you want to be a patholgist?!

[fun8stuff]

How many people do you think start medical school off thinking that they want to be a pathologist? Did any of you start out wanting to do something else, then fell in love with pathology during 2nd year and during the clinical years?

What's the typical way people come upon pathology? ..just curious

---

Members don't see this ad.

 

[BomberDoc]

.

 

[rirriri]

i think there are alot of younger people who wanna be Forensic Pathologists...which is why they investigate Pathology.

I, personally, wanted to be a Surgeon, until i contaminated so many sterile fields, inched closer with forceps in my shaky hands, and thought surgeons were actually a bit dim.........combine this with my HUGE love for Pathology during 2nd year of med. school and Histology during 1st year, and my superb experience during 4th year path electives...and i was convinced Pathology was the way.

every day, i think i made the right choice

 

[anencephalic]

I entered med school wanting to do path.

Along the way, I considered psych, med-psych, and neurology.

Thankfully, I'm back to doing what I'd originally set out to do...

 

[DarksideAllstar]

Entered with the intention of pursuing rad-onc. Third year wanted to do Ortho. End of third year threw up my hands and said fck it, time for Path or Rads. Eventually path won out.

 

[Circumflex]

I entered wanting to do surgery, enjoyed my 3rd year surgery clerkship, and did my required 4th year "clinical" sub-internship in surgery. I hated outpatient medicine clinics, and really, really disliked inpatient issues. I'm a MD/PhD student and really love basic research. I also like the challenge of making a diagnosis.

I did a pathology elective first thing this past summer and loved it. I like the independence of doing my own work, coming up with my own diagnosis, at my own pace (for the most part), and having a lide outside of work. The idea of giving up treating patients is kind of weird, but knowing that I'll be leaving behind all of the headaches that come with it ease the pain. Pathology offers so many different ways to practice (specialties plus types of practice), that I know I will be happy.

 

[danaphosaurus]

I never thought about it at all- I didn't even realize that it was something you could do- Wanted to do ENT then realized I was not that hard of a worker- I liked the class but thought it would be boring and was really hard- Guess not!

 

[112641]

I went into medical school thinking I'd do infectious disease mostly and specialize in HIV care. However, I majored in neuroscience in undergrad and loved it and didn't really even know there was a specialty in neuropathology until I did a path elective in the beginning of my 4th year. LOVED LOVED LOVED it and also loved the rest of pathology. So here I am loving my job and looking forward to doing neuropathology later.

 

[magician]

i like research. path offers access large numbers of free patient samples for research. do not need to beg for collaboration.

 

[BU Pathology]

I joined pathology 24 years ago. As I concluded medical school and reflected on my research experiences and patient care exposure, it was clear that greater intellectual stimulation came from the basic science research. At that point I investigated which fields would allow me to pursue bench work and still be very active as a physician. Pathology was the perfect combination.

After 24 years in the business, mostly performing autopsies for clinical work, teaching and 50 to 70% of my time on basic science research it has been the best career imaginable.

 

[magician]

Dear BU Pathology,

is your clinical work closely related to your research? since you are senior faculty and established, I am sure you have no problem getting funding and you can dedicate 50 to 70% of your time on basic science research. but junior faculty probably have to dedicate most of their time on clinical service.

I have a question for you. I am applying residency and some programs suggest me to go physician scientist pathway. My Q is: how practical is it for me to get an academic job after 2yrs of AP or CP + 2 yrs of research? I have already had many yrs of basic research and many publications.

 

[BU Pathology]

Dear BU Pathology,

is your clinical work closely related to your research? since you are senior faculty and established, I am sure you have no problem getting funding and you can dedicate 50 to 70% of your time on basic science research. but junior faculty probably have to dedicate most of their time on clinical service.

I have a question for you. I am applying residency and some programs suggest me to go physician scientist pathway. My Q is: how practical is it for me to get an academic job after 2yrs of AP or CP + 2 yrs of research? I have already had many yrs of basic research and many publications.

First, I am the current chair of pathology at BU school of Medicine.

