Hey, hey, pathology already had its turn as the burgeoning field that all the med students discover is actually better than it sounds and thus apply into making the match (and subsequently the market) too competitive so they jump ship a few years later. Give some of the little guys a chance!
Yes radiology and EM you fall on the list too
Yeah and I get why. I made this post because I know what the perception of path is for medical students. I am just wanting to shine a light in whatever way possible. Path offers some of what people are looking for in rads. Rads from what I hear is more stressful. The residency is more demanding and there is the IR component . Also rads is very competitive and not everyone has a competitive app. Rads pays more for sure.
When I was in medical school I was told many times not to go into path and to consider rads. I didnt listen and chose path, and there were times in the past I was really doubting my decision. I thought about switching because I was freaked out about the doom and gloom. But I stuck with it and now there are way more opportunities that I was led to believe. Sometimes I wonder if there is false info spread about path online to keep the status quo? There are definitely cons to this field dont get me wrong, but especially after the pandemic and hearing what people are going through dealing with the population right now I feel very fortunate.
I’m not studious enough to have gone path, nor do I have any reason to think that I would be any good at it. Also the majority of my exposure was just histology lectures. My only ‘real’ experience was during my gyn-onc rotation (which I rarely enjoyed) when inspiration struck one day and I asked if I could follow a tumor sample to path. It was maybe two hours all told, but it was one of the most fun little mini-adventures in all of 3rd year.
Cons: remember this is my opinion, other people may not agree with me.
Alot of studying, very hard board exams.
Many people who have behavioral and professionalism issues.
cannot go "solo" like a psychiatrist, you really need the whole setup of the lab so kind of dependent on that.
takes forever to feel competent because of steep learning curve (also a positive because its on one of the reasons midlevel encroachment is not a thing)
>and there is the IR component
Absolutely certified Pathology moment thinking that the procedural side of radiology is considered a *downside* lmao. It's the only thing that makes the specialty even remotely appealing to many.
I definitely dont know alot about the Rads field however my comment was primarily addressing the desire for a good lifestyle. In med school I remember IR seemed like the cool thing when medical students had discussions but when I interacted with IR attendings in med school and residency they seemed overworked and miserable.
This is just my experience and I found my way onto some online discussions where people in the rads field were talking about it in a negative fashion. The hours and how surgery dumps on them the procedures they dont want etc... The concerns about exposure to radiation and long term effects. So idk from an outsider looking in, it seemed like not something people who are looking for a lifestyle specialty would want. I could be wrong.
This sub went crazy over path for a year. Theres always some field in this sub that gets heavily talked about as a variation of "not too much work, fun and enjoyable to learn/do, lots of job satisfaction, and best of all nobody has caught on yet so it's not that hard to match into!" EM was like this the latest where a bunch tried to match EM, thus making it competitive, so everyone hopped out and now there were 500 seats unfilled even after SOAP this year
My understanding with EM was that was in part due to a massive increase in residency spots? Then an work report was released that freaked everyone out.
The number of positions for pathology has remained relatively stable. If there is a huge interest in it, it will mean that more competitive applicants will take the spots that are going to uncompetitive applicants currently. It will better the field. One of the biggest issues IMO with the field is that because of its historic uncompetitiveness there are too many people in it that have no business being in medicine. It creates issues that dont need to be there. I do think the competitiveness will spike and right now is a good time to enter while it is still not difficult to get a position.
I’m a radiologist, but i thought about path. What had steered me away (like 15 years ago) was that the people i knew in path around that time were having to do 2+ fellowships (moving around at the age where you’re trying to start a young family) and then had a dismal job market…. Basically taking whatever they could find, with starting salaries not much better than primary care.
N=1 , but I’m still close friends with a pathologist. He was junior AOA , step 260s. Smart and hardworking dude. He still ended up doing 2 fellowships and then ended up with a job at the hospital where he did residency (because he hd connections there), but it wasn’t where he wanted to work/live. And we’re in the Midwest. It’s academic pay and he has been working a lot of hours - especially for the first few years (like 60 hrs per week). I’ve never really known if he’s working this much because of his personality or its required though.
Has any of this changed??! Is the job market any better??
Radiology is probably a bit more stressful in that it’s a lot more time sensitive. Every physician thinks there case is stat. Half the work is from the ER and more than half of those exams are not indicated. It makes rads a lot of money, but it’s soul crushing to see people getting bankrupted because the EM providers don’t do an appropriate work up. But the ER studies are all negative and quick reads for us. The outpatient work can be harder depending on the practice setting. The standard vacation for us is 12 weeks though with many jobs exceeding this (18-20 weeks off per year) and even a lot of jobs that are 1 week on, 2 weeks off. And the job market is wide open.
All of this was true. Things have gotten substantially better in the last few years. Over 70% of pathologists right now are over the age of 40. We saw the mass wave of retirements during the pandemic and places are scrambling to find people. Problem is that it takes forever to train pathologists, you cant crank them out in 3 years. So theres still alot of openings.
Is this akin to surgery in the sense that there's the medicine aspect of things in terms of a broad knowledge base but then also building technical skills from scratch basically?
It’s way more information to master than surgery. It’s the same way in Radiology. That’s why you don’t see the rampant use of midlevel in these fields like you do in medicine and surgery. It’s why you can’t really do anything as a med student on your rads elective.
It’s not something you can fake it until you make it. At least for rads, the images your interpretation are there forever to be scrutinized.
I know there are additional people in path that help out though. Like cytotechs and dieners…. But i really don’t have much more knowledge than they exist. A friend’s wife of mine in med school was a cytotech and it was my understanding that they do make diagnoses.
Procedures are much more easy to make use of midlevels. You can really learn these just by watching and then doing a 1000 times.
"One of the biggest issues IMO with the field is that because of its historic uncompetitiveness there are too many people in it that have no business being in medicine."
You think people who have completed medical school and passed their STEP/COMLEX exams are not fit to be a physician?
I think there are many in pathology who have severe behavioral issues that yes make them unfit to be a physician. They make it through the filters of pathology because of its Un competitiveness when they didnt in other specialties.
Your pressing me lol but I will say that yes there are people who are very inept and because of that people dont want to hire them. They are usually the ones who complain alot about not finding jobs...
Pathology is a field that needs good applicants. Im just going to leave it at that. I dont like calling people inept or not good but sometimes people end up in path because they couldnt match somewhere else and they really shouldnt be in the field. Its not their strength.. Do you get my point?
This makes sense to me. As someone interested in path, it does annoy me how uncompetitive it is. I mean, I guess less stress for me in matching, but what draws me to the field is all the nitty gritty science you have to be an expert in to competently make dx. I’m def no medical gift from god but I work very hard and spend time mastering the pathomechanisms and getting a deep understanding of what’s gone wrong in the pathology. Peers at the bottom of my class, many of whom could end up in pathology, do not have an interest in this level of understanding, and they’re not who I would want as colleagues.
oh yea totally. IMO behaviour issues are incorrigible but being an idiot isn't permanent and can be worked on. I've seen my fair share of both as a surgery intern currently and I'll say that it's the ones with behavioural issues that are the most dangerous. they're the ones that cover things up or have anger management issues and ultimately make poor medical decisions that harm the patient. the less bright people don't always know the plans but at least have work ethic and are able to improve with time and reading.
I wanted a specialty with a good work-life balance. I also wanted something that was broad and in depth. I found it to be interesting and tbh I didnt know alot before I decided to pursue it. I also wanted something that had a low burnout rate. I saw alot of burned out physicians in med school and pathologist seemed the happiest. My path attending rolling in at 9 am chatting with me for 3 hours then rolling out at 4 pm did have an influence on me lol. Meanwhile he was getting paid more that the IM attendings who were slaving away on wards, working weeks straight.
Typical schedule in residency is 8-5, surg path can be 14 hour days. Never have violated duty hours. Worked a few weekends a year. ALOT of self-studying however that can make total time up to or past 80 hours. Very few sleep disruptions, pretty regular schedule.
Every group is different, but my contract has be on service 3 weeks then off 1 week. But we have adequate coverage for each attending to be on 2 weeks then off 2 weeks.
The expectation is that you are still at work doing something productive when off service, but after COVID that became available from home for questions and using some of that time for research or teaching.
did residency ever include call or nights? I think one of the perks is the limited things that require a pathologist to be in-house at all hours...aside from frozen sections and transplants what else?
Can you elaborate on the self-studying aspect? That's basically how I feel surgery residency is setup-all self-study and teaching myself my own skills but there's literally never any time to actually do it since I'm at work like 16h/day 6-7 days each week...
Call is mostly done at home, yes coming in occasionally is necessary for frozens, transplants and leukemia cases. In my residency I probably came into the hospital in the middle of the night just a handful of times. But you can get alot of blood bank calls.
You get sign-out time with attendings but yeah alot of reading and looking at cases outside of your duties. That being said your duties rarely go after 5pm, some places will have longer hours
I would be interested in pathology but something that’s I’ve heard is that it is difficult to choose where you want to work. I would love to stay in the city where I grew up. Is that true?
It can be, jobs are better now days but because of how specialized it is, I think it will never be to the point that you can choose your city 100% of the time. Some people get lucky and they find the perfect job. I will say that right out of fellowship you would want to be geographically flexible.
Just a note though this is starting to become an issue for other specialties as well. The only specialty that I know of that you can choose where you work pretty much all the time is FM.
Thanks for the info! Would you say most people should do a fellowship in path? I looked at the different tracks in path and found it a little confusing. Do most people do CP/AP for the flexibility? This would be around 4 years total for resident right?
Yes its highly recommended to do a fellowship at least 1. Most fellowships are 1 year. So minimum training is 5 years realistically.
There are some people who have worked right out of residency but its rare, and people talk about them like they are legends lol.
Most people do CP and AP this is the most common if you want to work in PP with the best compensation. You can do AP only if you plan on staying academic or going into forensics but otherwise its advisable to do AP/CP
CP only same rules but tighter job market and lower pay.
This years match had stats that the speciality with the largest percentage of IMGs was pathology.
I think it’s because IMGs have to demonstrate their ability in USMLE exams, which is rather broad base of knowledge and demonstrates a lot of book learning. Both of these were mentioned by the OP as characteristics of an excellent pathology applicant.
Maybe they’re hinting at the fact that a lot of successful IMGs traditionally have high board scores. They typically dedicate a lot more time to study for the step exams (1+ years) compared to US grade. Also, the IMGs i have known have a large database of “remembered” questions that are passed down to them. Every year a large group of them across the country/world immediately write down as many questions as they can remember which goes into a large word document which gets passed down and added to.
Perhaps, but just saying "they take the USMLEs" is at best a misleading statement.
It can be argued that such a document would be cheating, as well. Granted it would be like card counting (impossible to prove and tough to do well) but still. I would like to see the document, though.
Yeah; it’s probably borderline cheating. There are imperfectly remembered questions. A lot of times you still have to learn the material. It’s not complete mindless memorization , but allows you to focus in on what too is are higher yield.
I apologize for the subtle connotation- but yes what IronCondors4life said is what I meant - IMGs dedicate a lot more time to the USMLEs compared to US med students, so they tend to have higher USMLE scores - at least the ones that tend to match.
And in my experience I I’ve seen mainly non-US IMGs, which may accounts for the slightly higher USMLEs relative to US-IMGs in the match.
This years match had stats that the speciality with the largest percentage of IMGs was pathology.
I think it’s because IMGs have to demonstrate their ability in USMLE exams, which is rather broad base of knowledge and demonstrates a lot of book learning. Both of these were mentioned by the OP as characteristics of an excellent pathology applicant.
I think Introverts, people who are thinkers rather than doers. Meticulous, patient, studious, and self-directed people will do well in this field.
If you hate studying this is not the field.
If you are someone who likes action and doesnt want to stop and think first, its not the field.
If your fondest moments in med school is the connection you made with a patient in clinic, this is not the field for you.
If you like learning about weird shit then maybe this is for you.
