Switching to pathology from another specialty

[throwaway88309]

Hey everyone. I'm an attending psychiatrist considering switching to pathology, as the day-to-day work seems more in line with my personality and interests. I was wondering if anyone here has made this switch or knows someone who did. On one hand, the job market has me hesitating, as psychiatry is in high demand everywhere. Going back to residency would also be a significant hit financially. On the other hand, I think I'd enjoy and be good at reading slides and interfacing with referring clinicians based on a couple path rotations and I'm burned out on all the adversarial patient interactions and social issues in my current job despite cutting hours as best I can. Thanks.

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[KeratinPearls]

Hey everyone. I'm an attending psychiatrist considering switching to pathology, as the day-to-day work seems more in line with my personality and interests. I was wondering if anyone here has made this switch or knows someone who did. On one hand, the job market has me hesitating, as psychiatry is in high demand everywhere. Going back to residency would also be a significant hit financially. On the other hand, I think I'd enjoy and be good at reading slides and interfacing with referring clinicians based on a couple path rotations and I'm burned out on all the adversarial patient interactions and social issues in my current job despite cutting hours as best I can. Thanks.

Think long and hard about going into Path and going back to being a “resident”. It’s going to suck to be someone’s b%#>£ for the next 5 years and then going into a job market where options aren’t exactly plentiful. In the end you got to do what’s right for you. Make sure you aren’t going into Path as a solution to burnout or getting away from patients. Know what your getting yourself into.

 

[deleted314957]

Have an Ambien, a shot or two and hit the sack. Wake up in the morning and imagine it was all a terrible dream. Your an older dude and in the high cotton. Save as much as you can and retire.

 

[Med Director New England]

Stay in psych and become an expert with pediatric issues (anxiety, pervasive developmental disorders, etc).

You’ll be in huge demand and once established you will rake. Literally you could go cash only.

 

[octopusprime]

If you're an attending, it would be extremely hard--from a financial standpoint (both income wise and retirement saving wise--not maxinf 401k for 4-5 years would be killer) and workload standpoint.
I really suggest you consider taking your current expertise to a different venue--either a different practice structure, area of focus, or simply geographic location. You've spent a lot of time and effort to get where you are.

My father was in the mental health field and worked closely with a psychiatrist who seemed to have a great set up. The psychiatrist had a private practice but contracted with the state to provide services for state-funded/run facilities, and my father always seemed envious.

To reiterate, you are in a very high demand field--open up your geographic search and use that to your advantage.

 

[mark-ER]

Agree with what's been stated. 10X "cons" than pros for going back into training. And path rotations in med school are a cakewalk, not representative of being a resident or being in practice. Find a niche in psych you'd enjoy -- I hear oncopsych is pretty good, and stick with that.

 

[WEBB PINKERTON]

I have a family member who is a psychiatrist and she works from home, never even sees patients.

 

[deleted314957]

Consulting and expert testimony in forensic psych and competency hearings is easy and you set your fee.

 

[90sportsfan]

They are the opposite ends of the spectrum (little/no patient care vs. very tough patient encounters), but 4 years and pretty much a required 1 or 2 fellowships is about 6 years worth of opportunity costs and not contributing to retirement/401K. That would be a huge financial setback. Also to relive the residency lifestyle at this stage of life could be somewhat depressing if you are married/have kids/etc.

Mentioning that you "think" you would be good at reading slides doesn't sound like you've fully researched it. To make that big of a jump, you would want to know for sure that you are 100% committed to a career in Path. I would personally at least shadow, talk to attendings, and learn everything about Path before even considering. Even if you did truly want to make a change, you would need to clearly articulate to PDs why you want to make the change, especially given how far apart these fields are on the spectrum.

Like others said, you sound burned out, and may want to first look for other options within Psych to address your challenges. Redoing a residency in a different field could bring on other challenges down the road. Best of luck.

 

[deleted314957]

90sports makes a very good point about thinking you may like pushing glass. I am not saying it would be you, but ALL of us here have seen plenty of folks who just do not have a good “eye” and never really get comfy with it. If that were your case, and you cannot tell until you do it, that would be tragic.

 

[psyguru]

Consulting and expert testimony in forensic psych and competency hearings is easy and you set your fee.

Even the easy cases will tax my neurons more than clinical work in most cases. Some cases are far more complicated than clinical work with 1000s of pages of records and 50+ page reports. Although I do competency to stand trial cases, I don't do those high-volume treasspassing/ public indecency ones with 2 page reports that maybe "easy". I have done a few guardianship forms that are not too difficult but I still charge my hourly. However my practice strategy is to be retained on the larger, more interesting cases.

 

[psyguru]

Hey everyone. I'm an attending psychiatrist considering switching to pathology, as the day-to-day work seems more in line with my personality and interests. I was wondering if anyone here has made this switch or knows someone who did. On one hand, the job market has me hesitating, as psychiatry is in high demand everywhere. Going back to residency would also be a significant hit financially. On the other hand, I think I'd enjoy and be good at reading slides and interfacing with referring clinicians based on a couple path rotations and I'm burned out on all the adversarial patient interactions and social issues in my current job despite cutting hours as best I can. Thanks.

What about pathology appeals to you vs psychiatry? Have you fully explored all the non-clinical options in psychiatry? If it is autopsies that are appealing, you could get trained in psychological autopsies (American suicide association). I don't do psychological autopsies per se, but many of the cases involving a death come with a forensic pathology report I review. Also, there are other 1-year fellowships that can allow you to do other types of work like sleep, pain, neuropsychiatric, and brain. If you are interested in neuropathology or neuroanatomy, there are other paths than doing a 4 years pathology residency.

If you are interested in expert witness work, consider a forensic psychiatry fellowship. It was my most interesting year of training by far. What I like about my setup is I see patients about 2.5 days a week and then rest of my time is doing expert witness cases PRN. It keeps things interesting. PM me more more.

 

[throwaway88309]

Thanks for the thoughtful replies, everybody. Psyguru you bring up a good point. I hadn't considered some of the less typical fellowships like sleep, pain, and neuropsych. A 1-year fellowship would be significantly more tolerable financially than 5 years in path residency+fellowship. I think I'll go find a low-key job in the public sector or academia for awhile and work on finding a niche to get into. Neurostimulation and biological psychiatry have always been pretty interesting to me so maybe something incorporating those.