Monday, August 3, 2015

A high school student has questions about a medical career and pathology vs. surgery

A female high school student asks about pathology, surgery, and medicine in general. [Email edited for length.] See if you agree with my answers.

The field I am most interested in is pathology. I have a very logical mind and would enjoy being able to solve the complex puzzle of disease. I would also like the somewhat flexible hours compared to other more intensive specialties. However, I do have some qualms.

I'm also interested in general surgery. I would love to learn how to perform all the different types of surgeries that surgeons perform. If I were to be a pathologist, would it be "knife-free"? Pathology really intrigues me, but participating in the occasional surgery sounds like it would be extremely interesting and full of learning opportunities.

There is some knife wielding in pathology. Specimens must be properly cut, and there is the occasional autopsy. However, it's definitely not surgery.

What does a pathologist really do? I've looked at various descriptions online, and none of them seem to be very specific. What would a typical day look like for a pathology resident? I was also wondering what types of skills pathologists are taught?

Pathologists spend most of their days looking at specimens, mostly microscopic slides. Here is what pathology residents at Johns Hopkins learn.

I know that medicine is constantly evolving. With new medical technology, certain fields will soon become obsolete. Do you think this will happen to pathology?

I suppose there will be some technical advances that might involve automated digital reading of pathology slides, but I believe there always will be a need for pathologists. A residency position in pathology is much easier to obtain than one in general surgery.

Since I'm interested in both pathology and general surgery, I was wondering if there was a way I could do them both (in a combined program or something like that). I know this is highly unlikely.

It can't be done.

I am a very anxious person. Specifically, I have health anxiety. (I'm all too aware of the irony). Do you think that the amount and intensity of the material covered during med school and residency could take a severe toll on a person's mental health?

I think every medical student at some point worries she might have a disease she just read about. I'm not sure what to tell you because I am not a psychiatrist, but studying diseases for four years and having a health anxiety might be a problem.

I would also like to know whether being involved in medicine could dramatically alter a person's personality by magnifying their negative characteristics. I am very driven, hard-working, ambitious, logical, easily annoyed/frustrated, and sometimes easily distracted. I'm quite anal-retentive and OCD. Some of my friends and family have described me as an emotional robot. How do you think these characteristics would be affected by a journey through medicine?

Many medical students and residents become less empathetic and more jaded as they go through medical school and residency. Except for being easily distracted, many of your traits are common in med students. Here's more about empathy and medical students.

Do you know how difficult it is for Canadian students to get into American med schools? Or do you know any medical schools abroad in English speaking countries (e.g. Scotland, England) that would be willing to admit international students? Also, would it be more difficult for a woman?

It's not easy. Here is a link to a website that has some data on Canadian applicants to US schools. I don't know much about UK schools. I've written about Caribbean schools. Type "Caribbean" in the search field of my blog. Being a woman won't matter.

How would medicine affect interpersonal relationships? I'm really close with my immediate family, and it would be difficult not being able to see them all the time, let alone during holidays or breaks. How can a person manage a serious relationship and medicine at the same time?

It can be done, but it takes some effort. I have written a few posts about so-called work-life balance.

Choosing a specialty is difficult
More about choosing a specialty
Anguish about choosing a specialty
Surgery and work/home conflict

I hope this helps. Good luck.


Anonymous said...

The traits are right on but one of them: logical. Do you know how many doctors react when you bring up medical research data compared to their beliefs? It sure isn't logical. :)

Matter of fact it reminds me of some female named Jenny Mccarthy. Hee hee hee.

connmannic said...

Thank you for posting this and answering her questions. As someone preparing to go to medical school, your support to people considering this field is extremely generous.

artiger said...

Go with pathology. Aside from the bizarre after hours frozen section, or autopsy, the hours are good, and no one calls you for narcotic prescriptions.

Skeptical Scalpel said...

Anon ???

Conn, thanks.

Artiger, and the patients are compliant.

Anonymous said...

