For Whom the Match Tolls

Last week, hundreds of M4 students across this country hoping to match at pathology residencies learned their fates. On the flip side, training programs also learned whom they would welcome as trainees come end of June/July 1st. We also learned that there were 51 unmatched positions, even at some of the so-called “highly prestigious” programs that one expects to always fill. That’s the most I’ve seen in recent memory and more than double the number that were unfilled when I matched 2 years ago.

Several questions went through my mind when I learned of the increased number of unfilled spots this year. Is this a harbinger of things to come for our profession? Did programs make their rank lists too short? Was there a significant decrease in the number and/or quality of the applicants this year? And if less people applied, what is the reason? Are the significant anticipated reimbursement cuts, for pathology services in the most recently released federal physician fee schedule part of the problem? Besides the decrease in compensation, did the uncertainty of the pathology job market also contribute?
I was talking with another resident who thought that it was a good thing that we had more unmatched spots. He felt that we have too many trainees and not enough jobs for when we graduate. Although I did point out that after the SOAP week, the majority, if not all of those 51 positions would most certainly fill. This year’s match results may indicate the start of a possible trend for our profession or it may just be a fluke…we’ll have to wait until next year to have a better idea.

Robboyet al in an article entitled the “Pathologist Workforce in the United States” in the Archives of Pathology and Laboratory Medicine predicted that a retirement cliff would begin in 2015, resulting in a steady decline in the number of working pathologists in this country. I served as the resident representative on ASCP’s Future of the Pathologist Workforce Round Table that discussed some of the preliminary data that was included in the aforementioned article. I’ve also participated on other ASCP and CAP committees/councils since then. Despite the predictions, what I’ve heard personally from the physicians that I’ve worked with on those committees/councils is that at their current locations of employment, the overwhelming majority are not looking to hire any new pathologists in the near future.

So for those of us hoping for employment as new physicians in the next few years, will we have even more difficulty finding jobs than those who are currently struggling now to get enough interviews to ensure employment? Do you have suggestions as to a solution to this issue? It’s hard to predict what our profession will look like in a couple of years, especially with all the changes occurring post-ACA. But instead of being passive bystanders to this process, we need to actively interact with other specialties and engrain our worth into the clinical process in a very visible and palpable manner that we are missed when we’re absent, or be left behind.

The results of the match highlighted to me that our profession is going through some growing pains right now. While the etiology is unclear, we can start attempting to treat our differential to shape the outcome we would like to see. So how did the match go for your program? Do you feel that the match results were a good measure of the pulse of our profession right now? And what do you see as our profession’s biggest issues and what are some possible solutions?



Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

3 thoughts on “For Whom the Match Tolls”

  1. There is a perverse incentive for pathology programs to accept residents to act as PAs rather than to actually hire real PAs, since the former is a cheaper alternative to the latter.

    Corporate pathology labs also benefit from an oversupply of pathologist labor, since with a tight job market they can drive down labor prices and pocket a higher percentage for professional services.I wonder if big names in pathology are profiting from the oversupply.

    Pathology has never been a popular specialty; as far as true specialties go, it is the least popular one. Yet every year most programs fill, probably because the lower-tier programs will accept anyone with any prior training as long as they can hold a knife and gross.

    Robboy’s study is flawed and biased, and it must be taken with a grain of salt. Robboy’s study did not define workload in a proper way. Pathologists have become more efficient and can absorb extra work – few pathologists are working at maximum capacity. Furthermore, new technologies will make the job even more efficient, and his study does not take that into account.

    A job market that demands that people have two or more fellowships to obtain the base-level job is one that is oversupplied.

    My solution is simple; stop recruiting IMGs for a while. We have enough domestic interest in pathology, however little it may be, and the job market is not good. IMGs were recruited to fill a need in society, and that need no longer exists. It would take about a decade to even out.

  2. Agreed 100%… pathology as a specialty is in real danger. The CAP really needs to get its act together and push for a cut in residency spots, at least 25%. There are simply way too many pathologists being trained especially in an era where technology is increasing the amount of work each pathologist can do.

  3. I do agree that its hard to do predictive studies and to be honest, I didn’t get to analyze the data or study design used for Robboy’s study (only heard the results by the time I was appointed as the resident on the Roundtable). So as to the validity of the predictions, I can’t say that I support or disagree. While it may be true that many pathologists currently are ‘older’, many are not retiring at 65…and from what I’ve seen on rotations, there is wiggle room if in fact a hospital fired some staff and required the remaining staff to pick up the slack…they wouldn’t like it but most likely would be able to without having to work til midnight. Pathologists would have to become more efficient or stay a little later but its possible. So, for those of us graduating in the coming years, job security is a topic that often comes up. We hear and read about the dismal prospects about procuring a job and about the increase in work and knowledge that we will need. Cutting IMGs I don’t think is viable b/c whether we admit IMGs or domestic grads, the fact still remains that there are many built-in policies that incentivize residency programs taking more residents (regardless of who they are, the numbers are likely to remain the same)…maybe we need to start with these policies or at least discuss them as a topic on the table?

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