Choosing a Pathology Subspecialty: Have You Considered Patient Contact?
When you’re trying to decide which pathology subspecialty to pursue, there are many factors to consider, but have you given thought to how much patient contact you would like? Compared to our clinical colleagues, pathologists have very limited interaction with patients. However, there are a few subspecialties within the field of pathology that see patients on a daily basis.
Below are a list of pathology subspecialties that are frequently associated with increased patient interactions.
1. Blood Bank and Transfusion Medicine
This is probably the most clinically oriented of all pathology subspecialties. Pathologists are often in charge of the hospital Blood Bank. They are key players in monitoring transfusion reactions. They also manage apheresis treatment, which is where much of the patient interaction comes from. Before apheresis, pathologists perform physical exams and monitor patients during the procedure. Pathologists will also be on call to perform apheresis on critically ill patients.
During my fourth year of medical school, I did a “Sub-Internship” or “Acting Internship” in Transfusion Medicine at Virginia Commonwealth University under the direction of Kimberly W. Sanford, MD. It is a clinically heavy subspecialty within the field of Pathology so it qualified as an acting intership. I did multiple physical exams every day as part of the preparation for aphaeresis treatments. Emergency aphaeresis treatments required me to see patients admitted to the main hospital floors and the ICU.
Be aware that not all job opportunities in blood banking will have a robust Transfusion Medicine service. Choosing blood banking as your primary subspecialty won’t necessarily guarantee patient contact, but you can investigate which programs and hospitals will have the most patient contact.
What has your experience been with blood bank and transfusion medicine? Have you had to brush off your stethoscope during residency? Please comment below. Knowing whether you dreaded or looked forward to blood banking can definitely help you rule this subspecialty in our out.
In many hospital systems, the cytopathologist performs fine needle aspirations (FNA). FNA is a minimally invasive procedure where the cytopathologist sticks a needle in a mass (often in the head and neck area) to aspirate cells. Frequently, the aspirated material will then be examined near the bedside. This can be a rewarding experience where you can give the patient good news very quickly. Although not all hospitals have this system in place, you can research which ones do. Cytopathologists will also be at the bedside to determine if a specimen is adequate when other physicians like interventional radiologists perform the FNA.
Hematopathologists who perform bone marrow biopsies as part of their practice will also interact with patients. Signing out a bone marrow case is a time intensive task, so the majority of your time will still be at the microscope. However, performing the bone marrow biopsy and aspiration yourself can be a rewarding process with a lot of patient interaction. At the institution where I trained we did not perform bone marrow biopsies but the fellow who trained there said she had performed up to 100 during her residency.
4. Rural Pathology
Some thought should be given to pathologists who practice in rural areas of the country. You may be asked to perform FNAs or bone marrow biopsies in remote hospitals even if your primary subspecialty isn’t in either field.
Patient Contact in Pathology: Something to Think About
The Intersociety Council for Pathology Information has another nice description of the settings in which pathologists interact with patients the most: http://www.pathologytraining.org/Career/patientcare.cfm
You probably weren’t thinking about patient contact when you decided to go into pathology but now that you’re here, it’s actually worth thinking about. Are you the type of pathologist who is glad to be done seeing patients? Would you like to do a few procedures every once in a while? How about going back into the clinic full time? All of these are options within the different subspecialties of pathology.
Let me know what you think in the comments below!
Rashna Meunier, MD
Rashna, who currently practises in upstate New York, says, “I try to remember that every single slide I look at represents a patient whose life I have the capacity to change forever. I do my best to give every case the full attention it deserves, treating each one as if they were a loved one.”
Justin D. Richey, MD
Pathologist at Naples Pathology Associates
Editor of Pathspective and pathologist at Naples Pathology Associates where he sees a large volume of dermatopathology cases. During his time as Chair of the CAP Residents Forum, he focused on improving residency education and making the transition into practice smoother.