2011 ASCP Fellowship & Job Market Surveys

A Report on the RISE, FISE, FISHE, and TMISE Surveys

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By Henry M. Rinder, MD, FASCP, and Jay Wagner, MBA, MLS(ASCP)CM

Table of Contents

Introduction Applying for Pathology Fellowships Principal Reason for Pursuing a FellowshipNumber of Fellowships Intended to CompleteNumber 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 SearchReasons to Restrict Job SearchAnnual Starting Salaries by Type of Position SoughtNumber of Job Offers ReceivedJob Offers at Own Training ProgramRanking of Factors in Job Choice for ResidentsConclusions

Applying for Pathology Jobs after Fellowship

Number of Jobs Formally Applied forNumber of Job Offers ReceivedHow Long to Get a JobAdditional Subspecialty FellowshipAnnual Starting SalariesSigning BonusMoving BonusReasons for Specific Job SelectionsEmployer CategoryAnticipated Job ResponsibilitiesConclusions

AcknowledgmentsASCP Resident Council, 2010-11

3

45567

8

899

10101112121313

14

1415161717181818192021

2223

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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.

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

4 | This report is available at www.ascp.org/residents.

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:

• SurgicalPathology• Hematopathology• Cytopathology• Gastrointestinal/HepaticPathology• Dermatopathology• ForensicPathology• GynecologicPathology• MolecularGeneticPathology• BloodBanking/TransfusionMedicine• BreastPathology• MolecularPathology• GenitourinaryPathology• PediatricPathology

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Principal Reason for Pursuing a Fellowship

Number of Fellowships Intended to Complete

Job not available after residency(5%)

Pathology skills enhanced (35%)

Fellowship in future career path (33%)

Fellowship enhanced ability to secure employment (27%)

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.

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 40% of residents intend to complete at least two fellowship training programs.

1 Fellowship (59%)

2 Fellowships (40%)

3 Fellowships or more (1%)

6 | This report is available at www.ascp.org/residents.

Number of Fellowship Offers Received

The reported results for fellowship offers in 2011 were remarkably similar to those reported in 2009 and 2010. Slightly more than half of residents received a single fellowship offer; in 2011, 12% of applicants (up from 10% 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.

1 fellowship (54%)

2 fellowships (21%)

> 3 fellowships (5%)

3 fellowships (8%)

0 fellowships (12%)

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ConclusionsSeeking 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.

8 | This report is available at www.ascp.org/residents.

Applying for Pathology Jobs Immediately after Residency

Number of Jobs Formally Applied for

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.

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.

1-3 jobs (25%)

4-6 jobs (6%)

7-10 jobs (2%)

>10 jobs (4%)

0 jobs (63%)

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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.

ReferenceLabolatory (1%)

No Preference (24%)

Other (18%)

Academic Institution (24%)

Community Group Practice(33%)

Helpful Employment Resources

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.

www.Facebook.com/ASCP.Chicago

2.3

2.3

2.3

2.5

2.5

2.7

2.7

2.7

2.6

2.8

3.0

3.1

3.4

monster.com

careerweb.com

mdconsult.com

New England Journal of Medicine advertisement

Executive recruiter

American Journal of Clinical Pathology advertisement

ASCP Job Finder

College of American Pathologists Job Listing

www.pathologyoutlines.com

Faculty/word-of-mouth

“Job Board” post at pathology conferences

Target inquiries, i.e., calling/ writing potential employers

Archives of Pathology and Laboratory Medicine advertisement

3.8

5=extremely important, 4=somewhat important, 3=minor importance, 2=not very important, and 1=not a consideration).

Scale:

10 | This report is available at www.ascp.org/residents.

Restrict Job Search

Reasons to 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.

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.

Yes No(48%)(52%)

Professional contacts (4%)

Native to area (25%)

Spouse or partner’s job (34%)

Other lifestyle / family issues (37%)

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> $250K$200K-$250K$150K-$200K$100K-$150K

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 40% of academic practices which did detail starting salaries offered less than $150,000 per year, whereas slightly more than 80% of starting salaries in community practices were greater than $150,000.

Academic Institutions

0%

Community Group Practice

< $100K

37% 37%

5%

26%

16% 16%17%

21%

25%

Annual Starting Salaries by Type of Position Sought

12 | This report is available at www.ascp.org/residents.

