty

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Pathologist here. Pathology and radiology both have little to no patient contact. Would like to know if any of you considered Pathology and if so, why did you consider Radiology over Pathology?

Numbers of US grads applying to Pathology have been decreasing over the past years and would like to get direct feedback from those that may have actually considered both but chose radiology instead.

Be brutally honest in why you may have chose Radiology over Pathology. Or why you didn't consider Pathology at all in the first place.

I understand there are med school graduates who still want to see patients and obviously you can't ask them for input as to why they didn't choose Pathology. But those who apply to either Rads or Path are ok with not seeing patients so I wanted to target this particular group (Rads folk) as to why they didn't choose Pathology as a profession?

Thanks for any input and be brutally honest !
 

GoPelicans

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I think the main thing is underexposure to path. My school had a third year radiology rotation. On other rotations (medicine, surg, etc) you have come contact with radiology. I don't think I had any chance to interact with a pathologist as a med student until my fourth year. In addition you see all these posts on the internet about how much the path job market sucks. Those were the main things for me about why I never considred path. i bet once path becomes digitized and you are looking at tissues on monitors instead of microscopes it will be way more popular.
 
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Splenda88

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People don't want to have a hard time getting a job after residency and heck! they want to make 500k/yr...
 
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maxxor

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Because I have been reading SDN since I was a premed and got the message about pathology early on.
 
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Kuratz

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I really liked my pathology rotation. Through the internet and the fellows I spoke with it seemed like the job market issues were real (not that rads doesn't have its own problems) and the training length has become de facto 6 years for both. I found pathology to be more interesting but the actual day to day workflow of rads was my preference. It seemed like unless we were doing frozen sections very little contact with consultants occurred in path while during my rads rotation it seemed like consultants either came to the reading room or called quite frequently. I liked the technology aspect of rads. The personalities in rads clicked better. Lastly the opportunity to maintain some patient contact with procedures, fluoro and mammo were appealing to me. I like working with patients in doses, just not clinic and rounding. Money is only a part of what drives med student interest but when you constantly hear about how poor the job market is for path (true or not) it really weeds out people who might consider it. FWIW we had quite a few go into path from my US MD school. They all had their pick of very prestigious residency programs.
 
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I did a few path rotations and was like 90% on the path train. But ultimately decided that I want to choose my geographic location and make more than 200k. There was too much negativity around path that i didn't like.
 

SeisK

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Your job market is simply terrible. I wasn’t under the impression this would be news.
 
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Radology

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Honestly? Dealing with dead bodies and organ specimens freaks me out. The smell in a path department is disgusting. I also have a strong astigmatism which made microscopes hard to use.
 

Purple&Gold

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Med school buddies I know who went into path did so to pursue research at big name institutions - they were smart, got the foundational basics of path training in residency, but moved on to focus on applying that knowledge in various research endeavors while keeping a 20% clinical experience.

Radiology is almost the inverse of this: most people do it for the clinical work/ less opportunities for research.
 
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Dro133

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For the folks who cite microscope issues as their main reason for not considering pathology further -- do you think your decision tree may have gone differently if pathologists looked at digital slides on the computer rather than looking down a microscope?
 

maxxor

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For the folks who cite microscope issues as their main reason for not considering pathology further -- do you think your decision tree may have gone differently if pathologists looked at digital slides on the computer rather than looking down a microscope?
Possibly but digitization will shred their job market even more.

They need to cut training spots by at least 50%.
 
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For the folks who cite microscope issues as their main reason for not considering pathology further -- do you think your decision tree may have gone differently if pathologists looked at digital slides on the computer rather than looking down a microscope?
It wouldn't have made a difference. Much more interested in macro-anatomy than micro-anatomy, if that makes any sense.
 

808s&heartbreak

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Loved pathology as an idea, found it super intellectually stimulating and have huge respect for the field as the smartest people in medicine IMO are pathologists and radiologists. Considered path but didn't like my rotation and the day to day; autopsies were very depressing and morbid, couldn't stand the smell of specimens, job market was not good. Also looking at microscopes made me dizzy. Also wanted some patient contact.
 