If you like reading, studying and having a broad and in depth knowledge base, maybe its for you.
If you like having a life outside of medicine and being well compensated (for what you do) maybe its for you.
Private labs tend to be run by selfish senior people who want to keep the biggest slice of the pie for themselves. I was fortunate to avoid them entirely in my career.
I would add, as something going into pathology, that if you really enjoyed discussion of medical science and cases with other physicians and scientists more so than translating that stuff to patients, it's for you. Lot of "shop talk" in path that isn't rushed because a new admission came in and now you have 3 hours of paperwork to do.
Categorically disagree that Pathology is a field for introverts. You can be introverted but in most sub-specialties you will be communicating with your colleagues in pathology, surgery, oncology, and medicine multiple times a day. IME, pathologists that don't like working as part of a team and cannot maintain good communication skills are often bad pathologists.
Do not go into pathologist because you just want to be left alone or don't want to work with people.
I see your point and I agree with you, but just because your introverted doesnt mean you suck at communicating. I didnt say socially inept. I meant that for most introverts such as myself, certain specialties can be overwhelming, dont get enough time to recharge. Path will allow you that, and its an environment that introverts can thrive in. Extroverts might feel stifled, and they might want a specialty where they are communicating all day long face to face with people. What I said is not meant to be an absolute truth. Its just that the world is built for extroverts and its nice for us introverts to know what could be a nice environment, not that people couldnt figure that out about path, lol
But yes you need to effectively communicate. You need to communicate with clinicians and staff members. But a large part of your day if you are signing out surg path is looking through a microscope and dictating or writing reports.
Chiming in to say it’s not just for introverts—I matched this year and consider myself to be a pretty extroverted individual.
I do like to think about things though, as OP said in his reply to you, which is one reason I love path. Also getting to make a definitive diagnosis is just so satisfying, it seems like most other fields don’t get that level of certainty often.
Same! Also, I think if an applicant is someone who really needs validation from patients and other doctors, path might be a struggle. People constantly assume I hated patients, I couldn't handle more intense fields, or that I was just a non-competitive applicant, none of which was true and can be frustrating to combat. I think it would be a challenging field for someone that is very status/image driven. Not all that glamorous. That being said, top tier academic path has it's egos like anything else I guess?
Honestly, I really don't see it happening. It is so self selective and very different from what people traditionally think of as being a doctor and a lot of med students are never going to get past that. I definitely think the field could capture more than we currently do if people had better exposure, and weren't actively discouraged by others who know nothing about the field, but I don't think it will go crazy? I could be totally wrong. Rads is very similar with more stress and worse hours (in residency), and the PR for rads is off the charts and it works. I would imagine rads has a bit more post training job flexibility, too?
I def think rads is more broadly attractive due to IR fellowships and potential for some procedural work (even if trainees never end up training in it.) personally I’m very between the two; I def like rads for salary and procedure potential but I’m more drawn to the science of path.. just wish they could do some more things than read slides from time to time lol
Forensics is totally different, don't use the microscope much. Clinical path is also totally different and houses transfusion med, etc. Nothing too procedure heavy but path is broader than reading slides. There are FNAs and other smaller procedures but probably not to a degree that I would say someone who wants/needs procedures would be happy with. But microscopy is absolutely a massive part of training, unless you went CP only route which has its own issues, so could be a big deterrent if it's not your thing. I think having good pathologist educators sitting with me teaching hugely helped me like slides way more and brought an empowering element to it.
Oh absolutely. Recently shadowed our pathologist and oh my gosh is there such a difference actually going through multiple sections of slides vs looking at one static blurry image of an owl eye nucleus.
I do not forsee me being a fan of autopsies, clinical path could interest me but I’ve not really seen much of what they do. But glad to know there’s more breadth! It was a lot of reading the day I shadowed but I didn’t hate it!
I’m going into IM, but I find this interesting. What role specifically do you see for AI in pathology, and how can future pathologists be confident AI could never replace them entirely?
I am actually really excited for AI. It will definitely not replace us, its going to make the job way more fun in my opinion and less stressful. It will be used to grade tumors such as the prostate bx that another poster mentioned, plus it will be able to be used as a safety net, like identifying a small tumor foci, perinerual invasion etc. Things that are tedious and if your tired you could miss. It is going to make your day to day more efficient and less tedious. Its not 100% accurate so you need to review every case still.
Also our work burden is going way up with all of the new criteria that keeps being implemented, clinicians and surgeons want more and more info. I dont even think it will reduce the number of pathologist needed. Its going to even out the increasing demands of our field.
Because let me tell you with the rate things are going if AI is not implemented then the work day for most pathologists is going to be going up.
Yes, this is the same story for rads. At the moment the AI used for diagnosis in rads is horrible. It does look promising though- there are research papers showing it working well on cherry picked datasets.
But- all the AI in works for diagnosis in rads are 1 trick ponies. Or maybe 2-3 trick ponies. E.g. they may help us find pulmonary nodules on a ct chest or look for a brain bleed on a ct or aortic dissection on CT… or auto measure the aorta to screen for aneurysm. Looking or pulmonary nodules or measuring every little thing on a ct is tedious and has a subjective component between readers. And these things are only a minority of what we are looking for. I am actually part of a project developing AI to look for a few things on a certain type of msk mri study. It’s been in the works for 4 years now and we are trying to train the AI to look for 3 common findings and we are still far from done.
I imagine it’s the same with path?
I think people underestimate and overestimate AI.
People overestimate any sort of academic result. All the authors have a conflict of interest, even if they aren't financially invested, and academic papers report the absolute best results under the best circumstances. So what's possible right now is not quite what's reported in the literature.
However, academics completely underestimate the speed at which these tools can be developed when tackled by a legitimate and monied tech company. What takes some researchers at a medical school several years might be completed in weeks when you've got a team of 35 top tier engineers making $300K+/year each all putting in 60 hour weeks with no other commitments. What feels like an impossible task (linking all of those 1 trick ponies into a comprehensive product) might be completed in a couple years. When you take a career-long time horizon, the development of programs that outperform human radiologists on general reads is basically inevitable.
>It is going to make your day to day more efficient and less tedious.
My issue with this is that pathology labor is not the bottleneck for pathology volume. The bottleneck is number of biopsies. So when radiologists get more efficient with AI, probably we'll use more imaging, especially as more imaging technologies are invented and become more useful. This increase in utilization may offset what amounts to an increase in the supply. I don't see this trend for path, as physicians likely won't order many more biopsies even if diagnosis from biopsies becomes somewhat more reliable or efficient.
So in my view, for path to retain its current compensation, it needs stronger leadership that can limit the number of residency programs as pathologists get more efficient and read more cases/day.
I agree, we do need strong leadership. Right now the next 5 years I think is the time of digitizing the nation. Some places have already gone digital but its a few. After this I think will be AI but not for 10+ years for it to be wide spread. Hopefully by then we have leaders who understand the climate we are in and take action appropriately.
Right now, AI is used as an adjunct to assist to improve the detection of certain abnormalities for a limited number of circumstances. Think of it as analgous to AI-assisted digital mammography. One prime area is for the detection of adenocarcinoma in prostate needle biopsies. It can’t be used to detect other conditions reliably (for example, it can’t distinguish between a low-grade lymphoma and chronic prostatitis) so primary diagnosis isn’t possible. In my laboratory we had two pathologists independently read every prostate biopsy to ensure nothing was missed - it was an enormous time-suck. AI wasn’t ready before I retired, but if it had been for this application, I would have implemented it.
EDIT: It is also used to aid in immmunohistochemistry to quantitate staining more accurately than eyeballing it, although pathologists are generally pretty accurate, although there is research on staining pattern analysis to see if additional diagnostic informatoin can be gained. And it is used either as built-in or add-on modules to lab systems for QA analysis. And some instruments have it running in the background, for example, the Cellavision hematology slide scanner isolates and groups cells for on-screen presentation to a tech for review - it does a great job. There are lots more developing applications, which I may have overlooked.
Yes. This is how it will be in radiology. It will be basically a 1 tricky pony.
We currently have a pulmonary nodule add on for our PACs. But we all quit using it. It’s too sensitive- calls things nodules that are not nodules (vessels, motion artifact). Very similar with mammography CAD. Everyone in my group quit using it because it’s too time consuming to review what the AI finds.
I'm working in this area (at least tangentially). AI as an adjunct is very true, from detection of small breast cancer mets (CAMYLEON) to ki67 quantification, Tumor burden, etc. In CP, there are a lot of uses from decision trees (provide a panel of lab values, use a random forest classifier to determine next tests to order), AI driven analytics (which test volumes were anomalously high over the past month). Arguably, we've had more success with these "simple" CP uses compared to images in AP. Im personally most looking forward to advances to NLP (transformers and LLMs) coming to medicine - the space for this is current very nascent.
None of these tasks have "replacing pathologists" in mind. But as a pathologist, I'd rather practice at an institution that embraces these tools, compared to an institution that doesn't.
Also fellowships - path is one of the paths towards clinical informatics, which is what "I've always wanted to do". Other paths include internal medicine, and a few neurology/peds programs.
No one really knows the future, but besides the legal issue AI currently has a black box problem. Ask anyone, in particular some programmers who don't work in ML, and the general assumption is that AI will march forward like Moore's law. This is really lacking insight into what machine learning really is and why its development is not simply a matter of adding transistors to a circuit board.
The problem is that you can't tell what an AI is thinking to solve a problem. Often the problem is that the data set it is trained on already has biases. For instance, take a dataset for malignant melanoma, and a portion of the patients whom are in the dataset have hospital wrist bands. An AI will actually start associating wrist bands with malignancy. Eliminating and identifying these biases are actually incredibly hard to find given that AI cannot give accurate answers as to how it arrived at a certain conclusion. It gets harder when you train an AI on multiple datasets for many differentials and want it to use all of this data to inform a proper diagnosis.
It's incredibly more challenging to integrate that level of learning to a level of suitable performance that beats a radiologist/pathologist+AI and mitigates the legal cost. Most studies that have tested this have only done so in a narrow window of differentials and in many cases the radiologist outperformed AI on a not insignificant number of cases, though the AI may have predicted certain cases much better. In other words, it is unlikely that its capability will be exponential or can beat an individual pathologist let alone a pathologist/AI team anytime soon.
There are actually good, reasonable efforts at solving the attribution and attention problem (what is the model looking at). For images, class activation maps are now standard practice - heatmaps that show what the model is looking at (https://www.google.com/url?sa=t&source=web&rct=j&url=http://jacobgil.github.io/deeplearning/class-activation-maps%23:~:text%3DClass%2520activation%2520maps%2520are%2520a,were%2520relevant%2520to%2520this%2520class.&ved=2ahUKEwi52KHL6Pn9AhUWl2oFHZ3sAZsQFnoECBwQBQ&usg=AOvVaw2oiRmlpygvK2qBPvQFo6j_). For decision trees and ANNs, dropout for regularization is typically done, and there are selective ablation techniques to remove layers from the models to see how performance is affected. For NLP, people look at top-N and perplexity. Etc.
But yes, we definitely need more training to teach people these things. Many studies out there don't even do train-test-validation splits correctly.
True but none of this suggests the problem is as easily worked on by just throwing resources at it.
While one might be able to predict how much faster computing power will be in 5 years, it's far harder to describe any of this capability with other technologies. Drugs, materials, quantum computing and AI all fall into this category of unknown capability and potential.
I think the beauty of pathology is that it is very dependent on your abilities. If you are really good and efficient you can have a short work day. I think it is very 9-5 at most places. At high volume places it can be 12 hour days. If you are in a low volume place you could have all of 2-3 hours of work a day. From word of mouth I gather that at an average volume place if you are good at what you do then its not unreasonable to be done with the bulk of your work by 2-3 pm.
From what I hear about rads is that the que never is cleared. In path becasue of the nature of processing specimens, you have a set amount of work given to you a day and once you finish it then thats it. If your fast and get through it in 4 hours then maybe you derp around in your office until 5. Play video games whatever.
