Pathology as a calling
Donald S. Karcher, MD
June 2024—All of us in the pathology community, no matter how winding our career paths may have been, at some point made the same choice. Of all the medical specialties available to us, we were drawn to become pathologists.
I’ve interviewed residency candidates for nearly 40 years now, and I ask every one of them the same question: Why pathology? After hundreds of these interviews, common themes have emerged. One of them is that pathology is a calling that could not be ignored.
That response has always resonated with me, and I bet a good number of CAP TODAY readers feel the same. Like many pathologists, my own medical career began elsewhere. Even though I always loved pathology in medical school—the Robbins textbook is the only one I ever read cover to cover as a student—I had already set my mind on a career in internal medicine. I wasn’t listening to the countless signals indicating that I should really consider pathology instead. Halfway through my first year of internal medicine residency, I realized my favorite part of the job was admitting new patients and figuring out what was wrong with them. That’s when I remembered why I loved pathology. It’s the diagnostic challenge. Solving the patient puzzle. Fortunately, I was able to transfer into the pathology program the following year and get myself on the track that had been calling to me all along.
When I interview residency candidates, that puzzle-solving mentality is a common trait they bring up. I would say at least half of them talk about figuring out the puzzle or solving the mystery. We are diagnosticians to the core. It’s something intrinsic about people who are attracted to pathology: We love getting to the root of the problem.
We accomplish that by applying our basic science knowledge many times in the course of each day—far more than our physician colleagues in other specialties. We use our scientific foundation for morphologic evaluation, genomics, chemical analysis, microbiology, and much more. Medical students often tell me they love basic science but don’t necessarily want to be bench researchers. Pathology is the specialty that makes it possible to bring our appreciation for basic science into the clinical work we do all day, every day, for our patients.
Many pathologists also have a deeply artistic sensibility. I have heard several residency candidates talk about the beautiful patterns that emerge under the microscope, even for devastating diagnoses such as cancer. They find inspiration in the patterns and colors that exist in the samples we examine.
Rounding out the common themes about what draws people to this field is the pathologist’s ability to interact with all corners of medicine. Our medical specialty informs decisions made in surgery, oncology, dermatology, immunology, neurology, infectious disease, and on and on. We touch every organ system and get involved in almost any type of patient case. That gives us more variety than most of our medical colleagues experience daily, and allows us to be specialists and generalists at the same time. Increasingly, pathologists also get to interact directly with patients, adding an exciting dimension to our work.
Summer is the time of year when many medical students are making decisions about their upcoming residencies and specialties of interest. If you are a student reading this, I encourage you to talk to pathologists about how our field can offer a rewarding and satisfying career. And if you are a practicing pathologist, I hope you’ll seek out opportunities to share what you do with medical students and other prospective pathologists. There is nothing as compelling as a pathologist’s passion for patient care to show how our work matters and what we gain from it. If we can build on that passion to recruit talented young people into our profession, the future of pathology will indeed be in good hands.
Dr. Karcher welcomes communication from CAP members. Write to him at president@cap.org.