This is just a brief article discussing Pathology for those medical students and FMGs who are still considering which medical specialty to enter. We’ll have these articles occasionally to act as a resource for anyone trying to make the most informed decision.
What to expect as a Pathologist
While most laymen associate pathologists with the dead, the fact of the matter is these doctors make decision of life and death everyday, usually without ever meeting the patient.
Pathologists determine the course of treatment though many patients by making minute and extremely accurate diagnoses that may mean the difference a lifesaving procedure or one doomed to failure. The information provided by a pathologist determines whether an organ can be repaired or must be removed.
It is a specialty that requires diligent study, an attention to detail in the extreme, confidence in one’s abilities and the ability to recognize the limitations those abilities. Pathology is the backbone of all medicine and so a pathologist supports the practicing physician. As William Osler, the first Chief of Staff at Johns Hopkins and founder of the residency method of training put it, the pathologist is the doctor’s doctor.
Pathology requires an inquisitive nature and a voracious appetite for knowledge. Pathology training puts an emphasis on research, reading and study. First-year students looking to pathology will often concentrate in such courses as gross anatomy, cell biology, histology and chemistry.
There are two types of pathologists and the length of residency is dependent on the path chosen.
Studying primarily bodily fluids, blood and other patient specimens, the clinical pathologist is the laboratory expert. They key here is scientific analysis. They are concerned with the management of data, quality control and all facets of diagnostic testing. Clinical physicians often call upon these doctors to consult on what the best test might be, given certain symptoms These experts in scientific processes, both natural and in the laboratory setting, require three years in residency. Rotations include clinical chemistry, transfusion medicine and immunology.
Anatomic pathologists study the organs, tissue and cells to make exact diagnoses as to what caused that specimen to be removed from the patient. Through the use of biopsy, autopsy, fine-needle aspiration or surgery, this physician will conduct examinations from gross to microscopic. Where the clinical pathologist relies on testing and analysis, the anatomic pathologists determinations come largely from visual inspection. They remain alert for unexpected processes at work. Residency training for the anatomic pathologist is three years. Rotations include forensic pathology, autopsy and surgical pathology.
The third choice would be to study both types of pathology. This is a four-year residency program.
During residency, pathology students are not on call in-house. While they may be called into the hospital at night from time to time, for the most part, they adhere to a regular daily schedule. However, this specialty calls for intensive study and most pathologists use those nights off for that express purpose.
Pathology does not require an internship year.
Following residency, there are many fellowship programs available that can lead to certification by such bodies as the American Society for Clinical Pathology and the American Board of Pathology. These fellowships include such diverse subspecialties as Forensic pathology, Hematopathology, Medical Microbiology, Blood Banking/Transfusion Medicine, Cytopathology, Clinical Chemistry and Surgical Pathology.
In practice, the pathologist is generally an anonymous entity to the patient, much like the radiologist or anesthesiologist, in most cases more so. Physicians seeking to have a doctor-patient relationship of any kind should probably look elsewhere. To say that pathologists never meet their patients would be overstating it. Exceptions include such procedures as plasmapharesis and bone marrow biopsies.
The lack of patient interaction, or the common perception of pathologists as doctors to the dead, does not mean they aren’t lifesavers. Physicians rely on the work of pathologists in determine treatment courses. Careful specimen study by a pathologist may be what detects whether or not a surgeon fully resected a tumor, thus perhaps saving the patients from further pain or death.
The specialty is also ideal for those who wish to be on the cutting edge of medicine and technology. Pathologists use the latest equipment and scientific processes and have access clinical material in the course of their study. They are often on the front line of detecting new and unusual conditions and advance medical understanding of disease.
What your life will be like as a Pathologist
The average pathologist works a fairly regular schedule of just over 40 hours a week, very nearly keeping regular office hours. Late calls are rare, though in their capacity as consultants to other doctors, they are occasionally called in for emergencies. Surgical pathologists, for instance, must be present when an intraoperative consultation is called for. Generally, a pathologist’s career life allows ample time to spend with family or on outside interests.
The practice options open to pathologists are many and varied with the majority working in private practice, specifically in hospitals or laboratories. A smaller number choose to take the academic path and become take faculty positions at universities and medical schools, both in research and teaching jobs. The popularity of the CSI television programs has shone a light on the next most popular choice, that of civil service as a forensic pathologist in city and county crime labs and medical offices.
According to the American Medical Group Association, the average salary in this specialty is just over $220,000 annually. The American Society for Clinical Pathology places the bottom end of the range at $167,000 and the top end at just under $300,000.
As with other specialties, certifications will tend bring more money. Over half of pathologists surveyed by the American Medical Association have indicated that their current compensation package has exceeded their expectations.
Is Pathology for you?
While the lifestyle perks of the pathology specialty make the choice very attractive for some medical students, there are certain qualities that must be in place to succeed as a pathologist. An inquisitive nature and the discipline to maintain independent study (and not while in training) are imperative. Management skills will also be called for, especially as a clinical pathologist who may be in charge of a laboratory setting. If these apply and you enjoy serving as a consultant to other doctors rather than being more “hand on” in doctor-patient interactions and enjoy a challenge, then pathology is specialty that, though often overlooked, bears closer examination.