Path Talk

Commentary by
David B. Roth, Irene Diamond Professor of Immunology and Chair of the Department of Pathology

Putting All Your Eggs in One Basket
January 30, 2009

Advice to a Prospective Pathology Resident: A Conversation with a Residency Applicant

A chilly Saturday morning, another interview day here in the NYU Department of Pathology. The Department is quiet, including the 20 or so nervous residency applicants. Dark suits, way too hyped up to eat more than a bite or two of the lavish spread of bagels, pastries, and fruit we have set up in the conference room. (Note to self: cut the food order in half, again. No one is eating.)

The ritual begins: I go through my introductory remarks, giving a brief history of our Department (arguably the oldest academic Pathology Department in the nation—see my previous PathTalk on the history of pathology at NYU). I describe our research, our clinical service, our dedicated teaching faculty, the earnest, hardworking, energetic residents in our program.

Blah, blah, blah....  I'm never sure whether they are really listening or going over their interview schedules in their minds. At the end of the presentations, after our Residency Director has described the ins and outs of our program (rotations, hospitals, specimens, teaching, sign-out, electives....), the applicants politely file out, following us up to the interview rooms.

The first candidate walks into my office. Dark suit (Prada?), nice shoes. We discuss her background for a moment, her impressive scholastic accomplishments, her eagerness to get outstanding clinical training, and her enthusiasm for research, her commitment to a career in academic pathology.

The time seems right to pop The Question:
"Are you interested in AP, AP/research, or AP/CP?"  
(For the uninitiated, these abbreviations identify our three main training tracks – Anatomic Pathology, AP with a research focus, or combined Anatomic and Clinical Pathology.)    
She is ready for this one and pounces: "AP/CP."

"Why?"
"Because I want to cover my bases."  
Ahh, the answer I've been waiting for.
"What's the best pair of shoes?"
"Excuse me?"
"Just tell me, in your opinion, what's the best pair of shoes?"
"That depends, doesn't it?"
I play dumb: "On what?"
"On what you are going to do with them," she answers, clearly wondering how this dimwit became Chairman of a major Department.  
"Exactly. Those 4 inch Manolos (I have a good eye) might be perfect for the Metropolitan Opera, but they would be completely impossible for a track-and-field-event."
I rest my case, sitting back in my chair with a satisfied smile.
"What's your point, exactly?" The unspoken message: If, indeed, you have one.
"Let me refine my question. What's the best pair of shoes to have if you could only pick one?"

I see wheels turning. Still, the answer doesn't take long.  
"Tennis shoes."
"Good choice. So shod, you can walk, run, more or less navigate an icy sidewalk, walk in the rain, maybe trek through Nepal, and even make it into some of the restaurants on my A-list. But you'd probably stick out at those black tie events, and you'd be fairly unhappy in a major snowstorm. In definite trouble climbing Everest." Gotcha! I think.
 
She has no choice but to agree warily, sensing a trap.
I press on: "So the AP/CP track is, essentially, a pair of tennis shoes. It's all-purpose, and will get you through many situations, but it represents a significant compromise, and is clearly not the best choice for some career options."

I see that this is clear as mud.  I have some explaining to do.
 
"What may not be obvious is that trying to cover all the bases entails a compromise. You see, if you don't know what you want to do with your career in Pathology, I agree that AP/CP is the safest way to go. It covers you if you want to run a private lab, or be in private practice, perhaps covering the entire pathology service at a community hospital. If you are sure you want to go into academics you don't need the dual training, and you could really use that extra year much more productively in a fellowship."
"But I want to make sure I cover my bases. I need the combined training track to do that."
"You said you want to go into academic pathology. Are you sure?"
"Yes, but I still think I need the dual training. I don't want to miss anything."

I try again: "As a Chairman, I do quite a bit of faculty hiring. Let's say we need a surgical pathologist—I never, ever need them to also cover the blood bank, or clinical chemistry, or any other aspect of CP. It would be a great plus, however, if they have done a year of fellowship in some subspecialty in surgical pathology. If they could cover general surg path plus take some of the endocrine work, for example. Or in CP, someone who can cover clinical chemistry and who has specialized training in blood banking would be a plus. In other words, spending the extra year or two getting specialized training within either of the AP or CP disciplines would broaden your appeal to any academic pathology department. I'm sure it works more or less the same way in all big academic centers."

She sits back in her chair, looking pensive in that dark Prada suit.
"You're suggesting I put all my eggs in one basket. Anyone who reads the newspapers knows that you shouldn't invest all your money in one fund. That doesn't sound like a good idea."

I sense my status returning to Dimwit level. "Au contraire. I'm suggesting you diversify your portfolio, but only after examining your personal goals. You have to know what your investment goals are. Are you planning to retire soon? If so, stay in safe investments—they may be low-yield, but you don't want to take risks at that stage of your life; if retirement is far off, invest more aggressively or you may not have enough to retire on...I'm sure you've seen this on TV."
"Hmm.  I'll have to think about it."

I sense I have, once again, lost the argument. This is a debate I've never won, as far as I know. What am I missing?

"Here's my advice: In all areas of life—at least all the ones that occur to me right now—the key is to figure out what you really want. Examine yourself, know yourself first, and then use that knowledge to inform your plans. That's not to say you'll never change course, or never make a mistake, but if you know what you want, and you accurately identify your goals (goals that are consistent with your skills, talents, and abilities), then you can go for it. Then, instead of taking a compromise position trying cover all the bases (leaving something important only partially covered), you instead cover the right bases. The advantage of self-knowledge is that it allows you to focus all your energy in the right places. All your eggs are pulling in the same direction, to mix a metaphor."
"Thanks for the advice."
"You're welcome. Nice shoes, by the way."


Photo: © 2009 David B. Roth