What Does a Pathologist Do? A Look Inside Life as a Disease Expert


11.25.2019

Make no mistake. While a primary care physician can communicate a complex diagnosis quickly, there’s a lot of behind-the-scenes work that needs to come first. This is probably welcome news if you’re seeking a medical career that calls on you to be the problem-solver. You might be a natural fit for pathology.

If you’re like most aspiring physicians, you probably aren’t very familiar with this particular medical specialty. What does a pathologist do, exactly? And how can you become one?

While you could try digging up information here and there, you might find it helpful to explore all the details of this profession in one place. Begin your investigation here.

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What is pathology, exactly?

Pathology is vaguely defined as the study of disease. But Dr. Shivayogi Bhusnurmath, dean of academic affairs and co-chair of the Department of Pathology at St. George’s University (SGU), offers a bit more clarity.

“Pathology is the basis of all clinical medicine,” he explains. Dr. Bhusnurmath further adds that pathologists determine why a disease occurred, how the tissues were damaged, and what functional changes took place.

"Pathology is the basis of all clinical medicine."

This is how pathologists work toward explaining symptoms, signs, and clinical investigations in a patient to reach a diagnosis. Clinical diagnosis alone is the physician’s best, most reasonable guess. Pathology helps solidify that into a definitive diagnosis.

What does a pathologist do in a typical day?

Pathologists are sometimes called “the doctor’s doctor.” They’re the ones who help the patient’s physician make, or confirm, a diagnosis by studying tissue and fluid samples. Pathologists can even help identify an appropriate treatment plan based on their knowledge of what the patient is likely to experience in the coming days and weeks.

“They’re experts in predicting—if a cell or structure is altered in a certain way, the patient will have these symptoms,” Dr. Bhusnurmath says.

In any given day a pathologist can investigate health issues ranging from cancer to blood disorders like anemia. Dr. Bhusnurmath also highlights the following as things a pathologist might do during a typical day:

• Conduct blood investigations to look for bleeding disorders as well as abnormalities in blood chemistry and cells. Dr. Bhusnurmath also highlights the importance of reviewing reports for quality assurance. Issues related to sample collection, storage, and transport plus controls for the machine can occasionally lead to inaccuracies.
• Study Pap smears to detect cervical cancer or pre-cancer. They can also work up slides to identify whether there are any changes related to human papillomavirus (HPV).
• Perform fine needle aspirations on lymph nodes, the thyroid, etc. to look for malignancy.
• Run blood sugar tests to help diabetic patients determine the proper medication dosage.
• Perform autopsies to determine the underlying disease process and the cause of death.
• Examine biopsies to diagnose cancer or other conditions.

"Any lump, bump, or ulcer gets biopsied to confirm the diagnosis."

“Any lump, bump, or ulcer gets biopsied to confirm the diagnosis,” Dr. Bhusnurmath elaborates. This is essential, because while two conditions might look similar clinically, the proper treatments can vary substantially.

What are some pathology subspecialties?

There are two primary types of pathologists: clinical pathologists and anatomic pathologists. The former focus on analyzing laboratory results while the latter are more concerned with examining structural changes in tissue samples. Pathologists can also choose to become board-certified in both branches.

There are also numerous subspecialties pathologists can pursue through fellowship training and the corresponding certification. These include:

• Blood banking and transfusion medicine
• Chemical pathology
• Clinical informatics
• Cytopathology
• Dermatopathology
• Forensic pathology
• Hematopathology
• Medical microbiology pathology
• Molecular genetic pathology
• Neuropathology
• Pediatric pathology

How do you become a pathologist?

The road to pathology starts out the same as it does for any other medical field. You first need to attend a four-year medical school to build a solid educational foundation. You’ll devote the first half of your education to classroom instruction and lab work. The final two years will be spent completing clinical rotations to get more familiar working with patients. You’ll also begin the United States Medical Licensing Examination (USMLE) series during medical school.

Dr. Bhusnurmath says it’s particularly important for students interested in pathology to start getting involved early in their education. SGU, for example, provides opportunities for students to participate in a pathology observership to become familiar with interesting specimens and cases in the pathology department’s diagnostic lab during their first two years. Another option is offered as well:

"They’ll see a lot of pathology slides, write about them, and also get involved in teaching pathology to students in small groups."

“During their fourth year of medical school, they can opt for a one-month elective back in Grenada,” Dr. Bhusnurmath explains. “They’ll see a lot of pathology slides, write about them, and also get involved in teaching pathology to students in small groups.”

That elective rotation can really expose you to cases you wouldn’t otherwise see. Continued involvement in the field can also improve your chances of securing a postgraduate training position at a four-year pathology program, which have become very competitive.

While in residency, you’ll take the final USMLE test and also obtain board certification. If you wish to pursue a subspecialty, you’ll need to complete further training in the form of a fellowship. You can obtain the corresponding certification at that time.

What are some of the most important qualities pathologists need?

Before we get into what characteristics make for a good pathologist, it’s worth addressing some misconceptions. Pathologists are often rumored to dislike working with people, exhibit poor communication skills, and have an unsettling fascination with crime or death. Dr. Bhusnurmath thinks some of these myths stem from how these specialists are portrayed on TV and are not always accurate.

As for the qualities that are actually common among good pathologists? Some researchers actually looked into the specifics. A survey of more than 600 practicing pathologists who were involved in hiring physicians just starting out in the field identified which qualities are most desirable. Aside from the necessary technical proficiencies, some of the competencies identified as critical are:

• Communication skills
• Emotional stability
• Integrity
• Professionalism
• Work ethic
• Ability to work well with a team

But perhaps most important is an inherent sense of curiosity. Dr. Bhusnurmath says this is a large part of what motivated his decision to pursue pathology.

"I always wanted to know the confirmed diagnosis."

“I always wanted to know the confirmed diagnosis,” he explains. “I wasn’t satisfied with, ‘It could be this or that.’ I was looking for definitive answers.”

How much do pathologists make?

Like other specialists, pathologists stand to make a very good living. According to Medscape’s most recent compensation report, pathologists earn an average annual salary of $308,000. Your starting salary will likely be lower, but your earning potential typically increases as you gain experience in the field.

Furthermore, there’s a need for pathologists. While you may have heard there’s a looming physician shortage, you may not realize that it extends beyond primary care. The AAMC reports the shortfall of “other specialists”—a category that includes pathologists—is expected to range between 20,600 and 39,100 by 2032.

Picture yourself as a pathologist

Pathology is undeniably different than most other medical fields. It’s understandable that aspiring physicians have questions. But hopefully you can offer a bit of insight the next time you hear a fellow pre-med student ask, “What does a pathologist do?” Maybe you’ll even be able to speak from your own personal experience in this field one day.

Before you can think about specializing in pathology, you first need to gain acceptance to medical school. While there are numerous components to the application process, one of the most important is the interview. These conversations can give you the final boost you need to secure your seat. Make sure you’re prepared by practicing with our article “10 Medical School Interview Questions All Future MDs Should Expect to Answer.”

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