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Radology

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Yea. The microscope was an annoyance. The dead bodies and smells were enough to make me not even consider it
 

qxrt

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Never considered pathology. I love the acuity of radiology, the on-the-spot decision-making (Does this patient have an active bleed?) that immediately changes patient management. That's also part of why I like IR. Pathology seems too slow-paced for me. As a gamer, I always was more into first person shooters and other action games than I ever was into, say, chess or turn-based games.
 

Unty

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Smells bad man. Can’t drink your coffee while working.

Lol you won't be grossing specimens in some practice settings. Some practice settings you just look at slides all day long. Some practice settings you may never ever do an autopsy. So in residency is the only time you do your required 50 autopsies to sit for boards. You may have to gross specimens in private practice but that depends on your group.
 

jupiterianvibe

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Smells bad man. Can’t drink your coffee while working.

i dont do autopsies or grossing. i drink coffee and listen to music all day long while working. its not bad. the only smell is that of the coffee.

i am of the opinion that our training requirements in pathology are outdated, and that autopsies should no longer be done by anyone who is not in forensics. forensics should also be its own direct entry residency program as it has little overlap with surgical pathology.

once we egress the autopsy from our ranks i would expect that it could help increase interest slightly. same with grossing, which should only be done by technical staff.

the modern pathologist should never smell a specimen.
 
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tco

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I did a PSF in path, and can tell you that other than "not seeing patients," they're not even close to the same thing. It's hard to describe without a long winded post, but the interactions with clinicians are different, the work itself is different (different search patterns for each modality, and even sometimes situational search patterns - for example a high velocity car accident with trauma over your neck), plus I wanted to do IR.

The only appeal to path was the hours in private practice. I liked the idea of getting my stack of slides in the morning, reading them, and then leaving when the work was done.
 

dvsr

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I seriously considered path and set up my 4th year electives with lots of path. I ended up switching it all around for radiology after the first rotation.

Multiple reasons:
- Kept getting headaches with looking into a microscope all day
- Kept falling asleep on the other side of the microscope when the attending was reading slides
- Thought I would love autopsies until the attending opened the bowel on my first autopsy and the smell was unbearable (otherwise not squeamish)
- On the topic of forensics, I had a really hard time with autopsy cases of child abuse, even on a ppt slide ( although must be a fraction of cases)
- Felt that the breadth of pathology was pretty limited (disproportionate amount of cancer)
- No patient contact (at least that I saw during my elective), while there is a decent amount in rads
- Low salaries (less important)
- Bad job market

With all of that said, my rotation gave me a great appreciation for the field of pathology. Pathologists have been some of the smartest, nicest, most professional physicians I have met!
 
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siliso

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Autopsies were the only thing I found compelling in pathology! Despite the odor and lack of coffee. I guess if you’re picking between looking at 1000 of one thing all day vs looking at 1000 of another, while smelling pleasant and drinking coffee, I don’t personally see much diff. Maybe whether you prefer light rooms vs dark. Or enjoy the ability to do special stains &c to cut back on hedging for clinical correlation - or to do on the spot interpretations that will change management right now ie frozen sections? Or on the other side want to do therapeutic interventions on live patients as IR and some others do.
 
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CherryRedDracul

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I seriously considered path and set up my 4th year electives with lots of path. I ended up switching it all around for radiology after the first rotation.

Multiple reasons:
- Kept getting headaches with looking into a microscope all day
- Kept falling asleep on the other side of the microscope when the attending was reading slides
- Thought I would love autopsies until the attending opened the bowel on my first autopsy and the smell was unbearable (otherwise not squeamish)
- On the topic of forensics, I had a really hard time with autopsy cases of child abuse, even on a ppt slide ( although must be a fraction of cases)
- Felt that the breadth of pathology was pretty limited (disproportionate amount of cancer)
- No patient contact (at least that I saw during my elective), while there is a decent amount in rads
- Low salaries (less important)
- Bad job market

With all of that said, my rotation gave me a great appreciation for the field of pathology. Pathologists have been some of the smartest, nicest, most professional physicians I have met!

