A Report on the RISE, FISE, FISHE, and TMISE Surveys ASCP Fellowship & Job Market Surveys

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1 knock out process logo and black 2011 ASCP Fellowship & Job Market Surveys A Report on the RISE, FISE, FISHE, and TMISE Surveys By Henry M. Rinder, MD, FASCP, and Jay Wagner, MBA, MLS(ASCP) CM

2 Table of Contents Introduction Applying for Pathology Fellowships Principal Reason for Pursuing a Fellowship Number of Fellowships Intended to Complete Number of Fellowship Offers Received Conclusions Applying for Pathology Jobs Immediately after Residency Number of Jobs Formally Applied for Type of Position Sought Helpful Employment Resources Restrict Job Search Reasons to Restrict Job Search Annual Starting Salaries by Type of Position Sought Number of Job Offers Received Job Offers at Own Training Program Ranking of Factors in Job Choice for Residents Conclusions Applying for Pathology Jobs after Fellowship Number of Jobs Formally Applied for Number of Job Offers Received How Long to Get a Job Additional Subspecialty Fellowship Annual Starting Salaries Signing Bonus Moving Bonus Reasons for Specific Job Selections Employer Category Anticipated Job Responsibilities Conclusions Acknowledgments ASCP Resident Council,

3 2011 ASCP Fellowship & Job Market Surveys A Report on the RISE, FISE, FISHE, and TMISE Surveys By Henry M. Rinder, MD, FASCP, and Jay Wagner, MBA, MLS(ASCP) CM Introduction Each year the American Society for Clinical Pathology (ASCP) Resident Council directs an annual survey on fellowships and the job market for pathologists in training, including residents and fellows. The surveys are conducted as part of the Resident In-Service Examination (RISE), the Fellow Forensic In-Service Examination (FISE), the Fellow In-Service Hematopathology Examination (FISHE), and the Fellow Transfusion Medicine In-Service Examination (TMISE). These data are compiled by ASCP to provide information useful to all pathology trainees, residency and fellowship program directors, and prospective employers. A total of 2,591 individuals participated in the Spring 2011 RISE, including 2,524 residents (655 PGY-1, 665 PGY-2, 650 PGY-3, and 554 PGY-4) and 67 individuals who cited training status as other than PGY 1-4, e.g., fellows. Mobile QR-Code This report is available at 3

4 Applying for Pathology Fellowships As part of the 2011 RISE, 1,034 PGY-3/4 residents were surveyed about their experience in the fellowship process and their attitudes towards fellowship training. Since more than three-quarters of pathology residents finalize their choice of fellowships in the PGY-3 or PGY-4 year, this report only addresses their experience and opinions. From the 2011 survey, the fellowships that most PGY-3/4 residents have already applied to or intend to apply for are listed in their order of preference: Surgical Pathology Hematopathology Cytopathology Gastrointestinal/Hepatic Pathology Dermatopathology Forensic Pathology Gynecologic Pathology Molecular Genetic Pathology Blood Banking/Transfusion Medicine Breast Pathology Molecular Pathology Genitourinary Pathology Pediatric Pathology 4 This report is available at

5 Job not available after residency (5%) Fellowship in future career path (33%) Pathology skills enhanced (35%) Principal Reason for Pursuing a Fellowship The reasons for applying for fellowships were straightforward. Enhancing pathology skills and gaining experience for a future career path were equally important, while a slightly lesser percentage cited fellowship training as critical for gaining future employment (this category decreased slightly from 2010). The percentage of residents who applied for fellowships because of job unavailability remains very low and relatively unchanged from previous years. Fellowship enhanced ability to secure employment (27%) 3 Fellowships or more (1%) 1 Fellowship (59%) Number of Fellowships Intended to Complete The percentage of PGY-3 and PGY-4 residents who plan on completing only a single fellowship continues to decline (by 4% since 2010), and currently, slightly more than 4 of residents intend to complete at least two fellowship training programs. 2 Fellowships (4) This report is available at 5

6 Number of Fellowship Offers Received > 3 fellowships (5%) 0 fellowships (12%) 1 fellowship (54%) The reported results for fellowship offers in 2011 were remarkably similar to those reported in 2009 and Slightly more than half of residents received a single fellowship offer; in 2011, 12% of applicants (up from 1 in 2010) did not receive any offers, confirming that pathology fellowship opportunities still remain tight compared to the number of graduating residents. About one-third of residents had positive responses from two or more fellowship programs, certainly suggesting that there is competition among fellowship programs for strong applicants. About 15% of residents who received multiple offers accepted more than one offer. 3 fellowships (8%) 2 fellowships (21%) 6 This report is available at