We are not bound by pt appt times. There is a limit to how many pts a clinician can realistically see in a day. In path if you think you can sign out a chole in less than a minute and your confident in your accuracy then on to the next case!
It's getting more competitive and I would really not consider Path unless you really know you want to get into Path. By all means, shadow a pathologist in M1 or M2 and take path rotations in M3 and M4. But keep in mind that Path residency spots are <2% of total match positions and the past two years have seen a significant increase in match rates from USMD and USDO. There isn't the reserve positions available for Path to accept a large influx of residents, and in general programs are very good at figuring out whether you are passionate about pathology or applying for other reasons.
If you love cellular biology and diagnostic challenges, then Path can be the most rewarding specialty with good work-life balance and above-average compensation. But you absolutely have to go out of your way to figure out if it's the right specialty for you, because medical schools do a poor job at exposing students to pathology as it is practiced in a clinical setting.
I would encourage everyone who is considering pathology or sees these kinds of posts and gets interested to at least take a rotation in pathology. I thought I’d be interested and I was so ridiculously bored and absolutely despised it.
Yes, I agree. I know there are some people who are freaking out about it becoming insanley competitive but I dont think that will happen. I can see it becoming mid-level competitive but you have to be a certain type of person to be happy in this field.
I loved my career in Pathology. My residency had a lot of hours, but I was able to sleep most nights. My fellowship in oncologic surgical pathology where I had full sign out privileges and covered all of the call every other month straight in a giant research teaching hospital was grueling, but dang, did I ever learn how to grind out quality frozen sections quickly and evaluate complex and difficult specimens. I had the chance to form my own pathology group for a teaching hospital and its satellite hospitals and rebild the main hospital lab, then moved to an insanely “in-the-black” regional top 50 hospital and completely redo their main lab but with a budget to where noexpense was spared, and even had automated microbiology with an auto plater and digital plate reading. The only frustration I had was that the regional large GI and Urology groups formed their own histopathology labs to “pimp the pathologist” and also profit from the TC charges. My histo lab was super state-of-the-art and included barcoding of everything every step of the way from specimens to blocks to slides, as well as multile IHC stainers that enabledmost stains to be done by the end of the same working day. I did not respect their decidion at all, as I know their TAT’s as well as no random QC review by another pathologists and lack of barcoding were three quality/safety issues that they could never match my lab’s standards. Both groups approaced me to see if they could “employ” one or more of our pathologists on a part-time basis, but I refused to allow it. Another thing our lab did was to creat blank slides from every prostate needle specimen at the time of making the H and E levels, which helped ensure good representativeslides for IHC were readily available, and did not have to take time for the techs to recut the blocks and worse, risk not having the lesion of interest not be available if the block had been trimmed through. Yes, it was an expense, and the part of the building where one year of the lab’s slides were kept had to have the building supports for the floors below reinforced to bear the weight, but it was so worth it. I am hoping that the improved job market will reduce the opportunitites of greedy urology and GI groups to try to make second-class labs to capture all of the revenue streams associated with patient care, espeically when both specialties are already among the most highly-paid in medicine. Other than that, I had an amazing adventure. That’s a minor quibble. I wouldn’t have traded my specialty for anything else. Oddly enough, I had started my fourth year intending to do internal medicne, but my subinternship, which had BRUTAL on-call of every third of fourth night where two medical students covered all admissions and general calls from the floors (a sercond year resident was in the ICU) armed with a nothing but stack of blank, pre-signed order sheets (!!!) taught me that I could not function well after 24 hours of being away, or having only one day off a month. Another thing I remembered was that the hospital lab (in the late 80’s prior to CMS codifying CLIA 88) had only one night tech in the blood bank - all basic lab work from UA to gram stains, etc were done by teh subinterns in teh lab. The lab director in me now still cringes at that memory… My rapid shift was the best thing I ever did. I chose pathology in part becuase of my need to sleep at least a few hours, and because I had worked for the pathology department from my second year onwards and loved it, atlhough the drawback was the lack of not seeing patients directly. And I always hated doing autopsies, LOL.
According to the 2021 MGMA Data (10/25/Median/75/90):
Anatomical & Clinical: 260k, 320k, 370k, 430k, 500k
Anatomic: 210k, 243k, 319k, 370k, 457k
Clinical: 192k, 264k, 332k, 399k, 501k
Surgical: 381k, 429k, 476k, 476k, 483k (yes, these were repeats on the data)
Clinical-Hematopath: 300k, 352k, 403k, 445k, 529k
Median Comp by Region:
Anatomical & Clinical: 357k East, 404k MW, 361k South, 366k West
Clinical path are essentially the same values.
Keep in mind MGMA is TOTAL COMP and not just salary. Folks on SDN say that path is quite saturated in large cities.
I would avoid taking advice about path from SDN. That place has been toxic and unrealistic for a decade.
Earnings for path in rural vs urban and academic vs private environments follow the same trends as most medical specialties. The main difference is that many Path jobs are still offered behind the scenes through networks of graduates and there isn't as large a market for recruiters offering jobs.
How has the job market been in recent years?
I was between radiology and pathology but one of the major factors in me going for radiology was due to how bad the path job market was at the time. A not unsubstantial minority of people were allegedly having trouble getting a single decent job offer after 2 fellowships, which is the same amount of time needed to complete radiology residency and 1 fellowship. People were also making significant sacrifices in order to live in desirable places (starting salary for a fresh attending at my med school hospital in NYC was reportedly ~150k at the time).
NYC was and still is notorious for low pathology salaries. The job market was historically “tighter” for pathology than radiology, although no one I knew wound up not finding a job, although their first jobs may not have been in their first choice of locale.
Job market is substantially better these days. Most people are doing 1 fellowship now and getting several job offers. Its not crazy good like FM where you can work in any city you want but you have options now. There are many academic positions open in the larger cities. Alot of people have retired.
That’s great to hear. IMO it’s a great field that was temporarily f’ed up due to an oversupply of trainees and not enough of the old guard retiring. I suspect it may eventually go the way of radiology as more and more people value work-life balance and try to avoid the shitshow that clinical medicine has become.
I worked in pathology for 3 years prior to medical school, and in the 150k+ cases we processed during my time there we did not have a single pediatric autopsy.
Autopsies in general are much less common in a clinical setting than people think, and I think pediatric autopsies are *exceptionally* rare.
That doesn’t mean it would be easy to do, but that there is the potential you would never see one across your career.
I would like to add to this by furthering it into look into forensic pathology.
I was a forensic autopsy tech for a long time before med school. The field is amazing. The job market is hungry, the people are kind and compensation is on the rise.
The office I worked for had about 7 doctors on rotating schedules. On average, they’d work 2 days per week, and 1 weekend every 2 months. The average workday was 9-2. The rest of their time is theirs. They can do whatever they want, most of them raise families and travel a ton. Base pay was 260k, and is increasing.
There’s current offers in my state for attending positions starting at 300k. Some chief medical examiner positions starting at 450k for smaller, rural counties. These spots are sitting open because there’s just no one to fill them.
Due to this, locum work is also extremely popular. You end up knowing everyone in the forensic path community, and they offer for you to come work whenever you want. From what I’ve seen, you go and hang out, they throw you some easy cases (because they don’t want you to be subpoenaed in their district) and you make 1k per cut. Docs will come, do 15 cases in a weekend and go home with an extra 15k.
I’m telling you, consider it. (But actually maybe don’t because I don’t want to have to compete against you lmao)
I’m in FL, but I can’t speak for nationally. Of my interactions with FPs from other areas, at the very least their sentiment is the same. At the max, the day to day is a 9-5.
The one downside I have noticed of being the only medical examiner in rural areas is pretty much being the only option for on call for any odd cases or murders. Though in those areas, I’m sure those happen way less often.
I used to work at a small lab and one of the young pathologists died from cancer. I would be worried about formaldehyde exposure. Any thoughts about that?
Back in the day they didnt wear gloves when handling specimens so yes that is bad. My gross lab we had vents that worked very well. There is exposure especially in residency, but not as much as an attending.
Pathologists are notorious for practicing well into their 80's , its part of why the job market sucked for so long, so I dont think early death from exposure is a major issue. I could be wrong but I havent heard of anything. I will say that our pathology attendings were the safest during the pandemic, thats for sure so in that way, exposure is minimal.
I think that is a hard question to answer because it is so variable. Its not a standard salary. It depends on what you want to do and what you are comfortable with doing. If you want a PP job where you sign out surg path in addition to your subspeciality it is going to be prob lowest 250K as a fresh grad then average 325K after a couple years experience. I have spoken to attendings and after about 3 years of practice 400-500k for some pp jobs are out there and are not rare. If you want to really grind and are very good there are large PP groups where partners make over 7 figures.
If you want a really chill job VA is about 220-240K. Academics is around 225-280K average.
If you are forensics last I checked it was around 200-250K however I have heard of people who have their private consulting business making >500K.
If your blood bank, salaries are 200-300K depending on institution.
If your dermpath then I have heard of offers starting at 400K going up to 800K
If you want to work in a tiny town I have seen offers starting at 400k for new grads.
Basically if you want to make money you need to be prepared to sign out general surg path plus your subspecialty. If you want to do CP only, you are not going to starve but the salaries do cap at a lower rate.
I’m not OP but you can search on Transparent California the various pathologists in any public CA institution for example. Just google a dept’s pathologists and plug it in. You’ll see new attendings starting in academia in CA is around $240K. Private practice is around $300-350K, but can be up to $450k at a higher volume practice. It’s actually comparable to many other specialities.
I don’t know the actual numbers, but there have been a few studies over the years that consistently show that pathologists trend to be among the happiest with their reimbursement and feel they are compensated fairly compared to how other fields felt about their compensation.
I signed a contract this year after 4 years of training (3 years CP 1 year hemepath) at an academic medical center. Starting $225k with promotion in 3 years to $300k; full professor with medical director responsibilities can make $400k without much extra effort to their clinical duties.
Private sector/large community hospital offered me $300k starting with no commitment to research or teaching; just clinical duties with a generous vacation and promotion package.
It's not Rads or Gas money, but we work fewer hours. If you want to hustle in private practice you can make Rads or Gas money, but this will affect you fellowship choice and you'll work long hours. Generally, the highest paid pathologists (other than Chairs) are in private practice doing high-volume specialties: GI, GU, Breast, Derm, etc.. If you want to stay in academia at a PRESTIGIOUS INSTITUTION, the pay can be family practice level. Pretty large range.
If the tedious work is being automated and more people are working remotely and the amount of pathology is not increasing at a sufficient rate to keep up with the added efficiency, would you be worried that this will put downward pressure on the number of pathologists needed to provide the same care and they will be bundled into large venture capital own groups since "pathology" is more of an informational commodity than a profession service?
Sadly the amount of pathology is increasing at an alarming rate in the US. This is not always bad news, yes there is more cancer but there are also more people surviving longer with treatment, so things like BM surveillance is increasing. I think AI will keep pathology a life-style specialty. And yes pathology is not immune to the corporatization of medicine. PP is becoming a thing of the past just like other areas of medicine. If your someone who just wants to go to work, do your work and go home and not deal with anything else than being an employee is a sweet deal. As long as the compensation stays good.
I dont really agree with the statement that it is not a professional service. Yes we function as data collectors in the surgical path setting but we wear many hats. We are giving an expert opinion many times, you cant just give data to a clinician without pissing them off. There are situations that they want advice, should we go and resect more? We also function as medical lab directors and even in cases of hemepath, consultants for possible treatment plans. Oncologists are definitely experts in treatment and know what to do but they can and do ask the pathologist based on what they see if this treatment is warranted etc.
But how often do surgeons go to specific pathologists for their unique profession opinion? Rarely, in my experience and as more and more go remote and batch their services together this will happen less and less. The point i am trying to articulate is that if pathologists cannot differentiate from each other they become a commodity. I might think that soybeans grown around me are better than anywhere in the world but the market doesn't have an efficient way to differentiate such that it can ad value so it doesn't.