This is DrMuchogusto, twitter. Wishing best of luck to all students considering medical school. It really is rewarding and an amazing field.

One point I would like to make about pathology. Based on what my friends in medical school have gone through that choose pathology. Finding a job seems to be really challenging after you complete residency and I would do a lot of research in regards to that. Many of my friends ended up doing a fellowship because of the lack of jobs. It seems that one must have a fellowship completed to open doors. One of my good friends graduated from a reputable med school and decided he did not want to do a fellowship, but ended up getting a job in Tucson, Arizona. Now he is trying to work in Tucson for a few years and then get a job in a bigger city where he is from. Nothing wrong with Tucson, I'm just saying his options were limited and I'm sure numbers salary wise had to do with his decision. I can't speak for his salary, but I know he got very few interviews. What is said in the previous comments about hours, good life, etc is all true. I am not a pathologist, I'm in the surgery side. Please talk to a few people in pathology and not just the pathologist who has been at one hospital for 20 plus years. Find a resident, a fellow, and just ask around at more than one location if you can. So just to be clear I'm not saying you will be jobless, I am just saying the process of finding a job seems to be more cumbersome in comparison to other specialties,

Another thing I would like to briefly discuss, there is a point in med school you decide whether to go surgical or non-surgical. Keep an open mind. You will be surprised, I think most med students end up choosing a specialty they initially never had in mind. I never intended to become a surgeon. A certain experience, attending, who knows what could steer you into a certain specialty. I always encourage people to pursue medical school, but keep an open mind about other fields in healthcare. Recently, a good friend of mine earned her NP and I was quite surprised the opportunities she was getting and financially was being taken care of in terms of education loans/salary. Good luck!

Skeptical Scalpel said...

Mucho, good comments. Thanks.

artiger said...

I like Mucho's comments as well.

I've said it before, and I realize it now just as before, but I'll still think wishfully...all graduating medical students should do a one year rotating internship, then decide on a specialty.

Skeptical Scalpel said...

I agree with you that everyone should do a rotating internship. Unfortunately, that will never happen. Surgical specialties have no reason to want any changes to the system. Residency training is already too long for many specialties. There wouldn't be enough rotating internship slots to handle the volume.

Anonymous said...

Anonymous Europe: I thought I would give my two cents here too. First and foremost what I need to tell you, is Europe and the US have a way different take on life as a medical/health care specialist. Having lived and worked/working on both continents gave some perspective to compare them.
Let us start with the US:
In the US medical professionals and pretty much everyone else lives to work. A three week paid vacation is mostly unheard of.... Doctors usually work 80-90 hours a week, and there are still complaints that young surgeons, who have recently taken the board exam cannot operate independently... Paperwork is enormous and you get 2x2 weeks holiday per year.... But: once you get there you will be very very good at what you do, just because the number of cases that you get to crunch as a surgeon/radiologist,etc are way higher than in Europe. Besides, American health care professionals earn way more than their European counterparts. Work atmosphere is usually more relaxed and egalitarian than for example in some European Countries.
Europe: Europe is a different place. Europeans value free time and family above all. Carreer is important but if you get to do your hobbies besides that, all the better! The common belief is that (Western) European professionals do not earn as much as their American colleagues but still, they cannot really complain about how much they make in a month.... Still it is hard to say general things about the continent as it has thousand-year- old cultures existing next to each other,but if you want to work and live well you can only consider the western and northern parts. Postcommunist, Eastern European countries are very poor in comparison and pay usually only a few hundred Euros per month to their health care professionals.
Working hours also vary from region to region. In Scandinavia it is more like 55 hrs a week, whereas in Germany you can easily reach 70 hrs...There is a European Union law for how many hours health care experts are allowed to work and there is a goal set that it may not exceed 48 hrs/week. This law is already accepted by the European Parliament, still the implentation is lagging.
The only relative hardship is that you have to speak the country's language where you actually live to be able to work there as a doctor. You usually get 4-6 weeks of paid vacation every year that you are expected to use up till the beginning of the next year..
What I can say is: I would rather work in Europe because life is a bit slower where I am right now and the food is of better quality as in the US. I might not make as much as I would overseas but I can still afford a comfortable life and get the numbers needed to be a good professional.
As for your health care anxiety: no wonder. You only see these idiotic avareness posters and shows and radio ads and whatnot everywhere ranging from thyroid cancer to osteoporosis. ( I still listen to my old favorite radio stations online and these ads about medicaments and different diseases still give me the creeps..)If you do not heed them, it will get better (happened to me too...)
If I were in your shoes I would come to Europe and study medicine here. Almost all countries have very good medical schools that offer education in English and you know the old saying. "Nothing better than an American with a European education":)

