Thoughts from Pathology Job Market Conversations

So, as you know, I recently attended the 2014 CAP Annual Meeting in Chicago. In addition to meeting with residents, I also had many interesting conversations and meals with non-trainees. I met new-in-practice pathologists who had completed two or three fellowships who were unemployed and were at the meeting networking with potential job prospects. I met veteran pathologists who were working in part-time or locums tenens positions while searching for a more permanent position. And finally, I met pathologists who were currently working but who told me that over the years, the amount of work that they have had to do for the same or less pay had significantly increased.

These conversations left me wondering how we can address this issue. How do the reports that this country would see an impending shortage of pathologists in the near future fit in with these first-hand stories? Most, if not all, of the reports about a pathology workforce shortage were based, at least partially, on survey data. This can be influenced by selection bias, volunteer bias, or both depending on how the survey was conducted. Also the modeling applied, at best, can only make estimates about future occurrences based on the data available now. It cannot take into account unforeseeable game changers (eg – Affordable Care Act) that may significantly alter the practice of medicine compared to the practice today. I’m not saying that we should discount these reports, just that we should be aware of how to critically analyze the conclusions from them.

I do believe that there is a pathologist shortage in terms of misdistribution geographically and subspecialty-wise, but this is a trend that holds true for most medical specialties. We may not have enough pathologists per person (aka a shortage) in this country but we definitely have a surplus in many urban settings where it may be more popular to practice. Certain popular and well-paying subspecialties, like dermatopathology, could have a surplus but don’t because the number of fellowship positions are limited. But other popular subspecialties like hematopathology seem to be saturated in terms of positions near cities that are popular to live in from my anecdotal experience.

And even though an impending shortage is always the battle cry to increase the number of residency spots, our community is polarized on this issue. Some residents and pathologists I’ve spoken with feel that we should, like other specialties have done in the past, limit the number of residency positions we have. Without more data, I can’t really say which side of the argument I agree with but I do acknowledge that we are at a crossroads. The decisions we make now about how we train our residents and what roles pathologists should fill (eg – molecular diagnostics) will affect our future, patients’ futures, and our profession’s future.

But regardless, the problem does remain that the job market currently seems tight and that pathologists have had to perform more work than they have had to in the past. So, what is your take on the situation and your suggestions for a possible solution? And how can we incentivize to address misdistribution of pathologists to address a shortage in more underserved areas?

 

Chung

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

 

7 thoughts on “Thoughts from Pathology Job Market Conversations”

  1. I’ll be honest.

    The handmaiden role of pathology has made me regret ever entering the field.

    I hope to enter residency in a better field – yes, better – soon.

  2. We need to reduce the number of pathology residency spots for sure, at least by half. In addition, we should restrict entry only to MD’s, so US seniors or US FMGs at Caribbean schools for example. English skills are lacking in Pathology so we need to start putting up walls against IMG and DO applicants.

    1. Whoa. I am Dr. Webb Pinkerton and this is NOT ME. Someone has stolen my name for this posting. Shame on whomever did this. Use your own name next time please.

      1. Even if it is NOT from Dr. Webb Pinkerton, the original post is completely spot on. The number of training programs should be slashed in 1/2, The job market is making life miserable for nearly every Pathologist I know. 2 fellowships just to get a job (which usually is a horrible job because they will dump all over you, and if you don’t like it, they will get rid of you and replace you with someone else), is ridiculous. Clearly there is not a “shortage”.

  3. I’m not sure if this is common knowledge, but the ACGME and AOA agreed just a few months ago on a combined MD/DO GME system for the future though the logistics have not been worked out completely yet. This means that in addition to DO’s being able to go to ACGME residencies (we have zero DO pathology residencies so we all go to MD programs btw), now the vice versa will be true (I know MD friends who wanted to do DO family medicine with OMT and who went to every OMT conference they could while in med school). There’s also some changes that went into effect in 2014 changing the ACGME Common Program Requirements that are now moot that I can expound on but this is probably way more than is needed here. Personally, I have found some subtle DO discrimination (or ignorance at the very least..but rarely) while applying to fellowships, but the more open minded programs (top programs btw and the majority) don’t seem to have an issue with it and have started to invite me for interviews.

    I don’t agree with the “walls against IMG and DO applicants” opinion. I am a DO and know many who chose to go DO when they could’ve gone MD (I know my MCATs were way more than adequate and I had MD interviews). Most of those chose DO b/c they wanted to do OMT and go into PM&R due to life-changing OMT they received when they were injured and no MD’s could help or because they liked the osteopathic philosophy, etc. So making assumptions may lead you to wrong conclusions (the average MCAT score at my med school now is >30).

    And I know many fine IMG residents (even some who were pathologists in their own countries). And not all IMG’s have poor English skills especially if they come from an English speaking country (some may have accents but not everyone in the US speaks with the same accent either…I know being from the NE, I can’t always understand my friends from the deep South but that’s OK…I ask them to repeat or clarify). I also know some great Caribbean AMG’s as well who went to the better Caribbean schools. And I’ve met some American-born who have poor English skills/grammar and more than my share of MD’s who I wonder why they are in medicine. I also know a friend who scored way lower than 30 on their MCAT, went to an MD school (some might say got in by affirmative action), did well, and then matched to an E-ROAD specialty at an Ivy. People come in all flavors and there’s more than what’s just there at the surface at one point in time. And no one cares or asks about this friend’s premed grades/poor MCAT because they are intelligent and well-trained and a resident who is rocking it in a competitive specialty at an Ivy institution (if those types of surface things matter to you).

    I’m hoping that your comment was more of the trolling persuasion because this ‘wall’ is never going to happen. In fact, its beginning to crumble as I already mentioned with the unified GME system/merger.

  4. Over 45 years practice experience IMHO There have always been too many resident positions busy academic programs depend on residents and the field is constantly consolidating… currently in a large HMO 600K patients 11 pathologists and consider myself extremely lucky after having gone through DRG’S in 1982…. Most of the manpower studies have been tweaked by well meaning folks in the academic world …. just my thoughts

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