2020 Match - Pathology Continues to be Less Competitive

[D1b()4]

I don’t in any way buy the lack of exposure argument for why people aren’t choosing pathology. I’ve met pre-meds trying to get into medical school who’ve told me to my face they want to do dermatology. Do you honestly think they know in totality all the things a dermatologist does or just that they make a boat load of cash on banker’s hours? Same for all the other specialities everyone is dog piling over each other to get into.

Given the current state of pathology, we’d be better off swindling people into it rather than trying to explain what we do truth be told. My program is one of the few that still has a significant amount of post sophomore fellows every year. Anyone want to take a guess as to how many go into pathology after essentially functioning as a PGY-1 resident in pathology. Spoiler - I don’t need all the fingers on one hand to count them out. What we do manage to do, ironically, is make the PSFs hyper-competitive applicants for all the desirable specialities.

We have to get it into our thick skulls that few are buying an inferior product as compared to other specialties. The academically top one percent of medical students don’t go into ortho because they find human carpentry intellectually stimulating. The top one percent don’t go into dermatology because popping pimples and acne are the epitome of career development. The top candidates of IM don’t fight for cardio, GI, and pulmonary spots because sticking instruments in their field’s respective lumina is an endorphine releasing experience.

Good specialties sell themselves on their merits irrespective of an applicant fully appreciating the future job description. By no means do I condone going into a field for all the wrong reasons, but we’re not here to question or judge people’s motivations. We can only say with absolute certainty that other specialties are doing a good job of sucking up the talent that our leadership wants and all we’re doing in response is to still try to make pathologists groovy.

I totally agree with you. What could be more boring than human carpentry aka orthopedic surgery, and still they have no difficulty recruiting medical students.

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[KeratinPearls]

Even in the thread you are referring to, the posters consistently bring up poor job prospects.

yup, although there are jobs there was no abundance of jobs in my area like I mentioned. I’m happy with the job because the people seem nice and it’s close to home but I felt like there wasnt much to pick from.

 

[Iceman24]

Despite the constant crying on this forum, the average pathologist ... makes a lot more money than the average primary care doctor.

This is absolutely not true based on the experience of real people who I personally know.
My friends who are clinicians do hospitalist, primary care, urgent care, and psych. Nobody is making less then 250K.
From the other side, my former path co-residents and co-fellows do not make more then 240K and this number is almost an outlier among all of them.

 

[ScubaV]

debt load after med school completion is Also trending up. Imagine being 250k in debt and then struggling to find a job. I think today a field with nothing but good job prospects is risky if you have a lot of debt. Path is risky. It is not always a greedy choice migrating toward fields with strong job markets / higher pay.

This is a great point and may get exacerbated by the current COVID crisis. Anyone dealing in elective procedures is getting hurt, but if you get laid off or the hospital/practice group goes bankrupt how easily can a pathologist get another job once the dust settles vs. a proceduralist who could pick from dozens of offers when volumes return? Stories from now could have ripple effects years down the line.

 

[KeratinPearls]

This is a great point and may get exacerbated by the current COVID crisis. Anyone dealing in elective procedures is getting hurt, but if you get laid off or the hospital/practice group goes bankrupt how easily can a pathologist get another job once the dust settles vs. a proceduralist who could pick from dozens of offers when volumes return? Stories from now could have ripple effects years down the line.

that’s a good point. In my case, I didn’t get offered the position in 2/3 interviews I went on. Actually it was really two interviews in my city. The third they were looking for a hemepath. So if something happens, I will have to resort to working in another city, wherever that may be. Jobs aren’t plentiful so if u want to change jobs you have to look in advance. If you suddenly get let go for some reason, you are in trouble. I don’t think one is readily able to jump into a new job in pathology quickly if that happens.

 

[yaah]

Well, exposure to pathology in med school was the primary reason I picked the field. And I know others who had the same experience as myself. I know I'm not the only one. Those of you who think it's not a factor can say that, but there isn't a lot of evidence to support you. I never said it was the only factor.

 

[Med Director New England]

Well, exposure to pathology in med school was the primary reason I picked the field. And I know others who had the same experience as myself. I know I'm not the only one. Those of you who think it's not a factor can say that, but there isn't a lot of evidence to support you. I never said it was the only factor.

And similarly no evidence to support your opinion that exposure or lack thereof plays a key role...

 

[D1b()4]

Well, exposure to pathology in med school was the primary reason I picked the field. And I know others who had the same experience as myself. I know I'm not the only one. Those of you who think it's not a factor can say that, but there isn't a lot of evidence to support you. I never said it was the only factor.

And I know plenty of people from my class who were fully aware of pathology (even were members of path interest group) but went into dermatology and even physical medicine & rehabilitation because of better job prospects. You need to be aware of the specialty to choose it, but in-depth exposure is not necessary. In fact, exposure to too much pathology (autopsy, heavy grossing) is more likely to repel a lot of good applicants.

And to say that most American medical graduates are not aware of pathology and the role of biopsy, at least to diagnose cancer, is utter nonsense. On my first IM rotation, I was asked three times to call pathology to get TAT on biopsy results by my attending. Even during the second year of medical school, when we practiced presenting patients, my classmates and I had to check pathology results for that abdominal or lung mass, and it wasn't a mystery to anyone what biopsy was and who interpreted it.

While there is no direct evidence to say that exposure or lack thereof plays a key role in career choice, based on the data from other fields with minimal to no exposure in medical school curricula but high proportion of American medical graduates (e.g. radiology, otolaryngology, child neurology, anesthesiology, neurological surgery, orthopedic surgery, vascular surgery, physical medicine and rehabilitation, dermatology, plastic surgery), I conclude that depth of exposure in medical school is probably not a significant factor. Ironically, fields with most exposure (e.g. family medicine, internal medicine) but lower prestige/crappy lifestyle tend to have lower proportion of American medical graduates.

