ASCP Fellowship & Job Market Surveys

STRONGERTOGETHER ASCP Fellowship & Job Market Surveys A REPORT ON THE 213 RISE, FISE, FISHE, NPISE, PISE and TMISE Surveys Henry M. Rinder, MD, FASCP Karen Frank, MD, PhD, FASCP Jay Wagner, MBA, MLS(ASCP) CM ascp.org/residents

CONTENTS Introduction Applying for Pathology Fellowships Preparation for Residency and for Independent Work Applying for Pathology Jobs Immediately After Residency Residents Perceptions on Training and Health Care Applying for Pathology Jobs After Fellowship Additional Subspecialty Fellowships Fellows Surveyed About Anticipated Job Responsibilities Acknowledgements ASCP Resident Council 212 213 2 3 8 12 15 2 24 31 34 35 Mary D. Le, MD Harbor UCLA INTRODUCTION ASCP Fellowship & Job Market Surveys: A Report on the 213 RISE, FISE, FISHE, NPISE, PISE, and TMISE Surveys By Henry M. Rinder, MD, FASCP, Karen Frank, MD, PhD, and Jay Wagner, MBA, MLS(ASCP)CM ASCP responds to the interests and needs of residents, fellows, and program directors by directing an annual survey on fellowships and the job market for pathologists in training, including both residents and fellows. The surveys are conducted as part of the Resident In-Service Examination (RISE) and the Fellow Forensic In-Service Examination (FISE), the Fellow In-Service Hematopathology Examination (FISHE), Fellow Neuropathology In-Service Examination (NPISE), Fellow Pediatric Pathology In-Service Examination (PISE), and the Fellow Transfusion Medicine In-Service Exam (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 2,56 individuals participated in the Spring 213 RISE, including 2,482 residents (669 PGY-1, 636 PGY-2, 626 PGY-3, and 551 PGY-4) and 24 individuals who cited training status as other than PGY 1-4, e.g., fellows. Some 85 percent of residents are in AP/CP training, while 11 percent and 4 percent are in AP only and CP only tracks respectively. For PGY-3/4 trainees, 66 percent have U.S. medical degrees, compared with 58 percent for PGY-1/2 residents. A total of 283 fellows participated in the five Spring 213 Fellowship In-Service Examinations 2 ascp.org/residents

Jennifer N. Stall, MD University of Michigan APPLYING FOR PATHOLOGY FELLOWSHIPS As part of the 213 RISE, 1191 PGY-3/4 residents were surveyed about their experience in the fellowship process and residents attitudes toward fellowship training. From the 213 survey, the fellowships that PGY-3/4 residents have already applied for or intend to apply for are listed in order of preference: Surgical Pathology Hematopathology Cytopathology Gastrointestinal/Hepatic Pathology Dermatopathology Forensic Pathology Blood Banking/Transfusion Medicine Breast Pathology Molecular Genetic Pathology Genitourinary Pathology Molecular Pathology Gynecologic Pathology Pediatric Pathology Neuropathology ascp.org/residents 3

Principal Reason for Pursuing a Fellowship (All residents) About 4 percent of residents cited enhancement of their pathology skills as the main reason for pursuing a fellowship, while one-third were planning their career in pathology to be based on their fellowship specialty. The third group of residents chose a fellowship to enhance their employability, and only a small number of residents chose a fellowship because of job unavailability. 23 In general, fellowship training enhances my ability to secure employment. 4 Desired job not immediately available after residency. The vast majority of residents finalized their fellowship plans during their PGY-3 year, while much smaller numbers made their decisions earlier in their training; still, 5 percent did not decide on fellowship pathways until their fourth year of residency training. 33 Fellowship is necessary for a desired position 41 Enhance pathology skills by additional training. Number of Fellowships Intended to Complete (All Residents) The desire for multiple fellowships continues with 37 percent of residents reporting interest in doing two or more fellowships. 4 Fellowship 1 3 or more Fellowships 37 2 Fellowships 57 1 Fellowship 4 ascp.org/residents