My clinical work is autopsies and my basic science looks at promoter elements responsible for signal transduction, asthma and sepsis. It is very easy to connect the dots between people dying and these basic disease processes.

Junior faculty typically are protected for 3 years from service work, committte work, and the need to generate their own salary. However, there are very few of these positions available and they are extremely competetive. Past publications are helpful, but academic medicine will look closely at what have you done lately. If you continue to publish, work on basic science during your residency and fellowship then you will be an attractive candidate for a faculty position.

 

[LADoc00]

First, I am the current chair of pathology at BU school of Medicine.

My clinical work is autopsies and my basic science looks at promoter elements responsible for signal transduction, asthma and sepsis. It is very easy to connect the dots between people dying and these basic disease processes.

Junior faculty typically are protected for 3 years from service work, committte work, and the need to generate their own salary. However, there are very few of these positions available and they are extremely competetive. Past publications are helpful, but academic medicine will look closely at what have you done lately. If you continue to publish, work on basic science during your residency and fellowship then you will be an attractive candidate for a faculty position.

I have a ?:

I have no idea if this is true but a BWH neuropathologist I worked with who also was on service at BU had a group of BU residents who had a brain autopsy to present at a medicine conference and since they only kept strict 8-5 hours, literally walked out of the conference because it was going past 5. Leaving one pissed off attending to present their autopsy results.

Now, could that be true? I was laughing so hard the next day when she (maybe giving away too much there..) told me that story I spit coke out my nose.

This would have been in the late 90s.

PS- Why are academics overtraining pathology so intensely? Have a heart.

 

[cytoborg]

How many people do you think start medical school off thinking that they want to be a pathologist? Did any of you start out wanting to do something else, then fell in love with pathology during 2nd year and during the clinical years?

What's the typical way people come upon pathology? ..just curious

Not many med students start off wanting to do path, I don't think. Most people just don't have the exposure to it. I went to med school wanting to do primary care, then on the wards loved pretty much everything, broadened my options to emergency medicine, surgery, a couple of surgical subspecialties. Was really all over the map. I had enjoyed my basic pathology course but didn't know if I could give up patient care, so I didn't really consider it until I did a year of research and realized that I was OK with not seeing patients directly.

 

[mlw03]

i'm only an ms3, but my story thus far is i got exposed to forensic path during my senior year of high school (i knew i wanted to go to med school already at that point). i worked as a transporter for a radiology department in undergrad and determined i didn't want to do that, and during my first two years of med school i've found i really enjoy knowing a ton of stuff. i've found pathologists to be "walking textbooks" a lot of the time, and i find it more satisfying to know how to make obscure diagnoses than to know the current treatment guidelines for hypertension (even know i do know the latter at preset and not the former - but that's what path residency will be for, right?) so for me path is about understanding medicine at its deepest level, and i just don't feel any other specialty will provide me that.

 

[BU Pathology]

I have a ?:

I have no idea if this is true but a BWH neuropathologist I worked with who also was on service at BU had a group of BU residents who had a brain autopsy to present at a medicine conference and since they only kept strict 8-5 hours, literally walked out of the conference because it was going past 5. Leaving one pissed off attending to present their autopsy results.

Now, could that be true? I was laughing so hard the next day when she (maybe giving away too much there..) told me that story I spit coke out my nose.

This would have been in the late 90s.

PS- Why are academics overtraining pathology so intensely? Have a heart.

I have no idea if this is true either. Our residents currently work until things are done. As a chair it is important that I do not perpetuate rumors and even hesitated responding to this because it keeps the rumor alive.

Regarding overtraining, which essentially means that there are not enough jobs available for those who have completed their pathology residency, there are plenty of jobs and fellowships available for qualified applicants who are well trained. As a specific example, when I was at the University of Michigan we trained between 5 and 7 pathologists every year. But in the Ann Arbor area there is only a need for 1 new pathologist every 2 to 4 years. The simple math would indicate that there was massive overtraining. Yet every resident finishing up their training was able to obtain a fellowship or position. The question is not whether there are jobs available in the same city but whether there are jobs available. To expect every community that requires a pathologist to start a training program would not be wise use of resources.