7 Conclusions Seeking fellowship training in pathology is the rule for graduating and senior residents. Fellowships are seen as critical for employment opportunities and career pathway advancement, but an equally substantial group of trainees see fellowship as a way to further enhance necessary pathology skills. The number of residents aiming for specialty training in more than one area of concentration continues to grow. Although more than one-third of fellowship applicants (presumably the strongest candidates) receive multiple offers, the number (12%) who are not being offered any fellowship position remains constant. Thus, fellowship opportunities are constrained relative to resident numbers. Surgical pathology, hematopathology, and cytopathology remain the top three choices for specialty pathology training after completion of residency. Gastrointestinal/hepatic pathology, dermatopathology, and forensic pathology also continue as strong choices for fellowship training, rounding out the top 6 for specialty training. This report is available at 7

8 Applying for Pathology Jobs Immediately after Residency Although relatively few pathology residents opt to go directly from training into the job market, the ASCP Resident Council deems it critical to survey residents in this situation and report relevant information for future trainees. Number of Jobs Formally Applied for In 2011, 304 PGY-3 and PGY-4 residents noted that they were seriously considering entering the job market; however, only 112 actually applied for a specific job, (up from 93 in 2010). The majority (68%) of the residents who were actively seeking jobs on the 2011 survey did so in a very targeted manner (they formally applied to only 1-3 positions), but about 6% of residents who actually applied for jobs explored at least 7 possible positions. 0 jobs (63%) >10 jobs (4%) 7-10 jobs (2%) 4-6 jobs (6%) 1-3 jobs (25%) 8 This report is available at

9 Academic Institution (24%) Other (18%) Community Group Practice (33%) Reference Labolatory (1%) Type of Position Sought Residents demonstrated a switch in their major preference for a specific job type, with community practice positions replacing openings in academic institutions as the highest percentage explored. Academic positions ranked about equally with no preference, with other positions making up the remainder of jobs sought; the latter presumably includes governmental, military, and corporate (excluding reference laboratory) entities. No Preference (24%) monster.com Helpful Employment Resources careerweb.com mdconsult.com New England Journal of Medicine advertisement American Journal of Clinical Pathology advertisement Executive recruiter ASCP Job Finder Residents learned of jobs through a variety of venues, but, as noted previously, hearing of jobs from faculty and by word-of-mouth is always the most important resource for the job search. Rounding out the top 4 best venues were (2) contacting potential employers directly, (3) using pathologyoutlines.com for job opportunities, and (4) job boards at conferences and meetings. Archives of Pathology and Laboratory Medicine advertisement 2.7 College of American Pathologists Job Listing 2.8 Job Board post at pathology conferences Target inquiries, i.e., calling/ writing potential employers 3.4 Faculty/word-of-mouth 3.8 Scale: 5=extremely important, 4=somewhat important, 3=minor importance, 2=not very important, and 1=not a consideration). This report is available at 9

10 Restrict Job Search Geography plays an important but not overwhelming role in job selection; 48% of residents in 2011 stated that their job search was limited to certain parts of the country, very similar to the 2010 survey. Yes (48%) No (52%) Reasons to Restrict Job Search Spouse or partner s job (34%) Other lifestyle / family issues (37%) Interestingly and perhaps related to the current economic situation, a spouse or partner s job plays a more significant role in geographic job considerations (34% in 2011 compared with only 18% in 2010). Other limiting factors for geography were lifestyle situation and being native to the area of desired employment, while the influence of nearby professional contacts has diminished. Although based on a small sample size (n=67), community practice, not surprisingly, was the preferred situation for residents seriously considering jobs immediately following residency. Native to area (25%) Professional contacts (4%) 10 This report is available at

11 Annual Starting Salaries by Type of Position Sought < $100K $100K-$150K $150K-$200K $200K-$250K > $250K 37% 37% 26% 25% 21% 16% 16% 17% 5% Academic Institutions Community Group Practice It is interesting to note that, during the interviewing process, 21% of prospective academic employers did not disclose a starting annual salary, while only 14% of community employers were similarly reticent. About 4 of academic practices which did detail starting salaries offered less than $150,000 per year, whereas slightly more than 8 of starting salaries in community practices were greater than $150,000. This report is available at 11

12 Number of Job Offers Received 0 offers (39%) 1 offer (42%) As noted previously, 112 residents formally applied for job openings in The largest group of resident applicants (42%) received a single employment offer, but a similar number (39%) failed to receive any offer. About one-fifth of residents received multiple offerings. > 3 offers (6%) 3 offers (4%) 2 offers (9%) Job Offers at Own Training Program Yes, but declined for another offer (21%) No, not offered (44%) Nearly 6 of residents who were actively seeking jobs did receive offers to become an attending at their current training program (significantly up from 35% a year ago). Residents who found employment were asked to rank factors in their job choice. Long-term security and the working environment remained at the top of the list, but family factors, perhaps related to spouse or partner employment as noted above, moved up in the rankings as compared with Yes, accepted but kept looking in the future (12%) Yes, accepted and planned to stay (23%) 12 This report is available at