Reasons for Pursuing Multiple Fellowships (All residents) 13 Job not available 6 Family/location/timing of training 34 Career goals include specialization in multiple fields. Specialization in several fields as a career goal declined dramatically (54 percent to 34 percent) compared with 212, and the pursuit of multiple fellowships is now most important for correcting residency training gaps and securing jobs in a competitive market (from 26 percent to 47 percent in combination) compared to 212. 18 Improve weak areas of residency training. 29 Multiple subspecialties needed for job. Current Interest in Applying for a Fellowship (PGY-3/4 residents only) 6 Already applied. 5 Intend to apply. 4 I do not intend to apply. 85 Already accepted a fellowship. ascp.org/residents 5

To how many fellowship programs did you formally apply? (PGY-3/4 residents only) The majority of residents apply for at least four fellowship positions. 17 7-1 5 39 1-3 19 >1 21 4-6 Number of Fellowship Interviews Received (PGY-3/4 residents only) Only a small number of residents interview for more than four to six fellowship positions. 7 1 >1 7 7-1 25 4-6 59 1-3 6 ascp.org/residents

1 3 8 5 >3 Number of Fellowship Offers Received (PGY-3/4 residents only) The reported results for fellowship offers in 213 were remarkably similar to previous years. Slightly more than half of residents received a single fellowship offer; only 8 percent did not receive any offers, a slight overestimate since a small percent did not apply to fellowships. About 4 percent of residents had positive responses from two or more fellowship programs, suggesting that there is competition among fellowship programs for strong applicants. 25 2 53 1 Did you accept more than one offer? (PGY-3/4 residents only) In what PGY-year did you finalize your choice of fellowship? (All residents) A minority of residents continue to accept and then subsequently decline a fellowship offer. 7 YES 5.1 Before residency began. 4.8 PGY-4.4 >PGY-4 5.8 PGY-1 93 NO 23.3 PGY-2 6.6 PGY-3 ascp.org/residents 7

Conclusions Fellowship training in pathology is sought after by 95 percent of residents; more than one-third of residents plan on multiple fellowships. Enhancing job opportunities and filling training gaps in combination outweighed specialization considerations in choosing to pursue two or more fellowships. As in 212, decisions on fellowship specialties were mostly made during the PGY-2 and PGY-3 training years. The majority of PGY-3/4 residents received only a single fellowship offer; about 4 percent received multiple offers. Less than 8 percent had not yet received a fellowship offer, suggesting that only a small number of residents are not finding fellowship opportunities. Surgical pathology remains the top fellowship choice; cytopathology, and hematopathology continue to trade for the No. 2 fellowship spot, while GI/hepatic pathology, dermatopathology, and a new entry, forensic pathology, round out the top six fellowship specialties. PREPARATION FOR RESIDENCY AND FOR INDEPENDENT WORK The ASCP Resident Council responded to requests from residents interested in learning about national trends regarding medical education prior to residency and sign-out procedure. 8 ascp.org/residents

23 Had adequate experience and education and felt prepared for residency. 1 Was not exposed to pathology as a career and/or did not know what pathology training entailed. How well did your medical school training prepare you for your pathology residency? (All residents) Medical school preparation for pathology residency training is problematic with 41 percent of residents citing no exposure to pathology and/or no first-hand pathology experience during medical school. Only one-quarter of residents felt that their medical school education left them prepared for pathology residency training. 36 Had some first hand experience and training but still did not feel prepared for residency. 31 Was exposed to pathology through labs and lectures but had no first-hand experience. 5 Other 2 No preview time, sign-out with attending What type of sign-out experience does your program have? (All residents) Sign-out experience did not differ significantly from 212. 45 Overnight preview time, sign-out with attending. 49 Morning or day-of preview time, sign-out with attending. ascp.org/residents 9

Do you believe that your sign-out experience would benefit from: (All residents) 1 Less preview time Again, sentiment for more sign-out has not changed from 212. 49 No change 5 More preview time Do you anticipate feeling ready to sign-out general pathology cases upon graduation from residency? (All residents) 16 YES 12 NO Only one-sixth of senior residents are ready for general sign-out. 22 Yes, but with a transitional period where all cases are reviewed 51 Yes, but with back-up if needed 1 ascp.org/residents

