Path Cutbacks?

[Bancroft]

Anyone heard about cut-backs in pathology?

 

Looks as if some of the bigger programs in Canada - Vancouver, Toronto, and McMaster all reduced the number of residents they are taking this year. I have heard that this is happening because of an overall reduction in pathology jobs across Canada (hospitals have less money, some labs are consolidating).

 

The last couple years have seen more people enter the field, but a pathologist I had met in the community mentioned to me that there are a growing number of pathologists struggling to find work (at least in cities they want to be in).

 

Am I wrong? Let me know if anyone has heard similar rumblings...or at least has a different perspective on the residency cuts.

 

B

[Mourning Cloak]

Are the numbers low? I looked at the match rates for 2009 Canadian grads, and 19 people matched in AP in the first round, and another 2 in the second round, for a total of 21 (plus two unfilled makes 23).

 

This seems well in keeping with the current offer of 24 spots in AP.

 

But it was another story in laboratory medicine.

 

For lab med, it was 13 in the first round and 3 in the second round (compared with 10 spots this year)*.

For neuropath, it was 1 in the first round and 1 in the second round (compared with 4 spots offered this year).

And one person matched in hemepath in the first round (compared with one spot offered this year).

 

*But Ottawa's numbers aren't up yet.

 

So lab med does seem low (I'm guessing 3 residents for Ottawa to give us 13 spots versus the 16 last year). Hmmmmm. Maybe those extra three spots came out of lab medicine and into neuropath (which is up 3 spots from last year). The thing about residency spots it that, like energy, they can't really be created or destroyed, only transformed.

 

The really interesting part is that the IMG quota for lab med in 2009 was 13! but it's only four right now (again, Ottawa's numbers aren't up). That, if it holds, seems like a big drop.

 

Now McMaster's numbers DO look low - one gen path spot! - but maybe they are absolutely full to the brim with residents and can't accommodate any more i.e. part of a year-to-year fluctuation.)

 

I think you might be right. There might be something going on, but I don't know what it is. Your guess about consolidation is a good one - I work in a lab and certainly in my province we've seen the mom-and-pop (or sometimes just pop by himself) path operations in the small hospitals getting rolled into larger departments e.g. move all the practicing pathologists into a central hospital to serve the entire region, rather than practicing in isolation scattered all over the region. Since there has been a chronic shortage of pathologists (and techs!) in the past, this was not only viewed as a safer way to practice, but also a way to optimize effectiveness (reduce re-duplication of effort).

 

Maybe the country's no longer short of pathologists (heaven knows that the US is very over-supplied at present).

[ec85]

keep in mind that in different years programs have seemed to switch between the lab med stream vs. anat path/gen path, etc. stream. if i'm not mistaken, mcmaster and UBC used to be (at some point in the last 4 or 5 years) using the "lab med" application stream, but now they are split into anat path, gen path, etc. thus you can't compare the numbers from year to year perfectly for each stream separately, u'd have to combine the numbers. having said that, the current quotas do seem to indicate a reduction in spots from some of the big schools. if you total things up, there isn't a big reduction overall across canada, but there may indeed be a bit more competition this year for the big cities. we'll see, especially since some quotas still aren't submitted.

 

as for why spots were reduced, your guess is as good as mine.

[bugette]

What I've heard from a path resident: many recent graduates are finding it difficult to find jobs. Jobs are not as plentiful as one might expect given the "shortage" of pathologists one often hears about. Even in the community. Apparently, there hasn't been much hiring for the last few years.

 

Path spots were significantly increased a number of years ago (maybe by increasing the number of img spots?)....compare the number of PGY-5 to more junior residents in some programs....and there are fears that the (changing) job market will have difficulty absorbing this increase in the near future, especially if the number of residents continues on the same trajectory. Some path programs are also becoming very crowded relative to their resources. So this decrease may actually lead to programs being more in line with historical numbers.

 

These are the reasons I have been given. I believe most of the eliminated spots have come out of the IMG stream. Again, I don't know the particulars or whether this is true for the entire country. Just what I've heard mostly from residents.

[blinknoodle]

I just checked and it seems to be true, at least in Toronto. There are 14 new PGY1s but the new quota for Lab Med is 5 CMGs and 3 IMGs. Personally, I never liked the bloated program size, so I think this is GREAT news!!

 

I can't say I know why they are doing it, but 2 years ago when I was applying they told me they wouldn't be keeping the program size so big. It is hard to accommodate everyone in the training program if it keeps growing exponentially.

 

I can't say I really know what the plan is for jobs. Toronto grads have gone into the community and many others go for fellowships. What I can tell you is that the Toronto hospitals are still hiring. There is a job available at St Mike's right now, and they recently hired a new pathologist (new grad straight from fellowship) that started a month ago.

[SuckaMD]

I'm not interested in pathology, but I think this bears mentioning regardless of the specialty that one is interested in.

 

Hearing about a "shortage" of physicians in a certain field does not mean that there are jobs available. It just means that there aren't enough people working in the field right now to do all the work that is needed in an efficient and timely manner.

 

The majority of specialty physicians do not work in a vacuum. For a job to be available, there needs to be infrastructure, staff, money, etc. in place to support that physician. In the case of pathology, that means lab equipment, assistants, office space, and so on. For other specialties like internal medicine, it might mean room in a hospital's budget for new inpatient beds, nurses, drugs and tests needed to treat the doc's patients, etc. Even if not applying for a hospital based position (e.g. if applying for a spot in a radiology partnership group), there must be enough machines/demand for radiology services in the catchment area covered by the group to support the billings of the new physician.

 

This is the reason we simultaneously hear about shortages of physicians and new grads being unable to find jobs. A shortage only translates into job openings if there is money and resources to to support a new staff person. This is not to say that jobs are unavailable in path at this time (apparently there is at least one at St. Mike's, as per above), but reading about a shortage of docs does not necessarily mean that job offers will come flooding in once you are done residency.

[physiology]

"In medicine, you never stop learning"

 

Well, surprise, surprise, now to get a pathology job at a major academic centre, you often need to do a fellowship. Of note, this is happening in all fields, the fellowship may not be of your choosing.

 

During your PGY5 year, the program director may meet with you for "career counselling" and mention that they may have an opening for a sarcoma pathologist in a few years. By that, he means, get your butt to some prestigious American medical school for a sarcoma path fellowship. Then come back when done, hopefully with the program's arms wide open.

 

That's why some path people are going back towards GP or general pathology. As difficult as the exam is, it's a very interesting specialty as you get to do everything AP, med micro, heme path, neuro path, med biochem...