How to become a pathologist

Pathology aims to understand the causes and effects of disease. It is on the cutting edge of the latest discoveries and technologies. Most pathology work takes place in the lab, hence pathologists are sometimes referred to as ‘the most important doctors you will never see.’

Pathology roles suit people who enjoy solving puzzles and working behind the scenes. Due to the specialized nature of the field and the demanding training required, pathology positions usually provide good job security and excellent compensation.

What is a pathologist?

A pathologist works with other medical providers to diagnose diseases and inform prognosis and treatment plans. Becoming a pathologist requires a deep knowledge of human physiology and the origins of health and disease. Working with tissues, cells, and other samples, ensures this role is more heavily lab-based than other medical specialties.

How hard is it to become a pathologist?

Would-be pathologists need to be intelligent and hard-working to successfully qualify for and complete medical school. They also need to be ready to work long hours during their residency placement.

How long does it take to become a pathologist?

The first step is a 4-year undergraduate degree. After medical school (4 years), students need to complete an accredited residency program in pathology (3-4 years). Some subspecialties such as neuropathology, breast pathology, or genitourinary pathology, require fellowship training that usually lasts another year.

What kind of jobs are there in pathology?

Many pathologists work in hospitals, clinics, or medical laboratories. Others work at colleges and universities, where they teach, or conduct laboratory research. Pathologists may also work for the government or for private industry. For example, the agricultural sector hires pathologists to evaluate how bacteria and fungi affect crops.

The most traditional role for pathologists is in a hospital or clinical setting. Pathologists work with clinical samples, including samples from organs or other tissues (for anatomical pathologists), or bodily fluids such as blood or urine (for clinical pathologists). They perform lab tests and examine these samples for signs of disease.

Four primary specialty areas in pathology

There are more than a dozen subspecialties within pathology. Most specialties fit into 1 of 4 categories:

9 steps to become a pathologist

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Step 1 – Study relevant subjects in high school

During the admissions process, colleges and universities assess a student’s transcript to decide whether they are ready for undergraduate coursework. If you are considering a career in pathology, the most important courses to take include:

• biology (at least 1 year, including AP classes if possible)
• chemistry (at least 1 year, including AP classes if possible)
• physics (at least 1 year, including AP classes if possible)
• social sciences, including history (4 years)
• math (at least 3 years)

In addition to these, your school may offer advanced coursework in biology, psychology, statistics, or foreign language.

» Read: Decision fatigue: how to manage during the admissions process

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Step 2 – Get an undergraduate degree

To qualify for medical school you need a bachelor’s degree. Although it is recommended to choose a science or health-related subject, you can choose any major, including philosophy, economics, or history, and still become a pathologist.

It is beneficial to register as pre-med to ensure you take the prerequisite medical school courses:

• 1 year of biology with a lab component
• 1 year of general chemistry with a lab component
• 1 year of organic chemistry with a lab component
• 1 year of physics with a lab component
• 1 semester of biochemistry
• 1 year of English

Most students who plan to attend medical school choose to major in biology, chemistry, or health sciences. You may also take additional coursework to prepare for medical school, such as:

• anatomy and physiology
• pathology
• cell biology
• genetics
• microbiology
• immunology
• statistics
• clinical lab science

» Read: Pre-medical and pre-health post-baccalaureate programs

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Step 3 – Pass the medical college admissions test (MCAT)

The majority of medical schools require applicants to take the Medical College Admission Test (MCAT). The MCAT covers 4 key content areas:

• biological and biochemical foundations of living systems (59 questions)
• chemical and physical foundations of living systems (59 questions)
• critical analysis and reasoning skills (53 questions)
• psychological, social, and biological foundations of behavior (59 questions)

The MCAT is a multiple-choice exam. Some questions test knowledge, others require candidates to use their critical thinking skills. Test centers around the country administer the MCAT in a computerized format. There is no ‘pass’ score. The majority of schools publish the average MCAT scores of their most recent class, which gives candidates a sense of what to aim for.

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Step 4 – Apply to medical school

Most candidates begin the medical school application process in the summer of the year before they plan to start school.

Factors to consider when researching medical schools include:

• M.D. versus D.O. degree – There are 2 major degrees that allow you to practice medicine in the United States. Most students get a medical doctor (M.D.) degree, which takes a traditional approach to medicine. Others prefer to get a doctor of osteopathy (D.O.). This typically focuses on a holistic model of medical care, with a focus on mind-body-spirit connections. Either an M.D. or a D.O. degree can prepare you for a career as a pathologist.
• Accreditation status – Whether you pursue an M.D. or D.O., it needs to be from an accredited medical program, otherwise you may be ineligible for licensure.
• Cost – The most affordable options are in-state tuition at a state school, while the most expensive are private schools. Also factor in the cost of living, as this can significantly add to your student loan burden.