Residents at every training level felt that they would not be independent at graduation, but the reasons for this changed with time-in-training (as noted in the following table). Why don t you anticipate feeling ready to sign-out cases upon graduation from residency? (PGY-1/2 and PGY-3/4) Graduated sign-out experience (All residents) PGY 1 & 2 PGY 3 & 4 YES NO Not prepared educational deficiency 32 17 Does your program have graduated sign-out? 8 2 Not enough graduated responsibility in training program Need fellowship training to feel confident in general pathology Did not see enough volume of cases in residency 6 15 49 59 9 Do you want graduated sign-out to be instituted? Do you benefit from graduated sign-out? 81 19 97 3 Did not see enough variety of cases in residency 5 4 Do you sign-out frozen sections on your own? 15 85 4 Preview time was about equally split between morning/day-of sign-out versus overnight, and there is a small but persistent percentage of residents citing no preview time at all. Similarly, residents overall were equally split between needing more preview time versus no change in the current amount of previewing. Training status influenced the desire for more preview time but perhaps not as much as might be expected; 53 percent of PGY-1/2 cited a benefit from more preview time versus 47 percent of PGY- 3/4. Interestingly, time in training also demonstrated a sobering effect upon resident expectations for independence; 27 percent of PGY-1 (but only 1 percent of PGY-3/4) residents felt that they would be ready for general pathology sign-out upon graduation. With time-in-training, senior residents generally felt a greater need for backup or a transition period to independent sign-out. ascp.org/residents 11 For residents who did not feel that they would be ready for general pathology sign-out at graduation, reasons for this deficiency changed over time. PGY-1 trainees were similarly concerned about both educational deficiencies (37 percent) and needing fellowship training (42 percent) to become adept at sign-out. By third or fourth year year of residency, these cited reasons had changed to 17 percent and 59 percent, respectively. In addition, a lack of graduated responsibility emerged as a significant reason for deficiency, with the percent more than doubling from PGY-1/2 to PGY-3/4. As an example, 85 percent of residents do not sign-out frozen sections on their own. Nearly 1 percent of the residents who experience graduated sign-out feel that they benefit from completely working up the case on their own, independently writing the report, and then having the attending do a final review. However, one-fifth of residents at every level of training consistently note that there is no form of graduated sign-out during their residency; 8 percent of such residents would like graduated sign-out to be instituted.

Conclusions Pathology residents overwhelmingly felt that their medical school education had not adequately prepared them for residency. Similar to 212, nearly all residents have overnight or morning/day-of preview time, and about half would benefit from more preview time. Only one-sixth of all residents anticipate that they would be able to independently sign out general pathology at the time of graduation. A similar but lesser subset would not feel competent even with a transition or backup period. Increasing educational experience and embracing graduated responsibility are readily available changes that pathology programs could use to enhance resident confidence in their general pathology skills. APPLYING FOR PATHOLOGY JOBS IMMEDIATELY AFTER RESIDENCY Although relatively few pathology residents opt to go directly from training into the job market, both the ASCP Resident Council and the RISE Committee deem it critical to survey residents in this situation and report relevant information for future trainees. Number of Jobs Formally Applied For In 213, only 52 PGY-3 and PGY-4 residents noted that they were seriously considering entering the job market, and only 16 actually applied for a specific job. Fourteen of these applied for between one to three jobs, and all received interviews. The majority of job opportunities were full-time in Community Group practice. 12 ascp.org/residents