13 Ranking of Factors in Job Choice for Residents Long-term job security Perception of staff Family factors Job availability Career advancement Salary considerations Practice subspecialty Fiscal pressures (loan repayments) Teaching 2.90 Research 2.59 Scale: 5=extremely important, 4=somewhat important, 3=minor importance, 2=not very important, and 1=not a consideration). Conclusions Only a minority of residents seriously consider taking jobs immediately following their general pathology training, and only a fraction of these residents actually proceed to formally apply for positions. Opportunities do exist for such residents in both community and academic practice, but 4 of applicants did not receive any employment offer; a significant proportion of available positions are at the academic institution where the individual trained. Faculty contacts and word-of-mouth are the best sources for job contacts. A significant percentage of employers, especially academic practices, remain quiet on disclosing starting salaries; residents need to be aware of this fact so that they can decide to specifically inquire about financial remuneration. Family issues have joined long-term job security and the staff-based working environment as strong factors in job choice. This report is available at 13

14 Applying for Pathology Jobs after Fellowship As in 2010, ASCP offered three fellowship in-service examinations for the Spring of 2011: the Fellow Forensic In-Service Examination (FISE), the Fellow In-Service Hematopathology Examination (FISHE), and the Fellow Transfusion Medicine In-Service Examination (TMISE). Fellow in-service examinations were taken by 252 individuals; postexam surveys offered the chance to query fellows in Forensics (n=33), Transfusion Medicine (n=48), and Hematopathology (n=149) about their experience entering the job market and any plans for additional specialty training. Number of Jobs Formally Applied for FORENSIC HEMATOPATHOLOGY TRANSFUSION MEDICINE 69% 37% 21% 31% 25% 27% 21% 14% 14% 15% 1 7% 6% 3% >10 Although the majority of fellows in all 3 specialties applied for modest numbers (<7) of positions, a continued large proportion (> one-third) of hematopathology fellows had 7 or more applications. This trend has existed since 2009, perhaps related to greater competition for hematopathology jobs. 14 This report is available at

15 Number of Job Offers Received FORENSIC HEMATOPATHOLOGY TRANSFUSION MEDICINE 56% 48% 48% 22% 24% 24% 25% 16% 9% 9% 4% 3% % 9% >3 For those fellows who did apply for employment, 75-85% received offers with most fellows having only 1 or 2 positions available, and only a small percentage received 3 or more job offerings. However, 16% and 22% of forensic and hematopathology fellows, respectively, and about one-quarter of transfusion medicine fellows did not receive any job offers despite active applications. These data are equivalent or only slightly higher than 2010, but still quite concerning for a persistent imbalance between the number of fellows seeking employment versus the number of job openings. This report is available at 15

16 How Long to Get a Job FORENSIC HEMATOPATHOLOGY TRANSFUSION MEDICINE 38% 33% 29% 28% 31% 28% 24% 24% 12% 14% 1 12% 12% 5% < 1 month 1-3 months 4-6 months 6-12 months > 1 year The majority of fellows found jobs within 6 months, but a not insignificant percentage had to continue searching for up to 12 months. 16 This report is available at

17 9 Additional Subspecialty Fellowship 1 21% 27% YES 79% 73% NO As noted above, a significant number of fellows did not apply for jobs, specifically because nearly all of them were planning to complete an additional fellowship besides the one they had just finished. Only a small proportion of forensics fellows planned additional training, while one-fifth to one-quarter of hematopathology and transfusion medicine fellows, respectively, were seeking added fellowship training. Interestingly, the majority of forensics and transfusion medicine fellows were seeking an additional fellowship because it fit their future career pathway. By contrast, the majority of hematopathology fellows cited enhancement of skills or employment opportunities as the reason for an added fellowship. FORENSIC HEMATOPATHOLOGY TRANSFUSION MEDICINE Annual Starting Salaries 71% 46% 44% 28% 2 19% 16% 12% 1 1 8% 8% 5% 3% < $100K $100K-$150K $150K-$200K $200K-$250K > $250K Not Discussed Annual starting salaries were quite disparate among fellowship groups. More than two-thirds of forensics fellows and one-third of transfusion medicine fellows reported annual starting salaries of <$150,000, whereas 75% of hematopathology fellows had starting salaries in the $150,000-$250,000 range. This report is available at 17

