Pathology-future job prospects, matching, etc.

[hemogoblin]

Hey there,

 

I'm hoping some path residents in the know will notice this and be able to help out. This was sort of addressed in another thread I was reading and asking questions in, but not so specifically.

 

First, what are future job prospects like in path? If we break it down into anatomical, general, hematopathology, etc. are any of those in danger of being replaced or facing a job crunch in the near future?

 

As far as matching goes, I've heard it's not very competitive, but would it be sufficient to only do one or two clerkship electives? I'd like to spread the rest out in family and internal subspecialties, since family is my other interest (completely different, I know). Keep in mind I don't have a graduate degree or much basic science research experience. I throw that in because all the hematopathologists I've met so far have PhDs....

 

Thanks!

[thebouque]

Would you be interested in informations about the state of path in Quebec?

[hemogoblin]

Would you be interested in informations about the state of path in Quebec?

 

Yeah absolutely. I'm francophone, but attending an English med school.

[thebouque]

There's a big shortage of pathologists in Quebec so the job market is just excellent in the province. There are jobs pretty much everywhere, in most areas and in most academic centers. Pathologists are not going to get outsourced, they have total control over their turf, the numbers of specimens (surgical and biopsies) is exploding, and there are a lot of recent/new technologies in the field (on top of histology and immunohistochemistry, there are a lot of advances in molecular pathology and tumor cytogenetics, giving precious diagnostic, prognostic and therapeutic information). In Quebec, we only have anatomic pathologists. There is no general path, or heme path etc. Infectious diseases specialists deal with the micro lab, biochem is a stand alone specialty, and heme is divided between clinical hematologists (flow on marrow, marrow aspirates, smears, blood bank, marrow cytogenetics) and anatomic pathologists (lymph nodes, lymph nodes cytogenetics and flow, core marrow biopsies). PM me if you have any questions.

 

Peace

[hemogoblin]

There's a big shortage of pathologists in Quebec so the job market is just excellent in the province. There are jobs pretty much everywhere, in most areas and in most academic centers. Pathologists are not going to get outsourced, they have total control over their turf, the numbers of specimens (surgical and biopsies) is exploding, and there are a lot of recent/new technologies in the field (on top of histology and immunohistochemistry, there are a lot of advances in molecular pathology and tumor cytogenetics, giving precious diagnostic, prognostic and therapeutic information). In Quebec, we only have anatomic pathologists. There is no general path, or heme path etc. Infectious diseases specialists deal with the micro lab, biochem is a stand alone specialty, and heme is divided between clinical hematologists (flow on marrow, marrow aspirates, smears, blood bank, marrow cytogenetics) and anatomic pathologists (lymph nodes, lymph nodes cytogenetics and flow, core marrow biopsies). PM me if you have any questions.

 

Peace

 

thanks a lot! i'm sure ill end up messaging you with questions at some point

[Lactic Folly]

I would say lifestyle - radiology is moving to a 24/7 shiftwork model, while I understand after hours for pathology is relatively benign. Would be surprised if that differs much in Quebec versus the rest of the country. Also, I think there are more barriers to outsourcing pathology.

[Laika]

Now thebouque, why would a student pick path over imaging in QC? I really have a hard time coming to grips with this since both are pretty similar jobs but rads just obliterates path in terms of earning potential. What does path offer that rads doesn't? This is a sincere curious question and not meant to be inflammatory.

 

I think you may underestimate how well path can pay... I know of one recent path grad who works FFS in QC and bills ~500K with little/no overhead.

[mavrik13]

I considered radiology, but chose (ie: did not wind up in it because I didn't get into something else) lab medicine for a several reasons. I'm in HP, and just love the material, in general. I think that's the most important thing that would sway someone. Radiology just didn't captivate me the way HP did.

 

If someone has a keen interest in basic science and research (which is not true of me), the opportunities to pursue it are probably most easily available in lab medicine.

 

Job opportunities are [probably] better for lab medicine than rads. I should be able to find a job at the end of my four year residency without a fellowship if I want (unless I'm desperate to work at the U of T or UBC). And, depending on the direction you want to take their career, if administration is appealing to you, lab medicine offers tons of opportunities.

 

Also, path residency is so, SO much more humane than radiology. My radiology friends are being put through the wringer, and I... am at home in my pyjamas writing a post on PM101.