Helpful Employment Resources monster.com 2.13 careerweb.com 2.17 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 three best venues were (2) contacting potential employers directly and (3) job boards at conferences (Scale for related chart: 5=extremely important, 4=somewhat important, 3=minor importance, 2=not important, and 1=not a consideration). ASCP Facebook Career Center mdconsult.com NEJM advertisement AJCP advertisement ASCP Job Finder Archives of Pathology and Laboratory Medicine advertisement Executive Recruiter CAP job listings pathologyoutlines.com Job Board posts at pathology conferences. Targeted inquiries (i.e. calling/ writing to potential employers) Faculty/word of mouth 2.17 2.26 2.46 2.51 2.53 2.57 2.61 2.73 2.8 2.92 3.28 3.71 Number Of Job Offers Per Resident Of the 52 residents who considered job opportunities, 22 did receive job offers, and most only had a single offer. Only one-third of offers were at their training program. Six job offers were unsolicited. Salary Range for Residents Who Accepted a Job Offer Coming Out of Their Own Residency Program 6 2 6 3 <$1,/year 14 $1, - <$15,/year 14 $15, - $2,/year 14 $2, - $25,/year 3 >$25,/year 24 A starting salary was not discussed. 31 31 1 58 ascp.org/residents 13

Factors in Job Choices Long-term job security 4.6 Your perception of staff and institution at interview 3.97 Family factors (e.g., spouse s job, children s school) 3.95 Job availability in a specific geographic region 3.87 Salary considerations 3.75 Opportunities for career advancement 3.64 Fiscal pressures (loan repayments, etc.) 3. Opportunity to practice a subspecialty interest 2.89 Teaching opportunities 2.75 Research opportunities 2.47 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, similar to 212, while family and geographic considerations were close behind as next most important. Conclusions The number of PGY-3/4 residents who formally considered job openings in 213 has declined precipitously, from 139 in 212 to 52. Only 4 percent of residents considering jobs actually applied for and/or received offers. In the 213 survey, one-third of the residents who were actively seeking jobs received offers to become an attending pathologist at their current training program. 14 ascp.org/residents

RESIDENT PERCEPTIONS ON TRAINING AND HEALTH CARE Although the resident comfort level with the business aspects of pathology increases somewhat during training (two-thirds of PGY-1 trainees answered No to this question), only about half of PGY-4 individuals say that they are minimally to moderately prepared for pathology business (see following chart). Nearly half of all residents have had no experience or lectures on coding and management, and almost none feel that they have even minimal business or managerial skills. Yet, as noted in the following chart, the largest percentage of graduating PGY-4 residents seek positions within community group practice, a setting where such skills are important for success. Do you feel prepared for the business aspects of pathology (PGY-4 residents) Very few senior residents have a comfort level with pathology business/management. 2 Yes, moderately (example exposure to coding and some lectures or other experience with management issues) 2 Yes, definitely (example you feel you have the necessary skills to handle some business aspects of pathology, including eventually assuming managerial roles within a practice setting 47 NO (not at all) 31 Yes, minimally (example some coding experience) ascp.org/residents 15

What type of practice environment do you plan to seek or are currently seeking? (PGY 1-3 vs. PGY-4) PGY 1-3 PGY 4 Academic institution 41 35 Community group practice 28 39 No preference 2 1 Government/Military 2 2 Other 5 5 Reference laboratory 18 16 Corporate (e.g., Ameripath) 4 3 Interestingly, PGY-1, PGY-2, and PGY-3 trainees consistently ranked academic positions as their preference by a margin of >1 percent over community practice, but PGY-4 residents who were about to graduate reversed that trend, possibly because of medical school debt (see following two charts). More than 9 percent of all residents would like to have a centralized database of employment opportunities in both private and academic fields and with information on the types of pathologists employed. 16 ascp.org/residents

PGY1 PGY2 PGY3 PGY4 Student Loans What was/is your general range of student loans when you exited medical school? Has or will your amount of student debt influence your job choice? No student loans 41 45 4 34 38 NO 48 45 4 Less than 14 $99,999 Yes, it will affect the 15 type of practice setting 17 I prefer to enter (private practice, academic 14 practice, reference laboratory, etc). 22 28 27 36 $1, $149,999 8 1 2 $15, $199,999 9 9 11 13 Yes, it will affect the subspecialty area in which I choose to practice. 2 2 2 Greater than $2, 14 18 26 21 Yes, it will affect both the practice setting and subspecialty areas in which I choose to practice. 31 22 25 22 25 22 Nearly 4 percent of pathology residents have no student loans at the time of medical school graduation; the distribution of this group between U.S. and non-u.s. schools was not examined. A similar percentage have more than $15, in debt, and one-quarter of all residents have more than $2, in debt. For residents who had student loans, the largest group (45 percent overall) felt that debt would not affect their choice of practice jobs. However, with more time in training, a larger percent of residents said that the amount of student debt would affect their decision as to practice setting, increasing from 22 percent of PGY-1 s to 36 percent of PGY-4 s. Interestingly, debt does not clearly affect the type of subspecialty practice sought by trainees. ascp.org/residents 17