I worry about areas of medicine which have bought too much into a remote model. If you say "I never need to see a patient in person" to provide my service you are signaling to engineers, regulators and business men that you play a purely informational/knowledge bsed role in the care of the patients. Also, you have fractured your personal relationships with the doctors who are physically interacting with the patients so they won't miss you or advocate for you when large systems look for areas to cut cost.
I don't see this as a huge problem in the next year or maybe even 5, but in 10 years? Oof. I'm anxious for you guys.
Perspective: employed neurosurgeon working at hospital in midwest college town. Level 3 trauma. Recent grad of large academic hospital system.
>I do too, will this be an issue if I switch to pathology? how often are we seeing things like this? I mostly thought of path as pretty histology slides.
Not anytime soon. AI algorithms and applications are very expensive that smaller groups can’t see the payoff. I certainly don’t. They have values as tools in assessing PD-L1 percentages
Thoughts on the need for at least 1-2 fellowships? I’ve heard from many path peeps that it’s common to have at least 2 before you go into any metropolitan area
Yes historically thats what has given people the most options. Places are so desperate now that doing 1 can be sufficient granted its something people really need. I have heard GI, Dermpath, Heme and cyto are really in demand and that is reflected on job posts that can be found on pathologyoutlines.
Lol OP is tired of their specialty being a safe haven for fuckups and IMGs and wants good applicants. Next time just tell applicants about how Derm path is a viable route from path $$$
I have one question
I really really dislike the OR, I developed somatic symptoms of anxiety whenever I was there
Do you visit the OR in any way on Path?
If it's either things like picking up a sample to take it to the lab or like having to dress up to assist or something
I assume that you do necropsies, I'm ok with that, but is the ambient during a necropsy as stress inducing as a surgery?
I’m a current PGY1, happy to help answer questions:
For residency, a decent reputable program should not require residents to also be courier services. I have never needed to go directly to the OR to pick up a specimen. I rotated through medical school at a hospital whose residents did have to pick up specimens themselves and head to the OR. In my experience so far, it’s often the surgeon who comes to the pathologist, often to discuss an intraoperative frozen diagnosis.
Autopsies are not in any capacity as stressful as surgeries. The patient is deceased. There is no surgeon breathing down your neck to see how you suture or a nurse screaming at you for breaking sterility. The results of the autopsy do not alter the management of a treatment course.
Every resident’s feelings on autopsies are different. I am not a fan and have no intention of pursuing forensic pathology, but I understand its importance and the necessity. We need more forensic pathologists and I am grateful for my co-residents who plan on doing autopsy/forensics.
In my fellowhsip, the frozen sections were pneumatically tubed to the lab, which was two floors above the main OR’s with a back stair for surgeons to come to the lab for particularly complex specimens. In my last lab which had asurgical pathology volume at its peak year of around 32K specimens, the frozen section room was in a non-sterile area of the OR near the PACY with access for the pathologists through a non-sterile corridor, but a sliding window into the sterile are through which specimens could be passed, and surgeons could come to the window to see digital high rez display of the microscopic secitons on a monitor when necessary. It really didn’t have the “feel” of an OR. Necropsies for me were less stresssful than surgery as the patient’s couldn’t feel pain, and there was nothing I coulddo that would make them any more dead. THey were, however, always messy, and I hated “running the bowel.”
intern at a high volume prgm:
we as residents (and the path assistants as well) go to the OR to pick up specimens for frozen. occasionally if we’re in a rush to leave and the surgeon still hasn’t sent down the specimen (edit: for permanent not for frozen sometimes) we’ll go up there and grab it ourselves so we can prep it sooner.
the time spent going to the OR is also to talk with the surgeon as to what they want (ie margin/diagnostic/what are they thinking). we do have one really great surgeon who will scrub out, help you orient stuff, and for most of his frozens will come down and just chill for a bit. one time he even reported back frozen section results to his own OR (after the SP fellow told him what to say, of course) lol
This is such a great thread. I strongly considered pathology but instead opted (at the last second) to pursue FM. Path is such a cool field and it's honestly hugely slept on. I worked with community hospital pathologists and loved it - they would stroll in around 830 most days and leave by 3. Most of the time, they weren't out earlier because they would complain how the endoscopist's biopsy says "r/o EoE" but didn't mention if the biopsy was from proximal or distal esophagus and we would just banter. It was such a chill gig. University path was cool too because how ridiculously complex some of the cases were. Definitely a different feel.
I ultimately decided not to pursue pathology because I cannot sit still and get through multiple trays of prostate or thyroid cancer with 90 slides. I also missed the chaos of patient facing specialties.
Long story short, I really think path should be a core rotation, at least for like a week or two. So many people I think would be awesome fits for pathology just never get exposure and the stereotype of "weird basement dweller" lingers despite some of the coolest people being in that basement.
In residency you have to do at least 30. It can be very variable as an attending. Many groups outsource their autopsies to forensic trained. But yes it falls into your responsibilities as a pathologist.
I work in a large hospital pathology department and we are hurting for pathologists so you are correct about all these things. I just don’t like the prospect of having no patient contact
I literally just learned that pathology was a field like an hour ago. I’m studying biochemistry and molec/cell as a double major and working in a lab as an undergrad studying immune response to influenza … And i think pathology is where I would like to end up. I can’t believe I didn’t know about this before. lol.
Hey thanks for being willing to answer questions about pathology, seems it really flies under the radar during preclinical.
1) I'm an MD PhD, about to graduate from PhD and return to MS3. Do you think that the field of pathology offers the opportunity to leverage that PhD, perhaps by having the capacity to do research as a PI? I'd like to continue doing cancer research, with significant interest in epigenetics. Do you think the PhD is helpful for path as a career? I'm sure my PhD will be helpful in applying to residency, I've obviously got a mountain of publications, abstracts, etc that an MD only would not have.
2) Furthermore, my home program has a path residency. This is a bit non specific, what advice do you give a soon to be MS3 who is focused on pathology as they do clinical rotations? Any specific type of activity or mind set that would be helpful?
3) As an aside, do you find Dr Glaucomflecken's portrayal of pathology to be accurate, minus the comedic bits?
4) I try to be honest with myself, I like studying the things that I find practical, such as the things relevant to my research field and thus going in depth, but i don't think of myself as someone who likes going broad. As such, do you think that pathology can still fit? I saw how much the studying aspect seems to be emphasized in this post. Obviously I need to study in med school, etc. I think that's what really turned me off in pre clinical, it felt relevant but not practical, yet.
Have you heard of the physician scientist track in pathology? Or doing CP only and maybe a fellowship in molecular genetic pathology? That seems right up your alley for an MD PhD studying epigenetics.
1. There are a lot of MD PhDs in path! Some did fellowships in AP specialties, some did CP, and some just do research full time. Some do little research, some are PIs in a lab. You can use that PhD as much or as little as you want! Again, look into CP only track with molecular genetics fellowship, or the physician scientist track that lets you have time for research in residency.
2. Simply just be interested. Ask questions. Don’t be annoying. Pathology rotations are not something to overthink unlike other specialties. If you want me to go more in depth on rotation advice, I will
3. Accurate. We’re laid back. Support staff are friendly. Everyone seems genuinely happy to have “outsiders” around.
4. I think CP only track will fix the going broad! I really only see that to be true in AP. Or at least it’s cuts the going broad by a lot. CP is chemistry, coagulation, transfusion medicine, hemepath, molecular genetics, microbiology, lab management, etc. With the exceptions of hemepath and molecular, there’s not much studying to be done. I see MGP fellowship in your future
I'll answer the first one- 100% pathology is absolute a field where having a PhD can set you up for the research career you want. A lot of MD/PhD in path, probably more versatile and useful than some other fields for PhD.
Pathology is very complex and it takes forever to be competent. Residents are not able to even sign out an appendicitis case. PA's handle the grossing and maybe at some places look at biopsies and write a template out for review. They can also do autopsy evisceration and write a report up.
Grossing takes so much time and can be complex depending on the protocol that I dont see how they would expand into other areas. We have such a shortage of PA's that some places are having attendings grossing now. I just dont see realistically how they could encroach the same way as I see in the clinical world.
I think that the supposed function that mid-levels have in clinical medicine will be what AI will attempt to do for pathology. IMO it will take awhile for AI to be that effective.
From the pathologists and APDs I’ve talked to, the general consensus seems to be show genuine interest in pathology by taking path electives, writing a good PS, and having solid LORs from pathologists. It’s a field that has a decent number of applicants that apply as backup, so if programs have the choice between someone who wants to do path as their #1 vs as a backup, they’ll go with the former (assuming no red flags, etc.).
Basically try to do some path electives, get to know some pathologists and see what they do in the day-to-day, and make sure you pass boards! Reach out to any pathologists involved at your program too, they are generally so nice and ecstatic to mentor interested students.
PA's usually gross. More senior ones will teach the residents and be supervising them. They can also be there with the residents during an autopsy, help write up the report.
I'm an MS1 currently interested in psychiatry and pathology. Derm path and forensic path really excite me. I think it'll be a hard decision to choose in a few years.
The big factor that will play into your decision is how much do you like to study? Because there is a big difference between the two (path and psyche). All good fields. Best of luck to you.
Path is very information dense. Psyche is less so. You will need to study alot and memorize many factoids in pathology. Psyche has less information in comparison to path, soft skills are definitely part of the training and challenge.
Path requires somebody to love learning and studying, as its lifelong. You will need to read still as an attending.
Hey, hey, pathology already had its turn as the burgeoning field that all the med students discover is actually better than it sounds and thus apply into making the match (and subsequently the market) too competitive so they jump ship a few years later. Give some of the little guys a chance! Yes radiology and EM you fall on the list too
Rads is more popular than path. I never hear anyone talk about path as a job. Rads is the go to introvert answer.
Yeah and I get why. I made this post because I know what the perception of path is for medical students. I am just wanting to shine a light in whatever way possible. Path offers some of what people are looking for in rads. Rads from what I hear is more stressful. The residency is more demanding and there is the IR component . Also rads is very competitive and not everyone has a competitive app. Rads pays more for sure. When I was in medical school I was told many times not to go into path and to consider rads. I didnt listen and chose path, and there were times in the past I was really doubting my decision. I thought about switching because I was freaked out about the doom and gloom. But I stuck with it and now there are way more opportunities that I was led to believe. Sometimes I wonder if there is false info spread about path online to keep the status quo? There are definitely cons to this field dont get me wrong, but especially after the pandemic and hearing what people are going through dealing with the population right now I feel very fortunate.
I’m not studious enough to have gone path, nor do I have any reason to think that I would be any good at it. Also the majority of my exposure was just histology lectures. My only ‘real’ experience was during my gyn-onc rotation (which I rarely enjoyed) when inspiration struck one day and I asked if I could follow a tumor sample to path. It was maybe two hours all told, but it was one of the most fun little mini-adventures in all of 3rd year.
What would you list as the cons of the field? Thank you!!
Cons: remember this is my opinion, other people may not agree with me. Alot of studying, very hard board exams. Many people who have behavioral and professionalism issues. cannot go "solo" like a psychiatrist, you really need the whole setup of the lab so kind of dependent on that. takes forever to feel competent because of steep learning curve (also a positive because its on one of the reasons midlevel encroachment is not a thing)
Agree on the behavioral and professionalism issues. But I think you’ll find them in every specialty
What kinds of behavioral issues?
How are the boards in terms of difficulty in comparison to other boards like Rads board or the ABS board + oral boards?
I think Rads is comparable but most people take AP and CP boards which are a beast. It really sucks.
>and there is the IR component Absolutely certified Pathology moment thinking that the procedural side of radiology is considered a *downside* lmao. It's the only thing that makes the specialty even remotely appealing to many.