 

It's not true for everyone, but whether I'm making $650K vs. $400K, I think I'll be more than comfortable. Maybe it's a trade-off? I just don't really see it that way, because, at a pathologist's salary these days (in absolute numbers, not relative to the ROAD specialities), it's hard to say I'm really losing.

 

I have always thought that the prospects of lab medicine were better than what people commonly believe.

 

Out of curiousity, if you see this post, would you mind writing a little blurb about what a typical day is like in your field as a resident (and as a staff, if you feel comfortable), what sort of specimens you see, do you see any patients, how many HP's work at your centre, how many residents, do you enjoy the residency you're currently in, and how does HP compare to the other lab medicine specialties?

 

Thanks a bunch!

[liszt]

I have always thought that the prospects of lab medicine were better than what people commonly believe.

 

Out of curiousity, if you see this post, would you mind writing a little blurb about what a typical day is like in your field as a resident (and as a staff, if you feel comfortable), what sort of specimens you see, do you see any patients, how many HP's work at your centre, how many residents, do you enjoy the residency you're currently in, and how does HP compare to the other lab medicine specialties?

 

Thanks a bunch!

 

No problem.

 

As residents, we do rotations in different areas of laboratory and clinical hematology, but the biggest chunk of residency is a rotation we call "Heme/Morph/Coag/TM". On that rotation, I usually get to work between 8-9am. One or two days a week, I'm assigned to bone marrow biopsies (ordered by the clinical hematologists). On those mornings, I go to the outpatient area, and meet the patients, get consent for the marrows, and procure the bone marrow specimens. I'll meet anywhere from 2-5 patients on a bone marrow day.

 

After bone marrows, it's time to grab a coffee and go for coagulation rounds. This is where the staff and resident assigned to coagulation, the coagulation technologists, our local coagulation expert (who might also be the staff on that week), and whoever else is around meet to interpret the coag tests (lupus assays, inhibitor screens, platelet aggs, etc.) and do teaching. Sometimes clinicians come by to brainstorm with us if a patient is giving them trouble.

 

Lunch after coag rounds. Once a week we have joint clinical-pathologic hematology rounds (with a catered lunch!). Lab medicine joint rounds are also over lunch on a different day of the week. After lunch, we do transfusion rounds. We do [home] call for one week at a time, once a month, and the bulk of what we're called about is transfusion related. We go over things with the staff on call with us and the local transfusion director/expert at rounds, and get a heads up about what might be happening later in the day (if there are incoming traumas, mass casualties, transplants or heart surgeries, etc.).

 

In the afternoon, I might go to the ICU to see any patients who've had massive transfusions the night before and write a note in their chart about what happened from a transfusion perspective. Then we might grab a coffee and go back to our reading room to look at the aspirates and flow cytometry of the patients I saw that morning, and get things rolling with any molecular or cytogenetic studies that need to be ordered for them, and contact the taking care of them if there's something significant there. I'd dictate the aspirates of those (the trephines aren't back until the next day), then depending on what's back from processing, I'd work on other marrows I have on the go, or work on peripheral smears (ordered by physicians or flagged by our technologists for physician review). Most days there are clinical teams coming through and I'll take them through the marrows or smears they're wondering about if they drop by. Some days are more quiet and I can get some reading done.

 

I usually leave by 1700.

 

Compared to the other lab med specialties, I really like that HP is specialized and focused, but within that focus there are so many areas to learn about and get involved in (there is tremendous breadth within its depth). Residency is hard work no matter what field you're in, but, relative to most specialties, my residency is learner-focused, flexible, and has a reasonable work load. It's a real hidden gem of a specialty.

[Partyboy]

Hey look at the 2012 md-phd graduating class from Harvard : out of 15 students, 4 chose pathology (the salary is way lower by the way than in Canada and the job market is bad).

 

http://www.hms.harvard.edu/md_phd/events/match_2012.html

 

What went wrong ? Are they rads reject ? Aren't they smart enough to realize that it's almost the same thing but rads pays more ? lollolllolol jkjkjkj

[rask]

My husband is a path resident (AP) and loves it. After having done graduate work that included aspects of both pathology and imaging, he was considering radiology during med school. But after doing electives in both fields, he quite simply liked pathology better and applied only to path programs. Matched to his first choice. I think he would also describe it as a 'hidden gem' specialty as liszt mentioned. It's not about the money but about doing something you love. Besides, pathology salaries are not awful, it's more than enough to live a comfortable life.