Resident Feelings About U.S. Healthcare in General PGY1 PGY2 PGY3 PGY4 Given the current economic/ political environment, what is your general feeling about the future of the healthcare system in United States? Also considering the current economic/political situation, what is your general feeling regarding future compensation for those practicing pathology in the United States? Optimistic Optimistic 4 36 32 28 32 26 25 21 Pessimistic Pessimistic 6 64 68 72 68 74 75 79 More than 9 percent of residents surveyed plan to live and practice in the United States nearly two-thirds of those residents overall are pessimistic about the future of United States health care in general and pathology practice compensation in particular. The majority of PGY-1 residents are pessimistic, and that percentile increases with time in training. As noted in the following chart, 7 percent of PGY-1 trainees are somewhat-to-very confident that they can find their desired pathology job position, that number declining to 58 percent for PGY-4 residents. 18 ascp.org/residents

How confident are you about finding the pathology job you desire? 7 Not confident at all 7 Very confident 11 Very confident 1 Not confident at all PGY1 PGY4 24 Not very confident 59 Somewhat confident 32 Not very confident 51 Somewhat confident Conclusions Very few residents are seriously considering jobs right out of pathology training. Of this small subset, less than half receive offers, perhaps because most are not formally applying. Most jobs for this very small subset of residents appear to be in community practice. Although residents are clearly interested in community practice, residency training in the business and management aspects of practice is lacking, both in terms of structured teaching and experience. A centralized database of employment opportunities for pathology would be highly desirable. Medical school debt is significant for many residents and may play some role in their choice of practice (i.e., community versus academic) but not in choosing a subspecialty of pathology practice. ascp.org/residents 19

APPLYING FOR PATHOLOGY JOBS AFTER FELLOWSHIP ASCP offered five Fellowship in-service examinations for the Spring of 213, the Fellow Forensic In-Service Examination (FISE), the Fellow In-Service Hematopathology Examination (FISHE), the Fellow Neuropathology In-Service Examination (NPISE), the Fellow Pediatric Pathology in-service Examination (PISE), and the Fellow Transfusion Medicine In-Service Exam (TMISE). Fellow in-service examinations were taken by 283 individuals; post-exam surveys offered the chance to query fellows in Forensics (n=35), Hematopathology (n=14), Neuropathology (n=44), Pediatric Pathology (n=13), and Transfusion Medicine (n=51) about their experience entering the job market and any plans for additional specialty training. About 6 percent of all fellows surveyed are currently in university public hospital training programs, with another quarter in university private hospital settings; the remainder is split between community, military, and other teaching hospitals or practices. About half of fellows in hematopathology, neuropathology and pediatric pathology received their undergraduate medical training in the United States, whereas 75 to 8 percent of transfusion medicine and forensics fellows were U.S.-educated. More than two-thirds of surveyed fellows are already diplomates of the American Board of Pathology, with the vast majority certified in AP/CP. Between 25 to 4 percent of forensics, neuropathology, and pediatric pathology are certified in AP only, while 4 percent of transfusion medicine fellows are boarded only in CP. The majority of fellows in Forensics, Hematopathology, and Pediatric Pathology came from a background of AP/CP residency training; as expected, about half of Neuropathology and Transfusion Medicine fellows did their residency training in AP-only and CP-only tracks, respectively. 2 ascp.org/residents

