Pathology

[blinknoodle]

I wanted to see whether this was still alive and kicking.. and it is! Even more awesome to see some familiar names around here! And since the path community is so small, I wonder who you all are!

 

PS. I still get a kick writing FRCPC after my name.

[Lactic Folly]

*blinks*

Hi!

[rask]

SO of an AP resident here, nice to see some path love!

[thebouque]

Histopathology?

[Eshi]

Hi! Third year med student here thinking of path. I have not yet done an elective in AP or HP yet but hoping to shadow a few between rotations to get a better sense. Loved histo and path specimen stuff back in pre-clinical years but just not sure if it's the right thing for me.

 

Where did you all train at?

[dynomedasaur]

Hey everyone, taking a break from studying in my MS1 year. I'm trying to look up pathologist compensation schemes, but it's no where to be found, any advise on where to look or what generally to expect? 

And also any input into lifestyle, work hours, call etc.? 

[Lactic Folly]

Actually it's easier to find pathologist compensation on the internet, as many are salaried. I feel the lifestyle is favourable - the pay isn't for the hours, but for the magnitude of and responsibility associated with one's decisions. I'm sure your local department would be happy to have you come shadow if you had an interest.

[GrouchoMarx]

Pathology is mostly salaried, which is a trojan horse. Maybe it was a good thing years ago, but work is increasing in volume and becoming more complex. As pathologists are salaried, there is no reflection of this increased work in income. It is easier for governments and hospitals to change pathologist income than other fee-for-service docs because of this, or to just not hire new pathologists to compensate for the increased work. Plus there is a bit of a feeling of being second-tier when your field is the only one that is mainly compensated through a less desirable model (salary) than other specialists (fee-for-service). Unless you really love pathology, or unless you have no other options, you should consider other fields in medicine with better opportunities. It's a good field for old age, but that's a long way off to be preparing for.

[schmitty]

Pathology is mostly salaried, which is a trojan horse. Maybe it was a good thing years ago, but work is increasing in volume and becoming more complex. As pathologists are salaried, there is no reflection of this increased work in income. It is easier for governments and hospitals to change pathologist income than other fee-for-service docs because of this, or to just not hire new pathologists to compensate for the increased work. Plus there is a bit of a feeling of being second-tier when your field is the only one that is mainly compensated through a less desirable model (salary) than other specialists (fee-for-service). Unless you really love pathology, or unless you have no other options, you should consider other fields in medicine with better opportunities. It's a good field for old age, but that's a long way off to be preparing for.

 

I think this is rather pessimistic. Most paths make $300K-$400K in salary and likely have benefits FFS docs do not. Less overhead (i.e.almost zero) and work no more (and often less) than other docs. If one likes path and that is what they want to do, the pay model is definitely not something poor enough that it should change ones mind. 

[Laika]

I agree Cain's post was overly pessimistic.  When you consider the totality of the workload and compensation, I think path's pay is competitive with most other specialties.

[pathman]

Haven't been here in years, and was just browsing.  Will agree with the previous few posters in that Cain's words are quite pessimistic.  Are you in path?  Cause it sounds like it definitely isn't right for you and perhaps you should switch to something else.

I'm a Canadian medical grad, finishing up my last year of residency at a Canadian school and I have absolutely NO regrets about my choice to go into path (and it was all I wanted to do from the time I spent some elective time in it as a med student).  A good field for old age?  How about a good field to exericise the vast medical knowledge you've accumulated over the years in a calm, comfortable setting?  How about a good field to have a balanced life and a family that knows you?  Hell, even in residency, although the amount we have to learn and the amount of reading is huge, it's still so much better lifestyle-wise than almost every other specialty.  I come to work at 9am everyday, and have had to come in to the hospital for call only a handfull of times for a few hours at a time throughout residency...'nough said.  This year prepping for the Royal College has been intense, but overall I am definitely healthy and happy...which is more than I can say for a lot of friends in different specialties.