Skeptical Scalpel said...

Anonymous Europe, thank you for the interesting comparison of practice in the US and Europe. You make practicing in Europe sound very good. However, some people for family and other considerations need to stay in the US for school and practice.

Pathologist said...

Do a surgical subspecialty. Subspecialty surgeons are the straws that stir the drink.

Pathologists are in abundant supply and the credentials for obtaining a residency position or job in pathology are essentially nonexistent.

If you look at the numbers, AMGs make up less than half of all pathology residency occupants each year, but almost all of the spots fill. That's because programs will just accept any FMG into the position. It's easy to just take in FMGs because pathology residents really have no true responsibility over patients and can't kill anyone, whereas surgery residents can really cause harm if they're not good.

Pathology is important and you could theoretically match to a good program like MGH or UCSF. But most programs out there are community or low-end programs that, because of the oversupply, will not give you an edge over your competition. Name matters in pathology.

Not to mention the landscape of pathology is one where pathologists are rank-and-file employees for large companies or hospitals, paid half of their billings and held to task on turn-around times and quotas, not on the care they provide.

Autopsies are no longer done in most places and that's not going to change. They don't pay and open up malpractice risk. Nobody wants to touch them anymore. As for forensics, that's probably the lowest paid job in medicine.

Do yourself a favor and see where your peers are going. Medical school is competitive because it is a better career than engineering. Surgical subspecialties are more competitive because they are better careers than pathology.

Good luck.

Skeptical Scalpel said...

Pathologist, thank you for telling it like it really is. I just saw today that some radiologists have seen the light and are calling for a reduction in residency training positions. ( I don't think the same situation exists in pathology. There's a need for pathologists but a lack of interest for some of the reasons you mentioned.

Pathologist said...

Unfortunately, the misconception that there is a need for pathologists is one that is borne of misinformation.

At present there is no need for any new pathologists. If one were to cut all residency positions today, a correction to appropriate levels would not be seen for ten years.

The professional organization that apparently represents pathologists, the CAP, consistently warns of impending shortages. They used to speak more urgently of apparent present shortages but given the years of ASCP surveys for newly graduating pathologists that show that most of them cannot find work without doing multiple fellowships, the CAP's narrative has shifted towards the future (to 2030 as per their most recent paper. 15 years from now). The CAP however has a very good reason to spread this misinformation.

If you consult the publicly available tax information for CAP, you'll see that income from their laboratory inspection business exceeds that from their professional membership by almost 4000%. That makes it obvious that the CAP's primary "client" is big lab companies, not the pathologist members. Due to this, many believe that CAP pushes to expand residency positions to keep labor cheap, and since any and all comers from any medical program anywhere in the world are recruited to residencies, it hammers in that pathologists are commodities and not professionals.

If you are interested you could find these documents via google. They're easily accessible.

I hope that clears things up. There is no need for pathologists. There is a need for cutting more than half of the positions (dare I say all community programs) and increasing applicant standards.

Skeptical Scalpel said...

Again, thanks for the comments. Very interesting. I'm sure you have heard about the maintenance of certification controversy that is going on in internal medicine and also pediatrics. There are money issues in that arena too.

Skeptical Scalpel said...

Pathologist, can you comment on this AP story stating that there is a severe shortage of medical examiners?

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