Radiology vs Pathology Lifestyle After Residency

[Mar50]

I'm curious about everyone's thoughts on this. Which specialty has the better lifestyle after residency, and why?

[offmychestplease]

-

[rmorelan]

10 hours ago, offmychestplease said:

Pathology x100

that make me chuckle

the why? very few emergency pathology requests to start with vs all the time. it is harder to disrupt the workflow to cause you to stay later in path compared to rads. Also the shear volume of radiology is quite high, and often other services require quite rapid turn around times. It is also cultural to a degree I think (rads is fee for service, path is often salary for instance). 

Not to say there aren't busy pathologists ha. This is all just relative. 

 

[offmychestplease]

-

[hero147]

1 hour ago, offmychestplease said:

not sure you understood what I said. I think we are in agreement. I said path is 100x better lifestyle than rads. 

I don't think he's disagreeing with you

[offmychestplease]

-

[csmphMD]

I think it's hard to say which has better lifestyle (because it probably partially depends how much you like the job how you view slightly longer hours).

I recently listened to this podcast episode: https://northernexposurepodcast.ca/podcast/20-academic-gynecologic-pathology-dr-mary-kinloch/. They ask about her day-to-day work and hour around halfway through.

I'm less interested in rads, so haven't sought out resources the same way and don't have comments on it. Path seems hard to beat, lifestyle-wise.

[liszt]

It depends what a good lifestyle means to you. 

A full time pathologist will generally make less money than a full time radiologist.  But, as a pathologist, my work hours are much more regular/reasonable compared to my friends who are radiologists (though i can't speak to how radiologist work varies between different practice settings).

[canada747]

I've never heard this comparison before, even though both are clearly not patient-facing specialties. Most people either love or hate path, but when you think about it... rads is just electric/digital path. Still, path isn't a ROAD specialty while Rads is.

[1D7]

5 hours ago, canada747 said:

I've never heard this comparison before, even though both are clearly not patient-facing specialties. Most people either love or hate path, but when you think about it... rads is just electric/digital path. Still, path isn't a ROAD specialty while Rads is.

They're very different specialties in most aspects except for direct patient contact... your comparison is like saying psychiatry is basically the same as cardiology just because you see patients in both. "ROAD" is an artificial acronym... you will still be taking busy call in anesthesia and radiology.

To go back to OP, the very fundamentals of radiology include emergency care. Trauma, stroke, bowel ischemia, and many other acute diseases are regularly dealt with in radiology and as such the call work is busy. In pathology you'll be called in late to look at frozen sections a few times per year, if that. The day work for radiology still resembles 'regular hours', especially in comparison to medical/surgical counterparts. 

TBH If we're talking full-time work, I doubt any specialty can really beat pathology in lifestyle except maybe some of the outpatient-only specialties.

[rmorelan]

7 hours ago, canada747 said:

I've never heard this comparison before, even though both are clearly not patient-facing specialties. Most people either love or hate path, but when you think about it... rads is just electric/digital path. Still, path isn't a ROAD specialty while Rads is.

ha, yeah I would question radiology position on the ROAD specialty list. Most of us would say its inclusion is from an earlier time period. it is still a higher paying specialty but I always want to avoid the notion that you don't have to work for it. The modern call requirements - particularly in the community setting are quite intense. 

Plus even academically there are now a lot of shifts that extend well into the evenings, plus weekend call. For instance at my centre that is weekend call of around 1 in 4 for many, and busier call but 1:7 for others. This is ignoring people in IR, neuro IR, or emerg radiology who of course work vastly more hours at times others would consider less civilized. 

 

[Snowmen]

During clerkship, I was in the OR in the middle of the night for organ harvesting before donation and the liver looked like it was cirrhotic. We asked the on-call pathologist if he could check liver biopsies to see if it was viable. He asked if it could wait until tomorrow.

I guess that gives you a clue about the lifestyle in pathology.

[shikimate]

-  both radiology and pathology are basically visual pattern-recognition specialties that generate a ddx, so fundamentally there are a lot of similarities in how the two field functions.

-  the on call pathologist should not refuse a liver assessment for fat/cirrhosis for transplant, one can argue that constitutes below standard practice and may be subject to College complaints. I assume you are in an academic setting? Some old timers there are entrenched and they know they can't be fired or they're near retirement so they don't give 2 ****s, so that could be the reason. There are too many old timers who should retire long long time ago. And I hate to say this, but a lot of them were IMGs who would never pass a med school interview here because other than medical experts they don't have any of the other CanMed traits. But any pathologist who practice patient centered medicine would not refuse.