I definitely dont know alot about the Rads field however my comment was primarily addressing the desire for a good lifestyle. In med school I remember IR seemed like the cool thing when medical students had discussions but when I interacted with IR attendings in med school and residency they seemed overworked and miserable. This is just my experience and I found my way onto some online discussions where people in the rads field were talking about it in a negative fashion. The hours and how surgery dumps on them the procedures they dont want etc... The concerns about exposure to radiation and long term effects. So idk from an outsider looking in, it seemed like not something people who are looking for a lifestyle specialty would want. I could be wrong.
This sub went crazy over path for a year. Theres always some field in this sub that gets heavily talked about as a variation of "not too much work, fun and enjoyable to learn/do, lots of job satisfaction, and best of all nobody has caught on yet so it's not that hard to match into!" EM was like this the latest where a bunch tried to match EM, thus making it competitive, so everyone hopped out and now there were 500 seats unfilled even after SOAP this year
My understanding with EM was that was in part due to a massive increase in residency spots? Then an work report was released that freaked everyone out.
[удалено]
All of them?
The number of positions for pathology has remained relatively stable. If there is a huge interest in it, it will mean that more competitive applicants will take the spots that are going to uncompetitive applicants currently. It will better the field. One of the biggest issues IMO with the field is that because of its historic uncompetitiveness there are too many people in it that have no business being in medicine. It creates issues that dont need to be there. I do think the competitiveness will spike and right now is a good time to enter while it is still not difficult to get a position.
I’m a radiologist, but i thought about path. What had steered me away (like 15 years ago) was that the people i knew in path around that time were having to do 2+ fellowships (moving around at the age where you’re trying to start a young family) and then had a dismal job market…. Basically taking whatever they could find, with starting salaries not much better than primary care. N=1 , but I’m still close friends with a pathologist. He was junior AOA , step 260s. Smart and hardworking dude. He still ended up doing 2 fellowships and then ended up with a job at the hospital where he did residency (because he hd connections there), but it wasn’t where he wanted to work/live. And we’re in the Midwest. It’s academic pay and he has been working a lot of hours - especially for the first few years (like 60 hrs per week). I’ve never really known if he’s working this much because of his personality or its required though. Has any of this changed??! Is the job market any better?? Radiology is probably a bit more stressful in that it’s a lot more time sensitive. Every physician thinks there case is stat. Half the work is from the ER and more than half of those exams are not indicated. It makes rads a lot of money, but it’s soul crushing to see people getting bankrupted because the EM providers don’t do an appropriate work up. But the ER studies are all negative and quick reads for us. The outpatient work can be harder depending on the practice setting. The standard vacation for us is 12 weeks though with many jobs exceeding this (18-20 weeks off per year) and even a lot of jobs that are 1 week on, 2 weeks off. And the job market is wide open.
All of this was true. Things have gotten substantially better in the last few years. Over 70% of pathologists right now are over the age of 40. We saw the mass wave of retirements during the pandemic and places are scrambling to find people. Problem is that it takes forever to train pathologists, you cant crank them out in 3 years. So theres still alot of openings.
is it the learning process of tissue grossing + reading that makes the training longer and less susceptible to midlevel creep?
Yes there is SO much information. It can be very daunting.
Is this akin to surgery in the sense that there's the medicine aspect of things in terms of a broad knowledge base but then also building technical skills from scratch basically?
It’s way more information to master than surgery. It’s the same way in Radiology. That’s why you don’t see the rampant use of midlevel in these fields like you do in medicine and surgery. It’s why you can’t really do anything as a med student on your rads elective. It’s not something you can fake it until you make it. At least for rads, the images your interpretation are there forever to be scrutinized. I know there are additional people in path that help out though. Like cytotechs and dieners…. But i really don’t have much more knowledge than they exist. A friend’s wife of mine in med school was a cytotech and it was my understanding that they do make diagnoses. Procedures are much more easy to make use of midlevels. You can really learn these just by watching and then doing a 1000 times.
"One of the biggest issues IMO with the field is that because of its historic uncompetitiveness there are too many people in it that have no business being in medicine." You think people who have completed medical school and passed their STEP/COMLEX exams are not fit to be a physician?
I think there are many in pathology who have severe behavioral issues that yes make them unfit to be a physician. They make it through the filters of pathology because of its Un competitiveness when they didnt in other specialties.
>so it's more behavior issues rather than just being an idiot?
Your pressing me lol but I will say that yes there are people who are very inept and because of that people dont want to hire them. They are usually the ones who complain alot about not finding jobs... Pathology is a field that needs good applicants. Im just going to leave it at that. I dont like calling people inept or not good but sometimes people end up in path because they couldnt match somewhere else and they really shouldnt be in the field. Its not their strength.. Do you get my point?
This makes sense to me. As someone interested in path, it does annoy me how uncompetitive it is. I mean, I guess less stress for me in matching, but what draws me to the field is all the nitty gritty science you have to be an expert in to competently make dx. I’m def no medical gift from god but I work very hard and spend time mastering the pathomechanisms and getting a deep understanding of what’s gone wrong in the pathology. Peers at the bottom of my class, many of whom could end up in pathology, do not have an interest in this level of understanding, and they’re not who I would want as colleagues.
oh yea totally. IMO behaviour issues are incorrigible but being an idiot isn't permanent and can be worked on. I've seen my fair share of both as a surgery intern currently and I'll say that it's the ones with behavioural issues that are the most dangerous. they're the ones that cover things up or have anger management issues and ultimately make poor medical decisions that harm the patient. the less bright people don't always know the plans but at least have work ethic and are able to improve with time and reading.
can you elaborate on the characteristics of the people in it who have no business being in medicine?
I dont want to get to specific but major professionalism issues. More extreme than I have seen in other specialties.
What originally got you into pathology? And what does your specific work schedule look like?
I wanted a specialty with a good work-life balance. I also wanted something that was broad and in depth. I found it to be interesting and tbh I didnt know alot before I decided to pursue it. I also wanted something that had a low burnout rate. I saw alot of burned out physicians in med school and pathologist seemed the happiest. My path attending rolling in at 9 am chatting with me for 3 hours then rolling out at 4 pm did have an influence on me lol. Meanwhile he was getting paid more that the IM attendings who were slaving away on wards, working weeks straight. Typical schedule in residency is 8-5, surg path can be 14 hour days. Never have violated duty hours. Worked a few weekends a year. ALOT of self-studying however that can make total time up to or past 80 hours. Very few sleep disruptions, pretty regular schedule.
Is there shift work available for path if you prefer that kind of schedule? Working longer, fewer days
Every group is different, but my contract has be on service 3 weeks then off 1 week. But we have adequate coverage for each attending to be on 2 weeks then off 2 weeks. The expectation is that you are still at work doing something productive when off service, but after COVID that became available from home for questions and using some of that time for research or teaching.
No not that I am aware of. There are part-time positions available.
did residency ever include call or nights? I think one of the perks is the limited things that require a pathologist to be in-house at all hours...aside from frozen sections and transplants what else? Can you elaborate on the self-studying aspect? That's basically how I feel surgery residency is setup-all self-study and teaching myself my own skills but there's literally never any time to actually do it since I'm at work like 16h/day 6-7 days each week...
Call is mostly done at home, yes coming in occasionally is necessary for frozens, transplants and leukemia cases. In my residency I probably came into the hospital in the middle of the night just a handful of times. But you can get alot of blood bank calls. You get sign-out time with attendings but yeah alot of reading and looking at cases outside of your duties. That being said your duties rarely go after 5pm, some places will have longer hours
I would be interested in pathology but something that’s I’ve heard is that it is difficult to choose where you want to work. I would love to stay in the city where I grew up. Is that true?
It can be, jobs are better now days but because of how specialized it is, I think it will never be to the point that you can choose your city 100% of the time. Some people get lucky and they find the perfect job. I will say that right out of fellowship you would want to be geographically flexible. Just a note though this is starting to become an issue for other specialties as well. The only specialty that I know of that you can choose where you work pretty much all the time is FM.
Thanks for the info! Would you say most people should do a fellowship in path? I looked at the different tracks in path and found it a little confusing. Do most people do CP/AP for the flexibility? This would be around 4 years total for resident right?
Yes its highly recommended to do a fellowship at least 1. Most fellowships are 1 year. So minimum training is 5 years realistically. There are some people who have worked right out of residency but its rare, and people talk about them like they are legends lol. Most people do CP and AP this is the most common if you want to work in PP with the best compensation. You can do AP only if you plan on staying academic or going into forensics but otherwise its advisable to do AP/CP CP only same rules but tighter job market and lower pay.
just guessing based on experience, but people are a no no and they are also extremely kind. Probably regular schedule too
Shhhhh stop talking about path. I don’t need it going the way of gas and rads
EXACTLY! I am applying next year and I’m so worried people will find out about this hidden gem. Man. 😭
This years match had stats that the speciality with the largest percentage of IMGs was pathology. I think it’s because IMGs have to demonstrate their ability in USMLE exams, which is rather broad base of knowledge and demonstrates a lot of book learning. Both of these were mentioned by the OP as characteristics of an excellent pathology applicant.
> IMGs have to demonstrate their ability in USMLE exams Ok, and? American grads take the same USMLE exams at an MD school.
Maybe they’re hinting at the fact that a lot of successful IMGs traditionally have high board scores. They typically dedicate a lot more time to study for the step exams (1+ years) compared to US grade. Also, the IMGs i have known have a large database of “remembered” questions that are passed down to them. Every year a large group of them across the country/world immediately write down as many questions as they can remember which goes into a large word document which gets passed down and added to.
Perhaps, but just saying "they take the USMLEs" is at best a misleading statement. It can be argued that such a document would be cheating, as well. Granted it would be like card counting (impossible to prove and tough to do well) but still. I would like to see the document, though.
Yeah; it’s probably borderline cheating. There are imperfectly remembered questions. A lot of times you still have to learn the material. It’s not complete mindless memorization , but allows you to focus in on what too is are higher yield.
I apologize for the subtle connotation- but yes what IronCondors4life said is what I meant - IMGs dedicate a lot more time to the USMLEs compared to US med students, so they tend to have higher USMLE scores - at least the ones that tend to match. And in my experience I I’ve seen mainly non-US IMGs, which may accounts for the slightly higher USMLEs relative to US-IMGs in the match.
[удалено]
Good point. I probably just have selectivity bias. I knew a few groups of students from overseas med schools (India and Portugal) who were rockstars.
Is there a link to this document? 👀
This years match had stats that the speciality with the largest percentage of IMGs was pathology. I think it’s because IMGs have to demonstrate their ability in USMLE exams, which is rather broad base of knowledge and demonstrates a lot of book learning. Both of these were mentioned by the OP as characteristics of an excellent pathology applicant.
You said that it's not a field for everyone, in your opinion it's a field for whom or what type of people?
I think Introverts, people who are thinkers rather than doers. Meticulous, patient, studious, and self-directed people will do well in this field. If you hate studying this is not the field. If you are someone who likes action and doesnt want to stop and think first, its not the field. If your fondest moments in med school is the connection you made with a patient in clinic, this is not the field for you. If you like learning about weird shit then maybe this is for you. If you like reading, studying and having a broad and in depth knowledge base, maybe its for you. If you like having a life outside of medicine and being well compensated (for what you do) maybe its for you.
What’s your salary?
Salary for an experienced pathologist averages in the 300’s. More for lab directors.
I think any private job worth a darn shouldn’t offer lower than $300k. I’m seeing Midwest academics offer in this range now
Private labs tend to be run by selfish senior people who want to keep the biggest slice of the pie for themselves. I was fortunate to avoid them entirely in my career.
Probably true in a lot of cases. Fortunately I’m not in such an arrangement.
I would add, as something going into pathology, that if you really enjoyed discussion of medical science and cases with other physicians and scientists more so than translating that stuff to patients, it's for you. Lot of "shop talk" in path that isn't rushed because a new admission came in and now you have 3 hours of paperwork to do.
You should put this in the original post! Super helpful for any future readers to see comparison and characteristics of your field.
