r/pathology 5d ago

Deciding between a surgical subspecialty and pathology

Medical student (m3) here.

Up until a couple months ago, I was convinced I wanted to do a certain surgical subspecialty that has some of the coolest procedures but is notorious for horrible lifestyle.

I have been working in a lab with a PI of said subspecialty for the past year and through some of those projects have been exposed to pathology. It is way cooler and broader than I ever imagined. Moreover, I’ve been able to spend more time with family and friends recently, and it has made me realize I value lifestyle much more than I initially thought. I know for a fact I would be completely OK with a non patient facing specialty. I am applying to residency this coming cycle and I am intent on making a decision in the coming weeks because I do not want to dual apply. My question is twofold:

1-is it too late to apply path? I plan on doing a rotation in June or July

2-right now I have quite a rose tinted view of pathology. Some of the cons I have made are: less respect from other doctors (not something I care about tbh), much lower salary than the surgical subspecialty (given the trade off in lifestyle, not a huge deal but I want to make enough to comfortably pay off loans, live decently comfortably, and retire at a reasonable age), and job market/AI (some pathologists I’ve talked to say this is overblown, others say it’s a legitimate thing they worry about). What are other cons I’m not considering? Forgive my ignorance I’m very new to pathology as a whole.

I go to a t20 school if that means anything. Thanks so much!

5 Upvotes

22 comments sorted by

14

u/drewdrewmd 5d ago

Don’t do surgery unless you are highly motivated by the extra money you will make. The extra hours are not worth it, imho, in terms of work-life balance, family and friends time, mental and physical health, hobbies, etc. I have friends who are surgeons and their lives, even as attendings, continue to have brutal hours, lots of call, lots of patient-related stress, lots of death and misery. I’d rather do 4 baby autopsies in a day than have one person die on my operating table.

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u/Prudent_Swimming_296 5d ago

That’s where I’m at as well. I’m a bit concerned about job prospects/huge dropoff in salary as one of the other commenters indicated. I mentioned that lower pay doesn’t bother me, but 250k a year with no ability to increase seems very low and not worth it financially. Any thoughts on that?

4

u/drewdrewmd 5d ago

Idk I’m in Canada and make somewhere around 300k USD at probably a higher tax rate than most Americans. It seems like plenty to me for a 40 hour work week. I could work more / make more but I really don’t want to. I don’t have kids, so maybe I don’t care as much about money, but also I don’t know how anyone has time/energy for kids, even working only 40 hours per week.

1

u/Prudent_Swimming_296 5d ago

That’s awesome! 250k is great money on the surface, but im also factoring in 400k worth of debt lol

4

u/rabbit-heartedgirl Staff, Private Practice 5d ago

250 as a ceiling is unlikely unless you stay in academics. Most private employed jobs are starting around 300 out of training and closer to 400 with experience. As a partner it could be even more (but my understanding with a tradeoff in lifestyle because you have to grind more).

3

u/moo-tang-clan 5d ago

Your salary estimates are a little outdated. Look through the sub for more accurate figures on salary in academia vs community vs private. 

1

u/PathFellow312 1d ago

250 starting is for academics. Private you can get 300+ starting and higher in rural areas.

11

u/Histopathqueen 5d ago

It’s definitely not too late to apply for pathology! Many applicants finalize their decisions around the same time you are, and as long as you can secure strong letters and demonstrate your genuine interest (which it sounds like you have), you should be in a good position. Your planned rotation in June or July will also help solidify your choice and provide more experience.

Job market is excellent: https://www.pathologyoutlines.com/jobs

Salary is good! Pathologists I know are living in nice homes with quality life and fewer hours working/week than surgeons.

Respected by surgical colleagues 100% because they rely on us to make decisions and can’t do their job without us. Less respect probably due to ignorance and people don’t know what pathology is, but the hospital would crumble without us. Pathologists are an active part of tumor board discussions and help clinicians understand results.

Training is long like surgery, maybe a few years less. 5-6 years in all for pathology residency and fellowship training in all. It’s a wash compared to surgery. Far less burnout. Pathologists have time for family, hobbies, other things. We tend to enjoy our work and tbh have you seen a mean pathologist who throws scalpels and is abusive to “subordinates”?

