Why is pathology so unpopular?

[Guest physiology]

I've read over and over in this forum that people always rank it as a back-up and that when you do get a pathology spot, people ask right away "What was your first choice?"

 

Why is this the case?

[Guest Akane200]

I thought pathology was a popular specialty... people who wanted path in our class went all out for path, and are going to be pathologists... I didn't hear of anyone ever backing up with it.... and, there are people from other programs who choose to switch into path, so, I thought it was a pretty popular specialty for those who like it....

[Guest byjude]

I think it's just that not everyone can see themselves specializing in pathology - it takes a certain sort of person, someone who doesn't want as much patient interaction as your typical med student, who doesn't mind working with dead bodies or samples, who can tolerate some stigma (ie, people asking, what was your first choice?). For the same reason that some people don't understand what the draw to the specialty may be, the specialty itself may be not so competitive - a lot of people go into medicine for the patient interaction.

 

That said, I think I've heard pathology is becoming a more popular choice for the lifestyle aspects. I bet pathology has the strongest division between people who do or don't want to pursue it - there are probably relatively few people who would be indecisive about pursuing pathology - they'd either be strongly opposed to it, or seriously considering it.

 

It's true though, there are a few specialties that are surprisingly unpopular in CaRMS selection. I've always wondered why Community Medicine seems to be one of the easiest specialties to get into..

[Guest physiology]

Hey Byjude,

 

UBC offers this joint community medicine/family medicine degree that you can obtain in 5 years.

 

www.carms.ca/programdir/857522.htm

 

UBC seems to like these joint programs. There's a combined radiology/nuclear medicine program too (6 years).

 

Regarding pathology, yah, I thought pathology would really popular now because of CSI and stuff. It's well paying and you're not on call that much. I think Ian described a pathologist as a "doctor's doctor" because all tests (biopsies, etc) go through pathologists, and then they inform the family doc.

[Guest milkytooth]

I do not see why it is unpopular, at least not this year. There are more applicants than previous years (about 50% increase) and we will wait to see the exact figures when CaRMS releases this year's statistics. My guess is that at least 30 applicants had applied for this specialty.

 

There are 8 from UBC who matched to either lab medicine or path this year. Please check out the following link:

b19.ezboard.com/fpremed10...=214.topic

 

Who knows, maybe Pathology will join Radiology and Anesthesia to become a more competitive specialty in the near future...

[Guest Ian Wong]

It's not a UBC-specific phenomenon. Most, if not outright all, Community Medicine residencies in Canada have the flexibility for their residents to satisfy also the requirements of the College of Family Physicians of Canada. In other words, within the 5 year residency of Community Medicine, you can complete a Family Medicine residency, and basically be double-boarded in the two fields.

 

The same is true for Nucs/Radiology. There is usually some mechanism for residents to cross-train in both, at most if not all programs across Canada. Nucs/Rads is a bit more tricky though, in that getting accepted to one does not necessarily mean acceptance to the other; whereas if you get into Community Medicine, the Family Medicine degree is there if you want it. Still, as Radiology moves away from anatomical imaging (ultrasounds, CT scans, or MRI's) towards more physiologic imaging (things like PET scans, or PET/CT fusion scans, or maybe even antibody/molecular tagged imaging), there will certainly be a niche for any physician knowledgeable in both cross-sectional Radiology as well as Nucs.

 

As far as Path goes, it is a wonderful field that would probably be a lot more popular if med students actually had good opportunities to get exposed to it throughout med school, and if there was as much emphasis on Histology/Anatomy/Embryology/Pathology in the basic sciences curriculum as there was in the past. It's probably pretty hard to get students excited about Pathology if their Histology/Embryo/Anatomy exposure was minimal, and they don't already have the background interest in that field by the time they hit third and fourth year med school.

 

Also, unfortunately, as CaRMS spots get tighter, students tend to use their valuable electives less and less for "exploration" and "becoming well-rounded", and more to get those letters of reference or to forge outside connections in their main field of interest. It's hard to justify spending a month of your fourth year electives doing Path if you think you might need that month to help you go after a competitive specialty. It's also probably tough for many medical students to make the jump into a field that is quite different from most clinical specialties, and probably not what they had envisioned themselves doing when they started med school.

