Medical Genetic vs Anatomical Pathology ?

[Ditu]

Hi there,

 

I'm 3th year med student and I'm interested in molecular and lab medicine.

 

Could someone please give me some comparison between MG and AP in term of lifestyle, income, job market and especially recidency safe !

 

I appreciate your comment !

 

Ditu

[thebouque]

2 of Brooksbane's favorite specialties. They're 2 extremely different fields and I've done rotations in both. I'm a path resident.

 

Of course, genetics is A LOT more clinically oriented than path. The clinical portion of genetics deals with metabolism and dysmorphology and reminded me of pediatrics. You also have prenatal consults and cancer genetics (BRCA counselling/testing etc). There's a lab portion but you need extra training to be able to work in a genetics lab. There are many kinds of ''genetics'' labs, and tests tend to be centralized, so what you'll do as a lab geneticist will vary a lot depending on where you work. That being said, you have metabolism labs (amino acids etc), cytogenetics labs (CGH, karyotypes, probably the most common type of lab) and the newer molecular labs (microarrays, westerns, PCR, new gen sequencing eventually etc). There's a bit of overlap between path and genetics in molecular, but usually, path takes care of solid tumours. Once again, who can do what varies a lot from institution to institution. There are almost always phds and an army of techs working in those labs and the MDs (geneticists or path) usually do some quality control stuff and validate the studies.

 

Path is not clinical, and you spend most of your time at the scope. Pathologists used to gross a lot (surgical specimens dissection) and did a lot of autopsies. Nowadays, autopsies make up less than 5% of most path practices and pathologist rarely ever gross (path assistants and residents do most of the grossing unless they're in remote locations). However, there are still a few urban hospitals where pathologists gross themselves but they're getting rare. Bottom line: if you really dislike microscopy, avoid path like plague, but you should try it first, it's very different from your 1st-2nd year histology couse. Simply liking the fact of knowing about pathophysiology or the ''science behind medicine'' is not enough to enjoy path, you really need to have the time of your life when you're behind a microscope.

 

lifestyle: should be great in both specialties. In path it's 8-5/6, call is almost non existent

income: 300-400k for path

job market: in Quebec the job great for both specialties, there's a big shortage of both. I don't know for the rest of Canada. I think it's not so good for path

recidency safe: we don't have safes in our residency like in hotels. However, I can lock the drawer on my desk.

[Ditu]

Are you the 3th lord?

 

"Are you the 3th lord ?" for you I am

 

I read some of your posts, I found that your pitch looks like The Lord One ???

 

Anyway thanks for your very first comment !

[Ditu]

2 of Brooksbane's favorite specialties. They're 2 extremely different fields and I've done rotations in both. I'm a path resident.

 

Of course, genetics is A LOT more clinically oriented than path. The clinical portion of genetics deals with metabolism and dysmorphology and reminded me of pediatrics. You also have prenatal consults and cancer genetics (BRCA counselling/testing etc). There's a lab portion but you need extra training to be able to work in a genetics lab. There are many kinds of ''genetics'' labs, and tests tend to be centralized, so what you'll do as a lab geneticist will vary a lot depending on where you work. That being said, you have metabolism labs (amino acids etc), cytogenetics labs (CGH, karyotypes, probably the most common type of lab) and the newer molecular labs (microarrays, westerns, PCR, new gen sequencing eventually etc). There's a bit of overlap between path and genetics in molecular, but usually, path takes care of solid tumours. Once again, who can do what varies a lot from institution to institution. There are almost always phds and an army of techs working in those labs and the MDs (geneticists or path) usually do some quality control stuff and validate the studies.

 

Path is not clinical, and you spend most of your time at the scope. Pathologists used to gross a lot (surgical specimens dissection) and did a lot of autopsies. Nowadays, autopsies make up less than 5% of most path practices and pathologist rarely ever gross (path assistants and residents do most of the grossing unless they're in remote locations). However, there are still a few urban hospitals where pathologists gross themselves but they're getting rare. Bottom line: if you really dislike microscopy, avoid path like plague, but you should try it first, it's very different from your 1st-2nd year histology couse. Simply liking the fact of knowing about pathophysiology or the ''science behind medicine'' is not enough to enjoy path, you really need to have the time of your life when you're behind a microscope.

 

lifestyle: should be great in both specialties. In path it's 8-5/6, call is almost non existent

income: 300-400k for path

job market: in Quebec the job great for both specialties, there's a big shortage of both. I don't know for the rest of Canada. I think it's not so good for path

recidency safe: we don't have safes in our residency like in hotels. However, I can lock the drawer on my desk.

 

Many thanks Thebouque for your great descriptions of these both specialities ! I will try to have an electives next years.

 

It seems that the MG income in Ontario is around 150 K, I mean it is quite disappointing for speciality that need 6-7 year of residency training with a ton of debt ! It is the same for Quebec ? Montreal is great town !

 

Thanks again !

 

Ditu

[Ditu]

Dude, I don't mean to be a jackass, but your English is pretty bad. You should work on improving that before tackling a residency.

I don't think that my bad English hurts anyone when people can understand what I want to say; but on the other hand, an arrogant attitude could do that.

[Ditu]

I was trying to help man. Communication is very important and its crucial that you can get your points across correctly. You've made a few errors in your posts that are nonsensical and would damage your credibility to residency program directors and on residency interviews.

 

You could take my advice and improve your English, or you could just not listen and see what happens.

Thanks Brooksbane ! That make sense your advice.