Lack of exposure to pathology in medical school curricula serves as a scapegoat for pathology leadership who gladly sweep under the rag the real problems our field, one of the most interesting and intellectually stimulating fields in medicine, is facing.

 

[Med Director New England]

It is amazing how many of our discussions migrate toward job market somehow....

So the original post as about match day / # US grads matriculating into path. So did the number go up or down, maybe I missed it.

Anyhow when I trained over 1/2 my residency class was AOA. A couple of year later when I was a chief resident and I actually saw the applications It was even tougher : everyone that year who matched was AOA, 250+ on the boards (that was ~99th % back then) or both.

I am still friendly with many where I trained and hear the number of competitive US applicants is way down compared to early 2000s.

 

[Alteran]

It is amazing how many of our discussions migrate toward job market somehow....

So the original post as about match day / # US grads matriculating into path. So did the number go up or down, maybe I missed it.

Anyhow when I trained over 1/2 my residency class was AOA. A couple of year later when I was a chief resident and I actually saw the applications It was even tougher : everyone that year who matched was AOA, 250+ on the boards (that was ~99th % back then) or both.

I am still friendly with many where I trained and hear the number of competitive US applicants is way down compared to early 2000s.

The answer to your question is that percentage has been going down since 2015 and appears to be holding steady. This is of course before the impending medical field realignment that will no doubt upend many pathology practices and become just another black mark our field seems to be aggregating at an ungodly pace. Success builds on success, repeated failures are compounded exponentially.

As an aside, it is nice to reminisce. I've only formally been in pathology since the late 2000s and in the decade since I hardly recognize it anymore. My program too was mostly US medical graduates when I was there. Now it exactly mirrors current match numbers. I recently had the chance to catch up with one of my mentors who is usually a very carefree, forgiving, and lovingly patient teacher - a total rarity in medicine. This particular person looked me in the eye completely mortified and told me that the current batch of trainees leave a lot to be desired.

 

[Splenda88]

Are there pathology programs out there that one can start fellowship after PGY3?

 

[Guest8]

Are there pathology programs out there that one can start fellowship after PGY3?

If you do AP only or CP only, yes. But if you do AP/CP combined you have to do 4 full years, then fellowships.

 

[y2k_free_radical]

The answer to your question is that percentage has been going down since 2015 and appears to be holding steady. This is of course before the impending medical field realignment that will no doubt upend many pathology practices and become just another black mark our field seems to be aggregating at an ungodly pace. Success builds on success, repeated failures are compounded exponentially.

As an aside, it is nice to reminisce. I've only formally been in pathology since the late 2000s and in the decade since I hardly recognize it anymore. My program too was mostly US medical graduates when I was there. Now it exactly mirrors current match numbers. I recently had the chance to catch up with one of my mentors who is usually a very carefree, forgiving, and lovingly patient teacher - a total rarity in medicine. This particular person looked me in the eye completely mortified and told me that the current batch of trainees leave a lot to be desired.

I am awaiting comment from B U PATHOLOGY,i.e.,DR. REMICK

 

[yaah]

And similarly no evidence to support your opinion that exposure or lack thereof plays a key role...

But yet your opinions and anecdotes are more relevant than mine?

 

[yaah]

Are there pathology programs out there that one can start fellowship after PGY3?

Some programs combine all their elective time into the last year, so you can use all your elective time (or however else they work it) as a fellowship, so long as it is an unaccredited fellowship. You can't do an accredited fellowship within a 4 year residency, but it is possible to do the equivalent of a fellowship in that time period.

 

[yaah]

And I know plenty of people from my class who were fully aware of pathology (even were members of path interest group) but went into dermatology and even physical medicine & rehabilitation because of better job prospects. You need to be aware of the specialty to choose it, but in-depth exposure is not necessary. In fact, exposure to too much pathology (autopsy, heavy grossing) is more likely to repel a lot of good applicants.

And to say that most American medical graduates are not aware of pathology and the role of biopsy, at least to diagnose cancer, is utter nonsense. On my first IM rotation, I was asked three times to call pathology to get TAT on biopsy results by my attending. Even during the second year of medical school, when we practiced presenting patients, my classmates and I had to check pathology results for that abdominal or lung mass, and it wasn't a mystery to anyone what biopsy was and who interpreted it.

While there is no direct evidence to say that exposure or lack thereof plays a key role in career choice, based on the data from other fields with minimal to no exposure in medical school curricula but high proportion of American medical graduates (e.g. radiology, otolaryngology, child neurology, anesthesiology, neurological surgery, orthopedic surgery, vascular surgery, physical medicine and rehabilitation, dermatology, plastic surgery), I conclude that depth of exposure in medical school is probably not a significant factor. Ironically, fields with most exposure (e.g. family medicine, internal medicine) but lower prestige/crappy lifestyle tend to have lower proportion of American medical graduates.

Lack of exposure to pathology in medical school curricula serves as a scapegoat for pathology leadership who gladly sweep under the rag the real problems our field, one of the most interesting and intellectually stimulating fields in medicine, is facing.