To the MS1, the hours are excellent compared to many other specialties.  Where I trained, average hours range from 6-8 per day for an experienced pathologist, and maybe 8-10 per day for the more junior pathologists fresh out of fellowship. Someone already outlined compensation.  It actually varies between ~300K-420K in Canada currently, depending on the province you work in.  That's enough $ for me considering that I'm gonna have a life and I don't have to give any of it up for any overhead.  If it's not enough for you, cool.

Yes, being salaried means if workload goes up, there is not necessarily a compensatory pay increase.  But for the lack of hassles in terms of no overhead and the general hours, that's fine for now.  Call in academic centres is minimal in general.  Where I am attendings do 1 week per year and residents are first call and 80% of the time can handle things on their own.  Pretty awesome, huh?  They don't get paid extra for that week of call where I am but I believe they do in certain provinces.  Either way, who cares?  It's awesome!  And if you work community, you may be on call more frequently, but you almost NEVER have to come in.

There are jobs to be had in academic or community settings.  If you wanna do research and teach, you can.  If you wanna go Community and just sign-out, you can.  Regardless though, a fellowship in a subspecialty area is pretty much a requirement now.  But it is for many other specialties outside of FM.  I'll be going to the US to do one come July.

Bottom line, don't let one person's pessimistic outlook sway you.  And on the other side of the coin, don't let my cheery optimism convince you to pursue this.  Go out of your way to spend some time in your institution's path department and really get a feel for it, as you should with every specialty you're exposed to and think you may be interested in in medicine.  Good luck!

[bakercyclist]

What are job prospects like for path if you want to work in a specific medium-sized city?

[GrouchoMarx]

 

I'm a Canadian medical grad, finishing up my last year of residency at a Canadian school and I have absolutely NO regrets about my choice to go into path (and it was all I wanted to do from the time I spent some elective time in it as a med student).  A good field for old age?  How about a good field to exericise the vast medical knowledge you've accumulated over the years in a calm, comfortable setting?  How about a good field to have a balanced life and a family that knows you?  Hell, even in residency, although the amount we have to learn and the amount of reading is huge, it's still so much better lifestyle-wise than almost every other specialty.  I come to work at 9am everyday, and have had to come in to the hospital for call only a handfull of times for a few hours at a time throughout residency...'nough said.  This year prepping for the Royal College has been intense, but overall I am definitely healthy and happy...which is more than I can say for a lot of friends in different specialties.

To the MS1, the hours are excellent compared to many other specialties.  Where I trained, average hours range from 6-8 per day for an experienced pathologist, and maybe 8-10 per day for the more junior pathologists fresh out of fellowship. Someone already outlined compensation.  It actually varies between ~300K-420K in Canada currently, depending on the province you work in.  That's enough $ for me considering that I'm gonna have a life and I don't have to give any of it up for any overhead.  If it's not enough for you, cool.

Yes, being salaried means if workload goes up, there is not necessarily a compensatory pay increase.  But for the lack of hassles in terms of no overhead and the general hours, that's fine for now.  Call in academic centres is minimal in general.  Where I am attendings do 1 week per year and residents are first call and 80% of the time can handle things on their own.  Pretty awesome, huh?  They don't get paid extra for that week of call where I am but I believe they do in certain provinces.  Either way, who cares?  It's awesome!  And if you work community, you may be on call more frequently, but you almost NEVER have to come in.

 

Bottom line, don't let one person's pessimistic outlook sway you.  And on the other side of the coin, don't let my cheery optimism convince you to pursue this.  Go out of your way to spend some time in your institution's path department and really get a feel for it, as you should with every specialty you're exposed to and think you may be interested in in medicine.  Good luck!