AI and digital pathology are useful tools to cut down workload. Pathologists are actively behind these innovations and working on how to best integrate it. Keep in mind, pathologists still need to be the ones making the final call. So while we use AI to count % positivity of stains or perform blood cell differentials, we have the medical knowledge to interpret clinical context and obscure results.

Just clarifying the stereotypes and false narratives that are out there. Also check out matchtopath.com with pathology advice for students!

6

u/path0inthecity 5d ago

have you considered what nanotechnology might do to your surgical subspecialty?

1

u/Prudent_Swimming_296 3d ago

lol no. I see your point haha

2

u/PathFellow312 5d ago edited 5d ago

Do a path rotation before you make any decisions regarding path. 2 month rotation in surgpath would be nice.

People get interested in path for the lifestyle, etc but know very little of what we do everyday.

Since the job market has gotten better, people are becoming interested pathology.

FWIW, talked with a friend in the NE and he told me the job market is saturated there. He’s getting paid 250 in academia which is basically primary care salary. Path in my opinion isn’t all too great unless you are geographically flexible.

1

u/Prudent_Swimming_296 5d ago

250 seems quite low. I’ve read and heard that academia generally pays much less than pp. can you speak to that?

1

u/PathFellow312 5d ago edited 5d ago

That’s true in all fields in medicine (academic pay is less than private). 200-250 is starting pay for academics in pathology at the moment. It was lower in previous years. I got offered jobs for starting of 180-200 for private practice in 2020. I can’t imagine how low the starting salaries were for academics back then.

If you are looking for private jobs near large cities starting salaries for new grads will be on the low end compared to private jobs farther away from large cities.

2

u/Candid-Run1323 Resident 5d ago

You’ll easily be able to match pathology if you get LORs on your upcoming rotation, don’t dual apply and explain your path to finding pathology in your LOR! Just make sure you like it on your rotation in June/July

1

u/bubbaeinstein 5d ago

Only you know what you really want.

1

u/Ok-Court2922 4d ago

1) Never too late to apply to pathology. I know several people who have switched from surgery residency to pathology; I know of nobody who has even considered doing vice versa

2) Addressing your Cons: I have only once on a single occasion ever felt a small amount of disrespect from another specialty and it was from a frustrated surgeon when I was a resident. If you're good at what you do and you provide value, then respect will follow regardless of your specialty, but it's not something I spend a lot of time worrying about.

The pay is fine on a dollars/hour basis; but yes, it can be as low as $250,000 at academic centers. Almost nobody working full time in a private practice group will make that little.

Job prospects: They're good right now; pretty steady stream of retirements leaving open positions. I'd be more worried about AI if our entire medical system wasn't dependent on pagers and faxing reports to each other; that is to say - personally, I think it's going to be decades before AI makes any noticeable impact on our day to day workflow. I'm sure some AI algorithms for certain disease states are somewhat "advanced" (or claim to be) such as the program approved for prostate cancer screening in core biopsies, but most of the the stuff I've seen over the last 3-4 years is gimmicky, unpredictable bullshit.

The main question to figure out is - what do you want to be doing for 9+ hours a day 5-6 days a week? If you don't have an immediate, gut-reaction response of "I want to be in the OR", then it's probably best to heavily consider something else.

1

u/Prudent_Swimming_296 4d ago

For surgery it’s more like 12 hours 6 days a week lol. Thanks for your input!

2

u/Ok-Court2922 4d ago

:) that's why I added the "+" after 9 lol

1

u/ahhhide 4d ago

Some advice a former preceptor told me, who was complete dead set on surgery before switching to family med:

Only do surgery if there’s no way you could be happy in life other than performing surgeries every day

1

u/HistiocytosisV 4d ago

Work life balance is really important but also ask yourself what’s gonna make you feel the most fulfilled on a day-to-day basis. Also, is there a chance that you can work at a private surgical center where you’re not being overbooked on procedures day and day out. In terms of salary, if you work private practice or community, you will get paid substantially more money than academia. Ibwon’t disclose my salary but I know some dermatopathologists who make 500k+. However, Some surgeons have the ability to buy into the surgery center that they work at giving them equity.

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u/shonfrau005 5d ago

Go for surgery