Is pathology really that bad of a deal right now?

[odyssey2]

I noticed a difference between how pathology is talked about online (especially sdn) and how people talk about it IRL. I know several very capable, accomplished medical students who decided to go into pathology, particularly people interested in a career in basic science, who say the reputation of pathology as a dead end field with no jobs and limited pay is overstated. Is going into path truly a terrible idea right now?

---

Members don't see this ad.

 

[deleted314957]

RIGHT NOW it is pretty crappy. Seems to be a little better than a year ago ANECDOTALLY. However, a current 1st or 2nd year med student may encounter an entirely different terrain. Things can change quite quickly within any given specialty. So, bottom line for your med student friend, no one knows how it will be when your time comes. If one does not go academic it is very highly likely that your entire career will be as a salaried employee or a 1099 independent contractor. Associate to equity partner situations are certainly no longer the norm and becoming rarer by the day.

If IRL means “in real life” I retired from path in 2013 after ~35years in the field .

 

[Alteran]

If the question is "will you have a job in pathology?" the answer is yes. If the question is "will you have financial equity for your work?" and "will I be able to find a job or career on my own terms and at a time and place largely of my own choosing?", the answer is more than likely no.

Briefly, Pathology as a field is going to suffer repeated cuts to professional reimbursement. Add to the mix other physician specialties (dermatology, urology, GI) building competing AP laboratories to not only self refer to themselves, but also entitle themselves to a percentage of your professional reimbursement as a condition of "referring" the professional work to you. Pathology is the only specialty in medicine where other physicians can skim your professional reimbursement, sometimes up to 50%. Why you ask? Complete and total oversupply of pathologists, many of them sub-standardly trained but willing to work at any price, cheapening the field overall. Oh, and I didn't mention that our professional organizations are completely feckless in mitigating any of the above and probably, just like everything else, just interested in making a buck off of managing the decline of our specialty.

 

[KeratinPearls]

To be fair, There are people who have good, but busy, high paying jobs. They seem happy (or at least they don’t look miserable). There are people who are happy in Pathology including friends who work for Quest. They have 8 hour days. They get to go home at 3 pm just as long as they get their quota done. If you get a decent paying job (250k+) and work with good normal people with job security, pathology can be a good field. My friends are happy. They never complain as much as the people on SDN.

Im not saying everything is rosy in Pathology however.

A lot of what Alteran says is correct. Clinicians are exploiting us in the private sector to get extra $$$$. In house office labs are bs.

Partnerships are long. 3 years plus. The places I interviewed at they had 4 to 5 years until partnership. Low starting salaries. 180-190k. One of these places with a low starting salary was at a busy tertiary hospital. They bumped up your salary every year but you don’t get full shareholder status until your 6th or 7th year. Employers have leverage in this field. As a young pathologist dont think you have negotiating power. It’s either take it or we will find someone else. There will be others competing for the same position especially in larger cities.

 

[KeratinPearls]

I live in a city with many residency programs. I see few jobs posted online from my city. If I were to lose my job tommorrow, I think I’d be screwed and would have to move miles away. So if you go into this field expect your choices to be limited for your first job. If you don’t like your first job, you can always move later.

BTW, I just talked with a family member who is a pediatric Hospitalist who works 14 hour days. I’m totally happy I’m not dealing with that clinical bullsh*t. I do my work. I don’t deal with much bs. I go home happy everyday. My colleagues are nice. I’m grateful for my job. I do less than 8 hours of actual work some days. There are some jobs that are 4 days a week. Pretty sweet if you ask me.

Seems to me like partnership positions are becoming less and less common. Most jobs seem to be salaried.

I agree there is an oversupply. Programs graduating subpar pathologists who go on to do 2 sometimes 3 fellowships. The bar is set low. Program directors who wet their pants when they fill 3 positions but ranked 50 candidates. Lol!!!! Our field is full of IMGs who wouldn’t have gotten in if this field was as competitive as some other fields like Derm.

There’s talk on here how Pathology is a niche field. Well then cut the number of programs if it’s so niche! Seriously pathologists can work 25-40 years. There’s only so many spots available in each group or hospital. We don’t need as many programs as we have currently.

Best of luck.

 

[Smoothbrain]

The Pathology field needs a proper labor union that represents the interests of Pathologists and not laboratories or pharmaceutical companies (CAP ahem...)