Number of Job Offers Received

Job Offers at Own Training Program

As noted previously, 112 residents formally applied for job openings in 2011. 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.

Nearly 60% 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 2010.

0 offers (39%) 1 offer

(42%)

2 offers (9%)

3 offers (4%)

> 3 offers (6%)

Yes, but declined for another offer (21%)

No, not offered (44%)

Yes, acceptedand planned to stay (23%)

Yes, accepted but kept looking in the future (12%)

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Ranking of Factors in Job Choice for Residents

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 40% 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.

4.02

3.93

3.91

3.81

3.75

3.43

3.24

2.90

2.59

Long-term job security

Perception of staff

Family factors

Job availability

Career advancement

Salary considerations

Practice subspecialty

Fiscal pressures (loan repayments)

Teaching

Research

4.02

5=extremely important, 4=somewhat important, 3=minor importance, 2=not very important, and 1=not a consideration).

Scale:

14 | This report is available at www.ascp.org/residents.

Applying for Pathology Jobs after Fellowship

Number of Jobs Formally Applied for

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; post-exam 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.

Although the majority of fellows in all 3 specialties applied for modest numbers ( one-third) of hematopathology fellows had 7 or more applications. This trend has existed since 2009, perhaps related to greater competition for hematopathology jobs.

0 1-3 4-6 7-10 >10

14%

21%

31%27%

21%

6%

15%

25%

10%

7%

37%

69%

14%

3%0%

TRANSFUSION MEDICINEHEMATOPATHOLOGYFORENSIC

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Number of Job Offers Received

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.

0 1 2 3>3

16%

22%24%

48%

9% 9%9%

48%

25%

3%

2%

56%

24%

4%0%

TRANSFUSION MEDICINEHEMATOPATHOLOGYFORENSIC

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The majority of fellows found jobs within 6 months, but a not insignificant percentage had to continue searching for up to 12 months.

How Long to Get a Job

< 1 month 1-3 months 4-6 months 6-12 months > 1 year

38%

12%

24%

28%

24%

12% 12%

29%

31%

28%

0%

33%

14%

10%

5%

TRANSFUSION MEDICINEHEMATOPATHOLOGYFORENSIC

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Additional Subspecialty Fellowship

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. YES NO

10%

21%

27%

73%

79%

90%

< $100K $100K-$150K $150K-$200K $200K-$250K > $250K Not Discussed

Annual Starting Salaries

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

18 | This report is available at www.ascp.org/residents.

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.

5% 13%

24%

76%

95%87%

YES YESNO NO

Signing Bonus Moving Bonus

24%

47%52%

48%53%

76%

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

TRANSFUSION MEDICINEHEMATOPATHOLOGYFORENSIC

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19%

44%

61%

10%

8%

8%

12%

3%

38%

4%

1%

1%

0%

0%

0%

0%

0%

0%

0%

0%

0%

0%

0%

3%

14%

33%

14%

10%

10%

University-Academic

Hospital

Community/Private

Reference Lab

Federal Gov

State Government

City/State

County

Military/AFIP*

Other

Employer Category

The majority (about 70%) 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 30% of forensics fellows found academic or community practice jobs. By contrast, about 80%-90% 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

TRANSFUSION MEDICINE

HEMATOPATHOLOGY

FORENSIC

20 | This report is available at www.ascp.org/residents.

Anticipated Job Responsibilities

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.

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).

Medicolegal Death Inquiry (90%)

FORENSIC Workload

Hematopathology & Clinical Pathology (6%)

Hematopathology, Surgical Pathology, & Clinical Pathology (36%)

Other(4%)

Hematopathology &Surgical Pathology(31%)

Hospital Autopsies (10%)

Hematopathology only (20%)

Research(3%)

HEMATOPATHOLOGY Workload

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Transfusion Medicine & Surgical Pathology(7%)

Transfusion Medicine only (40%)

Transfusion Medicine, Surgical Pathology, & Clinical Pathology (7%)

Transfusion Medicine & Clinical Pathology (32%)

Other(7%)

Research(7%) TRANSFUSION

MEDICINE Workload

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 (

22 | This report is available at www.ascp.org/residents.

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 Jay.Wagner@ascp.org or Jennifer.Hampshire@ascp.org.

This report is available at www.ascp.org/residents. | 23

ASCP Resident Council, 2010-11

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

33 West Monroe Street, Suite 1600Chicago, IL 60603P 312.541.4999 www.ascp.org

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