Utter nonsense to you? Have you done the study? You're refuting my anecdote by posting your own anecdotes, and consequently saying that my anecdotes are invalid for consideration because they don't match yours (and some other people you talked to). I'm not saying it's the major factor for everyone. There are an awful lot of people who have looked critically at this and found that the lack of exposure to pathology plays a role in people not choosing or otherwise considering pathology. You can post about this until you are blue in the face and continue to deny it, but it is a factor. You can argue whether it's the biggest factor, the smallest factor. I have no idea why you guys are choosing this hill to die on. Have you talked to tons of american medical graduates? There are a fair number who know nothing about what pathologists do. I told you myself that I didn't know when I started med school, I just thought they did autopsies and worked in the lab. It just never crossed my mind. I also never encountered physical medicine/rehab during med school and guess what, never considered that either! Exposure to fields can be critical - both to exclude it as a potential speiclaty (like surgical specialties for me) and to include it as potentially higher on your list than others (like pathology and oncology for me). Experience is important!

Now, you may ask, what percentage of people who go into pathology had no idea they were going to go (or favored a different career) into it before they started med school. That would be a great question- has that changed significantly over the years? Maybe it hasn't, which would support your opinion. Maybe it has though! Do you know? I don't! These are great questions! To dismiss one factor because you personally don't think it's a legitimate factor is a little bizarre and as I said, an extremely bizarre hill to die on.

Now, saying that lack of exposure may be a scapegoat to cover up for other factors - OK, that's not an unreasonable opinion. But still doesn't mean it isn't one factor that many consider or use to influence their decision in part.

Is "extreme exposure to pathology" more likely to attract or repel inviduals from the field? You apparently know the answer to this. Are you sure? How do you know? I did a post sophomore fellowship with another med student. She went into pediatrics. I went into pathology. Extreme exposure to pathology was 100% the main reason I chose it as a field. It was not the reason the didn't choose it, but for all I know may have been a minor contributing factor - we didn't break it down by percentile. The world is wide and varied, my friend. Not everyone has a uniform opinion.

 

[Unty]

Got off the phone with my friend today. Looked for a job in the NE. Nothing except a 6 month temp job.

Whatever labs or groups that were hiring have postponed hiring.

 

[yaah]

Got off the phone with my friend today. Looked for a job in the NE. Nothing except a 6 month temp job.

Whatever labs or groups that were hiring have postponed hiring.

Yeah, it's a horrible time to be a new grad. No one knows what's going to happen. If it's a stable group with known future state, and you are replacing someone, then it's probably fine and they will still want you. But they might ask you to delay your start date. No one really knows how long this is going to last, and it may vary by location and job type. I would think reference lab jobs would be most affected, but I don't have any data to support that other than our group's experience of outpatient stuff and cancer surgeries not really happening now.

 

[Med Director New England]

But yet your opinions and anecdotes are more relevant than mine?

Relax yaah
Where did I say or even imply this ?
I very often preface anything I write here that it is my opinion and experience to emphasize it is just that - one persons observations.

In fact I only bothered to reply to your post b/c you say to someone who happens to disagree with you “there isn’t a lot of evidence to support you” in a debate of a question that will never actually be formally studied.

btw yaah you kinda sound like a lunatic with your recent posts. No evidence base - just my opinion

 

[Unty]

Relax yaah
Where did I say or even imply this ?
I very often preface anything I write here that it is my opinion and experience to emphasize it is just that - one persons observations.

In fact I only bothered to reply to your post b/c you say to someone who happens to disagree with you “there isn’t a lot of evidence to support you” in a debate of a question that will never actually be formally studied.

btw yaah you kinda sound like a lunatic with your recent posts. No evidence base - just my opinion

Relax yaah
Where did I say or even imply this ?
I very often preface anything I write here that it is my opinion and experience to emphasize it is just that - one persons observations.

In fact I only bothered to reply to your post b/c you say to someone who happens to disagree with you “there isn’t a lot of evidence to support you” in a debate of a question that will never actually be formally studied.

btw yaah you kinda sound like a lunatic with your recent posts. No evidence base - just my opinion

When you’ve been on SDN Pathology for the past 20 years that’ll do that to you lolllllll!!!!

 

[D1b()4]

Utter nonsense to you? Have you done the study? You're refuting my anecdote by posting your own anecdotes, and consequently saying that my anecdotes are invalid for consideration because they don't match yours (and some other people you talked to). I'm not saying it's the major factor for everyone. There are an awful lot of people who have looked critically at this and found that the lack of exposure to pathology plays a role in people not choosing or otherwise considering pathology. You can post about this until you are blue in the face and continue to deny it, but it is a factor. You can argue whether it's the biggest factor, the smallest factor. I have no idea why you guys are choosing this hill to die on. Have you talked to tons of american medical graduates? There are a fair number who know nothing about what pathologists do. I told you myself that I didn't know when I started med school, I just thought they did autopsies and worked in the lab. It just never crossed my mind. I also never encountered physical medicine/rehab during med school and guess what, never considered that either! Exposure to fields can be critical - both to exclude it as a potential speiclaty (like surgical specialties for me) and to include it as potentially higher on your list than others (like pathology and oncology for me). Experience is important!

Now, you may ask, what percentage of people who go into pathology had no idea they were going to go (or favored a different career) into it before they started med school. That would be a great question- has that changed significantly over the years? Maybe it hasn't, which would support your opinion. Maybe it has though! Do you know? I don't! These are great questions! To dismiss one factor because you personally don't think it's a legitimate factor is a little bizarre and as I said, an extremely bizarre hill to die on.

Now, saying that lack of exposure may be a scapegoat to cover up for other factors - OK, that's not an unreasonable opinion. But still doesn't mean it isn't one factor that many consider or use to influence their decision in part.

Is "extreme exposure to pathology" more likely to attract or repel inviduals from the field? You apparently know the answer to this. Are you sure? How do you know? I did a post sophomore fellowship with another med student. She went into pediatrics. I went into pathology. Extreme exposure to pathology was 100% the main reason I chose it as a field. It was not the reason the didn't choose it, but for all I know may have been a minor contributing factor - we didn't break it down by percentile. The world is wide and varied, my friend. Not everyone has a uniform opinion.

