FAST FACTS:
Number of first year residency positions offered in the NRMP in 2011 : 518
Filled with US grads in 2011: 51.9 %
Competitiveness: Low - applicants have: an elective in anatomic or clinical pathology, research experience
Length of training: 3-4 years
Number of residency programs: 155
Number of residents in training: 2,212
Competitiveness Rank: Low Selection criteria for interview/ranking: published medical school research, class rank, grade in senior elective in specialty.
US senior matched applicants' mean Step 1 score: 227
US senior matched applicants' mean Step 2 score: 230
Number in US Board Certified in specialty: 14,127
Median compensation for all physicians in clinical practice: $252,000
Average work hours per week: 45
"THE PATHOLOGIST, I AM CONVINCED, IS THE UNKNOWN man of medicine."1 Often called "the doctor's doctor," the pathologist acts as consultant to clinicians; therefore the only channels by which his or her services reach the patient are controlled by other doctors.
Some medical students characterize the pathologist as being a "recluse—insecure, uncomfortable, ill at ease with others, and inept in interpersonal communication." Others see the pathologist as "simply trying to beat the hassles of everyday medical practice."2 All seem to agree, however, that the pathologist prefers the science of medicine over patient care and this specialty offers the physician the opportunity to serve as the link between basic science and clinical medicine.
Pathology is the branch of medicine concerned with the cause, manifestation, diagnosis, and outcome of disease. The pathologist provides the morphologic and laboratory analysis to assist in patient care. Although many pathologists have traditionally practiced both anatomic and clinical pathology, increasingly the trend is to limit one's practice to one or the other area of investigation. An anatomic pathologist's work, often done in a hospital setting, is related to the effects of disease on the human body, for example, the examination of tissues removed from surgical patients and the performance of autopsies. A clinical pathologist specializes in laboratory medicine which includes chemistry, hematology, microbiology, and immunology. The pathologist selects testing methods and equipment, supervises the technical staff, maintains quality control, and confers with clinicians regarding the significance of the tests.
Residency Information. A combined anatomic and clinical pathology residency, preparing physicians for the general practice of pathology requires four years; a single area - anatomic or clinical - requires three years. There is training in medical informatics and management as part of the residency, anticipating that many pathologists may someday direct large laboratories.
Board Certification. Following completion of a residency training program and successful passage of a written examination, one may be certified in anatomic or clinical pathology or both.
Special qualification certificates can be attained in more than 20 subspecialties including the following: blood banking/transfusion medicine, chemical pathology, cytopathology, dermatopathology, forensic pathology, hematolopathology, medical microbiology, molecular diagnostics, neuropathology, and pediatric pathology.
Supply and Projections. A shortage is predicted because growth in this field has been slow.
Economic Status and Types of Practice. An influx of foreign medical graduates in pathology in the 1970s brought increased competition and a drop in income. Many pathologists' expenses are paid for by their hospital employers, third-party payment is received for services rendered, and technicians are employed to help provide services.
The dominant mode of practice has been in a hospital-based setting. However, pathologists also can join a private group practice that may run the hospital laboratory under an exclusive contract and be compensated on the basis of laboratory revenue, per-test fees, or a negotiated salary. Pathologists report that there is increasing competition from large commercial laboratories that do not use the services of pathologists and charge less to perform automated clinical tests.
Other work settings for pathologists include state and local law enforcement agencies, public health departments, medical research centers in the private and public sectors, and academic institutions.
Further Information. The College of American Pathologists, 325 Waukegan Road, Northfield, IL 60093. Telephone: (800) 323-4040. Internet address: www.cap.org.
The American Society of Clinical Pathologists, 2100 West Harrison St., Chicago, IL 60612. Telephone: (312) 738-1336. Internet address: www.ascp.org . Free membership is available for students.
Intersociety Council for Pathology Information, Inc., a non-profit educational organization sponsored by national pathology organizations publishes the Directory of Pathology Training Programs and the brochure Pathology as a Career in Medicine. Accessed at www.pathologytraining.org
In choosing this specialty, respondents reported a strong influence by pathologist teachers or research mentors; the initial appeal of pathology involved both the opportunity to do research and the minimal patient contact.