 

[KeratinPearls]

The Pathology field needs a proper labor union that represents the interests of Pathologists and not laboratories or pharmaceutical companies (CAP ahem...)

Supposedly that’s supposed to be CAP lol!!! I still think about that job market study that concluded the pathology job market was a strong one. By the way, I realized it was authored by the incoming CAP President!

Talk about a huge conflict of interest and bias.

 

[caffeinegirl]

I noticed a difference between how pathology is talked about online (especially sdn) and how people talk about it IRL. I know several very capable, accomplished medical students who decided to go into pathology, particularly people interested in a career in basic science, who say the reputation of pathology as a dead end field with no jobs and limited pay is overstated. Is going into path truly a terrible idea right now?

Your description is from medical students interested in careers in basic science. I'm assuming that these students are likely MD/PhDs who are interested in becoming PI's or having a clinical+research track in academia. This is a very different job market than private practice. In my experience, those who are in academia do not have much experience and do not give good advice to students who are interested in private practice. The gripes you hear on SDN are mostly from those of us in private practice.

 

[gbwillner]

A lot of good points made so far... one not stated that I think needs to be repeated is that all of medicine is experiencing commoditization where fewer docs become owners in their practice. One thing about this that hits pathology a bit harder IMO is that pathologists don't have direct access to the supply of work as they rarely have direct patient access. This puts them in a position to negotiate and provide leverage to other physicians, which is why they take advantage.

That said, IMO this forum has very few voices in it, those voices are overwhelmingly people in private practice, and many of those are very outspoken in their displeasure with the field.

Some of us have done quite well and are very happy with our lot.

 

[deleted314957]

The Pathology field needs a proper labor union that represents the interests of Pathologists and not laboratories or pharmaceutical companies (CAP ahem...)

You can’t be serious. After enriching all the admin folks and everyone else who lives on the fruits of our labor, you want to feed more money to some crooked union? If you think we have any “collective bargaining “ power you are sadly mistaken. Do you not realize the people in this field are ~90% “scabs”. How do you threaten a strike when everybody is a scab?

 

[Smoothbrain]

You can’t be serious. After enriching all the admin folks and everyone else who lives on the fruits of our labor, you want to feed more money to some crooked union? If you think we have any “collective bargaining “ power you are sadly mistaken. Do you not realize the people in this field are ~90% “scabs”. How do you threaten a strike when everybody is a scab?

Im sorry I forgot Pathologists were scabs

 

[HowlPrenderghast]

A lot of good points made so far... one not stated that I think needs to be repeated is that all of medicine is experiencing commoditization where fewer docs become owners in their practice. One thing about this that hits pathology a bit harder IMO is that pathologists don't have direct access to the supply of work as they rarely have direct patient access. This puts them in a position to negotiate and provide leverage to other physicians, which is why they take advantage.

That said, IMO this forum has very few voices in it, those voices are overwhelmingly people in private practice, and many of those are very outspoken in their displeasure with the field.

Some of us have done quite well and are very happy with our lot.

I am curious of your background. Care to elaborate your level of satisfaction with your current practice as a pathologist? I am an IMG and planning to apply soon as a Pathologist. The reason why I want to pursue Pathology Residency in the US is because being board certified by the American Board of Pathology would grant me unrestricted eligibility to any US based fellowships for pathology, as opposed to pursing pathology residency in my home country. Furthermore, my country (Philippines) do not offer any fellowships for Pathologists and the state of its specialty is not as developed as the other medical specialties (IM, Pedia, etc.). I don't have any intention to practice in the US though as other countries such as in the Middle east, and perhaps UK respect and recognize being certified in the American Board of Pathology, hence I would rather try to find my luck of employment in those countries.

 

[deleted314957]

I am curious of your background. Care to elaborate your level of satisfaction with your current practice as a pathologist? I am an IMG and planning to apply soon as a Pathologist. The reason why I want to pursue Pathology Residency in the US is because being board certified by the American Board of Pathology would grant me unrestricted eligibility to any US based fellowships for pathology, as opposed to pursing pathology residency in my home country. Furthermore, my country (Philippines) do not offer any fellowships for Pathologists and the state of its specialty is not as developed as the other medical specialties (IM, Pedia, etc.). I don't have any intention to practice in the US though as other countries such as in the Middle east, and perhaps UK respect and recognize being certified in the American Board of Pathology, hence I would rather try to find my luck of employment in those countries.