I started with an anecdote to counteract your anecdote and to demonstrate that everyone has his or her own anecdote.

I also didn't know much about pathology when I started medical school, but in American medical schools you do learn some pathology as a part of pre-clinical curriculum. Hey, it is even tested on USMLE steps. My point is that all American medical graduates, unless they went to a fake medical school, do get at least some pathology exposure to be aware of pathology as a specialty. That's why I stated the claim that most American medical graduates are not aware of pathology as a career choice is utter nonsense. I did not state that most American medical graduates have in-depth understanding of pathology as a specialty.

Most medical students do not do PSF to see all the advantages of pathology, and extreme exposure to pathology as a medical school elective with emphasis on autopsy and grossing (what residents do) can definitely repel some good applicants. Hey, even I am not a fan of grossing or autopsies.

The main reason why I doubt the significance of in-depth exposure on career choice for specialty as a whole is the fact that most other fields in medicine with limited exposure (e.g. radiology, otolaryngology, child neurology, anesthesiology, neurological surgery, orthopedic surgery, vascular surgery, physical medicine and rehabilitation, dermatology, plastic surgery) have no difficulty recruiting American medical graduates.

 

[Splenda88]

A question people need to ask themselves is that: If pathology job market becomes "hot" like psych and salary is 300k-400k, will the specialty attrack US students?


You don't hear med students say that derm has cool pathologies, that is why they like derm... It's all about job market, lifestyle and $$$. The evidence is clear with radonc having issue attracting US students. 5+ years ago, you also needed PhD to be competitive for radonc, but now they can't even fill their spots with the bottom US applicants.


The same thing happened with diagnostic radiology. Diagnostic radiology had 99% match rate in 2016. But as soon as there is a resurgence in the job market, diagnostic radiology is getting competitive again.


Are all these things coincidence?

 

[Unty]

A question people need to ask themselves is that: If pathology job market becomes "hot" like psych and salary is 300k-400k, will the specialty attrack US students?


You don't hear med students say that derm has cool pathologies, that is why they like derm... It's all about job market, lifestyle and $$$. The evidence is clear with radonc having issue attracting US students. 5+ years ago, you also needed PhD to be competitive for radonc, but now they can't even fill their spots with the bottom US applicants.


The same thing happened with diagnostic radiology. Diagnostic radiology had 99% match rate in 2016. But as soon as there is a resurgence in the job market, diagnostic radiology is getting competitive again.


Are all these things coincidence?

You can make good money in pathology but don’t expect on average 300-400 out of the gate. 4-6 years partnership can pay 500K+ but expect to work hard.

I’ve seen starting salaries of 180-225 out of the gate. Some ppl don’t get that much higher over the years while some can go high depending on the group you land.

When I was interviewing I was told twice by two groups that they could be picky with who they choose.

Depends on which job you land. Some corporate gigs/pp jobs pay well, some just ok (250k+).

IMO high salary and good hours (banker hours) combined with a good job market will always open some eyes.

 

[deleted314957]

I started with an anecdote to counteract your anecdote and to demonstrate that everyone has his or her own anecdote.

I also didn't know much about pathology when I started medical school, but in American medical schools you do learn some pathology as a part of pre-clinical curriculum. Hey, it is even tested on USMLE steps. My point is that all American medical graduates, unless they went to a fake medical school, do get at least some pathology exposure to be aware of pathology as a specialty. That's why I stated the claim that most American medical graduates are not aware of pathology as a career choice is utter nonsense. I did not state that most American medical graduates have in-depth understanding of pathology as a specialty.

Most medical students do not do PSF to see all the advantages of pathology, and extreme exposure to pathology as a medical school elective with emphasis on autopsy and grossing (what residents do) can definitely repel some good applicants. Hey, even I am not a fan of grossing or autopsies.

The main reason why I doubt the significance of in-depth exposure on career choice for specialty as a whole is the fact that most other fields in medicine with limited exposure (e.g. radiology, otolaryngology, child neurology, anesthesiology, neurological surgery, orthopedic surgery, vascular surgery, physical medicine and rehabilitation, dermatology, plastic surgery) have no difficulty recruiting American medical graduates.

By and large, the pathology med students are exposed to has far more to do with pathophysiology and essentially no surgical pathology. There is some “morbid anatomy” as in Robbins but that’s it.


Sent from my iPad using Tapatalk

 

[Med Director New England]

I started with an anecdote to counteract your anecdote and to demonstrate that everyone has his or her own anecdote.

I also didn't know much about pathology when I started medical school, but in American medical schools you do learn some pathology as a part of pre-clinical curriculum. Hey, it is even tested on USMLE steps. My point is that all American medical graduates, unless they went to a fake medical school, do get at least some pathology exposure to be aware of pathology as a specialty. That's why I stated the claim that most American medical graduates are not aware of pathology as a career choice is utter nonsense. I did not state that most American medical graduates have in-depth understanding of pathology as a specialty.

Most medical students do not do PSF to see all the advantages of pathology, and extreme exposure to pathology as a medical school elective with emphasis on autopsy and grossing (what residents do) can definitely repel some good applicants. Hey, even I am not a fan of grossing or autopsies.

The main reason why I doubt the significance of in-depth exposure on career choice for specialty as a whole is the fact that most other fields in medicine with limited exposure (e.g. radiology, otolaryngology, child neurology, anesthesiology, neurological surgery, orthopedic surgery, vascular surgery, physical medicine and rehabilitation, dermatology, plastic surgery) have no difficulty recruiting American medical graduates.

