What it's really like in pathology—from 4 physicians who know

As a medical student, do you ever wonder what it’s like to specialize in pathology? Over the years, four pathologists from around the country and working in a variety of practice settings have taken the time to be featured doctors in the AMA’s "Shadow Me” Specialty Series, which offers advice directly from AMA member physicians about life in their specialties. Check out their insights to help determine whether a career in pathology might be a good fit for you.

1. Shadowing Scott Koepsell, MD, PhD

   1. Dr. Koepsell specializes in pathology and laboratory medicine with a subspecialty in transfusion medicine and cellular therapy. With more than 10 years in practice, he said one of the skills every physician in training should have for pathology is effective communication. 
   2. “We are constantly visiting and advising by phone with our colleagues, sometimes in high-stakes situations. Learning how to have an on-point message that is concise is imperative,” Dr. Koepsell said. “In addition, we generate pathology reports making a diagnosis after examining tissues or fluids or other tests, and those reports must be clear and contain all the information needed to take care of our patients.”
   3. He also said a pathologist’s lifestyle can be a mixed bag. “In general, pathology is one of the specialties where physicians maintain a structured schedule, which really helps work-life balance. However, with a lot of call duties, my family knows that my phone can go off anytime, even when we are on vacation."

2. Shadowing James R. Gill, MD

   1. A forensic pathologist, Dr. Gill said there is no typical day in his specialty, even after more than 25 years in practice. He noted that most forensic pathologists work as medical examiners, performing autopsies in investigations of sudden, suspicious and unnatural deaths, such as homicides, suicides or accidents. 
   2. “One never knows what will come across your autopsy table,” he said. “The structure of a typical day includes performing autopsies—usually for a few hours—and then doing office work, such as finishing up autopsy reports or other administrative duties. Some days it is only office work, or it may include testifying in court.”     
   3. A typical week for Dr. Gill is 40 hours. “Although death occurs 24/7/365, forensic pathologists typically have standard 9 a.m. to 5 p.m. work hours. There is a fair amount of flexibility in the specialty since we have very few emergencies,” he said, noting that his lifestyle is largely what he expected in training. 
   4. “Having spent some time at a medical examiner's office in medical school, I was able to see what it is like to be a medical examiner and so my expectations were met. Given our work in public health, forensic pathologists are gaining greater respect among our medical colleagues, who are now recognizing the important work that we do.”

3. Shadowing Michelle A. Jorden, MD

   1. Also a forensic pathologist, Dr. Jorden noted in this 2019 profile, “Unlike many other subspecialties in medicine, where my colleagues can talk to their patients, my patients are deceased. The autopsy allows me as a physician to tell the patient’s story of how they died, what they died from, under what circumstances, and what symptoms they may have experienced prior to death.”
   2. She said one of the most rewarding aspects of the job is helping families find closure by knowing how their loved ones died, adding that “it is not uncommon for me to have to answer difficult questions as to whether death was immediate or delayed, painful or peaceful.” 
   3. Another rewarding aspect of the job, she added, is public health outreach—for example, “alerting and educating the public on topics, such as drug overdoses, sudden unexpected infant deaths and the data on suicide.”

4. Shadowing Nicole Riddle, MD

   1. At the time of this 2019 profile, Dr. Riddle had seven years in practice and suggested one question to physicians in training who are considering pathology: Are you OK not seeing patients face-to-face every day?
   2. "That’s because while we can see patients to perform fine needle biopsies or after transfusion reactions, it’s not a large part of most practices,” she said. “However, that is part of why most of us love it. We can help patients but not have to talk to them all, and chart, and all that jazz.”
   3. She added that if you’re a medical student and interested in pathology, you should read “Robbins and Cotran Pathologic Basis of Disease,” as well as some histology books. “There is histology for pathologists, but any histology book should do. We do a really bad job of teaching histology and basic pathology in medical schools—and it’s only getting worse. Just starting with the basics will put you ahead of most residents.”

The AMA Specialty Guide simplifies medical students’ specialty selection process, highlights major specialties, details training information, and provides access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database^®. 

Learn more with the AMA about the medical specialty of anatomic and clinical pathology, as well as chemical pathology, forensic pathology, molecular genetic pathology, pediatric pathology and selective pathology.

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