 

[yaah]

Lots of answers here

 

[LADoc00]

Regarding overtraining, which essentially means that there are not enough jobs available for those who have completed their pathology residency, there are plenty of jobs and fellowships available for qualified applicants who are well trained. As a specific example, when I was at the University of Michigan we trained between 5 and 7 pathologists every year. But in the Ann Arbor area there is only a need for 1 new pathologist every 2 to 4 years. The simple math would indicate that there was massive overtraining. Yet every resident finishing up their training was able to obtain a fellowship or position. The question is not whether there are jobs available in the same city but whether there are jobs available. To expect every community that requires a pathologist to start a training program would not be wise use of resources.

BU-
I wont agrue with the numbers that PD can produce with regards to post-training employment.

This is an interesting link that still even today (it was last updated in 1999) is very relevant:
http://members.tripod.com/~philgmh/CIPJM.html

There have been significant losses of Pathologist job positions in the US for the following reasons:
First, mergers and acquisitions have increased the workload per Pathologist, thereby reducing the total number of Pathology positions needed in the US. For example, when I began training in July 1991, the hospital where I trained was averaging around 2,000 surgical cases per pathologist per year. The company which owned the hospital bought out several nearby hospitals. Each time the company bought a hospital it would merge half of their Pathologists into the existing group and lay off the other half. As a result, the workload increased exponentially with each new acquisition but no one could leave - there were no other jobs in the area, as the company had bought most of the hospitals. The workload is now well over 3,000 surgical cases per Pathologist per year (plus large numbers of cytology slides).

Secondly, the Pathology residency programs in the US are training large numbers of Pathologists many of whom will never get a job in the field. I'll go into more detail on this later.

Thirdly, administrative duties and Clinical Pathology duties have largely been turned over to non-MD administrative and technical staff. This decreased workload has generally been reflected in lower numbers of Pathologists. Generally, loss has been by attrition. If the workload decreases, you close job positions as people retire, move on, etc. This is not a problem for people who are already working but it kills the chances new Pathology graduates have in finding jobs.

Fourthly, there are large numbers of Pathologists over age 70 who are clinging to their job and refusing to retire. This decreases the number of positions available to people who are graduating from residency.

Here are some estimates I have of the numbers involved:

Let's say that the US Population is about 270,000,000 (latest census estimate). If there are roughly 6,000 surgical specimens per 100,000 population per year then there are 16,200,000 surgical specimens examined in the US per year. A full-time Pathologist working very hard doing only Surgical Pathology would average about 4,000 specimens/yr. Therefore the entire Surgical Pathology load of the US could be done by 4050 Pathologists.

Let's guess that the US Cytopathology load could be done by 2,000 Pathologists, Autopsy by 1,000 and Clinical Pathology by 1,000.

There is a need for a minimum of 8,050 Pathologists (an educated guess). HOWEVER THERE ARE CURRENTLY ABOUT 14,000 PATHOLOGISTS IN THE USA, AN OVERSUPPLY OF 73%. If every Pathology training program was closed, this oversupply would last at least 10 years.

One of the main reasons for the terrible Pathology Job Market has been the Pathology training programs. These programs have continued to train the same number of residents even though the job market has deteriorated badly. The Residency Program Directors should have known about the problem as far back as 1993, when the job market started deteriorating, but the decreases in residency positions have not kept up with the deteriorating job market.

So why train people who may never find jobs? BECAUSE OF THE TREMENDOUS AMOUNT OF MONEY INVOLVED. Keep in mind that Medicare provides Indirect Medical Education (IME) and Direct Medical Education (DME) reimbursements to hospitals that train residents regardless of what the job market is like. This is a considerable amount of money.