-  Lifestyle really depends on the setting, You'll find academic pathologists at UHN and Ottawa doing 996 because that's how they work you in academic hospitals. These people are either so subspecialized they can't work anywhere else, or are IMGs who needs that visa sponsorship so can't leave. Yeah in the community you'll find pathologists with great lifestyle (and get paid the same or more than academics!)

-  If rad can make a lot more money, you can just work hard for 5-10 years, invest and retire never see another case again, or get some cushy government/consulting job. FFS is great when you're young and can do on call and get paid extra. In pathology FFS is 99% thing of the past so even if you wanna hustle you're just working for free lol. That's why they always wanna do less not more! Same as government employees basically lol, when was the last time the government hustles like Amazon or Google?

[ChemPetE]

For the record, when I’ve had patients with solitary focus of malignant cord compression NYD, path on call has been helpful at some quick DDx’s for the weekend biopsies. Don’t necessarily want to irradiate something that could respond to curative intent chemo upfront that would jeopardize someone’s cure later on. Rare situation, but I’ve always enjoyed working closely with pathologists.

[Findanus]

On 11/19/2020 at 6:55 PM, shikimate said:

-  both radiology and pathology are basically visual pattern-recognition specialties that generate a ddx, so fundamentally there are a lot of similarities in how the two field functions.

-  the on call pathologist should not refuse a liver assessment for fat/cirrhosis for transplant, one can argue that constitutes below standard practice and may be subject to College complaints. I assume you are in an academic setting? Some old timers there are entrenched and they know they can't be fired or they're near retirement so they don't give 2 ****s, so that could be the reason. There are too many old timers who should retire long long time ago. And I hate to say this, but a lot of them were IMGs who would never pass a med school interview here because other than medical experts they don't have any of the other CanMed traits. But any pathologist who practice patient centered medicine would not refuse.

-  Lifestyle really depends on the setting, You'll find academic pathologists at UHN and Ottawa doing 996 because that's how they work you in academic hospitals. These people are either so subspecialized they can't work anywhere else, or are IMGs who needs that visa sponsorship so can't leave. Yeah in the community you'll find pathologists with great lifestyle (and get paid the same or more than academics!)

-  If rad can make a lot more money, you can just work hard for 5-10 years, invest and retire never see another case again, or get some cushy government/consulting job. FFS is great when you're young and can do on call and get paid extra. In pathology FFS is 99% thing of the past so even if you wanna hustle you're just working for free lol. That's why they always wanna do less not more! Same as government employees basically lol, when was the last time the government hustles like Amazon or Google?

Is that kind of work environment sustainable?

I have heard of a few community hospital pathology departments in Southern Ontario refusing after hours call, intraoperative consultations, and autopsies because they are tired of the ever expanding volume of cases without an increase in hires or payment.

I think this kind of thing is why pathology is so unpopular. It has nothing to do with the nature of the work, but with the treatment the field receives.

[rmorelan]

6 hours ago, Findanus said:

Is that kind of work environment sustainable?

I have heard of a few community hospital pathology departments in Southern Ontario refusing after hours call, intraoperative consultations, and autopsies because they are tired of the ever expanding volume of cases without an increase in hires or payment.

I think this kind of thing is why pathology is so unpopular. It has nothing to do with the nature of the work, but with the treatment the field receives.

The issue in part is pathology is often salaried. This puts them in an interesting position - if the work is there to be done and isn't their professional body will not take too kindly to the situation. We are obligated to do the work required to care for patients no matter what (including in many cases if we are not being paid for it). So the hospitals can up the work load on pathologists and they can either quit (but any other job they can get is basically similar) or work harder. Not ideal. Plus unlike any other professional in a similar state doctors cannot strike. They have no cards left to play. 

At least with most other specialties you would be compensated for doing the work. 

Ironically I think pathology went the salary route to simplify their lives - no billing, no worrying about retirement, shifts are structured and work life balance was to be maintained. That isn't exactly what happened. There are good reasons despite the complexity that doctors would to be independent.

 

[Laika]

I'm an AP at a large academic center.  To give you an idea:

• I work 10 hour days, M-F.
• I'm on call about 1 in 6, but call is extremely light.  Occasionally, this involves staying at work until 7 pm or so for a frozen section.  I need to go into the hospital about once every six months for a Saturday read, which takes 15 minutes.  I've never been paged overnight.
• I have significant flexibility regarding my schedule, both in terms of which days/weeks I can take off, and how I spend each day.
• I do spend some evenings and weekends doing research or other academic responsibilities, but this is more for my own interest than a job requirement.