My reasons were pretty similar. I didn't mind doing autopsies until my 3rd week into a forensic pathology rotation where the sheer number of gruesome and tragic murders (this is in a high crime city) we had to work finally started to take an emotional toll on me. The smell and body fluids I could handle (even the rotting or burnt cadavers), but having to open these bodies after knowing their tragic stories became a bit much.
 

pathslides

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Too much focus on the autopsies. Most non forensic path peeps hate them. In my hospital group, I avg 1 autopsy a year. Other than that, superb work life, pay, and vacation. Rads is dope as well and you cant go wrong in either field. But if you want to do path, you better not be a social *****-otherwise good luck getting a job.
 
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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.
 
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Why radiology over pathology?

1. Radiologists have a massive impact on acute patient care. Life-threatening disease like strokes, bleeds, bowel perforations, etc. are all diagnosed by (and sometimes even treated by) the radiologist or at least imaging. Pathology's closest equivalent are frozen sections, which do not happen as frequently.

2. Radiologists have better options for more patient exposure, if that is desired down the road, in the form of IR and radiology breast clinics.

3. For most medical students/residents, the microscope is an object meant for the lab. And most medical students are well worn out from looking down the microscope from their undergraduate research/courses. In a similar vein, I think the high tech nature of radiology is appealing to the subset of students that end up applying to the specialty.

4. Radiology is more 'connected' with the rest of the hospital. There are surgeons who come down to review scans with the radiologist before an OR., there are ED docs who call to ask about a patient, etc. I never saw any docs walking down to the pathology department, only the occasional resident to run there for a frozen section.

5. Radiology is 'cleaner'. Personally I enjoyed working with patients, but even then I still disliked examining patients who haven't bathed in several weeks or smelling the underside of a large pannus. In radiology you don't have to deal with these unpleasant stimuli much or at all. In pathology residencies you still have to do autopsies.

6. Radiology has better career options in the form of more job opportunities, fewer geographic restrictions, and better pay. For this generation of physicians, the former 2 are very important. To find a decent pathology job one often needs to move, sometimes several states over.

7. Lastly this might just be in my area, but there is the feeling that the autonomy in pathology has long ago been crushed by administrators in hospitals and corporations.

IMO the only strict advantages of a pathology career are a better lifestyle (which comes at the cost of pay and geographic restriction), and closeness with basic science research (which is probably actually a disadvantage since most of us want to avoid that).

As a medical student the Radiologist's impact on acute patient care appealed to me and on top of that, I knew radiology would provide me with a better career path.
 
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guytakingboards

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Random point about radiology vs pathology (i'm a radiologist):

With radiologists, clinicians are actually pretty damn good at looking at imaging within their limited scope. During tumor boards, it's very common for surgeons to ask pointed questions and hold the radiologists feet to the fire on findings and interpretation.

With pathology, it usually goes: clinician: "alright what does the biopsy show?" Pathologist shows a digital slide: "there are xyz features here and here with qrs features there and there. it's consistent with this" (room is completely quiet). clinician: "okay next case".

No one really questions what the pathologist sees on the individual slides. Never seen a surgeon say "oh that doesn't look like chondroid matrix to me" or "i think your overcalling the XYZ marker positivity on that stain".

It's a both good and bad thing. On the one hand, the clinician feedback puts immense pressure on the radiologists. On the otherhand, radiologists get a lot of good feedback and information that way. As mentioned above, clinician's respect for and perspective of pathology is very different than radiology.
 
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Cognovi

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5. Radiology is 'cleaner'. Personally I enjoyed working with patients, but even then I still disliked examining patients who haven't bathed in several weeks or smelling the underside of a large pannus. In radiology you don't have to deal with these unpleasant stimuli much or at all. In pathology residencies you still have to do autopsies.