FISE FISHE NPISE PISE TMISE Indicate your residency training track 77 94 32 62 51 23 2 68 38 4 49 AP/CP AP Only CP Only If you eventually plan to seek a job, for how many jobs did you formally apply? 9 24 57 9 13 71 25 29 27 28 9 9 3 36 3 12 11 6 27 9 31 6 2 1-3 4-6 7-1 >1 ascp.org/residents 21

How many job offers did you receive? FISE FISHE NPISE PISE TMISE 6 3 4 74 18 43 62 36 23 36 2 18 17 27 22 3 5 18 9 12 2 7 1 2 3 >3 Did you receive a job offer at your own residency or fellowship training program? 13 8 22 11 19 1 11 4 41 14 33 22 27 47 76 33 67 5 Yes, but declined for another offer Yes, accepted but will keep looking in the future Yes, accepted and plan to stay No, not offered 22 ascp.org/residents

Although the majority of fellows in all five specialties applied for modest numbers (< seven) of employment positions, more than one-fourth of hematopathology, pediatric pathology, and transfusion medicine fellows had seven or more applications. Most fellows interviewed for one to three positions. In 212, 4 percent of neuropathology and pediatric pathology fellows did not receive job offers; neuropathology fellows continued to struggle, with nearly three-quarters not receiving job offers in the 213 survey. Both transfusion medicine and hematopathology demonstrated a high number (4 percent or more) of fellows who did not receive jobs offers in 213. Most forensic and neuropathology fellows received only a single job offer, but a large percentage (4 to 65 percent) of Transfusion Medicine, Hematopathology, and Pediatric fellows received at least two job offers. The majority of fellows who did find jobs did so within six months. Only Hematopathology fellows had to continue searching for more than a year before receiving an offer. FISE FISHE NPISE PISE TMISE For fellows who received job offers, how long did it take you to find a job? 7 22 11 22 22 8 47 29 22 44 19 31 33 44 11 62 21 11 22 12 <1 month 1 to 3 months 4 to 6 months 6 months to 1 year >1 year For fellows who have applied for but not found jobs as yet, how long have you been looking? 1 61 69 5 4 14 12 5 2 12 3 14 15 5 4 5 <1 month 1 to 3 months 4 to 6 months 6 months to 1 year >1 year ascp.org/residents 23

ADDITIONAL SUBSPECIALTY FELLOWSHIPS We asked current fellows the following: Are you going to do an additional fellowship in a subspecialty other than your current fellowship? Between 29 to 54 percent of fellows are planning to complete an additional fellowship besides the one they had just finished (see the following chart). Overall, 42 percent of all fellows surveyed plan to complete two or more fellowships, consistent with surveys of residents from the 213 RISE and similar to 212 fellowship survey results. Total Number of Fellowships Planned Indicate your principal reason for pursuing fellowship training. FISE FISHE NPISE PISE TMISE Only the current fellowship 71 54 59 Fellowship is necessary for a desired position 77 36 45 46 46 49 2 59 26 Desired job not immediately available after residency 4 42 41 8 4 54 31 Enhance pathology skills by additional training 14 41 45 3 or more 3 23 29 4 In general, fellowship training enhances my ability to secure employment 9 19 9 1 23 18 24 ascp.org/residents

As in 212, only forensic fellows had a vast majority of respondents cite fellowship training as a necessity for their desired employment. For all other fellows, necessity for employment and enhancement of skills were the top two reasons with roughly similar percentages. Except for pediatrics, enhanced specialization in more than one field of pathology was the number one reason for completing multiple fellowships (see following graph). Competition in the job market was another important motivator. Fifty-nine of the fellows (2 percent of the total) had already completed a separate fellowship at the time of this survey; nearly half of these were in surgical pathology. Another 37 have already accepted a fellowship for the 213 14 academic year, so that 33 percent of all fellows are currently set for at least two fellowships. FISE FISHE NPISE PISE TMISE Desired job not available after the completion of 1st fellowship 7 17 7 9 For what reason(s) are you interested in completing multiple fellowships? 28 Career goals include advanced specialization in more than one field. 5 3 45 18 38 Need to improve weak areas of residency training to feel comfortable to practice. 7 13 17 36 3 Family/location/ timing of training 14 8 3 9 14 Believe that multiple areas of subspecialty are needed to compete in a sparse job market. 21 31 28 27 17 ascp.org/residents 25

