Disillusioned about Pathology

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M

mojo

I was talking with my doc and he said that pathology is not such a great field to pursue because it's a 5-year residency and, when you come out of it, you're not insured a job anywhere. Most hospitals only have one pathologist, they're not in high demand and their jobs have been made obsolete by modern technology. And, he said that the jobs just aren't there because it has reached its saturation point; however, there are guys who do retire. He said that the learning could be great, but in reality, I'd be wasting a lot of time in my life.
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Tony, was your doc a pathologist?

OK, I am not a pathologist, but I just got through the match process, and I'll tell you what I think.

First, ask people who are actually in the field -- ask people who are in various stages in their careers: residents, attendings, fellows. Sometimes, docs in one specialty will knock another -- there's lots of reasons for this. True, they could really be sincere, but I have seen people make negative remarks based on bitterness, envy, or just plain old ignorance.

Second, you are talking about something that will not take place for 5 years -- who knows what the market will be like? Molecular/cellular technologies in pathology are just breaking ground, and they will revolutionize the field. And since not many people are entering the field right now (there were only 2 in my class of 150), you may have less competition in 5 years.

I'll give radiology (my chose field) as an example: 5 years ago, it was a very UNcompetitive field. Many programs were having trouble filling positions. You had to do a fellowship following your 5year residency to be assured of a position. This is because there was an oversaturation of radiologists.

NOW, the market is red hot: residencies cut the # of positions, doc began ordering more studies, and the explosion in imaging technology is creating a huge market. In fact, many academic programs are having problems keeping younger faculty (they are being offered $500K positions with 12 weeks vacation per year) and finding residents willing to do fellowships (it's just too easy to get a good job). Who would have thought this 5 years ago?

The point is, you should do something that really interests you with a lifestyle that you can live with. There is no way of telling how the market is going to be (and I defy anyone to make predictions) or how medical technology and socio-political forces are going to affect it, and making decisions based on these factors is precarious. I am not saying they should play no part, but it should be only part of the broader picture.

best wishes, ana
 
Ana is on the money. There are many reasons why someone would be dissatisfied with a certain field - whether its theirs or someone's elses. You certainly need input from more than 1 person (especially if the physician you spoke with wasn't a pathologist).

The truth is that NO residency can guarantee you a job but there are cycles in residency competitiveness. Ana is correct that 5 years ago you couldn't give away a Rads position; now they are red-hot (one of my classmates feels very lucky to have gotten her first DR choice in the match). Surgery is on a down swing now - who knows what will happen in 5 years?

If Path were such a dead field I'm sure I wouldn't have classmates going into it, nor would Great Pumpkin (our resident Path expert) I'm sure he can directly speak to your concerns over path. You should be cognizant of career developements in your field, but in the end what is most important is what interests you and will for the next 35 years.

And on that note, I'll move this over to The Rotations and Residencies Forum! :)
 
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Kimberli,
I am just curious, when the surgery started to go down (I am not arguing with you). In 1998 I was told something as "cum laude and top schools are invited" only.
Down means its easier to get in or what. The reason I am asking that was what I wanted.
 
Originally posted by anna:
•Tony, was your doc a pathologist?

OK, I am not a pathologist, but I just got through the match process, and I'll tell you what I think.

First, ask people who are actually in the field -- ask people who are in various stages in their careers: residents, attendings, fellows. Sometimes, docs in one specialty will knock another -- there's lots of reasons for this. True, they could really be sincere, but I have seen people make negative remarks based on bitterness, envy, or just plain old ignorance.

Second, you are talking about something that will not take place for 5 years -- who knows what the market will be like? Molecular/cellular technologies in pathology are just breaking ground, and they will revolutionize the field. And since not many people are entering the field right now (there were only 2 in my class of 150), you may have less competition in 5 years.

I'll give radiology (my chose field) as an example: 5 years ago, it was a very UNcompetitive field. Many programs were having trouble filling positions. You had to do a fellowship following your 5year residency to be assured of a position. This is because there was an oversaturation of radiologists.

NOW, the market is red hot: residencies cut the # of positions, doc began ordering more studies, and the explosion in imaging technology is creating a huge market. In fact, many academic programs are having problems keeping younger faculty (they are being offered $500K positions with 12 weeks vacation per year) and finding residents willing to do fellowships (it's just too easy to get a good job). Who would have thought this 5 years ago?

The point is, you should do something that really interests you with a lifestyle that you can live with. There is no way of telling how the market is going to be (and I defy anyone to make predictions) or how medical technology and socio-political forces are going to affect it, and making decisions based on these factors is precarious. I am not saying they should play no part, but it should be only part of the broader picture.

best wishes, ana•
Click to expand...

