Updated: Apr 25, 2019
Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Fitzhugh chose the field of Pathology and why Pathology is a great field for women.
Once upon a time, I was chatting with a young surgeon while waiting for a frozen section, and he asked, "Why did you go into pathology? That's such a waste of your personality! You’re so good with people!" I stared at him blankly, wondering what lunacy provoked the question, before answering, "You like talking to me, right?" And he answered, "Yes, of course!" I immediately said, "Good, because doctors qualify as people, so it would serve me well to get along with them. I don’t think I've wasted my personality.”
One of the biggest myths in the world of medicine is that pathologists don't like people. I would argue that there are physicians in every specialty who don’t like people. Some of the best people I know are pathologists. I’m going to tell you some of the best parts about being a pathologist. I’m willing to bet many of the other medical specialties are completely unaware of.
If you’ve ever been admitted to a hospital, had blood drawn, or peed in a cup you’ve been cared for by a pathologist. If you've had surgery, you've definitely been cared for by a pathologist. Pathology is broken down into two specialties, anatomic pathology and clinical pathology. Those two areas are broken down into a number of subspecialties. Within anatomic pathology there is surgical pathology (which has a number of subspecialties broken down by organ system), cytopathology, and autopsy pathology (with further specialization in forensic pathology). Within clinical pathology there is clinical chemistry, immunology, microbiology, molecular pathology, hematopathology, transfusion medicine, and cytogenetics. My point in saying this is you can have as much or as little variety as you want in your practice and you can help people every single day.
Isn't that the dead people specialty? Autopsy pathology is an important part of the specialty, and it seems that the only pathologists who get to spend a lot of time on TV are my forensics colleagues! All jokes aside, forensic pathology is one of the areas of pathology where having a personality to match your intelligence is immensely important. After all, you want the jury to like you when you testify! In reality, autopsy is a very small part of the specialty; surgical pathology, cytopathology, and clinical pathology cases far exceed the number of autopsies performed. If you're interested in autopsy, you could consider being a medical examiner, or you could consider teaching residents and directing a hospital autopsy service. Again, variety.
About that no patient contact myth. It's just that… a myth. I can't tell you how many people have told me that they could never consider pathology because they wouldn't get to see patients anymore. Nothing could be further from the truth. First, all pathologists see patients, just not in the traditional sense. Every time we hold a glass slide, or read a gel, or interpret a transfusion panel, we are seeing a patient. Now for those of you who need to physically lay hands on a patient, and that is the only thing keeping you away from pathology, I have good news for you. We have subspecialties that allow you to see patients in the traditional sense! In cytopathology, we learn to perform fine needle aspiration (FNA) biopsies, where you use a fine gauge needle (25 or 23 gauge usually) to collect cells from a mass a patient has. I even learned to do them under ultrasound guidance in my fellowship. The best part about this is you can see the patient, do the procedure, and read the patient's slides, which allows you to do something other physicians cannot. In hematopathology, you can see the patient, perform their bone marrow biopsy, and interpret their biopsy AND flow cytometry findings. In transfusion medicine, blood bankers often see patients, particularly if the patient has a transfusion reaction or if they run an apheresis service. In short, if you love pathology but also need to see patients, there are ways to do that.
Practice settings. There is variety in where you practice! Some examples include community practice, academia, medical examiners offices, and commercial labs. In community practice, pathologists often cover several services within their departments. Many are fellowship trained, and the practices are often busy. This is the setting that has the highest number of pathologists, about 80 % . Academia tends to be more subspecialized, with pathologists practicing in one to two areas. Both of these settings have teaching responsibilities, primarily of residents in the community setting, and residents and medical students in academia. In medical examiners offices, forensic pathologists perform autopsies and gather critical information in order to determine why a patient died. Commercial laboratories don't always offer teaching experiences (although some do), but you tend to have a fixed number of cases to review each day. Commercial laboratories do not have traditional call, which is the rule in the other three settings, and in some commercial labs the hours are very flexible. If none of those suits you, after training, you can work in research or industry. There are also government and military positions available; you could work for the National Institutes or the Centers for Disease Control. The sky's the limit!