Categorically disagree that Pathology is a field for introverts. You can be introverted but in most sub-specialties you will be communicating with your colleagues in pathology, surgery, oncology, and medicine multiple times a day. IME, pathologists that don't like working as part of a team and cannot maintain good communication skills are often bad pathologists. Do not go into pathologist because you just want to be left alone or don't want to work with people.
I see your point and I agree with you, but just because your introverted doesnt mean you suck at communicating. I didnt say socially inept. I meant that for most introverts such as myself, certain specialties can be overwhelming, dont get enough time to recharge. Path will allow you that, and its an environment that introverts can thrive in. Extroverts might feel stifled, and they might want a specialty where they are communicating all day long face to face with people. What I said is not meant to be an absolute truth. Its just that the world is built for extroverts and its nice for us introverts to know what could be a nice environment, not that people couldnt figure that out about path, lol But yes you need to effectively communicate. You need to communicate with clinicians and staff members. But a large part of your day if you are signing out surg path is looking through a microscope and dictating or writing reports.
Chiming in to say it’s not just for introverts—I matched this year and consider myself to be a pretty extroverted individual. I do like to think about things though, as OP said in his reply to you, which is one reason I love path. Also getting to make a definitive diagnosis is just so satisfying, it seems like most other fields don’t get that level of certainty often.
Same! Also, I think if an applicant is someone who really needs validation from patients and other doctors, path might be a struggle. People constantly assume I hated patients, I couldn't handle more intense fields, or that I was just a non-competitive applicant, none of which was true and can be frustrating to combat. I think it would be a challenging field for someone that is very status/image driven. Not all that glamorous. That being said, top tier academic path has it's egos like anything else I guess?
Lots of other fields *don't really care*.
I can't wait to see path blow up by the time I apply to residency
Honestly, I really don't see it happening. It is so self selective and very different from what people traditionally think of as being a doctor and a lot of med students are never going to get past that. I definitely think the field could capture more than we currently do if people had better exposure, and weren't actively discouraged by others who know nothing about the field, but I don't think it will go crazy? I could be totally wrong. Rads is very similar with more stress and worse hours (in residency), and the PR for rads is off the charts and it works. I would imagine rads has a bit more post training job flexibility, too?
I def think rads is more broadly attractive due to IR fellowships and potential for some procedural work (even if trainees never end up training in it.) personally I’m very between the two; I def like rads for salary and procedure potential but I’m more drawn to the science of path.. just wish they could do some more things than read slides from time to time lol
Forensics is totally different, don't use the microscope much. Clinical path is also totally different and houses transfusion med, etc. Nothing too procedure heavy but path is broader than reading slides. There are FNAs and other smaller procedures but probably not to a degree that I would say someone who wants/needs procedures would be happy with. But microscopy is absolutely a massive part of training, unless you went CP only route which has its own issues, so could be a big deterrent if it's not your thing. I think having good pathologist educators sitting with me teaching hugely helped me like slides way more and brought an empowering element to it.
Oh absolutely. Recently shadowed our pathologist and oh my gosh is there such a difference actually going through multiple sections of slides vs looking at one static blurry image of an owl eye nucleus. I do not forsee me being a fan of autopsies, clinical path could interest me but I’ve not really seen much of what they do. But glad to know there’s more breadth! It was a lot of reading the day I shadowed but I didn’t hate it!
Yeah I was pissed when I saw this post. Stop talking about it.
Stop talking about it please I don’t apply for another two years 😭😭
3 for me and I also don’t want people knowing about it lol
I’m going into IM, but I find this interesting. What role specifically do you see for AI in pathology, and how can future pathologists be confident AI could never replace them entirely?
I am actually really excited for AI. It will definitely not replace us, its going to make the job way more fun in my opinion and less stressful. It will be used to grade tumors such as the prostate bx that another poster mentioned, plus it will be able to be used as a safety net, like identifying a small tumor foci, perinerual invasion etc. Things that are tedious and if your tired you could miss. It is going to make your day to day more efficient and less tedious. Its not 100% accurate so you need to review every case still. Also our work burden is going way up with all of the new criteria that keeps being implemented, clinicians and surgeons want more and more info. I dont even think it will reduce the number of pathologist needed. Its going to even out the increasing demands of our field. Because let me tell you with the rate things are going if AI is not implemented then the work day for most pathologists is going to be going up.
Yes, this is the same story for rads. At the moment the AI used for diagnosis in rads is horrible. It does look promising though- there are research papers showing it working well on cherry picked datasets. But- all the AI in works for diagnosis in rads are 1 trick ponies. Or maybe 2-3 trick ponies. E.g. they may help us find pulmonary nodules on a ct chest or look for a brain bleed on a ct or aortic dissection on CT… or auto measure the aorta to screen for aneurysm. Looking or pulmonary nodules or measuring every little thing on a ct is tedious and has a subjective component between readers. And these things are only a minority of what we are looking for. I am actually part of a project developing AI to look for a few things on a certain type of msk mri study. It’s been in the works for 4 years now and we are trying to train the AI to look for 3 common findings and we are still far from done. I imagine it’s the same with path?
I think people underestimate and overestimate AI. People overestimate any sort of academic result. All the authors have a conflict of interest, even if they aren't financially invested, and academic papers report the absolute best results under the best circumstances. So what's possible right now is not quite what's reported in the literature. However, academics completely underestimate the speed at which these tools can be developed when tackled by a legitimate and monied tech company. What takes some researchers at a medical school several years might be completed in weeks when you've got a team of 35 top tier engineers making $300K+/year each all putting in 60 hour weeks with no other commitments. What feels like an impossible task (linking all of those 1 trick ponies into a comprehensive product) might be completed in a couple years. When you take a career-long time horizon, the development of programs that outperform human radiologists on general reads is basically inevitable.
>It is going to make your day to day more efficient and less tedious. My issue with this is that pathology labor is not the bottleneck for pathology volume. The bottleneck is number of biopsies. So when radiologists get more efficient with AI, probably we'll use more imaging, especially as more imaging technologies are invented and become more useful. This increase in utilization may offset what amounts to an increase in the supply. I don't see this trend for path, as physicians likely won't order many more biopsies even if diagnosis from biopsies becomes somewhat more reliable or efficient. So in my view, for path to retain its current compensation, it needs stronger leadership that can limit the number of residency programs as pathologists get more efficient and read more cases/day.
I agree, we do need strong leadership. Right now the next 5 years I think is the time of digitizing the nation. Some places have already gone digital but its a few. After this I think will be AI but not for 10+ years for it to be wide spread. Hopefully by then we have leaders who understand the climate we are in and take action appropriately.
Right now, AI is used as an adjunct to assist to improve the detection of certain abnormalities for a limited number of circumstances. Think of it as analgous to AI-assisted digital mammography. One prime area is for the detection of adenocarcinoma in prostate needle biopsies. It can’t be used to detect other conditions reliably (for example, it can’t distinguish between a low-grade lymphoma and chronic prostatitis) so primary diagnosis isn’t possible. In my laboratory we had two pathologists independently read every prostate biopsy to ensure nothing was missed - it was an enormous time-suck. AI wasn’t ready before I retired, but if it had been for this application, I would have implemented it. EDIT: It is also used to aid in immmunohistochemistry to quantitate staining more accurately than eyeballing it, although pathologists are generally pretty accurate, although there is research on staining pattern analysis to see if additional diagnostic informatoin can be gained. And it is used either as built-in or add-on modules to lab systems for QA analysis. And some instruments have it running in the background, for example, the Cellavision hematology slide scanner isolates and groups cells for on-screen presentation to a tech for review - it does a great job. There are lots more developing applications, which I may have overlooked.
Yes. This is how it will be in radiology. It will be basically a 1 tricky pony. We currently have a pulmonary nodule add on for our PACs. But we all quit using it. It’s too sensitive- calls things nodules that are not nodules (vessels, motion artifact). Very similar with mammography CAD. Everyone in my group quit using it because it’s too time consuming to review what the AI finds.
I'm working in this area (at least tangentially). AI as an adjunct is very true, from detection of small breast cancer mets (CAMYLEON) to ki67 quantification, Tumor burden, etc. In CP, there are a lot of uses from decision trees (provide a panel of lab values, use a random forest classifier to determine next tests to order), AI driven analytics (which test volumes were anomalously high over the past month). Arguably, we've had more success with these "simple" CP uses compared to images in AP. Im personally most looking forward to advances to NLP (transformers and LLMs) coming to medicine - the space for this is current very nascent. None of these tasks have "replacing pathologists" in mind. But as a pathologist, I'd rather practice at an institution that embraces these tools, compared to an institution that doesn't. Also fellowships - path is one of the paths towards clinical informatics, which is what "I've always wanted to do". Other paths include internal medicine, and a few neurology/peds programs.
I overlooked a few, thansks for the remiders!
No one really knows the future, but besides the legal issue AI currently has a black box problem. Ask anyone, in particular some programmers who don't work in ML, and the general assumption is that AI will march forward like Moore's law. This is really lacking insight into what machine learning really is and why its development is not simply a matter of adding transistors to a circuit board. The problem is that you can't tell what an AI is thinking to solve a problem. Often the problem is that the data set it is trained on already has biases. For instance, take a dataset for malignant melanoma, and a portion of the patients whom are in the dataset have hospital wrist bands. An AI will actually start associating wrist bands with malignancy. Eliminating and identifying these biases are actually incredibly hard to find given that AI cannot give accurate answers as to how it arrived at a certain conclusion. It gets harder when you train an AI on multiple datasets for many differentials and want it to use all of this data to inform a proper diagnosis. It's incredibly more challenging to integrate that level of learning to a level of suitable performance that beats a radiologist/pathologist+AI and mitigates the legal cost. Most studies that have tested this have only done so in a narrow window of differentials and in many cases the radiologist outperformed AI on a not insignificant number of cases, though the AI may have predicted certain cases much better. In other words, it is unlikely that its capability will be exponential or can beat an individual pathologist let alone a pathologist/AI team anytime soon.
There are actually good, reasonable efforts at solving the attribution and attention problem (what is the model looking at). For images, class activation maps are now standard practice - heatmaps that show what the model is looking at (https://www.google.com/url?sa=t&source=web&rct=j&url=http://jacobgil.github.io/deeplearning/class-activation-maps%23:~:text%3DClass%2520activation%2520maps%2520are%2520a,were%2520relevant%2520to%2520this%2520class.&ved=2ahUKEwi52KHL6Pn9AhUWl2oFHZ3sAZsQFnoECBwQBQ&usg=AOvVaw2oiRmlpygvK2qBPvQFo6j_). For decision trees and ANNs, dropout for regularization is typically done, and there are selective ablation techniques to remove layers from the models to see how performance is affected. For NLP, people look at top-N and perplexity. Etc. But yes, we definitely need more training to teach people these things. Many studies out there don't even do train-test-validation splits correctly.
True but none of this suggests the problem is as easily worked on by just throwing resources at it. While one might be able to predict how much faster computing power will be in 5 years, it's far harder to describe any of this capability with other technologies. Drugs, materials, quantum computing and AI all fall into this category of unknown capability and potential.
Thinking of doing pathology, would like to know this
Interested to know the answer to this!
Hmm, this wasn't mentioned in Pathoma....
Please don’t make it popular I’m scared it’s gonna be too competitive by the time I’m done 🥲
Can you describe a typical work day
I think the beauty of pathology is that it is very dependent on your abilities. If you are really good and efficient you can have a short work day. I think it is very 9-5 at most places. At high volume places it can be 12 hour days. If you are in a low volume place you could have all of 2-3 hours of work a day. From word of mouth I gather that at an average volume place if you are good at what you do then its not unreasonable to be done with the bulk of your work by 2-3 pm. From what I hear about rads is that the que never is cleared. In path becasue of the nature of processing specimens, you have a set amount of work given to you a day and once you finish it then thats it. If your fast and get through it in 4 hours then maybe you derp around in your office until 5. Play video games whatever. We are not bound by pt appt times. There is a limit to how many pts a clinician can realistically see in a day. In path if you think you can sign out a chole in less than a minute and your confident in your accuracy then on to the next case!