Just go to the UK for your training. They are a 1st world country.

 

[HowlPrenderghast]

Just go to the UK for your training. They are a 1st world country.

I am actually considering it but I already took Step 1 with a score of 251 and I have already invested review materials for Step 2. Problem is I still don't have USCE nor LORs from US based physicians. I may have to shadow a US based pathologist though prior to the match.

 

[TrojanRaggy]

I am actually considering it but I already took Step 1 with a score of 251 and I have already invested review materials for Step 2. Problem is I still don't have USCE nor LORs from US based physicians. I may have to shadow a US based pathologist though prior to the match.

Once you come here, you would stay. All IMGs say they will go to UK, middle east, home country etc but once you start ****ting on water cleaner than drinking water back home, you never go back

Compare the average pathologist salaries at the NHS compared to US salaries and you will understand that you made the right choice by mistake...

 

[HeyDalaron]

I am actually considering it but I already took Step 1 with a score of 251 and I have already invested review materials for Step 2. Problem is I still don't have USCE nor LORs from US based physicians. I may have to shadow a US based pathologist though prior to the match.

Why not do radiology instead? That's an amazing score that'll get you noticed.

 

[octopusprime]

If the question is "will you have a job in pathology?" the answer is yes. If the question is "will you have financial equity for your work?" and "will I be able to find a job or career on my own terms and at a time and place largely of my own choosing?", the answer is more than likely no.

If you're more concerned about these latter questions, I would avoid pathology.

This is ultimately what it boils down to.

 

[time to move on]

Alteran said:
If the question is "will you have a job in pathology?" the answer is yes. If the question is "will you have financial equity for your work?" and "will I be able to find a job or career on my own terms and at a time and place largely of my own choosing?", the answer is more than likely no.

If you're more concerned about these latter questions, I would avoid pathology.

This is ultimately what it boils down to.


___

100% Accurate.

 

[deleted314957]

I am actually considering it but I already took Step 1 with a score of 251 and I have already invested review materials for Step 2. Problem is I still don't have USCE nor LORs from US based physicians. I may have to shadow a US based pathologist though prior to the match.

You have lost me. You assert that if you come to the U.S. you will get no “recognition” for board certification in pathology and you would be disrespected. How are some tests taken in medical school going to affect your reception in the USA as regards this supposed lack of respect and recognition?
I can assure you that NONE of your clinical colleagues will either know or care about your test-scores.
Just go to G.B. You sure won’t get much of a reception here if you think we suck but we’re ok for your training.

 

[futuredoc331]

Alteran said:
If the question is "will you have a job in pathology?" the answer is yes. If the question is "will you have financial equity for your work?" and "will I be able to find a job or career on my own terms and at a time and place largely of my own choosing?", the answer is more than likely no.

"If you're more concerned about these latter questions, I would avoid pathology.

This is ultimately what it boils down to."

If you think you will ever care about job location or working on your own terms. Because you might find out in 2 years that these things actually are important to you and you'll be faced with going through the match all over again.

 

[HowlPrenderghast]

You have lost me. You assert that if you come to the U.S. you will get no “recognition” for board certification in pathology and you would be disrespected. How are some tests taken in medical school going to affect your reception in the USA as regards this supposed lack of respect and recognition?
I can assure you that NONE of your clinical colleagues will either know or care about your test-scores.
Just go to G.B. You sure won’t get much of a reception here if you think we suck but we’re ok for your training.

I didn't say the training or anything else for that matter in the US suck. On the contrary, gaining the certification from the American board of pathology for AP/CP is recognized and respected globally and provides a greater employment opportunity as countries outside the US such as in the UK, common wealth countries, middle east, etc. consider it as a comparable post graduate medical qualification as opposed to being certified by the Philippine Board of Pathology. I wouldn't be applying to the US if I didn't see better growth professionally in comparison to my home country.

 

[HowlPrenderghast]

Why not do radiology instead? That's an amazing score that'll get you noticed.

I don't have a strong research background nor have a strong interest in the field.

