can I shift from internal medicine to pathology?

[ahmd222]

Hello everyone,
I wanna take your advice about my situation.

I'm an IMG graduated on 2012, finished 2 years internal medicine residency and currently working as a primary care physician, I completed all my usmle steps 248/222/1st. now I'm interested in applying next match on pathology residency but I don't know what my chances are? and how can I improve my cv in preparation for the match ?

Any advice is appreciated

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[Mr Derp]

@nr-xxx

 

[nr-xxx]

Hello everyone,
I wanna take your advice about my situation.

I'm an IMG graduated on 2012, finished 2 years internal medicine residency and currently working as a primary care physician, I completed all my usmle steps 248/222/1st. now I'm interested in applying next match on pathology residency but I don't know what my chances are? and how can I improve my cv in preparation for the match ?

Any advice is appreciated

I do not recommend that you go into pathology. Why not try a specialty in IM that lends itself to diagnostic work: e.g. Heme, Medical Microbiology, Infectious disease, Derm, Endocrine or Rheumatology. Under CLIA you can still run a lab with IM boards. the field of pathology may not survive, the PAP test is becoming obsolete replaced by HPV testing and now computers read pathology slides of lung cancer so the days of being a community pathologist and making $400 K are over with. the days of owning a private Cytology lab as a lucrative side practice to supplement a hospital or academic based practice are over with. If for what ever reason you must do pathology 1) could you consider just research? i.e. pursue an academic career getting an R O 1 grant and teach if yes then try places like Brigham's and Women's in Boston, MA or Stanford in CA or UWASH in Seattle,WA pursue straight Anatomic Path ( AP) and most of the training will be like a post doc. if that is not what you want then pockets of the field will survive try Anatomic and Clinical ( AP/CP) and then fellowship in things like Blood banking(BB) , although highly competitive then try straight AP and Dermpath. the research route is the easiest to get into because most do not want to do that so as an IMG that will increase your odds of getting a position . Trying a less well known outfit also will increase your odds, e.g. try University of Rochester in Rochester,NY Also try a program but do a fellowship after AP/CP in something a reference lab could use like Heme, GI or GU. largely the field is not all that good or lucrative as it once was. To me getting IM boards and a fellowship like Hematology, Dermatology and then run a lab under CLIA is the safer play . you can still see patients if the lab work re imbursement is cutback Research may not pay what the service work does but there is virtually no night call , no weekend call, no threat of malpractice lawsuits, no hassles with hospital / HMO execs, techs or employees, playing games with insurance companies or government regulations so that is a positive factor in choosing it good luck

 

[ahmd222]

I do not recommend that you go into pathology. Why not try a specialty in IM that lends itself to diagnostic work: e.g. Heme, Medical Microbiology, Infectious disease, Derm, Endocrine or Rheumatology. Under CLIA you can still run a lab with IM boards. the field of pathology may not survive, the PAP test is becoming obsolete replaced by HPV testing and now computers read pathology slides of lung cancer so the days of being a community pathologist and making $400 K are over with. the days of owning a private Cytology lab as a lucrative side practice to supplement a hospital or academic based practice are over with. If for what ever reason you must do pathology 1) could you consider just research? i.e. pursue an academic career getting an R O 1 grant and teach if yes then try places like Brigham's and Women's in Boston, MA or Stanford in CA or UWASH in Seattle,WA pursue straight Anatomic Path ( AP) and most of the training will be like a post doc. if that is not what you want then pockets of the field will survive try Anatomic and Clinical ( AP/CP) and then fellowship in things like Blood banking(BB) , although highly competitive then try straight AP and Dermpath. the research route is the easiest to get into because most do not want to do that so as an IMG that will increase your odds of getting a position . Trying a less well known outfit also will increase your odds, e.g. try University of Rochester in Rochester,NY Also try a program but do a fellowship after AP/CP in something a reference lab could use like Heme, GI or GU. largely the field is not all that good or lucrative as it once was. To me getting IM boards and a fellowship like Hematology, Dermatology and then run a lab under CLIA is the safer play . you can still see patients if the lab work re imbursement is cutback Research may not pay what the service work does but there is virtually no night call , no weekend call, no threat of malpractice lawsuits, no hassles with hospital / HMO execs, techs or employees, playing games with insurance companies or government regulations so that is a positive factor in choosing it good luck

Wow, that is a lot of info!!! I had to read them over and over to get them in my mind.

thank you for your elaboration.

