Pathology residency prospects: is it easy for IMGs?

This was written by Dr. Anurag Sharma, a pathologist.

​Few facts about Pathology residency in the US:
1) There are just 500-600 spots.

2) AMGs have not been interested in Pathology residency for almost 15 years now. The first reason is that it is a 4-year residency and requires fellowships to get good jobs which increases the time period to 5 or 6 years. Anyone would want to become an internist in 3 years and start earning if they have a 500K loan to pay off. Jokingly, people say that the AMGs applying to Pathology are so less that the only qualification for an AMG to get Pathology is to apply to Pathology. The second reason is that the job market in Pathology has NEVER been good in the US. A 79-year-old US Pathologist commented on my “matched” status that it is great as long as you are not looking for jobs. From what I have gathered from my experience till now is that US grads define job market much different from IMGs. Salaries are compared with fellow surgeons and everyone wants to stay in California. We know, we will even go to Alaska for half the surgeon salaries. Still, the real picture would be evident once I go to that scenario myself. Being a pathologist, good/bad job market doesn’t matter to me. I will do it either way as Pathology is my life now. 

3) IMGs, as you know, are never too fascinated with the paraclinical specialties.

4) 2+3 makes the number of people applying only around 1000-1500 at max which increases the odds.

5) Most programs have an absolute requirement of past pathology experience, either a home country residency, a Ph.D. in lab-related disciplines, post-sophomore year in pathology, postdoctoral research fellowship, 3-4 observerships, experience as lab techs or pathology assistants. However, few including top ones like MGH, BWH, JHU etc prefer more fresh graduates with good scores.

6) Old YOGs are seldom a filter in Pathology with the average YOG being 6-11 years for 50% of matched candidates.

7) The programs range from low tier to mid-tier to elites with the competitiveness increasing in a very steep manner. While the low tier ones are so hungry to fill their spots that they would close their eyes and select a clear-cut IM applicant with okay scores despite knowing it was just his/her back-up while the elites would act like a typical IM/Peds program and ignore all your emails (from observerships to letter of intent) and won’t even send you the rejection email .

8) Observerships are valid USCE in Pathology as everything in Pathology is Observing!

9) They love smart people who could talk and communicate properly as communication through written speech or by phone in an intraoperative consult is the only way a pathologist connects to the surgeon and the patient.

10) Pathology resident has to read a lot. At least 20 books are finished from cover to cover in 4 years of residency.
So, it is not all Hunky dory! I felt morally obliged to share the current scenario so everyone could see beyond my glamorous posts and make a truly informed decision.

Despite all these shortcomings, there are some positives which might help you make your decision:

1) It is an open-book specialty. You can sit on a case (unless it is an intraoperative consult), show it to your colleagues, send an image to your mentor, or read it in all the books possible before signing it out. There won’t be a patient staring at you all the time while you are doing this.

2) The slides don’t talk back and lets you do your job.

3) Weekends are yours and any time beyond 5 pm is completely yours. It has a good work-life balance.

4) Average pathologist compensation according to Medscape is 293K which is far above that of an internist or a pediatrician without good fellowships. However, this average is the result of pathologists earning on a spectrum from 150K to 700-800K but it is true for all specialties.

5) Due to the wonderfully designed and protective wordings which you will learn in your residency, you have to try really hard to invite a lawsuit which is a big problem here.

6) You can sit on the microscope and work till you die.

7) You get your hands on the best research projects and are usually at the center of all high-powered projects as you are that one bridging point between the Ph.D.s and the clinicians.

8) You get to teach all levels of trainees and doctors if that is what interests you.
​
Bottom-line: This specialty has its own set of problems and its own sets of perks. Just do a lot of research yourself and then decide if you are okay with this specialty before jumping into it just because you read few good posts on Facebook.

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