iPathology

Thoughts on Pathology and Laboratory Medicine as a Career

As the Fall rolls on, senior medical students will be choosing their fields and applying for residency programs. It's an exciting and critically important time in their lives. The choices made between now and the Match day will determine the course of their lives.

What about Pathology as a career? Ever thought about it? What do Pathologists do?

Pathology is a very broad field that is commonly said to bridge the divide between basic science and clinical medicine. In fact, it's far more than that. Pathology is an incredibly dynamic area. This may come as a surprise to those who think of pathology as all about looking at slides and doing autopsies. While those are important and essential for patient care, which is the field that is taking the new genomics and applying to medicine? Or the new proteomics? The answer is these are being applied in pathology, particularly in the field known as clinical pathology. That's the field that includes the medical direction of clinical laboratories. It's also called laboratory medicine. A clinical pathologist may practice some anatomic pathology, but most clinical pathologists have a specialty interest in one of the areas of the clinical laboratories such as clinical chemistry, molecular diagnostics, hematology, cytogenetics, coagulation, blood banking, immunology, or microbiology. That's a lot of areas each of which has plenty of depth. Some of them involve primarily laboratory work, others, like coagulation and blood banking involve patient care to one degree or another. Molecular diagnostics is said to be the bridge between clinical pathology and anatomic pathology. Increasingly, tumors are being studied at a molecular level, providing data that complements morphology and offers information for diagnosis and sometimes prognosis. This is where the fruits of the human genome project are being applied. It's a very exciting field that is at the cutting edge of applying science to patient care.

What's the training like to become a pathologist? In the U.S., most people take 4 years of residency in anatomic and clinical pathology in accredited programs and are then eligible to apply to take the American Board of Pathology exams. Subspecialty training is available in academic medical centers around the country. To my mind, what distinguishes programs is usually not the anatomic pathology which tends to be of a uniformly good standard, but the level of involvement with clinical pathology. Does the program have full-time clinical pathologists? Who runs the clinical laboratories? Here are some questions to consider if looking at a pathology program: how many anatomic and clinical pathologists are directly involved in the teaching program? Is there a real interest in clinical pathology or is a part-time activity? What are the opportunities to be involved in cutting edge research? On anatomic pathology rotations, do residents get to see the cases from start to finish? Are the "most interesting" cases reserved for fellows? (A red flag if you're a resident). What is the activity in molecular pathology? If it doesn't exist, I'd look at other programs: it's not a good idea to begin a 30-40 year career in pathology today and not know about molecular pathology.

What are the job prospects like? What do pathologists earn? I'll talk about these more in later note.

For more information see the American Society for Investigative Pathology website.

Survey Sounds the Alarm on Physician Labor Trends

A recent survey conducted by Merritt Hawkins and Associates of physicians aged 50-65 reveals several striking and alarming findings. But before looking at the survey findings, let's remind ourselves of a few important points. First, this group of physicians is presumably at the peak of their careers in terms of clinical experience. Second, nearly one-half of all U.S. physicians are over 50 years of age, so it's a very large group of professionals. Third, the U.S. population is rapidly "graying" and the need for physicians will never have been greater than it will be in the coming decades. We face a physician shortage that may range from 100,000-200,000 physicians by 2020.

So here are some of the findings that are very troubling.

1. In the next 1-3 years, nearly one-half of physicians surveyed plan to either retire, take a new (non-clinical) job, or cutback significantly on their clinical work.

2. Only 10% agree that their work is "very satisfying".

3. 18% have already closed their doors to new patients.

4. A clear majority (57%) would not recommend a career in medicine to their own children.

Unfortunately, there are no specific data on pathologists in the survey, but in my personal experience, I'd guess that the degree of job satisfaction among pathologists is significantly higher than among primary care physicians. I think this is attributable to many reasons among which I'd cite more regular hours, less paperwork, a more structured working environment, and possibly greater intellectual stimulation given the dynamic developments in laboratory testing.

If the findings of this survey are accurate, the U.S. is going to face a crisis in physician health care delivery in the next few years. The reasons for the high level of dissatisfaction have to be addressed.

The Merritt Hawkins report can be accessed here.