What are your current plans: Applying for Fellowship and/or Job? Only applying for a job (no more fellowships) 97 85 66 77 76 FISE FISHE NPISE PISE TMISE Only applying for fellowships (not applying for jobs) 3 9 2 15 1 Applying for both jobs and fellowships 6 14 8 14 Geography was modestly important in job selection; the reasons for geographic restriction varied among: family (especially spousal employment), lifestyle, and being native to the area (see graph below). About 1 percent of fellows restrict their job search based on their visa status. Did you restrict your job search to a specific geographic region? YES 59 51 4 36 52 NO 41 49 6 64 48 26 ascp.org/residents

FISE FISHE NPISE PISE TMISE Indicate your principal reason for such a restriction. Indicate the area to which you restricted your job search. Native to the area 25 18 14 Northeast US 35 2 36 25 42 Spouse s job 38 3 Southeast US 1 17 13 34 14 1 Midwest US 3 22 14 25 4 Other lifestyle/ family issues 33 45 48 Northwest US 6 7 4 5 29 Southwest US 2 25 7 29 Professional contacts in area 21 Canada 5 2 7 25 Other 9 29 25 8 ascp.org/residents 27

Except for forensics, academic and community jobs make up the majority of positions accepted. Between 7 to 1 percent of positions were as salaried employees; only hematopathology (28 percent) and transfusion medicine (15 percent) fellows accepted significant numbers of partner/partner track jobs. Only a handful (5 percent) of all jobs were part-time positions. FISE FISHE NPISE PISE TMISE How would you best describe your employer? Annual Starting Salary Offered Academic institution 22 46 <$1,/year 5 67 11 56 11 46 4 Community group practice 3 41 22 22 27 $1, - <$15,/year 28 11 11 8 Reference Laboratory 3 $15, - $2,/year 63 34 67 44 46 Corporate (e.g. Ameripath) 3 $2, - $25,/year 6 36 8 11 35 Government/Military 56 4 >$25,/year 11 9 11 4 33 Other 19 4 4 11 15 A starting salary was not discussed 3 5 11 4 28 ascp.org/residents

Starting annual salaries ranged widely among fellowship groups (see following chart). Very few forensicor neuropathology fellows reported starting annual salaries of $2, or more. Less than 5 percent of fellows overall did not discuss a salary as part of a job offer. FISE FISHE NPISE PISE TMISE Average Reasons For Specific Job Selection In Order of Importance Your perception of staff and institution at interview Opportunity to practice a subspecialty interest Long-term job security Opportunities for career advancement Job availability in a specific geographic region Salary considerations Family factors (e.g. spouse s job, children s school) Fiscal pressures (loan repayments, etc.) Teaching opportunities Research opportunities 4.56 4.11 4.2 4.27 3.98 4.22 4.21 3.98 4.43 4.36 3.7 4.14 4.29 4.18 4.3 4.18 3.7 4.8 3.71 3.85 4.2 4.9 3.76 3.92 4.24 3.8 3.77 3.91 3.85 3.91 3.62 3.67 3.74 3.91 3.46 3.68 3.94 3.69 3.71 3.18 3.85 3.67 3.5 2.98 2.91 3.55 3.54 3.3 3.5 2.98 2.91 3.55 3.54 3.3 2.32 2.66 3.69 2.73 2.72 2.82 ascp.org/residents 29

The majority of pathology fellows do not receive a signing and/or moving bonus for their new job. Did you receive a bonus? Based on your experience, where are most available specialty pathology positions at this time? FISE FISHE NPISE PISE TMISE Signing bonus only 1 11 Academic institution 6 52 8 91 8 Moving bonus only 15 13 39 Community group practice 3 28 9 7 22 56 35 Reference Laboratory 6 2 Signing and moving bonus 3 9 22 15 Corporate (e.g. Ameripath) Government/Military 2 9 2 74 3 No 84 5 56 33 35 Other 18 11 9 9 The majority of forensic fellows have consistently found jobs with governmental entities, which may be one reason why they were not offered higher starting salaries. The vast majority of neuropathology, pediatric pathology, and transfusion medicine jobs are in the academic sector. Faculty contacts, targeted inquiries, job boards at meetings, and pathology outlines.com were the most important sources of job opportunities. 3 ascp.org/residents