Contact with every kind of body fluid is as routine to a general radiologist as autopsies are to the average pathologist. Abscess drainage, thoracentesis, paracentesis, lumbar puncture, enteric tube placement, barium enema, hysterosalpingography and sonohysterography, retrograde urethrogram, voiding cystourethrogram, ultrasound of the breast and axilla.
 
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Contact with every kind of body fluid is as routine to a general radiologist as autopsies are to the average pathologist. Abscess drainage, thoracentesis, paracentesis, lumbar puncture, enteric tube placement, barium enema, hysterosalpingography and sonohysterography, retrograde urethrogram, voiding cystourethrogram, ultrasound of the breast and axilla.
Those are mostly relatively clean procedures from my experience (including the abscess drain).

For me it comes down to the smell. The range of smells in pathology autopsies are much worse.
 

pathslides

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For context for peeps considering path - I have been in practice for a few years
1) I have grossed a total of 2 times- most groups use PAs.
2) I have done a total of 3 autopsies (which entails me just looking at slides, the PA does everything else. I see no mess or encounter any smells).
3) I have a motorized stand up desk with a motorized microscope for optimal ergonomics and a decreased sedentary work life.
4) 95% of radiologists will make more money and have more vacation than the typical pathologist, but I make >350k (employed so only increases a bit each year) with 6 weeks vacation for 40-45 hrs/wk on avg and home each day to chill with family - this is completely fine with me.
5) 95% of my weekends are free.
6) I do side work with AI companies and computational path has really neat tech but is no where near replacing pathologists.
7) Try to avoid a career in academic pathology if you are thinking of path. For the most part, Academic pathology is what has destroyed the field (25%-33% of institutions are great, the rest are worthless).
8)Residency does have lots of grossing which sucks but is mainly your first year and you see neat things and learn a bunch during sign out and preview time. Overall residency is laid back and working more than 45 hours in a week was rare and after first year, grossing decreases and slide time skyrockets ( obviously programs will vary).
9) Radiology has a superior job market, that’s 100% fact.
10) Most physicians have no idea what a pathologist does which contributes to the lack of respect in the field.
11) 90% of the time, pressure is low. If I don’t feel like working on a case I can just push it to the side for the next day or if it’s too hard/complex, I just ship the case out to a respected academic center and sleep well at night.
 
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Cognovi

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7) Try to avoid a career in academic pathology if you are thinking of path. For the most part, Academic pathology is what has destroyed the field (25%-33% of institutions are great, the rest are worthless).
Really curious why you have that opinion - please educate us trainees as we really only get exposed to academics, particularly early in training when making specialty decisions.
 
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Tiger100

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The only similarity between two fields is that pathologists and many radiologists (but not all) have zero or minimal patient contact.

Otherwise, the two fields are as different as any other two medical specialty or as different as medicine versus dentistry.

Pathology is a great field but there is a fundamental difference between looking at cells from recent endometrial sampling under microscope versus calling ED at 10 pm because the patient has an acute occlusion of left PCA seen on CTA done 5 minutes earlier. Just to give you an idea, this didn't exist 15-20 years ago and is an evolving technology (CT perfusion, rapid MR, etc)
 
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pathslides

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Really curious why you have that opinion - please educate us trainees as we really only get exposed to academics, particularly early in training when making specialty decisions.

Based on my interviews at academic places during my job search time- many academic places want to hire you as junior attending for 1-2 years paying sometimes barley above 100k and treated no better than a resident. After that when you become assistant, If you make more than 200k you are lucky, even though you are producing RVUs way above the amount they are paying you. Then after 6-8 yrs of being heavily underpaid and overworked and forced to publish clinically insignificant “research” you become an associate and maybe might make 250-275k, however at least your work schedule will get a bit better as they will have plenty of other assistants to overwork. Again not every academic place will treat you like this, but many will. Community path is where it’s at. Academics treat you like an insignificant factory worker. Private practice can be extremely lucrative, but is very volatile these days with so much uncertainty that it’s not worth the stress.