[fan_med]

2 of Brooksbane's favorite specialties. They're 2 extremely different fields and I've done rotations in both. I'm a path resident.

 

Of course, genetics is A LOT more clinically oriented than path. The clinical portion of genetics deals with metabolism and dysmorphology and reminded me of pediatrics. You also have prenatal consults and cancer genetics (BRCA counselling/testing etc). There's a lab portion but you need extra training to be able to work in a genetics lab. There are many kinds of ''genetics'' labs, and tests tend to be centralized, so what you'll do as a lab geneticist will vary a lot depending on where you work. That being said, you have metabolism labs (amino acids etc), cytogenetics labs (CGH, karyotypes, probably the most common type of lab) and the newer molecular labs (microarrays, westerns, PCR, new gen sequencing eventually etc). There's a bit of overlap between path and genetics in molecular, but usually, path takes care of solid tumours. Once again, who can do what varies a lot from institution to institution. There are almost always phds and an army of techs working in those labs and the MDs (geneticists or path) usually do some quality control stuff and validate the studies.

 

.

 

Hello Thebouque,

 

I'm just curious about the utility of new and fascinated cytogenetic/molecular analysis in Path.

 

Does molecular analysis in Path or MG arms just to personalize cancer cell or we can also use that to diagnose the the malign cell ? How do you see the future of these new technology in medicine ?

 

Thanks !!!

 

F_M

[thebouque]

Hello Thebouque,

 

I'm just curious about the utility of new and fascinated cytogenetic/molecular analysis in Path.

 

Does molecular analysis in Path or MG arms just to personalize cancer cell or we can also use that to diagnose the the malign cell ? How do you see the future of these new technology in medicine ?

 

Thanks !!!

 

F_M

 

Hey

 

I don't know what rotations you've done so far but I can give you a few examples. The main purpose of molecular testing is to be able to choose a specific treatment, but it can also be used as a diagnosis tool, albeit more rarely.

 

HER2 overexpression in breast cancer is detected via immunohistochem (not molecular), but often a FISH is needed for confirmation. If HER2 comes back overexpressed you can use herceptin (anti tyrosine kinase).

 

The same logic applies to BRAF in melanoma, bcr alb and gleevec in CML/ALL, etc.

 

''Does molecular analysis in Path or MG arms just to personalize cancer cell or we can also use that to diagnose the the malign cell ''

 

I'm not sure what the 1st part of the sentence means. As to the 2nd part, aneuploidy can help in the detection of ''malignant cells'' but the quickest, cheapest and most accurate way to detect cancer is still the good old H&E stain. Aneuploidy studies aren't reliable on their own and aren't routinely used clinically, even for early cancer detection such as esophageal adk over a barrett. HPV DNA testing by PCR will probably replace most pap tests in the near future, but it won't ''diagnose the malign cell'' per se.

 

''How do you see the future of these new technology in medicine ?''

 

One word: overhyped. Yes, gleevec and herceptin were 2 major revolutions in medicine, but they're far from new discoveries. Otherwise, most ''personalized medications'' you give to patients whose tumors have certain mutations only add a few weeks to months to their life and cost dozen thousands dollars. Are they worth it? It's debatable, and the ethical considerations are huge.

 

If you're interested, read up on the EGFR and ALK testing for patients with lung adenocarcinoma. It used to be done for people with stage 4 disease only (metastatic), but now the test is performed for with every new dx of lung adk. It's a hot topic currently in the world of personalized medicine and molecular pathology.

 

But keep in mind that it always sounds fancy, especially for fund raising purposes, to talk about how great ''molecular medicine'' or ''personalized medicine'' is. You're a doctor and you have to use your judgement. Finally, as I told the other poster, make sure you enjoy H&E slides if you want to go into path, because if all you like are the advances in molecular medicine (I'm not saying it's necessarily your case), you could be very disappointed.

[fan_med]

Hey

 

 

One word: overhyped. Yes, gleevec and herceptin were 2 major revolutions in medicine, but they're far from new discoveries. Otherwise, most ''personalized medications'' you give to patients whose tumors have certain mutations only add a few weeks to months to their life and cost dozen thousands dollars. Are they worth it? It's debatable, and the ethical considerations are huge.

 

 

Thanks for giving me the real picture of molecular pathology, I agree with your point of view !

 

I'm thinking to do a second residency and back to work in Quebec, I'm quite interested in Hem path, AP and medical genetic. At that point I'm not sure I can spent most of my time at the scope (Sorry for that ! ), seeing patient is still funny job for me. Hem Path is not exist in Quebec, right ? So the last option is MG, do you have any comment on MG as career ?

 

F_M

[thebouque]

Thanks for giving me the real picture of molecular pathology, I agree with your point of view !

 

I'm thinking to do a second residency and back to work in Quebec, I'm quite interested in Hem path, AP and medical genetic. At that point I'm not sure I can spent most of my time at the scope (Sorry for that ! ), seeing patient is still funny job for me. Hem Path is not exist in Quebec, right ? So the last option is MG, do you have any comment on MG as career ?

 

F_M

 

Heme path does not exist in Qc. If you don't see yourself spending most of your time at the scope (even though you're saying you're quite interested in AP), pathology would probably be a terrible mistake.

 

The MG lab is very technical and phdish, like clinical path. You don't interpret much, it's mostly quality control. The clinical part is a mix of counselling and paediatrics, more or less. Still a fascinating field, but definitely not for me.

 

Good luck