Thanks for your replies! My doc's an internist, he's been doing it for a while, and seems to know his stuff. He actually said that radiology was a good one to do, and that in order to get a residency that you want, you have to show good interest in med school.

I hope you're right that the outlook changes, and there are probably better perspectives that I can get on the issue. It just bugged me a bit to hear this, because I'm so interested in this field that I've taken forensics classes and read an intro to pathology book. I like the science behind it very much, and I like the learning process. I wouldn't mind doing a long residency, but I'd like to find a job afterwards :D I would hate to go into a field where nothing is doing.
 
Originally posted by Dreamer:
•Kimberli,
I am just curious, when the surgery started to go down (I am not arguing with you). In 1998 I was told something as "cum laude and top schools are invited" only.
Down means its easier to get in or what. The reason I am asking that was what I wanted.•
Click to expand...

The downturn in General Surgery's popularity was noticeable this year, with many more Unfilled spots during the NRMP.

While it is true that for some programs "cum laude and top school graduates" are preferred candidates (still), there have always been some Unfilled spots which less stellar candidates have been able to obtain.

Despite the downturn, given what you told me in your Private Message I still think you will face an uphill battle obtaining a spot except perhaps at some of the lesser community programs.
 
Are you allowed to open up a primary care practice after a pathology residency? Are there good opportunities for teaching/research? Where's that Pumpkin doc; I think I saw him on the forum before?
 
Primary care after pathology? As my friend who is a pathologist, said I like my patients, they don't complain.

Kimberli, I know I would face an upmountain, not uphill battle, it was just curiosity. Thank you for reply.
 
Hi Tony!
Pathology is the study of pathos--or disease. This is essentially the building block for which all other components of medicine are built. Your internist, while perhaps knowledgeable in his field, must wait for the "labs to come back" before he is able to manage any of his patients. Pathologists...not machines...assign meaning to the lab values and data which is extracted during a test. It is only through years of study that the difference between "normal" and "diseased" states can be detected. A pathologist needs to be aware of all of the physiology of a human body plus whatever can go wrong with it. This is a HUGE undertaking which cannot be learned completely in a lifetime, let alone in the 5 years of a residency. So while your internist may feel pathology is a "waste of time" his ability to perform his job is rendered nearly impossible without the information supplied by a pathologist. Furthermore as technology advances many new fields in pathology emerge: genetics, informatics, immunology. These hi-tec fields probably hold the keys to medical advancement which will be utilized by all specialties (e.g. try diagnosing a CML without a genetic study--and this is now a very old example!) As a current post-soph fellow in Path. I can assure you that the field is pretty desperate for bright American graduates (sorry IMGs, this is common knowledge.) Hospitals also have a wide range in the number of pathologists employed--teaching hospitals can employ over a hundred! Not to mention the ultra-cool opportunities in surgical (****Make sure you treat your frozen section team well Kimberli!***) and autopsy pathology which your internist probably knows little about. Finally, forensics is INCREDIBLY FASCINATING! And while the starting pay is traditionally lower than other fields, the excitement and drama (yup I work at a morgue and there is PLENTY of it), plus relatively benign hours can be worth it.

****Final note: most pathologists make more than your internist does and they work 40 hour weeks ... (ask your doc how many hours he puts in!)
 
Originally posted by Mindy:
•Hi Tony!
Pathology is the study of pathos--or disease. This is essentially the building block for which all other components of medicine are built. Your internist, while perhaps knowledgeable in his field, must wait for the "labs to come back" before he is able to manage any of his patients. Pathologists...not machines...assign meaning to the lab values and data which is extracted during a test. It is only through years of study that the difference between "normal" and "diseased" states can be detected. A pathologist needs to be aware of all of the physiology of a human body plus whatever can go wrong with it. This is a HUGE undertaking which cannot be learned completely in a lifetime, let alone in the 5 years of a residency. So while your internist may feel pathology is a "waste of time" his ability to perform his job is rendered nearly impossible without the information supplied by a pathologist. Furthermore as technology advances many new fields in pathology emerge: genetics, informatics, immunology. These hi-tec fields probably hold the keys to medical advancement which will be utilized by all specialties (e.g. try diagnosing a CML without a genetic study--and this is now a very old example!) As a current post-soph fellow in Path. I can assure you that the field is pretty desperate for bright American graduates (sorry IMGs, this is common knowledge.) Hospitals also have a wide range in the number of pathologists employed--teaching hospitals can employ over a hundred! Not to mention the ultra-cool opportunities in surgical (****Make sure you treat your frozen section team well Kimberli!***) and autopsy pathology which your internist probably knows little about. Finally, forensics is INCREDIBLY FASCINATING! And while the starting pay is traditionally lower than other fields, the excitement and drama (yup I work at a morgue and there is PLENTY of it), plus relatively benign hours can be worth it.

