Emerging From the Basement: The Visible Pathologist

Abstract

T here is a perception that US medical school graduates' (USMGs) interest in pathology is waning. This concern, in an era of projected physician and pathologist shortages, 1,2 has implications for the delivery of quality patient care to an aging population. Given this, can we increase interest in our field?Data from the National Residency Match Program reveal a steady decline in the percentage of first-year pathology positions filled by graduating medical students from allopathic schools since 1978. 3 During that same time span, the percentage of total graduating US allopathic seniors selecting pathology as their specialty fluctuated cyclically. In 1979, 2.16% (282 of 13 036) of students selected pathology, whereas 0.88% (128 of 14 610) did so in 1998. By 2005, 2.21% (326 of 14 719) selected pathology, with the percentage falling to 1.17% (220 of 18 818) by 2018. Although the percentage of total positions filled by USMGs has decreased since 1978, the actual ratio of USMGs choosing pathology compared with the total number graduating has only mildly fluctuated. Therefore, the outlook may not be as bleak as once suspected; however, the drive for increased interest in our field should remain a goal.To increase interest in pathology, we must focus on visibility within both medicine and popular culture. Medical students think of pathology as a clinically invisible specialty and are unaware of it, forget about it, or ignore it as a career path. 4,5 Therefore, students are not rejecting pathology; it simply is not included in their slate of career options. Pathology is not a required clerkship in most American medical schools, which limits students' exposure to the role that pathologists play in patient care. If students complete elective pathology clerkships, they typically do so during the fourth year of medical school, when career path changes seldom occur. Recent changes in undergraduate medical education could also be leading to a poor understanding of the clinical practice of pathology. After the release of the Carnegie Report in 2010, many medical schools changed curriculum delivery from a traditional subject-based approach with multiweek pathology courses to a systemsbased approach with integration of subjects. 6 This more fragmented view of pathology may lack sufficient exposure and leads students to believe pathologists are basic scientists with limited career options. 4,7,8 Moreover, when students are aware of pathologists their perceptions are limited to unflattering stereotypes perpetuated in medicine and the media.Stereotypically, the depiction of pathologists on television has usually been restricted to autopsy and forensic pathology. Furthermore, it is unclear that those characters are physicians or they are forced to do autopsies because they are incompetent physicians. Negative portrayals of pathologists are difficult to counter in the media. Good role models in pathology, such as Bennet Omalu, MD, and his work with concussions and chronic traumatic encephalopathy, need highlighting to balance the more ...

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