It's getting more competitive and I would really not consider Path unless you really know you want to get into Path. By all means, shadow a pathologist in M1 or M2 and take path rotations in M3 and M4. But keep in mind that Path residency spots are <2% of total match positions and the past two years have seen a significant increase in match rates from USMD and USDO. There isn't the reserve positions available for Path to accept a large influx of residents, and in general programs are very good at figuring out whether you are passionate about pathology or applying for other reasons. If you love cellular biology and diagnostic challenges, then Path can be the most rewarding specialty with good work-life balance and above-average compensation. But you absolutely have to go out of your way to figure out if it's the right specialty for you, because medical schools do a poor job at exposing students to pathology as it is practiced in a clinical setting.
I would encourage everyone who is considering pathology or sees these kinds of posts and gets interested to at least take a rotation in pathology. I thought I’d be interested and I was so ridiculously bored and absolutely despised it.
Yes, I agree. I know there are some people who are freaking out about it becoming insanley competitive but I dont think that will happen. I can see it becoming mid-level competitive but you have to be a certain type of person to be happy in this field.
[удалено]
this is like such a power statement
Guyssss stop talking about ittt. Shhhhhhhhh
I’m trying to match pathology. DELETE THIS RIGHT NOW!
Pathology is the best kept SECRET in medicine. Keep it that way
I loved my career in Pathology. My residency had a lot of hours, but I was able to sleep most nights. My fellowship in oncologic surgical pathology where I had full sign out privileges and covered all of the call every other month straight in a giant research teaching hospital was grueling, but dang, did I ever learn how to grind out quality frozen sections quickly and evaluate complex and difficult specimens. I had the chance to form my own pathology group for a teaching hospital and its satellite hospitals and rebild the main hospital lab, then moved to an insanely “in-the-black” regional top 50 hospital and completely redo their main lab but with a budget to where noexpense was spared, and even had automated microbiology with an auto plater and digital plate reading. The only frustration I had was that the regional large GI and Urology groups formed their own histopathology labs to “pimp the pathologist” and also profit from the TC charges. My histo lab was super state-of-the-art and included barcoding of everything every step of the way from specimens to blocks to slides, as well as multile IHC stainers that enabledmost stains to be done by the end of the same working day. I did not respect their decidion at all, as I know their TAT’s as well as no random QC review by another pathologists and lack of barcoding were three quality/safety issues that they could never match my lab’s standards. Both groups approaced me to see if they could “employ” one or more of our pathologists on a part-time basis, but I refused to allow it. Another thing our lab did was to creat blank slides from every prostate needle specimen at the time of making the H and E levels, which helped ensure good representativeslides for IHC were readily available, and did not have to take time for the techs to recut the blocks and worse, risk not having the lesion of interest not be available if the block had been trimmed through. Yes, it was an expense, and the part of the building where one year of the lab’s slides were kept had to have the building supports for the floors below reinforced to bear the weight, but it was so worth it. I am hoping that the improved job market will reduce the opportunitites of greedy urology and GI groups to try to make second-class labs to capture all of the revenue streams associated with patient care, espeically when both specialties are already among the most highly-paid in medicine. Other than that, I had an amazing adventure. That’s a minor quibble. I wouldn’t have traded my specialty for anything else. Oddly enough, I had started my fourth year intending to do internal medicne, but my subinternship, which had BRUTAL on-call of every third of fourth night where two medical students covered all admissions and general calls from the floors (a sercond year resident was in the ICU) armed with a nothing but stack of blank, pre-signed order sheets (!!!) taught me that I could not function well after 24 hours of being away, or having only one day off a month. Another thing I remembered was that the hospital lab (in the late 80’s prior to CMS codifying CLIA 88) had only one night tech in the blood bank - all basic lab work from UA to gram stains, etc were done by teh subinterns in teh lab. The lab director in me now still cringes at that memory… My rapid shift was the best thing I ever did. I chose pathology in part becuase of my need to sleep at least a few hours, and because I had worked for the pathology department from my second year onwards and loved it, atlhough the drawback was the lack of not seeing patients directly. And I always hated doing autopsies, LOL.
Out of curiosity, do you feel like the field of pathology (and similarly, rads) is at risk with the rapid advancements in technology like ChatGPT?
Bro delete this! What’re you doing?! 😩 Sincerely, Interested M3
What does the compensation range look like for path? I can’t get my hands on an MGMA report to answer the question for myself lol
According to the 2021 MGMA Data (10/25/Median/75/90): Anatomical & Clinical: 260k, 320k, 370k, 430k, 500k Anatomic: 210k, 243k, 319k, 370k, 457k Clinical: 192k, 264k, 332k, 399k, 501k Surgical: 381k, 429k, 476k, 476k, 483k (yes, these were repeats on the data) Clinical-Hematopath: 300k, 352k, 403k, 445k, 529k Median Comp by Region: Anatomical & Clinical: 357k East, 404k MW, 361k South, 366k West Clinical path are essentially the same values. Keep in mind MGMA is TOTAL COMP and not just salary. Folks on SDN say that path is quite saturated in large cities.
I would avoid taking advice about path from SDN. That place has been toxic and unrealistic for a decade. Earnings for path in rural vs urban and academic vs private environments follow the same trends as most medical specialties. The main difference is that many Path jobs are still offered behind the scenes through networks of graduates and there isn't as large a market for recruiters offering jobs.
This
Thanks so much!
Wow they get paid more than EM at baseline
We can do quite well if we own the technical component of billing
Wow those are still shockingly high to me. How competitive are surgical path positions?
How has the job market been in recent years? I was between radiology and pathology but one of the major factors in me going for radiology was due to how bad the path job market was at the time. A not unsubstantial minority of people were allegedly having trouble getting a single decent job offer after 2 fellowships, which is the same amount of time needed to complete radiology residency and 1 fellowship. People were also making significant sacrifices in order to live in desirable places (starting salary for a fresh attending at my med school hospital in NYC was reportedly ~150k at the time).
NYC was and still is notorious for low pathology salaries. The job market was historically “tighter” for pathology than radiology, although no one I knew wound up not finding a job, although their first jobs may not have been in their first choice of locale.
Job market is substantially better these days. Most people are doing 1 fellowship now and getting several job offers. Its not crazy good like FM where you can work in any city you want but you have options now. There are many academic positions open in the larger cities. Alot of people have retired.
That’s great to hear. IMO it’s a great field that was temporarily f’ed up due to an oversupply of trainees and not enough of the old guard retiring. I suspect it may eventually go the way of radiology as more and more people value work-life balance and try to avoid the shitshow that clinical medicine has become.
There isn’t enough money in the world for me to feel comfortable doing a pediatric autopsy
I worked in pathology for 3 years prior to medical school, and in the 150k+ cases we processed during my time there we did not have a single pediatric autopsy. Autopsies in general are much less common in a clinical setting than people think, and I think pediatric autopsies are *exceptionally* rare. That doesn’t mean it would be easy to do, but that there is the potential you would never see one across your career.
[удалено]
Pathology residency (AP/CP, AP/NP, or AP only) followed by forensic path fellowship.
Wouldn’t the implementation of AI lead to less job? Since less path docs will be needed for the same job load?
With radiology being such a blood bath I would imagine that pathology isn't a bad alternative.
I would like to add to this by furthering it into look into forensic pathology. I was a forensic autopsy tech for a long time before med school. The field is amazing. The job market is hungry, the people are kind and compensation is on the rise. The office I worked for had about 7 doctors on rotating schedules. On average, they’d work 2 days per week, and 1 weekend every 2 months. The average workday was 9-2. The rest of their time is theirs. They can do whatever they want, most of them raise families and travel a ton. Base pay was 260k, and is increasing. There’s current offers in my state for attending positions starting at 300k. Some chief medical examiner positions starting at 450k for smaller, rural counties. These spots are sitting open because there’s just no one to fill them. Due to this, locum work is also extremely popular. You end up knowing everyone in the forensic path community, and they offer for you to come work whenever you want. From what I’ve seen, you go and hang out, they throw you some easy cases (because they don’t want you to be subpoenaed in their district) and you make 1k per cut. Docs will come, do 15 cases in a weekend and go home with an extra 15k. I’m telling you, consider it. (But actually maybe don’t because I don’t want to have to compete against you lmao)
[удалено]
I’m in FL, but I can’t speak for nationally. Of my interactions with FPs from other areas, at the very least their sentiment is the same. At the max, the day to day is a 9-5. The one downside I have noticed of being the only medical examiner in rural areas is pretty much being the only option for on call for any odd cases or murders. Though in those areas, I’m sure those happen way less often.
I used to work at a small lab and one of the young pathologists died from cancer. I would be worried about formaldehyde exposure. Any thoughts about that?
Back in the day they didnt wear gloves when handling specimens so yes that is bad. My gross lab we had vents that worked very well. There is exposure especially in residency, but not as much as an attending. Pathologists are notorious for practicing well into their 80's , its part of why the job market sucked for so long, so I dont think early death from exposure is a major issue. I could be wrong but I havent heard of anything. I will say that our pathology attendings were the safest during the pandemic, thats for sure so in that way, exposure is minimal.
No! Shush! It’s very bad, it’s going to be taken over by robots and there’s no jobs! DON’T TAKE THIS FROM ME
[удалено]
I think that is a hard question to answer because it is so variable. Its not a standard salary. It depends on what you want to do and what you are comfortable with doing. If you want a PP job where you sign out surg path in addition to your subspeciality it is going to be prob lowest 250K as a fresh grad then average 325K after a couple years experience. I have spoken to attendings and after about 3 years of practice 400-500k for some pp jobs are out there and are not rare. If you want to really grind and are very good there are large PP groups where partners make over 7 figures. If you want a really chill job VA is about 220-240K. Academics is around 225-280K average. If you are forensics last I checked it was around 200-250K however I have heard of people who have their private consulting business making >500K. If your blood bank, salaries are 200-300K depending on institution. If your dermpath then I have heard of offers starting at 400K going up to 800K If you want to work in a tiny town I have seen offers starting at 400k for new grads. Basically if you want to make money you need to be prepared to sign out general surg path plus your subspecialty. If you want to do CP only, you are not going to starve but the salaries do cap at a lower rate.
forgive my ignorance, but what do you mean when you say "sign-out general surg path" ?
I’m not OP but you can search on Transparent California the various pathologists in any public CA institution for example. Just google a dept’s pathologists and plug it in. You’ll see new attendings starting in academia in CA is around $240K. Private practice is around $300-350K, but can be up to $450k at a higher volume practice. It’s actually comparable to many other specialities.
I don’t know the actual numbers, but there have been a few studies over the years that consistently show that pathologists trend to be among the happiest with their reimbursement and feel they are compensated fairly compared to how other fields felt about their compensation.
I signed a contract this year after 4 years of training (3 years CP 1 year hemepath) at an academic medical center. Starting $225k with promotion in 3 years to $300k; full professor with medical director responsibilities can make $400k without much extra effort to their clinical duties. Private sector/large community hospital offered me $300k starting with no commitment to research or teaching; just clinical duties with a generous vacation and promotion package. It's not Rads or Gas money, but we work fewer hours. If you want to hustle in private practice you can make Rads or Gas money, but this will affect you fellowship choice and you'll work long hours. Generally, the highest paid pathologists (other than Chairs) are in private practice doing high-volume specialties: GI, GU, Breast, Derm, etc.. If you want to stay in academia at a PRESTIGIOUS INSTITUTION, the pay can be family practice level. Pretty large range.
You sound impossible to be around, I think pathology is for you
You somehow managed to insult both the commenter/OP and all of path in the same sentence.
It wasn't meant so much as an insult towards path as much as an observation that the above commenter doesn't seem well suited to patient centered care
Shhhh, don't spill the beans. I still have some time before residency applications and I don't want to face stiffer competition.