 

Still, as far as the job itself goes, Path has much in common with Radiology. Great working hours, good money (particularly with the opportunity to set up lab services outside of the hospital system), requires a huge fund of medical knowledge, you get to be a diagnostician without getting too involved with patients and all the work that accompanies them, your opinions are relied on by heavily by clinicians in all specialties, no office/overhead if you are primarily hospital-based, lots of opportunities for research, lots of different practice opportunities in large or smaller city settings.

 

It's definitely an underappreciated field that doesn't get as much interest as it deserves. I think this year it was more competitive than in past years, and suspect that this field will probably grow in competitiveness in the future.

 

Ian

[Guest McMastergirl]

Pathology is also a great field to go into if you like teaching. We have some great pathologists at Mac who made learning pathology in first year really interesting and clinically oriented.

 

By the way, McMaster has a training program in forensic pathology (see Mac's own brand-new journal, MUMJ, for an article on this exciting field)

www.mumj.org/archive/v1_i..._pg_55.pdf

[Guest UWOMED2005]

I think Path and Lab medicine aren't particularly popular with med students because its so different from the other specialties. (I'd argue the same for Psych, btw.) People often apply to medicine with some sort of idea of reading EKGs, interacting with patients, managing physiological problems. Both pathology and lab medicine often seem much more basic science than the other specialties, and there is the issue of patient interaction.

 

I think what you see with all of pathology, lab medicine, and psych is that you will find a limited number of people who go into med school aiming for these careers. You will then find a few others who expected to want family medicine or internal, and either found path or psych or lab medicine more interesting than they thought. . . or the more traditional medical specialties not as interesting (or more frustrating) than they thought.

 

I don't think many people end up in path, lab medicine, or psych as a backup. Most of the people not ranking these programs first choice aren't going to rank them at all.

[Guest byjude]

I agree with UWOmeds -- wouldn't Family Medicine be the most common backup plan? Aside from people aspiring to other technical specialties like radiology or medical genetics who might also be interested in pathology for its similar emphasis on knowledge more than interaction, family medicine would make more sense as a backup for people wanting to specialize in areas that allow a lot of patient interaction. Not to mention, it would be much easier to match to than pathology.

 

I think the assumption that a pathology resident is someone who was unlucky in the Carms match is just an assumption that everyone shares the same values, not necessarily a reflection of reality. Some people would be horrified to have to work with dead bodies or samples all day long, so they assume that everyone else shares the same perspective. Those are the same people who hold the view that successful medical school applicants should be a highly homogeneous bunch, with some stereotypical assumption of what a doctor should be, and your stereotypical extraverted doctor would want to work with patients as much as possible.

[Guest Ian Wong]

family medicine would make more sense as a backup for people wanting to specialize in areas that allow a lot of patient interaction.

The thing is that pretty much any clinically-based specialty will allow you tons of patient interaction if you want it (ie. Emerg, Peds, Internal Medicine, Surgery, Ob/GYN, Family Medicine, Derm, Radiation Oncology, etc.). Most people won't choose their backup specialty based on patient interaction (because you can get that in most any specialty), but rather because of high interest in that field, future career goals that might require that specialty (ie. you can't do Cardiology without going through Peds or IM first), lifestyle, money, job demand/portability, likelihood of getting that backup specialty (ie. Derm isn't a particularly reliable backup option), length of residency, etc.

 

Family Medicine can be a good backup because it's very flexible (you can do any number of fellowships after it, there's a huge demand for them in all urban and rural areas, you can do walk-in's or locums if you don't want an office-based practice, there's vacant spots in virtually every Canadian program after the first round so you have a very good shot of getting both the city and the program you want, you have some autonomy because you aren't tied down to a hospital and can therefore set your own hours and schedule, and it's a short 2 year residency).

 

As far as introverts/extroverts, Radiology and Pathology both have a lot of people contact, just not as much patient contact. Especially for radiologists, instead of talking to patients and giving them advice, you are instead talking to other physicians and sharing your opinions. It's all about figuring out what you enjoy doing, and which specialty fits your interests and personality the most. Medicine is such a diverse profession that there's usually, if not always, a specialty out there that will fit you well; it's just a matter of finding it.

 

Ian

[Guest satsumargirl]

Not sure if anyone comes to this board anymore it doesn't seem too active.

 

Can someone explain to me the difference between pathology and laboratory medicine? I had thought they were the same. But on the Carms site it is listed seperately.

 

I think pathology may be in my top 5 choices....will have to explore a little over the next couple of years. I am mostly concerned about odours as I have a particularly sensitive sense of smell! Otherwise I think it sounds to be a great problem solving type career.