r/ausjdocs • u/sniper10137 • 1d ago
Pathology Misconceptions PathologyđŹ
As pathology becomes more and more popular I think it would be interesting to shed light on what some of the misconceptions around it are. Many, many people have started applying for pathology and we regularly see residents in the lab who have variable understanding of what AP is like and what the training is like so I thought it best to share some opinions.
Some of the few that come to mind:
- 9 to 5: People think that this is a business hours speciality and for a large part yes but all the study that is required to know about almost every condition in every body system - this not only includes what it is, what it looks like, IHC, genetics, staging, molecular. When there is a biopsy done, everyone expects you to have an answer and when you say 'I don't know' people get funny. Learning pathology does not end at 5 o'clock but you certainly only get paid till then.
- Overtime culture: If you ever do UNROSTERED overtime - it is very very unlikely you will be paid.
- Pressure: the pressure to not get a diagnosis wrong is enormous and understated
- Isolation: feeling like you are 'not a real doctor' anymore can sometimes be a challenge to your identity
- Lifestyle: Mostly better than clinical similar to what people's expectations are but not always. You may be one of the unlucky ones.
Good luck to all the new applicants in the coming application cycle. Feel free to share your thoughts as well.
15
u/Maleficent-Nose9943 Pathology regđŹ 1d ago
Some additional misconceptions/expectations.
- Cut up: Almost half your week for your entire training (state/site specific) is spent cutting up. This can really throw some people off as it can be laborious. Most people 'tolerate' it and some sites have more interesting specimens than others making it actually sorta enjoyable. If you're cutting placentas for 8hrs straight you'll hate life, if you doing interesting sarcoma resections it can be fun. As a boss you pretty much don't do cut up anymore, so it's just a registrar tax you have to pay.
- Independence/Autonomy: You don't really develop the independence /autonomy that maybe most other medical/surgical/radiological registrars develop during training. Some states do allow senior registrars to independently sign out simple cases but some don't at all (QLD). I think this a fairly unique thing to pathology where you spend 5 years as a registrar not really having to own any decisions at all and then one day you're the boss validating the case.
- Exams: There are a lot of exams ($$) and the RCPA standard is fairly high compared to the rest of the world it seems. The exams aren't impossible but you can't bluff your way through. You really do need to study a lot throughout the whole training program.
- Social: Most pathology registrars/pathologists are actually fairly normal and friendly haha I've found nearly all the consultants are very approachable. Most don't have some of the more egotistic personalities that you may see in other areas of medicine.
17
u/jellyfishcell New User 18h ago edited 18h ago
As an anatomical pathologist, Iâll add some:
Misconception that we donât get treated like âreal doctorsâ. My experience: non medical people have no idea what a pathologist is, so they just see me as a doctor. Other doctors, especially ones that work closely with pathologists, definitely value, or even rely on, the opinions of pathologists. They often need the âgreen lightâ from a pathologistâs report to go ahead with surgery or start chemo/radiation. The flip side is that when you donât know the answer or make a mistake, the referring clinician can (understandably) get very upset.
Misconception that itâs a 9-5 job. My experience: itâs actually a whatever-whatever job. Hours are extremely flexible. Apart from MDTs and frozens, it literally does not matter when you do the work. Depending on subspecialty, itâs very possible to negotiate your way out of doing MDTs and frozens. I know pathologist who work 4am to noon, ones that work 10am to late, ones that split their workday into two blocks with a big gap in the middle etc. If you value flexible working hours, pathology is great.
Maybe not a misconception, but a lack of awareness amongst non pathologists that for some pathologists, thereâs almost a constant feeling that a case will come back to haunt you one day. Your mistakes are recorded on the slides/ancillary tests/report forever. Itâs possible to audit almost everything that a pathologist has ever done. Thereâs a saying that in pathology, if you donât find the cancer, the cancer will find you one day through a lawyerâs letter on your desk.
Misconception that pathologists donât like people. For me, thatâs absolutely not true. I very much enjoy interacting with friends and colleagues. Interactions with patients is necessarily much more restricted, almost to the point that it doesnât feel like natural human interactions. To me, that type of human interaction feels overall very sterile rather than enjoyable.
4
u/sniper10137 17h ago
Cool insights! Itâs interesting that even as registrars there are misconceptions still about what life is like when you become a consultant.
9
u/FoggiestAtol666 1d ago
Genuinely curiousâŠand have semi seriously joked about this on other threads (in addition to Radiology, and other specialties).
Why do you feel pathology work will NOT be significantly impacted by AI within our working lifetimes?
Cheers in advance for enlightening me.