 

I wonder what school you're at because in my department the staff, and they are experienced staff, are pulling 10 to 12 hours a day on a consistent basis. They're overworked, they have no power to change anything in their departments, administrators are always on their backs, and they're constantly measured against quality metrics. They are, in essence, the lowest rungs on the hospital ladder. They're also expected to teach and publish. Doing the math on their billings, if they were fee-for-service they'd be making double what they are now. I feel that making 400k is good if the work you are doing is valued at 400k. Same with not being paid for call. Even if call is infrequent, it should be paid. Does any other specialist not get paid for call? I don't think so. Overhead really should not sway someone's like or dislike of a specialty since that is something that is within one's control. Efficient billings can reduce the negative effects of overhead. Also some fields bill highly and regardless of the overhead still come out with a large profit. Family and other non-procedural specialties can be significantly affected by overhead but surgical subspecialties and some other ones are mostly safe. Switching to other fields is very hard and not guaranteed, especially switching out of pathology. This is only my opinion. As more of a self-directed type I agree that pathology is not a good fit. The subject matter is interesting but the way the job is set up goes against my internal motivation system. I like leading and managing things and making my own way in life, not being a corporate employee. If someone is ok with that, then pathology offers a comfortable job choice. Students should try to learn as much about the politics of the specialty as they do the subject matter. Both need to line up to be satisfying. 

[pathman]

Cain, where I've trained, there is a hard cap on the amount of slides a pathologist sees per day.  The halls of the deparment are bare by 6pm save for a few residents and a couple of junior staff.  All labs have quality improvement systems in place that take into account quality metrics of pathologists amongst many other things - this is necessary.  I wouldn't agree that pathologists have no power.    In speaking with academic pathologists with 30+ yrs experience under their belts, the argument of compromised patient care certainly goes a long way..

While teaching and publishing is a requirement for any medical staff in any academic institution, the amount required in pathology is certainly not extensive.  Additionally, some who are more inclined towards research and/or teaching can work out contracts that allow them more days dedicated to these things.  When it comes to call, let's be honest, it's not just the fact that it's very infrequent, it's also that staff never even get contacted when they are on.

I'll agree, yes, it would be nice if one could expect more money on days they worked more.  But in pathology, one can spend a few days on a 60 slide tumour case, and 40 minutes on another 60 slide tumour case - just like a surgeon could spend a significantly varying amount of time on the same type of operation depending on different factors specific to the operation...no system is perfect.  I suppose to any med students potentially interested in path, if your motivation to work is going to be solely based on the amount of money you can make for every unit of work, ok, maybe it's not for you.  But given all of the other upsides to this specialty I'm quite comfortable with what I'm going into.  All in all, and this is my opinion - it's one of the best lifestyle-intellectually stimulating-monetary compensation specialties in Canada.

Also, if one is so inclined, there are opportunities in a number of provinces to work more either within your institution or in other labs and earn more on a fee for service basis, but that's another conversation..

[pathman]

What are job prospects like for path if you want to work in a specific medium-sized city?

Well this depends on what "specific medium-sized city" you are talking about, lol.

[rmorelan]

side note on the pay - some centres have switched to fee for service as a result of some of the increased work. There is a limit to how far you can push them after all

[shikimate]

Do pathologists who work at Gamma Dynacare in Toronto or other private labs (eg. Alberta) bill fee for service in general? Aside from dermatopath are there any other subspecialty that these private labs generally employ? (I image they need GI for those out of hospital endoscopy bx?)

[GrouchoMarx]

Do pathologists who work at Gamma Dynacare in Toronto or other private labs (eg. Alberta) bill fee for service in general? Aside from dermatopath are there any other subspecialty that these private labs generally employ? (I image they need GI for those out of hospital endoscopy bx?)

 

They do but those positions are hard to come by and aren't often made available due to old-timers holding onto them forever.

Plus they sign out at a rate of 30% of fee-for-service. The corporation skims 70% off the top. Not ideal for professionals.

[Laika]

Do pathologists who work at Gamma Dynacare in Toronto or other private labs (eg. Alberta) bill fee for service in general? Aside from dermatopath are there any other subspecialty that these private labs generally employ? (I image they need GI for those out of hospital endoscopy bx?)

 

Cytology and gyne also come to mind.  Keep in mind having connections is probably more important than a subspecialty fellowship when securing a job in a private lab.

 

Even if the corporation takes a cut, the work can be very lucrative.  It's not uncommon for pathologists who have "full-time" jobs elsewhere to work in a private lab part time.