We're happy! Pathologists tend to be very happy people (you should see us at social events and at our meetings!). Most of us truly enjoy our chosen specialty. We have converts from other specialties who often wonder why they chose anything else. We also have a good lifestyle, so while we miss out on things occasionally, we also have the good fortune to be able to have time to spend with our families and friends. The hours we spend at work are busy, but fulfilling. Every day provides an adventure. I can say with absolute certainty that there is no specialty where I'd rather be.
Money, honey. The topic of compensation is often taboo in medicine, but the reality is, as the cost of attending medical school increases) future compensation is certainly a hot topic. According to the Medscape Pathologist Compensation Report  for 2017, the average salary for an attending pathologist is $293,000. Also on average, pathologists feel fairly compensated. Your compensation will vary based on your practice setting and where you live. The South Central (essentially Texas), Great Lakes, and Northeast (essentially New England) regions have the highest paid pathologists whereas the Northwest, Mid-Atlantic (unfortunately where I live), and North Central (much of the Midwest) regions have the lowest paid pathologists . In a first job you're unlikely to make 293K, but making 200K is not unheard of, particularly in community practice. Remember that compensation includes other factors such as health insurance, paid vacations, sick leave, and malpractice insurance. Also, if you are hired on a partnership track and make partner, your earning potential is much greater. Speaking of jobs…
The job market. This is something we need to address. Over the next few years, as the baby boomers retire (yes you read that right) we are likely to have a pathologist shortage . The number of pathologists that began to retire began to increase in 2014 and will likely peak in 2021. The number of pathologists retiring is greater than the number of graduating residents and fellows . This is a great time to consider pathology. Finding a job is more difficult if you are geographically restricted (which applies to any specialty) or if you have a super academic subspecialty (like one of my chosen subspecialties, bone and soft tissue pathology which is most prevalent at academic centers), but I have yet to meet a pathologist who couldn't find a job. As I peruse ads for jobs, there is a lot out there right now. Have faith, there is a job out there for you. Also, pathologists have wonderful job security. It's likely due in part to us being good colleagues to each other and to our colleagues in other specialties. We're pretty good at staying out of trouble also, which definitely helps.
Having the last word. This is one of my favorite parts of pathology. When we make a diagnosis, we are playing a pivotal role in patient care. The diagnoses we make are often the very first steps in a patient's journey through treatment of whatever disease they may have. Yes, at times we send cases out for a second opinion because a case is hard; it's so important to know what you don't know, even more so than what you do know. This is simply because we have to be right. Patients depend upon us to be correct. Having the last word certainly is a huge responsibility, and as pathologists we take that very seriously.
We are on the cutting edge of personalized medicine. Molecular pathology affords pathologists an awesome opportunity. We are the ones who are developing the tests that determine which therapies patients will receive. Immunohistochemistry, next generation sequencing, pyrosequencing, and reverse transcript polymerase chain reaction are just a few of the many tests pathologists are using to aid our colleagues, predominately in oncology, in determining next steps in a therapeutic plan. Right now these tests are in pathology's wheelhouse; in my humble opinion, that's where they should stay. Maintaining these tests within the specialty of pathology will ensure that we maintain our proper place on the forefront of personalized medicine.
Advocacy for our patients and our profession. As pathologists, we have the opportunity to advocate for our patients. We are the ones who know best what we need in order to make accurate, timely diagnoses for each and every one of our patients. We know what it takes to do right by them. Pathologists often speak with government officials, lawmakers, and the like in an attempt to work against negative changes to our practices. In doing so, we also advocate for our profession. The world needs and will continue to need pathologists.
I could probably say so, so much more, but I believe this is enough for now. If you've read this far, thank you. If you have any questions, you can reach out to me on Twitter (@DrFNA) or by email (firstname.lastname@example.org) and I can answer any questions you might have!
The Intersociety Council for Pathology Information, Inc. Career Opportunities in Pathology. www.pathologytraining.org
Medscape Pathologist Physician Compensation Report 2017. https://www.medscape.com/slideshow/compensation-2017-pathology-600582