Academic path has destroyed the field as there are numerous garbage programs with such low specimen volumes or lack of specimen complexity who are just using residents as grossing monkeys. They end up putting out subpar residents thereby saturating the field. How the acgme allows such programs to exist boggles my mind. Field saturation is what allows many of theses academic programs to treat pathologists the way they do.
 
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twospadz

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Radiology: Money, prestige, flexibility, good job market, interesting work
Pathology: You suffocate daily from all the chemicals and dyes
 
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Unty

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Radiology: Money, prestige, flexibility, good job market, interesting work
Pathology: You suffocate daily from all the chemicals and dyes

Yeah after having read this thread, it confirms what people have been talking about in Pathology....most people don’t know what pathologists do.
 

Unty

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For context for peeps considering path - I have been in practice for a few years
1) I have grossed a total of 2 times- most groups use PAs.
2) I have done a total of 3 autopsies (which entails me just looking at slides, the PA does everything else. I see no mess or encounter any smells).
3) I have a motorized stand up desk with a motorized microscope for optimal ergonomics and a decreased sedentary work life.
4) 95% of radiologists will make more money and have more vacation than the typical pathologist, but I make >350k (employed so only increases a bit each year) with 6 weeks vacation for 40-45 hrs/wk on avg and home each day to chill with family - this is completely fine with me.
5) 95% of my weekends are free.
6) I do side work with AI companies and computational path has really neat tech but is no where near replacing pathologists.
7) Try to avoid a career in academic pathology if you are thinking of path. For the most part, Academic pathology is what has destroyed the field (25%-33% of institutions are great, the rest are worthless).
8)Residency does have lots of grossing which sucks but is mainly your first year and you see neat things and learn a bunch during sign out and preview time. Overall residency is laid back and working more than 45 hours in a week was rare and after first year, grossing decreases and slide time skyrockets ( obviously programs will vary).
9) Radiology has a superior job market, that’s 100% fact.
10) Most physicians have no idea what a pathologist does which contributes to the lack of respect in the field.
11) 90% of the time, pressure is low. If I don’t feel like working on a case I can just push it to the side for the next day or if it’s too hard/complex, I just ship the case out to a respected academic center and sleep well at night.
Well said thanks for contributing.
 
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Centropyge

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Pathologist here.

The main drawbacks of pathology for me:

1)
A lot of cases take more than 1 day to report. Pathologists (un)fortunately have total responsibility over the specimens they examine, which means they are responsible for organising and interpreting relevant ancillary tests, for diagnostic purposes as well as predictive purposes e.g. colectomy specimen with adenocarcinoma --> need to order immunohistochemistry for mismatch repair gene expression as well as BRAF mutation --> then depending on the above results, may need to order further molecular tests for methylation analysis etc etc, so a case can drag on for a few days.

This means it is much harder for a pathologist to work 1 day here, 1 day there, as you need to be available every day to follow up test results/order more ancillary tests. Whereas I imagine in radiology, all the required information (images) are available at the same time, so at the end of the day after clearing the work list, you can go home and forget about all the cases you've seen during that day.

2)
When it comes to tumour excisions, pathologists are expected to come up with a WHO recognised entity. We simply can not get away with saying something vague like "high grade spindle cell neoplasm, wider excision recommended". If I can't reach a definite diagnosis for a particular tumour, then I am expected to consult other pathologists/send the case for review etc etc until one day I get a diagnosis. This can be very time consuming, especially when people you consult disagree with your diagnosis.

3)
This one also applies to radiology. A pathology case can get reviewed, re-reviewed, then reviewed again 5 years later after the patient develops a metastasis. Physical slides are stored for about 2 decades in my country, and digitised slides are stored indefinitely. One day, one case will come back to haunt you!!!

4)
There is so much to learn, so much that you will never have time to learn, but the clinicians expect you to know everything pathology related.