In the example given the DME is US $1,280,000/yr. and the IME is US $5,250,000/yr. Reimbursements are proportional to the number of residents. As a result, if the program substantially reduces the number of residents they have, there will be a proportionate decrease in reimbursements. The residency program in this example is much larger than any Pathology residency program - 80 Residents and 20 Fellows in the program; but it gives you some kind of idea of the amount of money involved. Medicare is paying this program US$65,300/resident/yr. However, the residency programs only pay each resident about US $25,000-35,000/yr. yet residents sometimes work 60 hours per week doing work that otherwise would have to be done by a Pathology Assistant making around US $65,000-85,000/yr. SO THERE IS A TREMENDOUS AMOUNT OF MONEY BEING MADE IN TRAINING PEOPLE TO BE PATHOLOGISTS EVEN THOUGH THERE IS NO CHANCE THAT THEY WILL ALL FIND JOBS IN THE FIELD.

If our math is correct the residency programs are making about US $80,000-$100,000/resident/yr

I want to say, I had no part in this PAC but have tried to advance their cause with my local congressmen. I have been following this stuff since I was a first year med student (as I knew as an undergrad I would applying to pathology).

Now, I agree that your residents may not have a hard time finding a position SOMEWHERE after your program but I will highly agrue these end up being some of the worst job in all of medicine. Often positions as contractors or sub-contractors with little or no benefits, long term employee positions with no chance of partnership and a lifetime of pyramid schemes run by senior partners who are making in the 7-figures while they struggle at the very bottom of the payscale. There is an IMMENSE differential between the rich and poor pathologists with almost no correlation to skils, work quality or effort on the job.

If you dont think there is a problem, then quite frankly I dont think you are looking at all closely enough.

 

[yaah]

I have heard a rumor that the "difficulty in finding a job" in part stems from claims floated by disgruntled foreign medical graduates who want there to be a perception that there are fewer jobs in pathology so that fewer american grads choose to go into the field and more spots will be open, etc.

Now, the fact that this particular rumor floats around is perhaps part xenophobia, part wishful thinking, and part ignorance, but sometimes I wonder if there is some truth to the matter. As I have posted before, the people who find jobs are generally not the ones who complain and/or float rumors. That is left to those who have trouble finding jobs. And bear in mind that people who have trouble finding jobs have this problem for a wide variety of reasons, only one of which is the lack of available positions.

As I have also said though, everyone I know who has trained at an at least decent program and who has reasonable skills and qualifications that extend to the professional work place has had no trouble finding a job. And a job that they want, not one that they just accept.

Part of the problem I see here is that many people have unrealistic explanations as to what a job in pathology actually entails - to be sure, there are the incredible success stories who write their own ticket and make seven figures, but is that a reasonable assumption? In general, one doesn't make seven figures by being a competent employee who shows up and does their job - one makes seven figures by being innovative, doing something few others do, being lucky, or by being a prick who stomps on others for their own benefit.

There are all kinds of jobs out there - for some people, the kind of job where you punch in and punch out, sign out your trays of slides and go home is the ideal job. They don't want the responsibilities or headaches of being a partner, and the financial rewards are not worth the extra effort or struggle.

Sure there are a lot of crappy jobs out there, as there are in any field, but the fact remains that there will always be subpar graduates who have trouble landing or holding a job as well. It beehoves everyone to be aware of their current and future situation, and to not be taken advantage of, however.

 

[LADoc00]

Yaah-

Yes many of the pathology disaffected are foriegners, typically from Asia. But many are American-born, women (or occasionally men) with less business and legal savvy than those who do make it. In my adventures, I was presented with all sorts of contracts and legal arrangments I had no experience and no help from residency training in dealing with. I became successful from having little to risk, be willing to move rapidly and being extremely entreprenurial, but what about the people with families, children FFS? I think the all too rosey of a picture that you paint is far more dangerous than my rhetoric.

Bad things are happening for MDs in all specialities but I fear if residency programs dont reign in the massive recent explosion of training slots, things will be very very bad for pathologists in the future.

Im not here trumpeting my sob story folks, I own my own business. If there is anyone who will benefit from cheap professional labor it will be businesses like my own, but I wonder at what cost. I have interacted with groups that proudly proclaim their turnover and to me that is despicable.

In conclusion, Im afraid no one in training or in academics is seeing the true picture. They observe a calm sea because they see only what they want to see. No one comes back to UMich to tell faculty they got screwed out of partnership, lost a contract or had their business revenue cut in half by a pod lab.