****Final note: most pathologists make more than your internist does and they work 40 hour weeks ... (ask your doc how many hours he puts in!)•
Click to expand...

To Mindy:

Wow, thanks so much for the reply! This is definately a field that I am inclined to pursue. You mentioned forensics being fascinating, and I totally agree with you. I like the challenge of learning as much as I can, especially when I could see such a knowledge base being carefully applied to medicine. I was taken aback when I heard that pathologists are not in good demand!
What really struck me from your post, in contrast to what I have heard, was that, 'teaching hospitals can employ over one hundred'. I think that's awesome. :eek:
Thanks again, best of luck, and WELCOME TO SDN!
 
Wow, I go away for the weekend and look what happens.

Tony, I had many doctors tell me that path was a terrible field. They were all not pathologists. They remember stories of the job market 5 to 10 years ago, when it was very hard to find a job. This is just not the case now. The residents at my program for instance who are getting ready to leave all had multiple job offers. Some even have jobs lined up during their fourth year. The ones that are going on to do fellowships have offers or leads as well. The people that are having more trouble are the non US citizen foriegn grads. Many of the jobs in path are controlled by the "good ol boy network" types. So you can see why there is this difference. With so many IMGs in the pathology pipeline, if you are a US citizen, US trained doc you will be in high demand.
You can also see that the market is better in the faculty leaving to go to the private sector. Every residency I went to had multiple faculty leaving because of the great offers that were comming in.

As a final note just pick the specialty that you will want to do for the rest of your life. You will find a job. If you pick something else, you may regret your decision.

Contact me if you need any more info.
 
GP,
I guess this means you are not allowed to go away on weekends anymore ;)
 
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Tony, "I feel your pain".

Take it from me, a non traditional student who hasn't even started his pre-meds:

If you are passionate about pathology, stop listening to the opinions of other people about pathology, whether such opinions come from professionals or laymen.

It is your passion for the field that will make you a better pathologist than most, and in the end, you will be a fulfilled, competent, respected and well compensated pathologist.

Of course if you are passionate about pathology, you aren't considering the compensation at this point, nor are you considering the geography of where you may have to place yourself in order to serve, and you certainly aren't motivated by the respect (approval) of other people. If you are considering these things as factors, then you aren't passionate about pathology. Or, if you are considering these factors as determinants, you perhaps aren't prepared to be an excellent physician at all, regardless of the specialty that you choose.

My two cents

john
 
Originally posted by Florida_style:
•Tony, "I feel your pain".


Of course if you are passionate about pathology, you aren't considering the compensation at this point, nor are you considering the geography of where you may have to place yourself in order to serve, and you certainly aren't motivated by the respect (approval) of other people. If you are considering these things as factors, then you aren't passionate about pathology. Or, if you are considering these factors as determinants, you perhaps aren't prepared to be an excellent physician at all, regardless of the specialty that you choose.

My two cents

john•
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I respectfully disagree John, you can be passionate about things and still think out and figure out some of the details beforehand. If not you may not like what you gotten yourself into. I think it is wise to worry some about your future, it makes you do things like plan ahead. Figuring out your field without considering the lifestyle, pay, job opportunities etc is not really making an informed decision.
 
Does anyone know the salary of pathologist? (Not knocking the income, because I am interested too.)
I just heard they do not make alot of money compare to other spcialist. I volunteer at the morgue and one of the doctors said that. She said it is a field you must be interested in, but not for the money. I have alway wanted to be a medical examiner and is the only reason I applied for medical school. If I could have been one without going to medical school I would have.

I know you are employed but the county and make a six figure income.

If any of you are interested in becoming a medical examiner you should see if you can volunteer at the county morgue, I have learned plenty of information by going their. And it is not depressing like I thought it would be.
 
Well you are talking about forensic pathology that is a lot different than the regular partnership surgical/clinical pathologist. In most states the forensic pathologist is a state or county employee, thus the relatively low salary. Forensic pathologist would start in the 70-80s and may make up into the mid 100s after working for many years. The surg/clinical path doc will likely start in the mid 100s and once he/she makes partner will make in the mid 200s. So as you can see it is a big diff. Also, the jobs are almost completely diff. Very successful forensic path docs can become expert witnesses, travel around the country and make very good money. But, this is a small minority. Just for your info if you were unaware forensics is a one to two year fellowship that you take after you finish your path residency. Hope that helps. Ask any more questions if you have them. As you can probably tell I love path. And, I hope I can encourage more people to give it a look.
 
What does a surg/clinc pathologist do?
 
It is good to see a revival of this thread. Thanks for the info. Is it possible to do fellowships in both forensics and surgical/clinical path?
 