Don’t waste your time with Yaah

Anything you opine on no matter how reasonable you present it or how much circumstantial experience of others support your view is invalid if it differs with Yaah own view due to lack of evidence. For some reason the same scrutiny should not be applied to Yaah views in his/her mind.

Yaah = Yahweh. Don’t question it. Yaah is All knowing.

 

[D1b()4]

By and large, the pathology med students are exposed to has far more to do with pathophysiology and essentially no surgical pathology. There is some “morbid anatomy” as in Robbins but that’s it.


Sent from my iPad using Tapatalk

It might have been true like 40 years ago, when you were in medical school. Excuse me, the whole second half of Robbins is a watered down version of what you can find in a general surgical pathology textbook.

 

[HeyDalaron]

I don't think exposure has anything to do with it. As people have said above, plenty of competitive fields get no exposure.

Instead I think it is primarily based on prestige and keeping up with your own cohort. The over-recruitment of FMGs in pathology makes going into it as an AMG seem like a step down.

 

[SetecAstronomy]

I have not dug into the data yet to see just how many of these positions were academic based - I know that many academic programs continue to hire ever more subspecialized people (seems as though many academic subspecialty services keep adding more people to their services, I don't know the full reason for that because I am not sure specimen volume is growing to that extent).

And all I will say from my perspective is that this paper matches my and my group's experience far closer than what a lot of people on this forum keep saying.

There also is a comment in there at the end that there is a caveat that many hiring practices wanted "experience" which is problematic, and they are going to address in their next survey and report.

State of the Job Market for Pathologists: Evidence From the College of American Pathologists Practice Leader Survey

Context.—. Disagreement exists within the pathology community about the status of the job market for pathologists. Although many agree that jobs in pathology were harder to come by earlier this decade, recent evidence suggests improvement is occurring.Objective.—. To assess the state of the job...

www.archivesofpathology.org

Academica and their affiliates were ~40% of the respondents (Table 2) and ~61% of the total open positions were offered by Academics and their affiliates (Table 6). This is out of a total of 246 positions. Since residencies produce more many more graduates than 246 (500? 1000?), I think it's reasonable to conclude the job market isn't great. Your chances of getting a non-academic are even worse, as compared to academic positions, which are (rightly or wrongly) synonymous with lower pay. On the plus side, it seems like the plurality of postions are for general path with no specific fellowship, followed closely by Heme, GI, and Cyto (really!?).

Being SDN, I'll add the requisite personal anecdote. About half of the graduates from my program around the time I graduated are "real" pathologists. Everyone else is in industry, government, or not in a pathology practice (eg, full-time research, informatics, etc).

 

[Med Director New England]

Academica and their affiliates were ~40% of the respondents (Table 2) and ~61% of the total open positions were offered by Academics and their affiliates (Table 6). This is out of a total of 246 positions. Since residencies produce more many more graduates than 246 (500? 1000?), I think it's reasonable to conclude the job market isn't great. Your chances of getting a non-academic are even worse, as compared to academic positions, which are (rightly or wrongly) synonymous with lower pay. On the plus side, it seems like the plurality of postions are for general path with no specific fellowship, followed closely by Heme, GI, and Cyto (really!?).

Being SDN, I'll add the requisite personal anecdote. About half of the graduates from my program around the time I graduated are "real" pathologists. Everyone else is in industry, government, or not in a pathology practice (eg, full-time research, informatics, etc).

Wrong !!
Thou shalt not make such a claim without an evidence base !!
You shall cower in my general presence, DONT LOOK ME IN THE EYE!! How dare you. I am Yaah, damnit. All knowing, all powerful. One more outburst like that I will smite thee and cut you off from SDN!

 

[gbwillner]

What's the point of all of this? Yaah has had valid opinions on this site for as long as I can remember- there is no need for bashing. I applaud him for wanting to discuss the issue based onthe merits of the data presented rather than opinion and anecdote. You all should know the data can be right and also your personal observation. My take from reading these articles is that the market has improved and is ok in academics, which is also where most of the jobs are, so it may not be incorrect to imply that is true for the overall market. That can be true with it also being true that the PP market is not great.

If you ever expected to get 20+ offers at a fellowship job fair like your family medicine or IM counterparts you just aren't living in reality and I don't think that has ever been the case with path.

 

[coroner]

You shall cower in my general presence, DONT LOOK ME IN THE EYE!! How dare you. I am Yaah, damnit. All knowing, all powerful.

I thought that was this guy...

 

[Med Director New England]

What's the point of all of this? Yaah has had valid opinions on this site for as long as I can remember- there is no need for bashing. I applaud him for wanting to discuss the issue based onthe merits of the data presented rather than opinion and anecdote. You all should know the data can be right and also your personal observation. My take from reading these articles is that the market has improved and is ok in academics, which is also where most of the jobs are, so it may not be incorrect to imply that is true for the overall market. That can be true with it also being true that the PP market is not great.

If you ever expected to get 20+ offers at a fellowship job fair like your family medicine or IM counterparts you just aren't living in reality and I don't think that has ever been the case with path.

A world with a little humor and sarcasm is a better world. That’s all, don’t read to much into this.

yaah was asking for it btw

 

[Unty]

Academica and their affiliates were ~40% of the respondents (Table 2) and ~61% of the total open positions were offered by Academics and their affiliates (Table 6). This is out of a total of 246 positions. Since residencies produce more many more graduates than 246 (500? 1000?), I think it's reasonable to conclude the job market isn't great. Your chances of getting a non-academic are even worse, as compared to academic positions, which are (rightly or wrongly) synonymous with lower pay. On the plus side, it seems like the plurality of postions are for general path with no specific fellowship, followed closely by Heme, GI, and Cyto (really!?).