 

[HowlPrenderghast]

Once you come here, you would stay. All IMGs say they will go to UK, middle east, home country etc but once you start ****ting on water cleaner than drinking water back home, you never go back

Compare the average pathologist salaries at the NHS compared to US salaries and you will understand that you made the right choice by mistake...

We only have two forensic pathologists in my home country. I have more incentive to practice outside the US despite getting a higher likelihood of lower pay.

 

[deleted314957]

I didn't say the training or anything else for that matter in the US suck. On the contrary, gaining the certification from the American board of pathology for AP/CP is recognized and respected globally and provides a greater employment opportunity as countries outside the US such as in the UK, common wealth countries, middle east, etc. consider it as a comparable post graduate medical qualification as opposed to being certified by the Philippine Board of Pathology. I wouldn't be applying to the US if I didn't see better growth professionally in comparison to my home country.

Your prior post said you were concerned that the in the USA cert by the ABP lacks respect or recognition. Now you say it is recognized and respected globally.

Apropos your comment about the PI having only 2 FP’s. Being boarded in FP myself and having a modicum of understanding of how things are in the PI (not so good), I would STRONGLY recommend AGAINST FP in a country run by a dictator (essentially) and having a very shaky rule of law. You may find yourself “recruited” by the dictator to dismember some political foe. In the PI the cause and manner of death will be whatever the police/military/Duterte says it is, and you’d better be on board with their “suggestions “.

Seriously, you cannot practice FP in the absence of the rule of law. Think about it.

 

[Drifter76]

I noticed a difference between how pathology is talked about online (especially sdn) and how people talk about it IRL. I know several very capable, accomplished medical students who decided to go into pathology, particularly people interested in a career in basic science, who say the reputation of pathology as a dead end field with no jobs and limited pay is overstated. Is going into path truly a terrible idea right now?

If you are talking to people in academics, many of them are either clueless about the real world or in some cases they may not want people to know what things are really like outside academia. PDs and chairmen want to keep filling those spots every year. The truth is, there is a large oversupply of pathologists. In addition to that, 90+ percent of jobs that are available are low quality jobs where people are exploited and treated like a cheap commodity. These are corporate lab jobs, employed positions with large hospital systems, and jobs with mega-groups where a few senior people at the top make all the money and you will spend your entire career being overworked and underpaid so someone else can get a bigger bonus check. There are also many physicians in other specialties exploiting us (the “pod lab” schemes that have been discussed extensively). The guy sitting next to you in your medical school lecture hall will end up being your boss because he made a smarter choice of residency.
It makes no sense whatsoever why anyone would want to invest the tremendous time, money, effort required etc to go through medical school, take on 6 figure debt, and 5, 6 or more years of postgraduate training to then be in a job market where they have to hustle just to get one of these third rate jobs. Anyone with enough intelligence, work ethic and initiative to get into and through such a selective, long, and rigorous process should have much better options than this.

 

[Drifter76]

RIGHT NOW it is pretty crappy. Seems to be a little better than a year ago ANECDOTALLY. However, a current 1st or 2nd year med student may encounter an entirely different terrain. Things can change quite quickly within any given specialty.

I’d say that it is highly unlikely that an entering med student would see entirely different terrain, given that the terrain hasn’t changed much (except to progressively get worse) in many years now. The forces at play, which are causing the field to go down the tubes, aren’t going to all of a sudden reverse themselves.

 

[Drifter76]

IOh, and I didn't mention that our professional organizations are completely feckless in mitigating any of the above and probably, just like everything else, just interested in making a buck off of managing the decline of our specialty.

Some people in leadership in these organizations are worse than feckless- they are actually playing an active role in exploiting the next generation. They don’t want to mitigate something they are profiting from- quite the opposite. Hence the CAP “pipeline” initiative..

 

[WEBB PINKERTON]

Be careful Drifter. The powerful in this field will be designating you excommunicado soon and sending representatives of the high table to have a talk.

 

[SunBakedTrash]

Be careful Drifter. The powerful in this field will be designating you excommunicado soon and sending representatives of the high table to have a talk.

Is that what happened to thrombus and nightmare3000? The academic dons and the goodfellas at CAP sent them to sleep with the fishes. No amount of money from Bosley hair transplants could save them from la cosa nostra.

 

[gbwillner]

Is that what happened to thrombus and nightmare3000? The academic dons and the goodfellas at CAP sent them to sleep with the fishes. No amount of money from Bosley hair transplants could save them from la cosa nostra.