[Kinase]

There was a pathologist in Montreal who was billing 800 000 $ a year working from 8 to 4pm 5 days a week. Yes, 800 000 $ a year. He still managed to do a great job people were saying, but he was working really fast. But they changed the way of billing last year and he couldn't make as much so he left for another province. The average quebec salary for path was raised about almost 100 000$ a year though. But you can't make extreme like the guy now.

 

I know a pathologist in Montreal who currently works 60 hours a week and bill 450 000$ a year.

 

Path seems like a great field, I wish I had done an elective in it.

[thebouque]

Now thebouque, why would a student pick path over imaging in QC? I really have a hard time coming to grips with this since both are pretty similar jobs but rads just obliterates path in terms of earning potential. What does path offer that rads doesn't? This is a sincere curious question and not meant to be inflammatory.

 

Even though they share some similarities (picture analysis), they're 2 very different fields. I don't know how it is elsewhere but none of the residents in my program (3-4 per year) ranked something higher than path. You could also ask why someone would choose neurosurgery over another surgical field since the job market is dismal in nsx. Sometimes, even though 2 specialties may seem similar, they are actually quite different and if you fall in love with a field you don't want to do something similar just because it pays more or because of the job market. I could enumerate many aspects of path that I love and that can't be found in radiology, but I don't want to start a flame war, so I can PM you my list if you're interested

[fan_med]

No problem.

 

As residents, we do rotations in different areas of laboratory and clinical hematology, but the biggest chunk of residency is a rotation we call "Heme/Morph/Coag/TM". On that rotation, I usually get to work between 8-9am. One or two days a week, I'm assigned to bone marrow biopsies (ordered by the clinical hematologists). On those mornings, I go to the outpatient area, and meet the patients, get consent for the marrows, and procure the bone marrow specimens. I'll meet anywhere from 2-5 patients on a bone marrow day.

 

After bone marrows, it's time to grab a coffee and go for coagulation rounds. This is where the staff and resident assigned to coagulation, the coagulation technologists, our local coagulation expert (who might also be the staff on that week), and whoever else is around meet to interpret the coag tests (lupus assays, inhibitor screens, platelet aggs, etc.) and do teaching. Sometimes clinicians come by to brainstorm with us if a patient is giving them trouble.

 

Lunch after coag rounds. Once a week we have joint clinical-pathologic hematology rounds (with a catered lunch!). Lab medicine joint rounds are also over lunch on a different day of the week. After lunch, we do transfusion rounds. We do [home] call for one week at a time, once a month, and the bulk of what we're called about is transfusion related. We go over things with the staff on call with us and the local transfusion director/expert at rounds, and get a heads up about what might be happening later in the day (if there are incoming traumas, mass casualties, transplants or heart surgeries, etc.).

 

In the afternoon, I might go to the ICU to see any patients who've had massive transfusions the night before and write a note in their chart about what happened from a transfusion perspective. Then we might grab a coffee and go back to our reading room to look at the aspirates and flow cytometry of the patients I saw that morning, and get things rolling with any molecular or cytogenetic studies that need to be ordered for them, and contact the taking care of them if there's something significant there. I'd dictate the aspirates of those (the trephines aren't back until the next day), then depending on what's back from processing, I'd work on other marrows I have on the go, or work on peripheral smears (ordered by physicians or flagged by our technologists for physician review). Most days there are clinical teams coming through and I'll take them through the marrows or smears they're wondering about if they drop by. Some days are more quiet and I can get some reading done.

 

I usually leave by 1700.

 

Compared to the other lab med specialties, I really like that HP is specialized and focused, but within that focus there are so many areas to learn about and get involved in (there is tremendous breadth within its depth). Compared to what I saw in AP, we work much more closely with clinicians (especially clinical hematology and anesthesia), and are really treated like a part of the team. We're really at the interface of clinical and laboratory medicine, and, I think, HP offers the best of both worlds. Residency is hard work no matter what field you're in, but, relative to most specialties, my residency is learner-focused, flexible, and has a reasonable work load. It's a real hidden gem of a specialty.

 

Hello Liszt,

 

I'm PGY-1 in family medicine and very recently I discovered HP, a small and quite discreet field from your post. For longtime I have a very big interest in oncology, and pathology, so I'm seriously thinking of switching into it.

 

I'd like to ask you:

1) How is the competitiveness of this specialty and do you think is it feasible in term of transfers request ?

2) What is about a call as resident and staff ?

 

Many thanks !

 

Fan_med