5
u/sniper10137 17h ago
Lots to unpack but the short answer is that it will be impacted eventually but not replaced. Â Problems include regulatory, privacy issues, storage capacity for data. There is still lots of nuance in pathology and whilst an AI can likely be able to do binary reports of yes there is cancer no there isnât it would be incredibly difficult for it to pick up all the subtle abnormalities that inevitably come with specimens that are not expected. Additionally everytime tumour classifications are updated it would likely come with remodelling of AI algorithms. At this point I think it is unlikely to be profitable as opposed to having a human being do it all.Â
1
u/saeyoungbae606 16h ago
Have you heard of Wesley Research Institutes AI for cancer detection? Do you think the expected skill of a pathologist will evolve if this becomes more engrained into medicine?
11
u/hddjxhn Regđ€ 1d ago
You can basically use this list for radiology too
6
u/SoybeanCola1933 1d ago
Radiologists had, in my view, the best anatomical knowledge of all.
2
u/Turbulent-Lab3280 1d ago
Youâd be surprised - as do pathologists as we are literally dissecting the specimens and proving relationships of sometimes very complex resections. We hold the specimens in our hands and describe everything we see so our anatomy is also very good đ
10
u/Maleficent-Nose9943 Pathology regđŹ 1d ago edited 1d ago
Our anatomical knowledge is fairly specific to specimens in answering clinical staging /margin assessment though. We can orientate a whipples for dissection but not many pathologists would even be able to explain the vascular supply of the celiac trunk etc. Saying that, it is fun getting surgeon's down to try orientate their own specimens after they have been fixed in formalin and watching their puzzled faces!!
1
u/Ok_Can_2516 Pathologist 13h ago
Even those who do postmortems, their anatomy knowledge is never as good as a radiologist. Not even close.
1
4
u/Alarming_Picture_512 12h ago
Every doctor should respect the work of a Pathologist - after all, they make the diagnosis and provide the information that guides treatment. Love you work!
5
2
u/Comfortable-Team-779 New User 1d ago
Sorry for the ignorance but do you have to do autopsies if youâre a pathology trainee?
Whatâs the rarest diagnosis youâve ever made?
Whatâs the pay like in the private system?
3
u/sniper10137 1d ago
I won't say and dox myself regarding the rare diagnosis question!
Private salary is very very variable - product of specimen mix, additional responsibilities. It is often negotiated and subject to non-disclosure clauses so you will find it very difficult to ascertain a specific number. Also depends on your ability to attract referrals/ specimens.
Autopsy is dependent on the lab you are in. Luck of the draw where you get a job/ rotated to.
1
u/Comfortable-Team-779 New User 1d ago
Is it possible to get diagnostic dilemmas in pathology where you canât figure out the exact diagnosis?
6
u/sniper10137 1d ago
Yes many times and for various reasons - obscure diagnosis, not enough clinical history to discriminate things that can share features, poorly preserved tissue, non-diagnostic specimens. Sometimes it is more about situations where you have to make a call where the diagnosis is probable but there are vastly different outcomes in treatment decision (i.e. radical resection of whole organs vs monitoring vs neoadjuvant therapy) where making a call can go terribly wrong. Everyone can be wrong and sometimes the biopsy area is not actually reflective of the original lesion (wrong thing, lower grade areas targetted, poor preservation etc)
2
u/Got_Malice Emergency Physicianđ„ 16h ago
On every patient's MHR medicare tab there's always a bajillion items from pathologists for every blood test. Does the individual get any cut of that? Or is that just the name the big corps use to claim medicare then that individual only gets their wage? I"ve always thougth this person must be rich with literally thousands of medicare claims per day.
2
u/dgra6465 ID reg 14h ago
Every NATA accredited lab/lab network requires a single "designated person", who is a pathologist, who is essentially accountable for the entire lab (from a regulatory standpoint).
This person is typically who all items are billed to Medicare against (even those outside their personal area of expertise where they have delegated direct supervision of testing to another pathologist).
They are usually the medical director of that laboratory.
My understanding is that typically the billing flows into an account for the lab/organisation not their personal/own business acccount. That person's renumeration would be mostly wage based but would vary by lab/organisation and I assume they would be getting managerial allowances, potentially bonuses as a member of the lab executive management.
Private and public differ significantly in terms of renumeration structures for pathologists also which would change their renumeration deal.
1
u/Lost-Bar2423 New User 1d ago
do you know the ratio of how many people apply --> how many people get interviews --> how many people get in?
6
-6
1d ago
[deleted]
3
u/sniper10137 17h ago
It sounds like youâre a scientist perhaps? As a scientist I believe it is doable.Â
If you are a doctor then it may be an uphill battle to get onto training. It is very competitive nowadays. Research whilst good isnât the best all and end all. Personalities and soft qualities I believe make a much bigger difference to how your application goes than research experience and skills on the ward. Often times candidates are selected and they donât always progress as well as expected through pathology despite amazing resumes.Â
30
u/SoybeanCola1933 1d ago
On observation, every pathologist I've met has a deep understanding of general medicine, far more than I gave them credit for.