Yes, they were "taken care of." Loose lips sink ships.

Remember, as Webb says, it's good to have a side-hustle. "Taking care" of folks pays pretty well. I "take care" of people all the time.

 

[WEBB PINKERTON]

I believe an adjudicator came to talk to thrombus and nightmare3000. They violated the rules. I have served, I will be of service.

 

[coroner]

We need dissidents like Drifter to speak up (within the forum rules). He is now SDN Pathology's equivalent of the Arab Spring and Hong Kong Civil Human Rights Front all rolled up into one united front as the voice of the voiceless against the authoritarian regime! Hopefully the powers that be don't Jamal Khashoggi him...

"C-A-P, what they gonna do...?
Chop him up like the Saudis do..?"

 

[WEBB PINKERTON]

Right now, the job market is probably the best I have seen it in many years. Stock market and fear of covid finally created that shortage people have been waiting for. If you can't find a better job now, I don't know what to tell you.

CAP has more fight in them than the afghan army i think.

 

[KeratinPearls]

Drifter=Thrombus

 

[fecalith]

Drifter=Thrombus

Honestly, I am not the most cheerful, optimistic person but that kind of pessimism is driving me nuts!

 

[futuredoc331]

Honestly, I am not the most cheerful, optimistic person but that kind of pessimism is driving me nuts!

I've found it helpful. If only it sunk in a year and a half ago.

 

[fecalith]

I've found it helpful. If only it sunk in a year and a half ago.

I mean, it is good to know all the hurdles and knowing them has helped a lot. However, the situation is not THAT dire. Again, it depends what you try to get into.

 

[KeratinPearls]

I posted some jobs for any of you poor souls in the jobs section. Hopefully this helps someone fighting the struggle, living under a bridge or eating ramen for dinner to make ends meet.

 

[coroner]

CAP has more fight in them than the afghan army i think.

That's saying the CAP has zero fight in them. The Afghan army crumpled like a wet paper bag when the Taliban rolled in...

Drifter=Thrombus

Minus the all caps...

 

[pathres9999]

Everyone seems to be piling on Drifter76. If you ask me, everyone sounds pretty defensive, but I suppose most people would when hit with an uncomfortable truth. Pathology has a terrible job market when considering the investment needed for a job. No amount of anecdotal examples or whataboutisms will change the reality of overtraining (shown In numerous papers), lack of jobs ( need for fellowship, low recruitment drive, poor relative salaries to medical peers), poor resident education, and lack of respect/interest from the medical community. We as a group need to be more realistic about our problems if we are going to fix them and honestly it is a little embarrassing to see highly educated people be so naive sometimes.

 

[HowlPrenderghast]

I posted some jobs for any of you poor souls in the jobs section. Hopefully this helps someone fighting the struggle, living under a bridge or eating ramen for dinner to make ends meet.

I am in this post and I don't like it.

 

[gbwillner]

Everyone seems to be piling on Drifter76. If you ask me, everyone sounds pretty defensive, but I suppose most people would when hit with an uncomfortable truth. Pathology has a terrible job market when considering the investment needed for a job. No amount of anecdotal examples or whataboutisms will change the reality of overtraining (shown In numerous papers), lack of jobs ( need for fellowship, low recruitment drive, poor relative salaries to medical peers), poor resident education, and lack of respect/interest from the medical community. We as a group need to be more realistic about our problems if we are going to fix them and honestly it is a little embarrassing to see highly educated people be so naive sometimes.

[CITATION NEEDED]

 

[WEBB PINKERTON]

Best thing about pathology is the lifestyle. You have lots of time to run other businesses and make real money.

 

[pathres9999]

[CITATION NEEDED]

Here are a few papers:
Reevaluation of the US Pathologist Workforce Size
Concerns about the pathology job market dominate a popular online pathology forum and likely deterred American medical students from pursuing pathology residency
The State of the Job Market for Pathologists: Evidence From the College of American Pathologists Practice Leader Survey - PubMed (The State of the Job Market for Pathologists: Evidence From the College of American Pathologists Practice Leader Survey)

I provide these papers not necessarily for you gbwillner, but for anyone else that is interested. I encourage everyone to read the actual results for the third paper and not just the discussion (since they try to diminish the negatives or even posit them as positive). If more proof is needed, the information is readily available to look up Match data, pathology salaries, and CPT code reimbursement trends. Also for anyone else that asks for citation needed when opposing viewpoints arise I feel its fair that they also provide their own citations.