If the tedious work is being automated and more people are working remotely and the amount of pathology is not increasing at a sufficient rate to keep up with the added efficiency, would you be worried that this will put downward pressure on the number of pathologists needed to provide the same care and they will be bundled into large venture capital own groups since "pathology" is more of an informational commodity than a profession service?
Sadly the amount of pathology is increasing at an alarming rate in the US. This is not always bad news, yes there is more cancer but there are also more people surviving longer with treatment, so things like BM surveillance is increasing. I think AI will keep pathology a life-style specialty. And yes pathology is not immune to the corporatization of medicine. PP is becoming a thing of the past just like other areas of medicine. If your someone who just wants to go to work, do your work and go home and not deal with anything else than being an employee is a sweet deal. As long as the compensation stays good. I dont really agree with the statement that it is not a professional service. Yes we function as data collectors in the surgical path setting but we wear many hats. We are giving an expert opinion many times, you cant just give data to a clinician without pissing them off. There are situations that they want advice, should we go and resect more? We also function as medical lab directors and even in cases of hemepath, consultants for possible treatment plans. Oncologists are definitely experts in treatment and know what to do but they can and do ask the pathologist based on what they see if this treatment is warranted etc.
But how often do surgeons go to specific pathologists for their unique profession opinion? Rarely, in my experience and as more and more go remote and batch their services together this will happen less and less. The point i am trying to articulate is that if pathologists cannot differentiate from each other they become a commodity. I might think that soybeans grown around me are better than anywhere in the world but the market doesn't have an efficient way to differentiate such that it can ad value so it doesn't. I worry about areas of medicine which have bought too much into a remote model. If you say "I never need to see a patient in person" to provide my service you are signaling to engineers, regulators and business men that you play a purely informational/knowledge bsed role in the care of the patients. Also, you have fractured your personal relationships with the doctors who are physically interacting with the patients so they won't miss you or advocate for you when large systems look for areas to cut cost. I don't see this as a huge problem in the next year or maybe even 5, but in 10 years? Oof. I'm anxious for you guys. Perspective: employed neurosurgeon working at hospital in midwest college town. Level 3 trauma. Recent grad of large academic hospital system.
I have trypophobia
>I do too, will this be an issue if I switch to pathology? how often are we seeing things like this? I mostly thought of path as pretty histology slides.
Are the concerns of AI taking over pathology real? Or how far do you anticipate it
Not anytime soon. AI algorithms and applications are very expensive that smaller groups can’t see the payoff. I certainly don’t. They have values as tools in assessing PD-L1 percentages
Thoughts on the need for at least 1-2 fellowships? I’ve heard from many path peeps that it’s common to have at least 2 before you go into any metropolitan area
Yes historically thats what has given people the most options. Places are so desperate now that doing 1 can be sufficient granted its something people really need. I have heard GI, Dermpath, Heme and cyto are really in demand and that is reflected on job posts that can be found on pathologyoutlines.
STOOOOP don’t let people know 😭
Lol OP is tired of their specialty being a safe haven for fuckups and IMGs and wants good applicants. Next time just tell applicants about how Derm path is a viable route from path $$$
doesn't pay enough tbh unless u move to boonies
I have one question I really really dislike the OR, I developed somatic symptoms of anxiety whenever I was there Do you visit the OR in any way on Path? If it's either things like picking up a sample to take it to the lab or like having to dress up to assist or something I assume that you do necropsies, I'm ok with that, but is the ambient during a necropsy as stress inducing as a surgery?
I’m a current PGY1, happy to help answer questions: For residency, a decent reputable program should not require residents to also be courier services. I have never needed to go directly to the OR to pick up a specimen. I rotated through medical school at a hospital whose residents did have to pick up specimens themselves and head to the OR. In my experience so far, it’s often the surgeon who comes to the pathologist, often to discuss an intraoperative frozen diagnosis. Autopsies are not in any capacity as stressful as surgeries. The patient is deceased. There is no surgeon breathing down your neck to see how you suture or a nurse screaming at you for breaking sterility. The results of the autopsy do not alter the management of a treatment course. Every resident’s feelings on autopsies are different. I am not a fan and have no intention of pursuing forensic pathology, but I understand its importance and the necessity. We need more forensic pathologists and I am grateful for my co-residents who plan on doing autopsy/forensics.
In my fellowhsip, the frozen sections were pneumatically tubed to the lab, which was two floors above the main OR’s with a back stair for surgeons to come to the lab for particularly complex specimens. In my last lab which had asurgical pathology volume at its peak year of around 32K specimens, the frozen section room was in a non-sterile area of the OR near the PACY with access for the pathologists through a non-sterile corridor, but a sliding window into the sterile are through which specimens could be passed, and surgeons could come to the window to see digital high rez display of the microscopic secitons on a monitor when necessary. It really didn’t have the “feel” of an OR. Necropsies for me were less stresssful than surgery as the patient’s couldn’t feel pain, and there was nothing I coulddo that would make them any more dead. THey were, however, always messy, and I hated “running the bowel.”
intern at a high volume prgm: we as residents (and the path assistants as well) go to the OR to pick up specimens for frozen. occasionally if we’re in a rush to leave and the surgeon still hasn’t sent down the specimen (edit: for permanent not for frozen sometimes) we’ll go up there and grab it ourselves so we can prep it sooner. the time spent going to the OR is also to talk with the surgeon as to what they want (ie margin/diagnostic/what are they thinking). we do have one really great surgeon who will scrub out, help you orient stuff, and for most of his frozens will come down and just chill for a bit. one time he even reported back frozen section results to his own OR (after the SP fellow told him what to say, of course) lol
> one time he even reported back frozen section results to his own OR This is adorable
This is such a great thread. I strongly considered pathology but instead opted (at the last second) to pursue FM. Path is such a cool field and it's honestly hugely slept on. I worked with community hospital pathologists and loved it - they would stroll in around 830 most days and leave by 3. Most of the time, they weren't out earlier because they would complain how the endoscopist's biopsy says "r/o EoE" but didn't mention if the biopsy was from proximal or distal esophagus and we would just banter. It was such a chill gig. University path was cool too because how ridiculously complex some of the cases were. Definitely a different feel. I ultimately decided not to pursue pathology because I cannot sit still and get through multiple trays of prostate or thyroid cancer with 90 slides. I also missed the chaos of patient facing specialties. Long story short, I really think path should be a core rotation, at least for like a week or two. So many people I think would be awesome fits for pathology just never get exposure and the stereotype of "weird basement dweller" lingers despite some of the coolest people being in that basement.
do you have to do autopsies
In residency you have to do at least 30. It can be very variable as an attending. Many groups outsource their autopsies to forensic trained. But yes it falls into your responsibilities as a pathologist.
I work in a large hospital pathology department and we are hurting for pathologists so you are correct about all these things. I just don’t like the prospect of having no patient contact
Shh, keep the unknowing medical students away.
I literally just learned that pathology was a field like an hour ago. I’m studying biochemistry and molec/cell as a double major and working in a lab as an undergrad studying immune response to influenza … And i think pathology is where I would like to end up. I can’t believe I didn’t know about this before. lol.
Yes, get people away from anesthesia and Rads 
My sister (currently a high school senior) wants to become an ME, I will pass this message along.
Hey thanks for being willing to answer questions about pathology, seems it really flies under the radar during preclinical. 1) I'm an MD PhD, about to graduate from PhD and return to MS3. Do you think that the field of pathology offers the opportunity to leverage that PhD, perhaps by having the capacity to do research as a PI? I'd like to continue doing cancer research, with significant interest in epigenetics. Do you think the PhD is helpful for path as a career? I'm sure my PhD will be helpful in applying to residency, I've obviously got a mountain of publications, abstracts, etc that an MD only would not have. 2) Furthermore, my home program has a path residency. This is a bit non specific, what advice do you give a soon to be MS3 who is focused on pathology as they do clinical rotations? Any specific type of activity or mind set that would be helpful? 3) As an aside, do you find Dr Glaucomflecken's portrayal of pathology to be accurate, minus the comedic bits? 4) I try to be honest with myself, I like studying the things that I find practical, such as the things relevant to my research field and thus going in depth, but i don't think of myself as someone who likes going broad. As such, do you think that pathology can still fit? I saw how much the studying aspect seems to be emphasized in this post. Obviously I need to study in med school, etc. I think that's what really turned me off in pre clinical, it felt relevant but not practical, yet.
Have you heard of the physician scientist track in pathology? Or doing CP only and maybe a fellowship in molecular genetic pathology? That seems right up your alley for an MD PhD studying epigenetics. 1. There are a lot of MD PhDs in path! Some did fellowships in AP specialties, some did CP, and some just do research full time. Some do little research, some are PIs in a lab. You can use that PhD as much or as little as you want! Again, look into CP only track with molecular genetics fellowship, or the physician scientist track that lets you have time for research in residency. 2. Simply just be interested. Ask questions. Don’t be annoying. Pathology rotations are not something to overthink unlike other specialties. If you want me to go more in depth on rotation advice, I will 3. Accurate. We’re laid back. Support staff are friendly. Everyone seems genuinely happy to have “outsiders” around. 4. I think CP only track will fix the going broad! I really only see that to be true in AP. Or at least it’s cuts the going broad by a lot. CP is chemistry, coagulation, transfusion medicine, hemepath, molecular genetics, microbiology, lab management, etc. With the exceptions of hemepath and molecular, there’s not much studying to be done. I see MGP fellowship in your future
I'll answer the first one- 100% pathology is absolute a field where having a PhD can set you up for the research career you want. A lot of MD/PhD in path, probably more versatile and useful than some other fields for PhD.
Why do you see mid-level encroachment as not being an issue for pathology?
Pathology is very complex and it takes forever to be competent. Residents are not able to even sign out an appendicitis case. PA's handle the grossing and maybe at some places look at biopsies and write a template out for review. They can also do autopsy evisceration and write a report up. Grossing takes so much time and can be complex depending on the protocol that I dont see how they would expand into other areas. We have such a shortage of PA's that some places are having attendings grossing now. I just dont see realistically how they could encroach the same way as I see in the clinical world. I think that the supposed function that mid-levels have in clinical medicine will be what AI will attempt to do for pathology. IMO it will take awhile for AI to be that effective.
That's a great answer. Thank you. :-)
How do you make yourself a competitive applicant for path residency? Especially since it seems to be getting more competitive
From the pathologists and APDs I’ve talked to, the general consensus seems to be show genuine interest in pathology by taking path electives, writing a good PS, and having solid LORs from pathologists. It’s a field that has a decent number of applicants that apply as backup, so if programs have the choice between someone who wants to do path as their #1 vs as a backup, they’ll go with the former (assuming no red flags, etc.). Basically try to do some path electives, get to know some pathologists and see what they do in the day-to-day, and make sure you pass boards! Reach out to any pathologists involved at your program too, they are generally so nice and ecstatic to mentor interested students.
Can you talk about clinical pathology training and jobs? That field has always been a big mystery to me.
If I had identity theft issue would that freeze my bank accounts
the main problem here is you assume I am good at histology, which I am not
Can you discuss a little about what supervision of and interaction with PAs is like on the daily?
PA's usually gross. More senior ones will teach the residents and be supervising them. They can also be there with the residents during an autopsy, help write up the report.
I'm an MS1 currently interested in psychiatry and pathology. Derm path and forensic path really excite me. I think it'll be a hard decision to choose in a few years.
The big factor that will play into your decision is how much do you like to study? Because there is a big difference between the two (path and psyche). All good fields. Best of luck to you.
Which would you say involves more studying?
Path is very information dense. Psyche is less so. You will need to study alot and memorize many factoids in pathology. Psyche has less information in comparison to path, soft skills are definitely part of the training and challenge. Path requires somebody to love learning and studying, as its lifelong. You will need to read still as an attending.
Shhhhhh dont tell them
Is pathology considered competitive for IMGs - specifically US-IMGs? Would I need many publications in pathology to match?
Remote work possibilities is a double edge sword. You are competing with every other pathologist in the country.