Is the unrealistic expectations you speak of such OUTLANDISH things as....
health coverage? or maybe health coverage for a spouse/children?
at least ballpark mean salary for your skill set?
reasonable retirement benefits either as a 401K plan or a solid IRA?
reasonable time off? reasonable call schedules?
because for many people none of these are happenings!

Make sense?

 

[yaah]

Well, we do have good communication with recent graduates, and to be honest have not heard these stories - going back more than 5 years, we know where almost all of the graduates are and how they are doing. They don't bounce from job to job, they aren't dissatisfied, they aren't complaining. Now, obviously there are difficulties and I am certainly not trying to say everything is wonderful. As you said, the business world is tough and people probably aren't getting the training they need to be successful in their own way.

It's not really about "seeing what you want to see" - I mean, I could make that argument about your position as well. We all have biases and opinions. Personally, I tend to see a lot of failure to land quality jobs as a failing of the person looking for the job. Others don't. Others blame the job market.

I obviously don't have the experience nor do I have the general knowledge of the community that you do, so I have to defer a lot. But as I said, I know what I see and experience for myself. And while I can clearly see when some people are seeing through rose colored glasses, not everyone who makes pronouncements about their own good experience with the job market is deluding themselves.

I do agree that there are too many trainee slots - I wonder though, how many trainees of american programs actually end up practicing in the US? I was under the impression that many are forced to return to the country they came from due to visa issues, etc, so the job market is not necessarily flooded with every graduating resident every year.

 

[sirus_virus]

I just got accepted to Med school and always wanted to be a pathologist but 30% unemployment rate is not what I envisioned.

 

[djmd]

I just got accepted to Med school and always wanted to be a pathologist but 30% unemployment rate is not what I envisioned.

Here we go again.
What 30% unemployment rate?

It isn't true.

 

[fun8stuff]

I just got accepted to Med school and always wanted to be a pathologist but 30% unemployment rate is not what I envisioned.

oh yes. there is 50% unemployment. please, do not go into pathology.... that way there will be more spaces for me.... *Sarcasm*

 

[sirus_virus]

oh yes. there is 50% unemployment. please, do not go into pathology.... that way there will be more spaces for me.... *Sarcasm*

I was going off this http://members.tripod.com/~philgmh/CIPJM.html posted by LADoc00 above. Is that info wrong? I just can't concieve of how after 9yrs of training one has to battle with that degree of unemployment.

 

[LADoc00]

The 30% quote is WAY BACK at the height of the chaos that occurred in the 90s. Read my post again, that website was circulated back in 1999 I believe.

Regardless, the rate is still far too high.

 

[ident_disorder]

Man I am called ident_disorder because I couldn't decide right now in 4th year what to do. I was in surgery, thinking I should go into surgery, looking at the 100000th hernia, holding the retractor, not being able to see anything, and suddenly realizing, what the hell? Why am I here? And the pretty little med student girl got picked for the thyroid? Oh, I see. This really IS boring, and ISN'T glamorous, and I'm totally scutted out, and I'm not as sexy as she is and I'd rather be reading Robbins. Yeah, that was the best part of medical school so far- pathophys in year 2. Well, after much consternation and about a month of meditiation I've finally decided to come to path : the path of truth and righteousness.

If only I can keep it up until the ROLs are due...

 

[yaah]

I think if you are applying for the current admission cycle and you are a 4th year med student you are probably out of luck for most programs, since the deadline was (correct me if I'm wrong) 11/1. Going outside the match is possible for people who can do this (people already in another residency, PhD researchers, etc), but not for 4th year US med students who graduate at the normal time.

 

[kittykat]

Wanted to be a Forensic Pathologist even before I knew what it was.

 

[LADoc00]

Wanted to be a Forensic Pathologist even before I knew what it was.

go with that.

 

[ident_disorder]

excising my five hundred thousandth pilonidal cyst, it suddenly came to me that surgery simply isn't glamorous. And I don't know who's in the whirled series. And I'd rather think than make motions about the operating room.