Although there is no perfect number of programs to apply to, most successful applicants apply to 15 – 20 medical schools. Applying to a range of programs and expanding your geographic area of preference can be a smart way to increase your odds of acceptance.

There are 2 centralized application systems for medical school applications: the American Medical College Application Service (AMCAS) is for schools offering an M.D. The American Association of Colleges of Osteopathic Medicine Application Service (AACOMAS) is for D.O. programs. These portals allow you to upload required application materials, including transcripts, personal statement, essays, and letters of recommendation.

 Timeline for application to medical school

• May-June of the year before you intend to go to medical school: apply for medical school through the AMCAS or AACOMAS portals.
• July-August: wait for invitations to complete a secondary application. This often includes additional essays specific to each medical school.
• September-December: medical schools invite candidates for interviews.
• October-May: schools provide offers of admission. The exact date of admissions offers depends on the program.
• May 15th: decision day. The day by which students need to inform programs of their decision to attend or decline the offer.
• August-September: orientation and beginning of classes.

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Step 5 – Go to medical school

Medical school takes 4 years to complete. The first 2 years are pre-clinical and comprise coursework in fields such as anatomy, physiology, and chemistry. The second 2 years involve clinical rotations in which you begin to see patients in a real-life medical setting. This  may be where you are first exposed to pathology. Some programs integrate clinical work into all 4 years of medical school, which can give students additional practice in interacting with patients and conceptualizing problems.

If possible, take at least 1 pathology course during medical school. Many programs offer forensic pathology, which is an opportunity to learn how to fill out death certificates, perform post-mortem exams, and interact with law enforcement. These pathology courses can make you a more competitive candidate for pathology residencies.

Medical school also involves studying for the United States Medical Licensing Examination (USMLE), which is required to become licensed as a doctor. USMLE Step 1 is typically taken after the second year of medical school. USMLE Step 2 is usually taken after the fourth year. If you are enrolled in a D.O. program, you may take the COMLEX exam instead.

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Step 6 – Get your medical license

Licensure is regulated at state level. In most states, candidates become licensed after  1 year of post-medical school training. This includes taking Step 3 of the USMLE, typically after the first or second year of residency.

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Step 7 – Complete a pathology residency program

Medical school graduates enter residency programs through a match process. This process sees candidates ranking programs and institutions ranking applicants. Based on this, a computer algorithm determines the best matches.

A general pathology residency usually takes 4 years. This includes rotations in anatomical and clinical pathology, as well as electives. Some specialized programs in clinical pathology/laboratory medicine or anatomic pathology take only 3 years. During this period, residents are paid a salary.

In addition to clinical rotations, many programs offer research opportunities for residents. Elective opportunities may include:

• cytopathology
• neuropathology
• pediatric pathology
• immunohistochemistry
• forensic pathology
• dermatopathology
• perinatal pathology

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Step 8 – Complete a fellowship program (optional)

Most fellowship programs take 1 year and provide very specialized training in the area of pathology the candidate is interested in. Subspecialty areas include:

• clinical informatics
• cytopathology
• blood banking/transfusion medicine
• forensic pathology
• neuropathology
• molecular genetics
• medical microbiology

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Step 9 – Get board certified in pathology

The American Board of Pathology sets standards for board certification. The exact details of the board certification process vary by specialty area, but the exam typically includes a written and practical element. Board certification is not mandatory to practice medicine, but certain jobs may require it.

How to find a job in pathology

Many pathologists take jobs in the hospital or medical setting where they did their training. They get these jobs from the connections forged during training and through word of mouth.

The JAMA Career Center and PracticeMatch are online resources with job postings. Joining relevant mailing lists, such as the American Board of Clinical Pathology or College of American Pathologists, is another great way to find a job.

» Read: Essential tips for finding a new job

Upon completing your education, there are various pathology roles to choose from. Examples include:

Financial aid for pathology students

On average, medical school costs $54,698 per year. Public schools cost an average of $49,842 per year, whereas private medical schools cost $59,555 annually. Many students take on student loan debt to cover these costs.

The first step in obtaining financial aid is to complete the Free Application for Federal Student Aid (FAFSA). After completing this, you may be eligible for Federal Direct Graduate PLUS loans, or unsubsidized loans. Individual medical schools and external organizations may also offer scholarships, grants, or other aid.

» Read: What is the Federal Pell Grant?

When looking for work, you may wish to prioritize employers that make you eligible for loan forgiveness programs. For example, the Indian Health Service offers a loan repayment program for medical providers who commit to 2 years of service. The Public Service Loan Forgiveness Program offers loan repayment for pathologists working at government or non-profit organizations. This program forgives the student loan after you make qualifying payments for 10 years.