18 FORENSIC HEMATOPATHOLOGY TRANSFUSION MEDICINE Signing Bonus Moving Bonus 95% 87% 76% 76% 47% 52% 53% 48% 24% 24% 5% 13% YES NO YES NO This disparity was also reflected in bonus pay. Fewer than one-quarter of forensics fellows received a moving or signing bonus, while at least half of both hematopathology and transfusion medicine fellows received one or the other bonus for their new job. Reasons for Specific Job Selections in Order of Importance Forensic Pathology Hematopathology Transfusion Medicine Job available in geographic region Long-term security Long-term security Long-term security Perception of staff Perception of staff Perception of staff Practice subspecialty Practice subspecialty Salary Career advancement Job available in geographic region Career advancement Job available in geographic region Career advancement Family factors Family factors Salary Practice subspecialty Salary Family factors Fiscal pressures Fiscal pressures Teaching Teaching Teaching Research Research Research Fiscal pressures 18 This report is available at

19 University-Academic 19% 44% 61% Hospital 8% 1 Community/Private 8% 1 38% Reference Lab 4% 12% Federal Gov 1% 3% State Government 14% City/State 1% 33% County 14% Military/AFIP* 1 Other 3% FORENSIC HEMATOPATHOLOGY TRANSFUSION MEDICINE Employer Category The majority (about 7) of forensics fellows found jobs with governmental entities, which may be one reason (especially in today s economy) they were not offered higher starting salaries or bonuses; about 3 of forensics fellows found academic or community practice jobs. By contrast, about 8-9 of hematopathology and transfusion medicine fellows found jobs in either community or academic practice, with a higher proportion (two-thirds) of transfusion medicine fellows in the latter. * Armed Forces Institute of Pathology This report is available at 19

20 Anticipated Job Responsibilities Medicolegal Death Inquiry (9) Fellows were also surveyed about their anticipated job responsibilities. As expected from both their training and the job locales, fellows who were completing training in forensics were overwhelmingly entering positions with primary medicolegal responsibilities. FORENSIC Workload Hospital Autopsies (1) By contrast, the majority of fellows completing their training in hematopathology or transfusion medicine expected to handle additional non-specialty responsibilities, with only one-fifth and slightly more than one-third, respectively, limiting their anticipated job description exclusively to their recent fellowship training area (see following two graphs). Hematopathology & Clinical Pathology (6%) Hematopathology, Surgical Pathology, & Clinical Pathology (36%) HEMATOPATHOLOGY Workload Hematopathology & Surgical Pathology (31%) Hematopathology only (2) Other (4%) Research (3%) 20 This report is available at

21 Transfusion Medicine & Surgical Pathology (7%) Other (7%) Transfusion Medicine only (4) Research (7%) TRANSFUSION MEDICINE Workload Transfusion Medicine & Clinical Pathology (32%) Transfusion Medicine, Surgical Pathology, & Clinical Pathology (7%) Conclusions A substantial number of fellows (from one-fifth to about one-third) who completed training in hematopathology and transfusion medicine in 2011 plan to complete another fellowship in 2012 before entering the job market. For those fellows who were seeking jobs for 2012, most applied for modest numbers of available positions (<6 opportunities). The job situation for these fellows is still mixed; most fellows receive 1-2 offers, but a substantial minority are not finding employment right away. This circumstance may be weighing on fellows and partially explain why some have chosen a priori to pursue additional fellowship training in Most fellows who do receive a job offer do so within the first 6 months, but some need up to a year for a positive response. There is a disparity in starting job salaries (and bonuses) between forensic, transfusion medicine, and hematopathology fellows coming out of training. This could be related to their mix of employment locales, namely governmental, academic, and community practice, respectively. Fellows in forensics expect that their job responsibilities will closely mirror their workload during fellowship training. By contrast, the minority of fellows completing their training in transfusion medicine or hematopathology expected to limit their new responsibilities solely to their subspecialty expertise; most positions appear to encompass at least some added workload in surgical pathology clinical pathology, or both. This report is available at 21

22 Acknowledgments The ASCP RISE Committee wishes to thank the members of the ASCP Resident Council.* Moreover, this survey would not be possible without the cooperation of all pathology residency program directors and the heartfelt participation of all residents and fellows who take these in-service exams and the associated surveys. We are very grateful for their assistance. Please address comments or questions about this survey to or 22 This report is available at

23 ASCP Resident Council, Jessica A. Kozel, MD, Chair Christopher H. Cogbill, MD, Chair-Elect Sara C. Acree, MD Dana Altenburger, MD Enid D. Boeding, MD Evelyn T. Bruner, MD Nilesh G. Dharajiya, MD Lauren Gilmore, MD Delecia R. LaFrance, MD Amberly L. Nunez, MD David Stockman, MD Sean R. Williamson, MD This report is available at 23

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