Trainee Worries, Level III Anecdotal Evidence, and Thoughts to Keep in Mind During Training

As you know, I serve as a junior member on one of CAP’s councils. Besides enjoying the opportunity to participate and represent the resident voice on issues that will shape the future of our profession, I always value the thought provoking conversations I am fortunate to have during our meeting dinner. And this past weekend’s meeting did not disappoint.

So, we’ve all heard the opposing arguments. There’s the one side that anticipates an impending “retirement cliff” and not enough pathologists to serve the needs of future patients. Then there’s the “doom and gloom” side that states that we have too many pathologists and no jobs for those of us who will graduate in the near future. So which side is correct?

As someone who was trained in critical analysis and statistics during my public health training, I can see a scenario where both of these situations can co-exist. Like the Indian story of six blind men who feel different parts of an elephant, our perception of reality is based on our experience (or if you think of grossing-speak, sampling informs our eventual conclusion). For trainees, of course, we fear  not being able to obtain this “competency.” Everyone seems to be stressing as of late and more so of not being able to find a job when we graduate. Couple that with the frequent nay-saying we hear about the paucity of job opportunities available (which amounts to level III anecdotal evidence), the landscape is set for us to believe that our profession is in a crisis.

We discussed these issues and more during our dinner last week and practicing pathologists pointed out to me that they had heard the same when they were training and yet, they were indeed employed, and in jobs that they love…so there is hope. I was told that if we focus on becoming “good” pathologists and working to obtain “true competency,” the rest should follow. A “good” pathologist is always employable and sought after.

But what about those of us who don’t make that cut of being the “cream of the crop” and who are your average trainee? After all, average means the majority. What I seem to hear repeatedly (even from the nay-sayers) is that there are jobs out there…just maybe not in the location or at the salary/benefits we initially want. But maybe we need to look at this as a “glass half full” opportunity. Most of our future “dream” positions may still be within our grasp but we need to be humble and realistic and may need to work our way up to it.

The most desirable characteristics in a successful job applicant, from what I heard over and over during this conversation and multiple others, are competency (especially since no one wants lawsuits), ability to fit in (of course, people have to like you and not think you will cause drama), and experience. This often translates to a fellowship or junior attending experience during residency training where we can build up our confidence and ability to sign out on our own (or almost with little supervision). So, the suggestion was to obtain employment (and it may not be your “dream” job) to nurture that capacity and then if you possess the other two characteristics, you should be able to find employment at a situation closer to what your “dream” job looks like in time. But patience is the main virtue here.

I found this outlook a little more practical than either of the two aforementioned, more extreme arguments. And either way, it is not worth wasting time and energy worrying about what may never come to pass (and attendings really get tired of the whining)…but rather to set the goal to become the best pathologist we can be in the present. Obviously, this is easier said than done or we’d all be acing our boards and RISE.

Making the transition from student to almost practicing pathologist is difficult. We may not be as used to the demands of a job (versus studying mentality) that we are expected to already possess during training and the volume of knowledge we need may seem prodigious at times. But set yourself some small sequential goals and push yourself to have the humility and dedication to meet them…and put entitled behaviors aside. If your residency isn’t giving you what you need, proactively (and nicely) ask for it…or find other outlets to obtain it – there are a lot of online free resources and your fellow residents, at your program and others, are a valuable, understated resource. Don’t expect others to do for you what you must now learn to do for, and demand, for yourself.

I feel inspired after the meeting last weekend and the conversations we had and I am re-dedicating myself to continue to address my weaknesses. Leave us a comment if you have an opinion on how we should approach residency training or how we should view the future of pathology in this ever changing health care environment.

 

Chung

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

2 thoughts on “Trainee Worries, Level III Anecdotal Evidence, and Thoughts to Keep in Mind During Training”

  1. The issue is that, within medicine, the pathology job market is particularly onerous WHEN COMPARED to every other specialty. Add to that the low remuneration, the requirements for multiple fellowships to land work, the usurping of professional autonomy by corporate interests, the fact that pathologists often work FOR fellow physician colleagues rather than WITH them, the general stigma of being a doctor in the “lab” who couldn’t relate to patients at all, the insistence of the continuation of including the obsolete, disgusting autopsy in our repertoire of skills, and a multitude of other things, and you can see why pathology may be the least competitive specialty in all of medicine.

    A “so so” job market is not good enough to get the best and brightest to sign up for the field when there are so many other, better alternatives in medicine. Radiology, which does essentially the same job as we do (looking at something and then giving an opinion) is frankly a better field to be in than pathology. Why would any student pick pathology over radiology other than that they didn’t match to radiology?

    The job market is bad. Full stop.

  2. I believe that part of the issue is in how pathologists have marketed themselves. We need to show that we are equals with other physicians by as you say, working WITH other physicians rather than giving or propagating the impression that we work FOR them. I have friends who are radiologists and they also complain about outsourcing of their work to other countries (think like NightHawk but not just for night reads) and decreasing compensation. Most of our medical specialties have varying degrees of job market issues. I chose pathology, not because I couldn’t match to something else, in fact I even interview at top tier programs, but I chose it because for a visually oriented, research trained, public health trained person like me, it made sense and keeps me excited. Rather than complain about the lack of jobs in our profession, we need to think out of the box – to create opportunities by changing the perception of what pathologists can offer…but only we can do that.

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