 

[gbwillner]

Here are a few papers:
Reevaluation of the US Pathologist Workforce Size
Concerns about the pathology job market dominate a popular online pathology forum and likely deterred American medical students from pursuing pathology residency
The State of the Job Market for Pathologists: Evidence From the College of American Pathologists Practice Leader Survey - PubMed (The State of the Job Market for Pathologists: Evidence From the College of American Pathologists Practice Leader Survey)

I provide these papers not necessarily for you gbwillner, but for anyone else that is interested. I encourage everyone to read the actual results for the third paper and not just the discussion (since they try to diminish the negatives or even posit them as positive). If more proof is needed, the information is readily available to look up Match data, pathology salaries, and CPT code reimbursement trends. Also for anyone else that asks for citation needed when opposing viewpoints arise I feel its fair that they also provide their own citations.

Pathres9999, thanks for sending these papers. I wonder, however, why you think any of these papers support your prior statement:

"No amount of anecdotal examples or whataboutisms will change the reality of overtraining (shown In numerous papers), lack of jobs ( need for fellowship, low recruitment drive, poor relative salaries to medical peers), poor resident education, and lack of respect/interest from the medical community. "

There is literally nothing in any of these papers that supports that position.

The first paper concerns how the workforce numbers have been difficult to attain because of how they have been reported in the past. The 2017 AAMC data reflects only 3/11 pathology specialties and subspecialties, the AMA 2019 data includes all subspecialties. Nowhere does this provide evidence of "overtraining".

The second paper is solely based on reviewing threads on SDN. As we all know, there are relatively few voices here, and many repeatedly yell in all caps how terrible the job market is. This paper sought to evaluate the impact of the threads on students considering pathology, not using it as evidence that there is any bearing in the actual job market. Again, this does not support your claims, AT ALL.

The third paper reviews a survey from "practice leaders" that are hiring and compared 2017 to the prior year. The study showed a growth in hiring and creation of FTEs year-to-year, suggesting an improving market. Again, not sure why you think this supports your position.

 

[pathres9999]

Gbwillner you appear to be nothing but combative in not just your replies to me but others when something goes against your belief. If you cannot see how undercounting pathologists (first paper), need for pathologist to move across state lines and having less opportunity compared to resident graduation (third paper) is not indicative of a healthy career which requires 4+ years of training, I don’t believe anyone can help you see otherwise. But who knows maybe every who has their reservations about things being rainbow and sunshine are just liars and charlatans.

 

[coroner]

 

[WEBB PINKERTON]

 

[gbwillner]

Gbwillner you appear to be nothing but combative in not just your replies to me but others when something goes against your belief. If you cannot see how undercounting pathologists (first paper), need for pathologist to move across state lines and having less opportunity compared to resident graduation (third paper) is not indicative of a healthy career which requires 4+ years of training, I don’t believe anyone can help you see otherwise. But who knows maybe every who has their reservations about things being rainbow and sunshine are just liars and charlatans.

And What is my belief, exactly? Maybe you should look at my post history. You came he making specific allegations, and stated that they were supported by publications. That's more than is typically thrown about. I reviewed the papers and explicitly called out how they don't support your argument.
Your response appears to be to try to attack me. Good luck with that.

Undercounting pathologists would be an issue if altered counts were used to lead to an inaccurate depiction of pathologist need compared to prior and CORRECT counts. This paper stated all the prior data were flawed, and it only compared 2017 and 2019. This paper makes no allegation or mention of what need is for pathologists, only that AAMC data does not account for as many pathologists as AMA data because not all subspecialties are accounted for in the AAMC data. That's it.

The third paper shows, based on survey results, that there were an additional 180 FTEs hired in pathology in 2017 compared to the prior year. Not a very robust dataset, but if you focus on people having to move for a job you are missing the forest for the trees.

BTW, here is a paper on path residents, jobs, and relocation

 

[HeyDalaron]

For a field that prides itself on being scientific, I find it both amusing and sad that the workforce models failed to account for what was it, 40% (?) of practicing pathologists, because they did not set their inclusion criteria correctly.