Conclusions About 4 percent of fellows confirmed plans to complete additional fellowship training, defined as two or more pathology fellowships before entering the job market. For those fellows who were seeking jobs, most (except Hematopathology) applied for a modest number of available positions (<six opportunities). A significant percentage of all fellows have not found jobs at the time of this survey. FELLOWS SURVEYED ABOUT ANTICIPATED JOB RESPONSIBILITIES Fellows were surveyed about their anticipated job responsibilities. 1 percent of fellows who were completing training in forensics were entering positions with primary forensic pathology responsibilities. Similarly, two-thirds of pediatric pathology fellows and more than half of transfusion medicine fellows expected that their workload would be limited to their pathology fellowship specialty. By contrast, fellows completing their training in hematopathology expected to be handling additional non-specialty responsibilities, with the largest group anticipating both specialty practice plus aspects of anatomic and clinical pathology practice. Nearly 8 percent of neuropathology fellows expected their job responsibilities to be combined neuropathology and surgical pathology. ascp.org/residents 31

Hematopathology: What types of cases will make up the majority of your workload? 5 Hematopathology and clinical pathology 5 Other 21 Hematopathology only 29 Hematopathology and surgical pathology 39 Hematopathology, surgical pathology, and clinical pathology Neuropathology: What types of cases will make up the majority of your workload? 11 Other 11 Neuropathology only 78 Neuropathology and surgical pathology 32 ascp.org/residents

11 Pediatric Pathology, surgical pathology, and clinical pathology Pediatric Pathology: What types of cases will make up the majority of your workload? 22 Other 67 Pediatric Pathology only 8 Transfusion medicine and surgical pathology 4 Other Transfusion Medicine: What types of cases will make up the majority of your workload? 12 Transfusion medicine, surgical pathology, and clinical pathology 19 Transfusion medicine and clinical pathology 58 Transfusion medicine only ascp.org/residents 33

Conclusions The job situation for pathology fellows is mixed; most receive one or more offers, but a substantial minority is not finding employment right away. This latter circumstance may weigh on fellows decisions to pursue additional fellowship training. Most fellows receive a job offer within the first six months, but some need up to a year for a positive response. There is some disparity in starting salaries for fellows coming out of training, possibly related to both specialty and range of responsibilities. Fellows coming from forensics, pediatric pathology, and transfusion medicine largely expect that their job responsibilities will mirror their fellowship specialty. Most fellows completing their training in neuropathology or hematopathology anticipate positions that encompass an additional general pathology workload, with the latter including clinical pathology. ACKNOWLEDGEMENTS The ASCP RISE Committee wishes to thank the members of the ASCP Resident Council for their dedicated input to these surveys. Moreover, this survey would not be possible without the cooperation of all pathology residency program directors and the 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 Jay Wagner at Jay.Wagner@ascp.org or Nancie.Thompson@ascp.org. 34 ascp.org/residents

Jennifer M. Hawkins, DO Drexel University College of Medicine 212 13 ASCP Resident Council Evelyn T. Bruner, MD Jennifer N. Stall, MD Jennifer M. Hawkins, DO Felicia D. Allard, MD Deirdre Amaro, MD Feriyl Bhaijee, MD Lauren Gilmore, MD Maria Hintzke, MD Mary D. Le, MD Mathew D. Rumery, MD David Stockman, MD Amanda Treece, MD Chair Chair-Elect Secretary Cover imagery: Feriyl Bhaijee, MD University of Mississippi Medical Center Evelyn T. Bruner, MD Medical University of South Carolina ascp.org/residents 35 Christopher H. Cogbill, MD, FASCP University of Pittsburgh Medical Center - Presbyterian

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