Being SDN, I'll add the requisite personal anecdote. About half of the graduates from my program around the time I graduated are "real" pathologists. Everyone else is in industry, government, or not in a pathology practice (eg, full-time research, informatics, etc).

Agree. The data in addition does not survey a majority of practices. The authors based the data on the number of groups who responded which If I remember correctly was less than 50% of those surveyed.

To say the job market is robust based on this data is misleading.

There are 600 pathology grads every year. 246 positions for 600 grads each year is NOT a good job market. Approx 150 out of 246 jobs are academic or academic affiliated (61%), leaving approx 96 jobs from private practice groups.

You will have to compete with other grads for pp jobs in an already saturated job market aka 246 jobs for 600 grads.

Let me read this paper in detail. I will be back.

 

[Unty]

This survey was sent to 2709 leaders and practice managers in 47 states and the District of Columbia. This list was compiled from several sources, including national databases of pathology practices and laboratories that bill Medicare for pathology services (sometimes supplemented by Internet searches for practice leaders or practice managers of those practices) and of hospital executive leaders; lists of laboratories that use the CAP's Laboratory Improvement Programs; and names of CAP laboratory inspectors and engaged leaders. We believe that there is a substantial amount of duplication in this list because we have found some cases of the same businesses operating under different names (for example, a practice associated with a particular hospital may be listed in one source as part of that hospital and in another source under a separate name). To prevent duplicate responses from practices, the survey instructions specified that there should be only one response per practice, and that the survey should be completed by the person with the primary responsibility for overseeing the practice (or by that person's designee). Although there are no rigorous data on the number of pathology practices in the United States, experts from the CAP estimate that this number is between 1400 and 1500. Reponses were received from 346 practices.

Argument #1: Concluding that the job market is strong based on a very small % of practices surveyed is misleading, irresponsible and conclusions like this should not have been made until a larger more comprehensive sampling could be made.

346/1400 practices surveyed. That’s a dismal 25% of total practices surveyed.

 

[Unty]

Argument #2-Too few job positions for the number of pathology grads does not equate to a strong job market.

From JAMA-“In 2019, the National Resident Matching Program reported 569 incoming first-year pathology residents, or 3.2% of 17 763 total residents matched.”

From the paper:

Results.— Among the surveyed practice leaders, 115 (45.5%) sought to hire at least 1 pathologist in 2017, and together tried to fill 246 full-time equivalent positions that year, of which 93.5 full-time equivalents (38%) were newly created.

246 job positions for a graduating class of 500-600 pathologists does not equate to a strong job market, a conclusion made by the authors of this paper.

 

[Med Director New England]

Argument #2-Too few job positions for the number of pathology grads does not equate to a strong job market.

From JAMA-“In 2019, the National Resident Matching Program reported 569 incoming first-year pathology residents, or 3.2% of 17 763 total residents matched.”

From the paper:

Results.— Among the surveyed practice leaders, 115 (45.5%) sought to hire at least 1 pathologist in 2017, and together tried to fill 246 full-time equivalent positions that year, of which 93.5 full-time equivalents (38%) were newly created.

246 job positions for a graduating class of 500-600 pathologists does not equate to a strong job market, a conclusion made by the authors of this paper.

Unity - how DARE you question these conclusions, how DARE you question the study design, how DARE you suggest the authors of this study are conflicted. You shall be judged without mercy. You make me sick. The good yaah giveth and the good yaah..

Wait a minute - did I hear a snicker. Is that you D1b?? Show yourself. Do you not know WHO I AM. You too shall be judged without mercy.

 

[Unty]

Unity - how DARE you question these conclusions, how DARE you question the study design, how DARE you suggest the authors of this study are conflicted. You shall be judged without mercy. You make me sick. The good yaah giveth and the good yaah..

Wait a minute - did I hear a snicker. Is that you D1b?? Show yourself. Do you not know WHO I AM. You too shall be judged without mercy.

My name is Unty not Unity how dare you call me by the wrong screename!

 

[gbwillner]

Argument #2-Too few job positions for the number of pathology grads does not equate to a strong job market.

From JAMA-“In 2019, the National Resident Matching Program reported 569 incoming first-year pathology residents, or 3.2% of 17 763 total residents matched.”

From the paper:

Results.— Among the surveyed practice leaders, 115 (45.5%) sought to hire at least 1 pathologist in 2017, and together tried to fill 246 full-time equivalent positions that year, of which 93.5 full-time equivalents (38%) were newly created.

246 job positions for a graduating class of 500-600 pathologists does not equate to a strong job market, a conclusion made by the authors of this paper.

Unty,
I think your arguments here (particularly #1) are highly flawed. This survey got responses from 346 practices (citing your post above), out of an estimated 1400 practices (also from your post above). This is a 24.7% sample.

Out of roughly 25% of practices, there were 246 positions (also quoting you). I don't think these facts are in dispute.

IF these 25% of practices are representative of all path practices, then accounting for all such practices the jobs out there for last year would be 996 jobs in the field. This means there are roughly 1.7 jobs out there for every path resident graduating. Claiming that the SAMPLE number is the actual jobs available and then concluding that means the job prospects are poor is disingenuous at best.

Now, you could argue that this sample is NOT representative of the overall marketplace (your second argument). a sample size of 25% is HUGE compared to most survey samples. You can use statistics to demonstrate this is an adequate number, and I believe it probably is. You could also argue that this sample is biased in some way, that labs not hiring are less likely to fill out the survey, or something else, but what evidence do you have for that, or even what practical hypothesis do you have beyond trying to support your own conclusions????