Pathologists' reactions to other specialties include: psychiatry, "too futile"; obstetrics, "too unpredictable"; pediatrics or internal medicine, "patient responsibility and not scientific enough.''
Once in practice, pathologists enjoy "the challenge of a difficult case," "the ability to organize tasks," and "conferring with colleagues in different specialties." Also cited as an advantage is the predictable and regular work schedule.
"Administrative problems—being held responsible for situations over which I have no control, such as lab requisitions getting lost, lab work not charted properly"; "nonproductive meetings"; "increasing government regulations"; and "the inability to concentrate on any one task." These responses all indicate that the frustrations in pathology come from not being able to control the environment in which one works to the extent one would like. In addition, pathologists need to obtain more clinical information from physician colleagues to enable better resolution of diagnostic problems.3
Pathologists tend to have regular schedules, but work hours depend on the type of practice. In a hospital setting the pathologists are tied to the habits of clinicians and because of the heavy involvement with surgeons, may start the day at 7:30 am and work through to 5:30 pm five days a week, and 7:30 am to 12:00 pm on Saturdays. They may have night and weekend telephone consultations, but rarely have to return to the hospital. One pathologist says, "In my case, I have duties in practice—looking at surgical pathology and bone marrow materials, seeing to the administration of the laboratories, teaching house staff and medical students, dealing with personnel problems, consulting for federal and private groups, travel on scientific and administrative matters, serving on committees, writing, reading the literature."
Pathologists attend and conduct many meetings because they are called upon to teach and perform consultations for the hospital staff and also to continue the medical education of practicing physicians in the community.
A strong scientific orientation with interest in anatomy and histology is basic to pathology. The nature of the work requires the pathologist to have a systematic approach to problems and to have a sense of thoroughness?"a basic trait of an interest in detail and accuracy." Laboratory directors need good management skills.
Some pathologists describe themselves as "compulsive," "serious people—somewhat aloof," "studious," and "sort of a blend of the personality traits of engineers and biologists." Another says that pathologists represent a "wide spectrum of human personalities." "People skills" are "invaluable to me as a teacher, interacting with large numbers of laboratory technologists or conferring hourly with clinicians."4
"If you are interested in the scientific aspects of medicine and do not need the ego gratification that comes from patients, pathology should appeal. Because your 'patients' are other physicians for the most part, you still must have a variety of bedside manners, but perhaps a more scientifically sophisticated sort."
While in medical school, students are advised to "develop a fundamental understanding of basic pathologic processes" and to do a research project. In choosing a residency, students are advised to find a program that "caters to the individual's interests. Don't go to a place which features research if your interests are to provide service."
Technological and laboratory innovations, such as the ability to explore the molecular origins of disease make this an exciting time to be a pathologist.
However, one respondent says, "Pathology is in a squeeze between governmental and administrative types on one side and physicians who feel threatened on the other." There is a belief that reimbursement practices have adversely affected the specialty and that there is danger of losing their freedom as private practitioners.
The College of American Pathologists has launched a multiyear campaign to "transform the specialty." The goal is to "strengthen and defend the value proposition (i.e., unique benefits) that pathologists offer to patients and fellow clinicians." 5
You can complete the questionnaires and obtain your scores for all specialties online at http://www.sdn.net/schools/selector .
German WM. The story of laboratory medicine. New York: Duell, Sloan and Pearce, 1941, Preface.
Coombs RH. Mastering medicine. New York: The Free Press, 1978, pp.199-200.
Transforming pathologists. Accessed December 29, 2011. www. cap.org/app/deocs/membership/transformation/new/transform_index.html.
Lembke A. A piece of my mind. A letter from the Foreign Legion. JAMA 1996;276(21):1974.
Transforming pathologists. Accessed December 29, 2011. www. cap.org/app/deocs/membership/transformation/new/transform_index.html.