[rmorelan]

3 hours ago, Laika said:

I'm an AP at a large academic center.  To give you an idea:

• I work 10 hour days, M-F.
• I'm on call about 1 in 6, but call is extremely light.  Occasionally, this involves staying at work until 7 pm or so for a frozen section.  I need to go into the hospital about once every six months for a Saturday read, which takes 15 minutes.  I've never been paged overnight.
• I have significant flexibility regarding my schedule, both in terms of which days/weeks I can take off, and how I spend each day.
• I do spend some evenings and weekends doing research or other academic responsibilities, but this is more for my own interest than a job requirement.

Thanks very much for that - very helpful!

Could I push for a few more details? What sort of vacation plan do you have, and I know the pensions are excellent but not any other details (like number of years to reach max amount etc). I am assuming the benefit plan is excellent. 

[Laika]

3 hours ago, rmorelan said:

Thanks very much for that - very helpful!

Could I push for a few more details? What sort of vacation plan do you have, and I know the pensions are excellent but not any other details (like number of years to reach max amount etc). I am assuming the benefit plan is excellent. 

I'm in the US, so these comments may not be directly applicable to Canadian pathologists.

4 weeks vacation, although this often higher in non-academic settings.   16 weeks "off service" for conferences and research.

The pensions may be "excellent" (i.e., grow to large amounts by the time you retire) but they are usually funded by payroll deductions (I know HOOPP in Ontario is), so my impression is there is no magic or free money.  I haven't researched Canadian pathologist pension plans extensively, but I'm not sure they're any better than a disciplined approach to investing the same amount in an index fund, for example.

Yes, the benefits are usually good.  My health insurance is excellent by American standards.

Happy to answer any other questions, with the caveat that my experience is limited to the US and these things likely vary between hospitals and departments, so I'm not sure my experience is generalizable/useful to others.

[rmorelan]

On 11/28/2020 at 6:59 PM, Laika said:

I'm in the US, so these comments may not be directly applicable to Canadian pathologists.

4 weeks vacation, although this often higher in non-academic settings.   16 weeks "off service" for conferences and research.

The pensions may be "excellent" (i.e., grow to large amounts by the time you retire) but they are usually funded by payroll deductions (I know HOOPP in Ontario is), so my impression is there is no magic or free money.  I haven't researched Canadian pathologist pension plans extensively, but I'm not sure they're any better than a disciplined approach to investing the same amount in an index fund, for example.

Yes, the benefits are usually good.  My health insurance is excellent by American standards.

Happy to answer any other questions, with the caveat that my experience is limited to the US and these things likely vary between hospitals and departments, so I'm not sure my experience is generalizable/useful to others.

thanks for the input! 

[shikimate]

Pensions, especially DB pensions, are being phased out for pathologists. Hospitals are happy to hire the group as AFP contractor and not worry about their pension, health benefits etc. This can be good for the finance savvy who want that extra cash to invest in their corp. But I know old timers love their HOOPP because who wouldn't wanna retire on 150K a year in pension? (after slaving away at an academic center for 30+ years)

Academic pathology in US is a mess. If you're new hire expect 10 hrs a day for 175K after doing 2 fellowships, you could make as much being a nurse anesthetist doing weekend/nights. Private partnership was lucrative, but I read Medicare is cutting path codes again , something like 8%, so they're really squeezing the private labs hard. Sooner or later it'll just be an oligopoly with ameripath, lab corp etc left. 

If you land the right community job, you can make 350K easy working 6 hours a day. Rumor has it there's an old timer at an unnamed hospital in GTA who goes into work at 6am, leaves work at 10am. Obviously he must know his s*** really well to be that efficient lol.

[shikimate]

I stand corrected, looks like CMS is cutting 9% instead of 8% for path in USA.  Also note the cut is across the board to many specialties.

"Despite unified warnings from lawmakers, specialty providers, and other stakeholders, the Centers for Medicare & Medicaid Services’ (CMS) plans to move forward with deep, across-the-board payment cuts to more than 30 specialties – including an alarming 9% cut to pathology – on January 1, 2021.
 
Fortunately, Congress is working to stop these severe cuts from taking effect. Representatives Ami Bera, M.D. (D-CA) and Larry Bucshon, M.D. (R-IN) recently introduced the Holding Providers Harmless from Medicare Cuts During COVID-19 Act (H.R. 8702), which would provide much-needed relief to dozens of specialty providers that are scheduled to incur severe Medicare reimbursement cuts by keeping funding levels for affected specialties at 2020 levels over the next two years."