A survey of first-year pathology residents: factors in career choice

Pathology has become less attractive to US medical graduates by every measure available to us. In 1981, 2.3 per cent of US medical school seniors planned a pathology career; by 1986, a steady decline had reached 1.6 per cent. In absolute numbers, adjusted for the response rate to the AAMC questionnaire, this means that the 290 seniors entering pathology in 1981 had fallen to 205 by 1986. FMGs enter pathology through the matching program in greater numbers than any other specialty. Our data show that slightly less than a third of current first-year pathology residents are FMGs, mainly from Caribbean and Mexican medical schools. The decline in US graduates entering pathology has resulted almost entirely from a drop in the number of men choosing the field. In 1984, 286 male US graduates matched in pathology, but this number dropped to 150 in 1985 and 149 in 1986. The group entering in 1985 was the first who will need 5 years to be eligible for certification in the anatomic pathology/clinical pathology programs. During the same years, the 116 women who matched in 1984 were followed by 111 in 1985 and 100 in 1986. The effect of the American Board of Pathology's change in requirements is not easily analyzed. The figures for residents entering, given above, would suggest that the requirements discouraged men, especially, from entering the field. This hypothesis is supported by our questionnaire data and by anecdote concerning the pressure felt by graduating seniors to finish their postgraduate training as fast as they can and start paying off their average debt of $33,650. Pathology still seems to attract people who like to teach, study interesting case material, and do research. The percentage of PhD/MDs entering pathology is almost 10 times as high as their percentage among graduating seniors. Discouragement against entering pathology came from a perceived shortage of job openings, negative statements from other physicians (including pathologists), the addition of a fifth-year requirement, and lack of patient contact. The last is hard to account for because pathology would obviously not offer the opportunities to see patients that exist in the clinical specialties, but it was prominent in the concerns of residents answering our questionnaire. The picture that emerges from our data is one of a specialty passing through a difficult period in attracting new talent into its ranks. The first step in dealing with the problem would seem to be recognizing its existence.(ABSTRACT TRUNCATED AT 400 WORDS)