I applied for IM residency and got 0 Iv this match , I think its becoming much more competitive than we used to , so my point was to get a less competitive residency that I still like.

I prefer the residency route as its more similar to the route in my country and who knows maybe one day I will have to come back home.

 

[KeratinPearls]

Kinda sad to see people apply to Pathology because it's a less competitive specialty. When I was a resident, there were candidates who openly admitted that they applied to both internal medicine as well as Pathology (as their backup). I knew if a guy who matched in Path and bailed into an IM resident after first year. Not sure if he was trying to game the system but if he did, it worked. Not trying to bash IMGs (as I know a lot of good IMG attending and residents) but this does happen with IMG candidates.

To the original poster, why not try family medicine?

 

[ahmd222]

Kinda sad to see people apply to Pathology because it's a less competitive specialty. When I was a resident, there were candidates who openly admitted that they applied to both internal medicine as well as Pathology (as their backup). I knew if a guy who matched in Path and bailed into an IM resident after first year. Not sure if he was trying to game the system but if he did, it worked. Not trying to bash IMGs (as I know a lot of good IMG attending and residents) but this does happen with IMG candidates.

To the original poster, why not try family medicine?

thanks for your reply
I dont know why you are sad?? you shouldn't judge people as you definitely don't know what the circumstances of each person are, right?
I like multiple specialties and thinking about applying for a less competitive one to have a chance of matching , whats wrong with that?
is it a shame to apply on a less competitive specialty? , as far as I know most AMGs apply on different specialties as a backup and of course in the soap they accept whatever they get, why you just judge IMGs?

you really have no idea how much effort, time, sacrifices IMGs do to get into the system. I worked day and night for years to reach my goal of becoming a physician in USA , that's of course after I spend 7 years in my medical school that means about 10 years of real hard work !!!!! and yet still in the journey.

we, IMGs really struggle a lot ,we work and study at the same time for years and spend tons of money to achieve a goal.
please don't be sad, give me a sincere advice that would help me in my journey, then I will be thankful to you.

and by the way , most family medicine programs prefer permanent residents, so for us it's still competitive.

 

[AZpath]

Pathology has been fill spots with 2nd choice folks for years. Just not seen as attractive.

 

[nr-xxx]

IM is preferred to family medicine because the work is more similar to the IM especially with a specialty that does diagnostic work. while family medicine is a good field most in that field do not do diagnostic work. the point I was trying to make is a person who wanted to do diagnostic work and chose pathology can just as easily get into IM and chose a specialty that does diagnostic work. it is a better match than just choosing family medicine that does not do diagnostic work. the key point is the ability to do diagnostic work and under CLIA can still run a lab with IM boards . I do not think a family medicine board type would qualify to run a CLIA approved lab. so that is why I said IM over family medicine

 

[coroner]

...there were candidates who openly admitted that they applied to both internal medicine as well as Pathology (as their backup)

Not doubting this, but I don't know why these candidates would choose Path as a backup. Path is slightly more competitive than IM based on number of residency slots and average board scores of applicants. There's slightly a higher proportion of IMG's in Path but I think those candidates are just as competitive as those applying to IM and usually with more of an extensive research background and PhD's. FM or Psych seems to make more sense as a backup.

I knew if a guy who matched in Path and bailed into an IM resident after first year.

Overall though, Path is a "go to" specialty rather than "get out" i.e. it has more people who want to switch into it (mainly for lifestyle reasons) than bail out. I've met both over the years, more of the former vs the latter.