However, to clarify some of the negative impressions of pathology:
- I have never grossed since completing training. Path assistants and trainees do all the grossing. I just supervise. The only time I ever need to put on gloves and hold a blade or scalpel is for intraop consults/frozen sections.
- I never ever do autopsies.
- I arrive at work/leave work at any time I please, as long as I'm not on call for intraop consults, and as long as I get through a reasonable amount of work.
- The surgeons don't pretend they can interpret pathology they way they think they can radiology.
- (This one applies to my part of the world) Very easy for anatomical pathologists to find employment. The average anatomical pathologists (and radiologists, to be fair) earn much more than the average doctor.
 
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r9too

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- (This one applies to my part of the world) Very easy for anatomical pathologists to find employment. The average anatomical pathologists (and radiologists, to be fair) earn much more than the average doctor.
Where is your part of the world?
 
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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.

Wow, what a great post! I am a pathologist and I can tell you spent a lot of time thinking about this subject. During med school, particularly early on, when I heard someone was doing a path rotation I automatically assumed they had failed their clinical entry exams. You are right in that there really was a stigma to the field. It took me a long time to realize that it was the right field for me- particularly because I loved patient interaction and saw a lot of the same negatives you did. However, my desire to work on the underlying mechanisms of disease (particularly in cancer genetics) overrode those concerns.
I think you are right about a general lack of exposure and respect, although it is not always the case, particularly at top academic centers. For path to survive I think you are right about a lot of things- like digitization (my goal is to sign out cases from a beach somewhere, not a basement somewhere), and have more direct patient interactions.
 

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and have more direct patient interactions

Sorry to butt in here, but I am interested in rads and path (among other things since I just started med school). The prospect of never talking to a patient again is one of the big things drawing me away from path. Do you think there are ways to incorporate patient interaction in general path if you want it?
 
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Sorry to butt in here, but I am interested in rads and path (among other things since I just started med school). The prospect of never talking to a patient again is one of the big things drawing me away from path. Do you think there are ways to incorporate patient interaction in general path if you want it?

As a third year I would suggest you keep an open mind. I was head over heels on how much I thought patient interaction was important, then I did my family medicine rotation and have no problem having less-zero of it. Obviously just an n of 1 but definitely something you should think about if you really like rads or path!
 
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Unty

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Sorry to butt in here, but I am interested in rads and path (among other things since I just started med school). The prospect of never talking to a patient again is one of the big things drawing me away from path. Do you think there are ways to incorporate patient interaction in general path if you want it?

No patient interaction in Path unless you are in academics talking to patient families about cancer diagnoses. It’s a thing they are trying to promote.

I haven’t seen any academic go and talk to a patients family yet. I’ve seen it for perinatal autopsies, where clinicians involved in a death sit and talk with family.

The other exposure is FNAs but most likely you have to be at a place that does high FNA volume, if you want to see patients often. In that case, your time with the patient will be minimal. You see the patient, talk to them about the procedure, do the FNA passes and leave. There’s no continuity of care. You talk to them, go back to your dept abd give a diagnosis.
 
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Bovary

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My opinion as a rads resident:

Look at where the two specialties work. Pathologists work in odd-smelling labs, and often have to go do gross dissections of surgical path.

Radiologists have comfortable chairs in an office-building type room, with coffee and snacks nearby.

The working environment is very different, and that matters!
 

Dro133

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Look at where the two specialties work. Pathologists work in odd-smelling labs, and often have to go do gross dissections of surgical path.

As a resident, maybe, but most attending pathologists work from an office, sometimes even with nice views (at least in academics), and don't routinely gross.
 
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pathslides

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My opinion as a rads resident:

Look at where the two specialties work. Pathologists work in odd-smelling labs, and often have to go do gross dissections of surgical path.

Radiologists have comfortable chairs in an office-building type room, with coffee and snacks nearby.

The working environment is very different, and that matters!

Take it from a practicing pathologist, this post is completely wrong.
 
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