 

[Med Director New England]

So this group has already parsed this paper up and down, debated it design (and flaws) back when it was published.

said this before but worth repeating:

you don’t even really need to survey practices to get a answer about the job market. The MOC / CC data that ABP possesses and gets updated every 2 yrs show what % of pathologists are employed (both part and full time), how many fellowships each diplomate has completed, what % are not working at all, what % left the US to work elsewhere and has this data going back to 2006. Why not take a look at these numbers. If the job market is good I would expect low and stable path unemployment and underemployment, number leaving the country to work outside the us to be stable, fellowships / diplomate to be stable.

While this data is limited by having no data for diplomates 2005 and earlier. It has complete data for all diplomates 2006 and after. Study this very powerful data source - this would be a much easier way to answer the question about the job market.

it is head - scratcher to me why someone in academia hasn’t done this already. I have my theories on why this hasn’t been done but it is just that, a best guess.

 

[Alteran]

So this group has already parsed this paper up and down, debated it design (and flaws) back when it was published.

said this before but worth repeating:

you don’t even really need to survey practices to get a answer about the job market. The MOC / CC data that ABP possesses and gets updated every 2 yrs show what % of pathologists are employed (both part and full time), how many fellowships each diplomate has completed, what % are not working at all, what % left the US to work elsewhere and has this data going back to 2006. Why not take a look at these numbers. If the job market is good I would expect low and stable path unemployment and underemployment, number leaving the country to work outside the us to be stable, fellowships / diplomate to be stable.

While this data is limited by having no data for diplomates 2005 and earlier. It has complete data for all diplomates 2006 and after. Study this very powerful data source - this would be a much easier way to answer the question about the job market.

it is head - scratcher to me why someone in academia hasn’t done this already. I have my theories on why this hasn’t been done but it is just that, a best guess.

That's not a bad idea at all. We all have to routinely update our information with the ABP to exist as a pathologist. Every 2 years we all have to list our professional affiliations and clinical activity or lack thereof. It would be super easy to know what percentage of boarded pathologists are actually employed and in what settings if someone were to compile the data. We could even see with perfect clarity how often pathologists migrate from one job to next and from what setting(s) we are transitioning to or from. Its the best treasure trove of jobs data for our specialty.

I doubt it'll never see the light of day though. If you look at the board of trustees for ABP, they're almost all academia and they have know what kind of information they have access to. They couldn't possibly be that clueless. I'm guessing someone's already looked at it and even at a glance, it's not worth showing. The best case scenario is it doesn't help anyone's narrative. But you can be absolutely sure that if showed super strong job numbers, they would have published it by now and waved it around in everyone's face.

 

[Med Director New England]

That's not a bad idea at all. We all have to routinely update our information with the ABP to exist as a pathologist. Every 2 years we all have to list our professional affiliations and clinical activity or lack thereof. It would be super easy to know what percentage of boarded pathologists are actually employed and in what settings if someone were to compile the data. We could even see with perfect clarity how often pathologists migrate from one job to next and from what setting(s) we are transitioning to or from. Its the best treasure trove of jobs data for our specialty.

I doubt it'll never see the light of day though. If you look at the board of trustees for ABP, they're almost all academia and they have know what kind of information they have access to. They couldn't possibly be that clueless. I'm guessing someone's already looked at it and even at a glance, it's not worth showing. The best case scenario is it doesn't help anyone's narrative. But you can be absolutely sure that if showed super strong job numbers, they would have published it by now and waved it around in everyone's face.

ding, ding, ding ding

 

[V5RED]

I was considering pathology. I did 2 pathology electives and very much enjoyed them. The work was interesting, the pathologists were highly motivated to teach, and everyone seemed happy. Up until close to the time for applying to programs, I was planning to dual apply to FM and pathology. The reason I did not apply to pathology was the jobs market. In FM, I will likely have many job offers partway through PGY2. I will be able to live wherever I want and move whenever I want. In pathology, I will need to go job hunting and have no choice in where I live. I would likely need to complete a fellowship to have a shot at a job. I looked at the available jobs and the number of FM offerings was orders of magnitude higher than pathology ones in every market I looked at, and that was before this pandemic hit.

 

[KeratinPearls]

I was considering pathology. I did 2 pathology electives and very much enjoyed them. The work was interesting, the pathologists were highly motivated to teach, and everyone seemed happy. Up until close to the time for applying to programs, I was planning to dual apply to FM and pathology. The reason I did not apply to pathology was the jobs market. In FM, I will likely have many job offers partway through PGY2. I will be able to live wherever I want and move whenever I want. In pathology, I will need to go job hunting and have no choice in where I live. I would likely need to complete a fellowship to have a shot at a job. I looked at the available jobs and the number of FM offerings was orders of magnitude higher than pathology ones in every market I looked at, and that was before this pandemic hit.

Shame on you for your anecdotes!

In all seriousness, the two fields are vastly different. Not just patient contact vs no patient contact. Just curious, what makes you like both?

 

[KeratinPearls]

I was considering pathology. I did 2 pathology electives and very much enjoyed them. The work was interesting, the pathologists were highly motivated to teach, and everyone seemed happy. Up until close to the time for applying to programs, I was planning to dual apply to FM and pathology. The reason I did not apply to pathology was the jobs market. In FM, I will likely have many job offers partway through PGY2. I will be able to live wherever I want and move whenever I want. In pathology, I will need to go job hunting and have no choice in where I live. I would likely need to complete a fellowship to have a shot at a job. I looked at the available jobs and the number of FM offerings was orders of magnitude higher than pathology ones in every market I looked at, and that was before this pandemic hit.

Having gone through the job search, I agree with you. The thingwith FM you can have a bunch of docs in a few blocks. The same doesn’t hold true with pathology. You can only have so many pathologists in a hospital or a group.

