Thursday, November 10, 2011

MD/PhD Student Seeks Advice About a Career in Neuropathology

I recently received an inquiry from a medical student named Stephen Briggs. Rather than pontificate on this topic myself, I am posting, with his permission, Stephen's email with hope that the readership of this blog might offer some advice to this young man in the comment section of this post. Thanks in advance to anyone who would like to put in their two cents' worth.

Stephen Briggs
Dear Dr. Moore,
  I have been avidly following your blog for a while now, and I would like to ask you a few questions about the field of neuropathology. I am an MD/PhD student, currently in the PhD phase of my training. I am researching neurological disease, and I want to continue in this field. I am still relatively early in the program (I just finished the first year of my PhD), but I would like to start thinking about possible future directions. Neuropathology seems to be a great fit based on my interests, but I would like to discuss some of the details with you.
  First, you have mentioned in some posts that a neurology residency followed by neuropathology is no longer the standard pathway (September 2010 guest post). Is it actually a disadvantage? If I want to do neuropathology work, should I plan to go through pathology? The guest poster (Dr. John Donahue) seemed to think that the neurology to neuropathology was a long shot for new students, because most departments want a more general pathologist instead of a total specialist in neuropathology.
  Second, I was interested in your take on research in neuropathology. To an outsider, it seems particularly well suited: it includes predictable work hours, access to human tissue, and a generally academic mindset. Is the actual practice different? Are there any challenges to pathology research that I may not be aware of? If I chose to do research in neurology instead, would it be substantially different?
  Finally, I am interested in the long-term prospects of the field. I count fully 20 openings posted on your blog, which certainly seems hopeful. However, from searching on Google I have seen horror stories about how difficult it can be to get into the field of pathology in general. Some pathologists report taking fellowship after fellowship to avoid being unemployed while waiting for a position to open up. Also, some residents were worried about the field as a whole, as it is easier to computerize or outsource than other fields of medicine. Are these concerns justified?
  Thank you for maintaining your blog. I am glad that there is a resource for students to find out a little about neuropathology, and to feel connected to the field as it evolves.
  Stephen Briggs


Agent86 said...

1. Depends on what sort of research career you want. If you're going to run a basic science lab, I think you could do so and do clinical neuropathology. I doubt that you could do substantial clinical neurology while accumulating R01s. Of course, this is a neuropathology blog, so you should ask the same questions on a neurology blog.
2. Research careers share predictable hours, but the number tends to be fairly high.
3. There are plenty of good jobs for good people who have a modicum of flexibility.
4. You are young, grasshopper. Follow your heart.


Anonymous said...

As a Neuropathologist heavily invested in research, I can see that Neurologists actually have an easier time balancing clinical demands and research efforts than "we" do. Pathology departments are surprisingly underfunded with respect to research and many neuropathologists actually need co-appointments in neurology to support their careers and find lab space. Neurology departments are more amenable to protecting time for basic research. There are also more Neurology departments with active research programs than Pathology departments with active research programs. This makes a huge difference when searching for jobs. (The blog is misleading as filled positions are not removed.) There are also distinct advantages to being closer to the patient than to tissue, particularly as iPS cell experiments take off as the mainstay of neurological disease research. But honestly, if basic science is what's driving you, why bother with residency at all? The non-residency route deserves serious consideration as it would save you 4-6 years in training that you may not use.

Brian E. Moore, MD said...

If your interest is in getting a research grant and having a lab in addition to practicing clinical neuropathology, I think there are sufficient numbers of those kind of positions on the market as compared to the number of quality neuropathology fellows being produced each year. Also, because it is a highly specialized field, there is probably more job security than for those who do general pathology (especially if you have grant support). Like major league baseball players, there aren’t many of us, so we are more valuable.

Regarding the statement by "anonymous" that the "blog is misleading as filled positions are not removed", I beg to differ. I do remove filled positions that I am informed about. I depend upon the neuropathology community to keep this list current, so please help me out by letting me know if you hear of a new opening or hear that a listed position has been filled.

poolmaven51 said...

Just to add to Brian's comments regarding updating job listings, the blog relies on the contact person to answer email inquiries regarding an active job position. If the job is no longer available on the Internet site link or we do not receive an email reply, then the decision is made by Brian to pull the listing. There have been several listings that a year out from the initial posting are still active, the position has not be filled and the search is ongoing. To not become an annoyance, we only send out inquiries seeking if the listing is still active every 4-6 months.

Samuel said...

I'm in a similar position as Stephen. I'm a fourth-year MD/PhD student interested in neuropathology. I've read about problems in the pathology job market, but it's not clear to me how much of these problems apply to research-oriented pathologists looking for academic positions.

Unfortunately, however, clinical neurology is really not that interesting. Pathology as a medical specialty has a lot more going for it, in that you get to spend all of your time diagnosing patients rather than doing long-term management. But if the situation in neurology for research/jobs is significantly better, then I could go into that field as well.

Scoutmd said...

I would like to nominate Agent86's comment as "Best Advice Ever", particularly item #4. If the young Dr. Briggs can follow this advice, he will not only have a successful career but also a happy life.

John Donahue said...

I think it is currently a disadvantage to do both neurology and neuropathology, as I said in my "guest post." If you're really interested in basic neuroscience research, you can still do it via a pathology residency and neuropath fellowship, and you'll have the additional surgical pathology and autopsy skills that pathology departments want. If you have your heart set on seeing patients and running clinical trials, then you should do a neurology residency followed by some research fellowship. (Currently, we have a very clinically-oriented neurology department, but we do have one neurologist that has a research lab.) Lastly, neuropathology is a small profession. As long as you don't restrict yourself geographically, there should be a neuropathology job for you. Neurology jobs are more numerous, but most of them are clinical. Basic science research-neurology jobs would probably be about as common as neuropathology jobs.

Brian E. Moore, MD said...

Thanks to everyone who weighed in on this discussion. I'm sure it helped a lot of young, would-be neuropathologists as they make decisions about their future trajectories.