Why Pathology? And What About a Fellowship Match? The Resident Council Wants to Hear From You!

By Jennifer Kasten - November 16, 2022


As residents, we build our lives around certain dates and seasons. July 1: the magic day that PGY clock clicks over to a new year. June (or October): the boards. Early April: the RISE. And perhaps the most circled day on the calendar of them all: Match Day (which, by the time you’re reading this, has just happened).

Just thinking about Match Day—and the months of applications, invitations, rejections, travel, interviews, rank list pruning, and anxiety that preceded it—usually evokes a flood of emotions. Match Day feelings run the gamut: excitement, dread, acceptance, stunned disbelief, shame, jubilation, fear of the unknown, anticipation, finality. Your emotional reaction is as unique and personal as your circumstances were during that fateful week.

What is common, though, to every single person reading this column, is the outcome: that’s the week you found out you were going to be a pathologist. Maybe you were dead-set on being a pathologist since the day you walked into medical school, or maybe you were convinced at the conclusion of your clinical rotations. Maybe you switched from a clinical specialty, and this was your second Match Day. Maybe it took you a couple of tries to secure a position. Maybe your match came after a few years working in research after leaving your home country and throwing your hat in the ring over here. Maybe you scrambled in (okay, SOAPed, but I still have trouble saying that with a straight face). Whatever your story, the end result was the same: you were going to be a pathologist.

Obviously, we at the ASCP Resident Council are very happy that you found your way to our somewhat hard-to-find, completely wonderful field. However, we exist in a climate where pathology recruitment in US medical schools has become critically endangered. I wrote earlier about our new Pathology Ambassadors program, which is gaining steam for full launch shortly: a large part of that program will be a PR campaign for pathology as a specialty choice. And to that end, we’d like to hear from you—anyone reading this column—about your reasons for choosing pathology.

As with the path that led you here, the reasons for choosing pathology are as varied as the individuals training therein. Among the reasons I’ve heard cited: a love of discrete problem-solving, the desire to “know everything about everything,” attraction to the diagnostic process, freedom to practice medicine away from patient reviews and Press-Ganey scores, a very favorable ratio of compensation to hours worked, attraction to the pure, cerebral, intellectual side of medicine, and a desire to better integrate basic science research with health care. What’s yours? Any answer you send us might well end up packaged in our PR materials.

Now, speaking of the Match. You might have noticed that pathology is just about the last field to have a match process for its fellowships (radiology is along with us, bringing up the rear). There are a lot of reasons for that—for one, only about half of our fellowships lead to board certification (all of the CP ones plus a handful of AP ones). With the exception of neuropathology, informatics, and chemistry, our fellowships are only one year long. And our fellowships have mushroomed in the last 20 years (particularly in the last 10); there’s still an inherited, somewhat lackadaisical approach to procuring them.

Feelings on the “should we have a fellowship match” debate are fairly passionate on both sides. Pro-fellowship advocates argue that standardizing the interviewing cycle will allow maximum competition, will no longer privilege in-house candidates so strongly, and will allow ultimate career decisions to be put off until later in residency, when an applicant has rotated through most fields and truly decided what he or she would like to do. A match would also permit more “churn,” that is, trainees going to a different institution for fellowship, and allow an applicant to see more programs (and a program to see more applicants) before making a decision. On the con side, there are worries that a match would make the fellowship process much more expensive for an individual applicant, and residents at large programs with many fellowships worry they will no longer be able to guarantee a position early in their training, which might well be why they selected that particular program.

Again, we’d like to hear from you. Are you in favor of a fellowship match? What upsides and downsides do you see? What about the middle option, a “uniform timeline,” where there is no match algorithm but rather a required window during which programs interview candidates, and during which no offers can be made? Tell me your thoughts, and anything else that might be on your mind, at Jennifer.kasten@childrens.harvard.edu.

Jennifer Kasten