You don't normally do a fellowship in surgical/clinical path that is what your residency if for. If you do the 5 year AP/CP (anatomic path/clinical path) residency you are ready to go to work. There are other fellowships like dermatopath and cytopath etc..But there is a surgical path fellowship if you really want more exp.

The job of the surg/clin path somewhat depends on the group and or hospital they work. But, usually they are in charge of all the hospital labs. Have administrative functions in that respect. And, they look at all the surgery samples both "grossly" and microscopically. They also recieve biopsies and difficult pap smear slides. Some may do a few autopsies now and then. They also may do fine needle aspirations or bone marrows. They also are in charge of the blood bank. And, they do frozen sections.
 
Originally posted by GreatPumpkin:
•You don't normally do a fellowship in surgical/clinical path that is what your residency if for. If you do the 5 year AP/CP (anatomic path/clinical path) residency you are ready to go to work. There are other fellowships like dermatopath and cytopath etc..But there is a surgical path fellowship if you really want more exp.

The job of the surg/clin path somewhat depends on the group and or hospital they work. But, usually they are in charge of all the hospital labs. Have administrative functions in that respect. And, they look at all the surgery samples both "grossly" and microscopically. They also recieve biopsies and difficult pap smear slides. Some may do a few autopsies now and then. They also may do fine needle aspirations or bone marrows. They also are in charge of the blood bank. And, they do frozen sections.•
Click to expand...


Sounds like fun! GP, thanks for the email back. I would not want to do autopsies all the time, I like the things you just detailed. Would skils in Transmission Electron Microscopy and Scanning Electron Microscopy come in handy?
 
Those skills would come in handy at large institutions. I doubt most path docs use those skills in normal practice, but I wouldn't know for sure. I do have a one month rotation in Electron Microscopy during 3rd year. But most of the rotations like those are just to become familiar with things not to really become proficient. The pathologist is more of a supervisor/troubleshooter for the labs and specialty labs.

We have similar rotations in microbiology, immunohistochemistry, medical infomatics, and others.

Path is such a diverse field. With so many things changing it is going to be so interesting. Biochip technology may really be a great breakthrough. And, right now our surg path program is switching to voice recognition software for dictation. Very interesting stuff.
 
Hey Tony Clifton,

Man, if you are going to post on every thread would you please remove those freakin long quotes at the end of every message. I'm so tired of having to scroll down half the page just to see the next message.

SBB
 
SBB, modified. Welcome to SDN! Great Pumpkin, how does one go about getting a residency in Surg/clinic pathology?
 
Just like any other specialty. Go to med school, take the USMLEs and enter the match. Pathology is not very competitive, so if you are a mid level student from a US med school you can pretty much write your own ticket. When you go on interviews you are treated like royalty. Everywhere I went paid for my lodging and took me out to a fancy lunch. This is not the norm for interviews in other specialties. All I can say it is nice to be in demand. All the places I interviewed called before the deadline to turn in your picks and told me to pick them high because they wanted me. And, it is not like I am some superstar. Just a middle of the road student. And, I interviewed at a couple of very presitgious schools in path Univ or Virginia and Wake Forest. So you shouldn't have any problems. DOs and IMGs match very regularly in path as well.
 
Hey SBB, if you named yourself after the bluegrass group, you have good taste. I'm a fan. :)
 
:rolleyes: Don't be impressed Jamie, I am sure SBB named himself after the recent George Clooney flop in which he played the lead singer of the soggy bottom boys. I doubt he was aware that it truly was a bluesgrass band and not cinematic fancy.
 
OK, assuming that SBB may indeed be a fake bluegrass fan, and maybe Mindy is as well, I'll ask a question to prove it.

What is Little Omie's last name?

Or

Who did Tom Dooley kill?

If either (or anyone else) can answer, they are true fans in my book. :)
 
Originally posted by Jamier2:
•OK, assuming that SBB may indeed be a fake bluegrass fan, and maybe Mindy is as well, I'll ask a question to prove it.

What is Little Omie's last name?

Or

Who did Tom Dooley kill?

If either (or anyone else) can answer, they are true fans in my book. :)•
Click to expand...

The Kingstone Trio's version of 'Tom Dooley' rocks, it was a song that was banned from the radio for a while because it details a killing. When it returned, it stayed on top for a while.

Anyways, Tom Dooley killed Laura Foster. His name was actually Tom Dula, as I believe. Either way, he sure as heck met his 'waterloo' when they hung him. :D
 
The only bluegrass band I can think of is Georgia Satellites...clearly not my genre. Talk pre-80s rock, and then you'll have a conversation I can contribute to. ;)

What I can say for sure is that I saw the aforementioned Clooney flick. And I'm guessing our SBB did also!
 
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