For example, take socal, a tight job market. I saw a handful of jobs over the past 6 months for Path. If you look for a job in FM you will see much more I’m guessing for the reasons I cited. Pay may not be much but you’ll have a job. There is a dermpath job at quest. One job at Kaiser permanente I applied to but never heard back from. Santa Monica job looking for hemepath. A few other jobs but that was it.

 

[Med Director New England]

I was considering pathology. I did 2 pathology electives and very much enjoyed them. The work was interesting, the pathologists were highly motivated to teach, and everyone seemed happy. Up until close to the time for applying to programs, I was planning to dual apply to FM and pathology. The reason I did not apply to pathology was the jobs market. In FM, I will likely have many job offers partway through PGY2. I will be able to live wherever I want and move whenever I want. In pathology, I will need to go job hunting and have no choice in where I live. I would likely need to complete a fellowship to have a shot at a job. I looked at the available jobs and the number of FM offerings was orders of magnitude higher than pathology ones in every market I looked at, and that was before this pandemic hit.

thanks for chiming in here. And good for you for doing your own research /r job market family med vs path.

did you by chance glean what is typical starting package for fam medicine regarding compensation, sign on bonuses, loan repayment, etc. If so would you mind sharing?

Good luck with your career. Having a little more knowledge of path and lab medicine will be a help for you in family medicine.

 

[Splenda88]

Offers for FM where I am are 200k-250k/yr M-Th 8-5p and Friday 8-12noon. 25k sign on bonus.

IM hospitalists are getting 250-300k/yr and nocturnists 300k-350k/yr for 7 days on/off, and ~25k sign on bonus. I am already receiving these offers as a PGY2 IM.

 

[yaah]

Relax yaah
Where did I say or even imply this ?
I very often preface anything I write here that it is my opinion and experience to emphasize it is just that - one persons observations.

In fact I only bothered to reply to your post b/c you say to someone who happens to disagree with you “there isn’t a lot of evidence to support you” in a debate of a question that will never actually be formally studied.

btw yaah you kinda sound like a lunatic with your recent posts. No evidence base - just my opinion

That post wasn't targeted at anyone. I said it was for me. My experience.

I have never said my own opinion is the only one that matters. I have a pretty standard track record here - I post my opinions when asked, never say they are valid for everyone, and ask for data. And then some of you guys get mad from time to time and say I'm making wild unsubstantiated claims. I post about what is being talked about in the literature and such to generate discussion. A lot of the things that you guys argue with me about are based on your own anecdotes or personal opinions (but yet anecdotes that don't support your opinions are somehow less important). When I ask for data many of you get mad or claim bias. At least there has been some discussion of data in this thread since then. This is good! I like data. I have been asking for 15 years on this forum for more data, But these studies are not easy.

Most of the things on this forum that I get involved with are things I have questions about. It's hard to know the truth! So many things are multifactorial. Different experiences and different opinions are important. I'm not sure why mine is less important than yours. I have never said anyone's opinion is less important (except maybe the "flee pathology now" people) - I do post frequently when people are certain about things and I post my own experience which counters that, but it doesn't mean my experience or opinion is true for everyone. Just because I am arguing or posting a contrary opinion doesn't mean I don't respect yours.

And by the way, however, this issue is being formally studied. There are actually working groups and committees looking at the potential future shortage of pathologists and the declining number of US grads going into pathology. That is where this paper that I cited came from, and where others are likely to come from in the future. There is a LOT of interest from national organizations into the reasons for this. Perhaps you should contact the individuals who are working on these papers and help them out since they are so wrong.

 

[yaah]

Shame on you for your anecdotes!

In all seriousness, the two fields are vastly different. Not just patient contact vs no patient contact. Just curious, what makes you like both?

His/her anecdotes are incredibly important - they are an individual experience. For this person, the key considerations were ability to be location limited and have lots of different job choices. That's important! And it's also a problem path has to deal with in recruiting future practitioners. It's hard to solve because the number of family med jobs is so much higher than the number of path jobs, but obviously it is a factor for some people. Not true for everyone of course, because not everyone is as OK with practicing in both path and FM, but obviously it's true for this person.

 

[yaah]

I was considering pathology. I did 2 pathology electives and very much enjoyed them. The work was interesting, the pathologists were highly motivated to teach, and everyone seemed happy. Up until close to the time for applying to programs, I was planning to dual apply to FM and pathology. The reason I did not apply to pathology was the jobs market. In FM, I will likely have many job offers partway through PGY2. I will be able to live wherever I want and move whenever I want. In pathology, I will need to go job hunting and have no choice in where I live. I would likely need to complete a fellowship to have a shot at a job. I looked at the available jobs and the number of FM offerings was orders of magnitude higher than pathology ones in every market I looked at, and that was before this pandemic hit.

Your story is interesting, thanks for posting.

There are current ~120,000 family medicine physicians in the US, and around 18000 pathologists (i don't know further breakdowns, if this includes all forensic docs, all research only academics, etc). So there are clearly going to be more FM jobs, and FM jobs are also going to be inclusive of all areas of the country, unlike pathology. That is always a challenge for path. There are very few rural pathology jobs, but in FM you can practice almost anywhere you want to.

 

[D1b()4]

Was I even responding to you? That post wasn't targeted at anyone - there were a couple that said my opinion was utter nonsense and that my opinion that exposure to path in med school was only ONE factor was crap. It wasn't crap for me and some others that I know personally, that's what I said, which to me means it's not utter nonsense. Sorry if it doesn't jive with what you want to believe. I don't really get what you're upset about.

My utter nonsense comment was a general statement and was not targeted at you or your opinion. I stand by that statement, and all I was trying to say is that most American medical school graduates are aware of pathology as a specialty/career choice.