General Pathology Questions

[CGreens]

A few questions about general pathology. During MS1 I was able to shadow a few anatomical pathologists and surprisingly enjoyed what I observed, so I am now considering pathology as a specialty. However, I do not want to work in an academic hospital, nor live in a major city (Toronto, Vancouver, etc). My understanding is that general pathology is better for community pathologists (especially outside of Ontario). I understand what the anatomic pathology side of general pathology entails, and the tasks associated with it from my shadowing.  I also know theoretically that the CP side of pathology entails hematological pathology, medical microbiology, and medical biochemistry. What I don't know is, what does the clinical pathology side of general pathology actually look like day to day? Note that I am asking this question for a setting where you would use these skills to some extent, not a setting where 99% of your tasks are anatomic pathology. I guess this raises the question, in how many GP jobs do you actually get to use those general pathology skills you acquire during residency? Due to COVID my opportunities to shadow are non-existent! 

In addition, do you feel that GP would be anymore insulated from advances in molecular biology/AI that may affect the job market compared to AP? Because general pathologists are involved in more than just AP, do they have more interaction with clinicians compared to AP? Will GPs practicing in a community hospital have transfusion medicine responsibilities? And I have heard that in Ontario that there is a push by pathologists to return to some sort of FFS or non-employeed state, anyone know anything about this - I am interested in the business side of medicine but I know that this is a bit limited for pathology currently, any changes on the horizon (physician autonomy is important to me!)? 

Thank you for any responses, I appreciate your thoughts during COVID where our opportunities for physician interactions are more limited!

[1D7]

On 10/26/2020 at 1:11 PM, CGreens said:

And I have heard that in Ontario that there is a push by pathologists to return to some sort of FFS or non-employeed state, anyone know anything about this - I am interested in the business side of medicine but I know that this is a bit limited for pathology currently, any changes on the horizon (physician autonomy is important to me!)?

I'm not a pathologist but once autonomy has been lost, it is very hard to regain.

[Findanus]

Ontario is a very negative environment for pathologists.

 

Pathologists are paid primarily through hospital budgets, which means there is a set of hands that takes money before it reaches the pathologists. The goal of the hospitals is to reduce costs. Here is how they do it:

Most of the positions are associated with university health centers, which puts them in the category of 'educational institutions'. 

An option that is frequently exercised by these institutions is to hire foreign trained unlicensed pathologists under an 'institutional/educational' license. These pathologists are beholden to the institution that hires them. This is how remote sites can keep full rosters despite having poor pay and isolated living conditions, and how volumes can go up without hiring more people or paying them appropriately. Much like temporary foreign workers at Tim Hortons, they can't change jobs, which makes them easy to exploit. None want to be the one that speaks up about the poor conditions because they rightly fear being replaced.

[CGreens]

Hoping that we can keep this thread on topic regarding my specific questions pertaining to the job duties of a general pathologist. While I appreciate the openness of hearing  about the non-ideal pathology job market, this discussion often emphasizes the academic job market, anatomical pathology, and IMG candidates. It has been thoroughly covered in other threads, and I’m hoping we can learn something new that hasn’t been discussed before in this forum on this thread. 

I’m hoping to learn about the GP role in community hospitals, not in the large city, academic centres, and CMG candidates.

[liszt]

So I am not a gen path, but I work with some GPs. The mix and how it's divvied up will vary depending on whether you're at a community hospital in a city, or at a hospital in a smaller community.

From what I see, they truly do a bit of everything. Some surg path, some hemepath (blood films, the occasional marrow, and maybe marrow procurement depending on how that procedure is delegated), some transfusion... I assume potentially some micro and chemistry as well, but I have minimal exposure to that side of their skillset. You will likely have the ability to tailor your practice to your interests and competencies. A significant difference from AP will be that GPs have a huge lab oversight component. Especially in smaller communities, you will be the medical decision-making authority for your lab - you will help oversee operations, troubleshooting,  and field technical questions. I'm always extremely impressed with the quality and lab management skills out GP residents have upon graduation.

If you are interested in learning more from a direct source, feel free to DM me, and I can put you in touch with some wonderful general pathologists who I am proud to call my colleagues.