On Choosing Pathology and its Compatibility with Motherhood

"What, you are going into pathology? But you actually like to talk to people, you are good with patients. Why would you do that?"

I decided to do pathology at the 11th hour. I already had a rumored slot in ophthalmology - I was looking to stay in my hometown as my ex had recently landed a residency in anesthesia here. At the urgency of my brother-in-law, a first year path resident, I did a month rotation in late fall, before the general residency applications were due but after I had completed my San Francisco match application. Despite enjoying the course and doing well in it I thought "Ha, pathology. That is for complete nerds." At the same time, a voice was nagging in the back of my head about ophthalmology - actually an attending's voice, one I met during a summer rotation in another state. "It's not like it used to be. I see 65, 70 patients a day. Do you think I get to talk to them? No. The techs do. I just look and dictate what goes on the chart and run to the next room. My job satisfaction has plummeted."

Before I get railed on by all the ophthalmologists or ophtho wanna-be's out there, my best friend in med school went into ophthalmology, and she is very happy practicing in a small town, doing lots of surgery, and talking to her patients. I just happened upon a woman in a bad job situation - I realize her opinion was not global. But everything you hear affects what you do, and every one's experience counts for something. I worried over ortho after calling, at the urgency of a male colleague, one of the few older female orthopedics in the state. She said, "If you want a family, don't do it. Do something else." I watched another girl friend start orthopedics, than bail out for radiology.

I admire all of the people that enter primary care, but I was never pulled in that direction. Ironic that I am now somewhat of a generalist in pathology. I do it all at a large metropolitan hospital - lab director, bone marrows, lymph nodes, apheresis, cytology, surgical pathology, frozen sections, traveling to small hospitals and clinics to cover the scope of my practice. So I did become a "primary care pathologist," to use a phrase that someone else coined, but more of a diagnostician than anything else.

Pathology residency was very conducive to starting a family. I had two kids during residency and while in retrospect that was probably more than I and my marriage could handle - when I read about the overnight call and the extent to which my colleagues here have to spend time away from their kids, I feel like I got off lucky. Aside from a few autopsies on weekend call it wasn't so bad. When I entered practice I was awed and fearful of my new responsibility and worked overly hard for the first couple of years, but now I find time to take breaks during the day and do other things. I've gotten into a nice groove. Pathology is feast or famine, and there are days when we get pretty busy, but if there is a school program or class party I can always find someone to cover for me so I can get away for an hour or two, even if it means working late. I imagine this is different from an outpatient practice where you have to show up for clinic if there are patients scheduled, no matter what. Difficult to find coverage unless there is an emergency, and emergency is probably the only reason you would cancel a clinic. My group is 13, including part timers, so it is a rare day that there isn't someone who can function as you, if needed, for a little bit. We all lean on each other so no one feels overburdened. I go to a Christmas program. Another partner needs to help her mom that just broke her hip. Someone needs to get to the bank or post office. Someone needs coverage to get to his son's basketball game. It's certainly not daily, but making the important things that fall short of broken bones in the ED is very do-able.

Most of the time, now that I am four years into practice, I have 8 hour days, even though that often means cramming lunch into 10 minutes. We are all used to that from residency, so not much difference there. I hire someone to get my kids to their after school activities - tennis, dance, etc., and often meet them before the activities are over. My current after school help marveled after she had been carpooling my kids around two weeks. "I tell everyone at my church - she's a doctor and she cooks for her kids! Can you believe it?" I laughed at the stereotype that seems to no longer be universally relevant, especially around here, where we are often begging for recipe ideas. Yes, we have our occasional mac and cheese and fish sticks days, but we sit down at night at the table together and talk about our day. We go over our multiplication tables (They go to 12 these days! I only learned to 10 so I had to brush up) and spelling words. We problem solve daily ethical issues - playground misbehavior they have witnessed, etc. We read every night. Call is usually over the phone and only rarely drags me away from my evenings with them. I fix breakfast and take them to school almost every day - I get help when I am on call and covering frozens for early OR's or have to drive to a small town, but that doesn't happen very often, either.

I know that there are not many readers out there who aspire to do pathology compared to the rest of the medical world - there are certainly a lot sexier specialties out there. But it is fun, it is image based, and although I interact a lot with colleagues, I spend a lot of time by myself and the scope - patients are few and far between. I guess one plus is that I get to save most of my emotional energy for my kids, for which I am very grateful. I have heard that jobs are tough to get these days in this specialty - I can understand why because I see that once you get settled in you are happy and it is tough to leave. I know lots of pathologists that work into their 70's and a few who go into their 80's - it is not a physically strenuous job and I'll bet frozen sections and surgical cases make a good match for Sudoku in staving off Alzheimer's. I watch my dad, a neonatologist in his early 60's, still working all nighters and am thankful that never has been, and never will be me (as a pathologist anyway, I hear with teenagers life gets challenging at night). That being said, most people I know get jobs, even if it is not their first choice of location, and I imagine there are location challenges in lots of specialties.

If you want to work part time, that is another story. Think twice about pathology. Part time path jobs are few and far between, and for those I see that have entered into them they either do too much work without benefits and bonuses and/or are not looked kindly upon by their colleagues even though they are taking a big pay cut for their shorter hours. It seems to have been worked out much better in other specialties - I notice pediatrics where I live, but not pathology. I would love to hear any dissension on this point - my only experience in my field is negative.

I agree with Cutter that being a working parent is a challenge many of us face these days, not just doctors. For women and men out there who aspire to be doctors, and have any interest at all in pathology, the field has my vouch for being a good one to combine with parenting. Our group is half men and half women, and the fathers (they all are - two of us are not mothers) seem to get to participate in parenting a lot more than other specialists I have observed or heard about. But you have to enjoy it - it's not for everyone. I feel lucky that I do.