Alert issued on upcoming shortage of pathologists

[BU Pathology]

This information is for medical students concerning a career in pathology.

In June, 2014, the group Health Care Development Services, Inc. issued a client alert concerning the projected shortage of pathologists. The alert specifically addressed the future shortage of pathologists and reviewed a range of information. Their conclusion – there will be a shortage of pathologists and hospitals need to begin planning for this.

Much of the data in the report came from groups who are not part of pathology. In other words, they would not benefit from having more residents in training. For example, Bureau of Health Professions projects that the shortage of pathologists will be twice as large as the shortage of radiologists. The American Association of Medical Colleges also predicts a large decrease in the number of active pathologist. The Council on Graduate Medical Education raises the concern that there will be increased demands on pathologists, both anatomic and clinical, due to increased cancer diagnoses. The Journal of Clinical Oncology predicts an increase in the number of cancer cases in the next few years. Analyzes from these groups should directly address many posters who erroneously claim the only reason that academic pathology advocates for more pathologist is in training so that they can reap economic benefits. All of the references to the original literature are found in the report. It should be noted that the report did reference the recent Archives of Pathology and Lab Medicine paper.

Medical students considering a career in pathology should be assured that at the completion of their training there will be a need for their services.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

The report may be found here:
http://hcdsinc.com/documents/Client...epage-image-link&utm_campaign=website-updates

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[turtle1966]

This information is for medical students concerning a career in pathology.

In June, 2014, the group Health Care Development Services, Inc. issued a client alert concerning the projected shortage of pathologists. The alert specifically addressed the future shortage of pathologists and reviewed a range of information. Their conclusion – there will be a shortage of pathologists and hospitals need to begin planning for this.

Much of the data in the report came from groups who are not part of pathology. In other words, they would not benefit from having more residents in training. For example, Bureau of Health Professions projects that the shortage of pathologists will be twice as large as the shortage of radiologists. The American Association of Medical Colleges also predicts a large decrease in the number of active pathologist. The Council on Graduate Medical Education raises the concern that there will be increased demands on pathologists, both anatomic and clinical, due to increased cancer diagnoses. The Journal of Clinical Oncology predicts an increase in the number of cancer cases in the next few years. Analyzes from these groups should directly address many posters who erroneously claim the only reason that academic pathology advocates for more pathologist is in training so that they can reap economic benefits. All of the references to the original literature are found in the report. It should be noted that the report did reference the recent Archives of Pathology and Lab Medicine paper.

Medical students considering a career in pathology should be assured that at the completion of their training there will be a need for their services.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

The report may be found here:
http://hcdsinc.com/documents/Client...epage-image-link&utm_campaign=website-updates

I am rooting with you for the prediction to come true. Unfortunately, I have been hearing similar predictions since early 1990's. I understand that as we age, there should be a need for more pathologists.

 

[veo1]

Blah, Blah, Blah. Please. No more.

 

[Mad Jack]

Guys, you heard it here first. The pathologist shortage will be twice as large as the radiologist shortage

 

[DermViser]

This information is for medical students concerning a career in pathology.

In June, 2014, the group Health Care Development Services, Inc. issued a client alert concerning the projected shortage of pathologists. The alert specifically addressed the future shortage of pathologists and reviewed a range of information. Their conclusion – there will be a shortage of pathologists and hospitals need to begin planning for this.

Much of the data in the report came from groups who are not part of pathology. In other words, they would not benefit from having more residents in training. For example, Bureau of Health Professions projects that the shortage of pathologists will be twice as large as the shortage of radiologists. The American Association of Medical Colleges also predicts a large decrease in the number of active pathologist. The Council on Graduate Medical Education raises the concern that there will be increased demands on pathologists, both anatomic and clinical, due to increased cancer diagnoses. The Journal of Clinical Oncology predicts an increase in the number of cancer cases in the next few years. Analyzes from these groups should directly address many posters who erroneously claim the only reason that academic pathology advocates for more pathologist is in training so that they can reap economic benefits. All of the references to the original literature are found in the report. It should be noted that the report did reference the recent Archives of Pathology and Lab Medicine paper.

Medical students considering a career in pathology should be assured that at the completion of their training there will be a need for their services.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

The report may be found here:
http://hcdsinc.com/documents/Client...epage-image-link&utm_campaign=website-updates

I respect you as an attending, as I loved Pathology and all that it encompasses from a scientific perspective, but you seriously tread the fine line between "ivory tower syndrome" and what can be labeled as active trolling.

Also why is your residency program so lopsided with respect to # of residents in each year and number of IMG grads? http://www.bumc.bu.edu/busm-pathology/residency-program/resident-profiles/

 

[veo1]

Also why is your residency program so lopsided with respect to # of residents in each year and number of IMG grads? http://www.bumc.bu.edu/busm-pathology/residency-program/resident-profiles/

Looks like a pyramid scheme.

 

[DermViser]

Looks like a pyramid scheme.

A very weird pyramid scheme: 2 --> 5 --> 1 --> 1

 

[unemployedpath]

As someone who is in the leader group in our field, please be responsible for what you say because there will be people who believe you. Please enlighten us where the pathologist shortage is. We need jobs. Thanks.

This information is for medical students concerning a career in pathology.

In June, 2014, the group Health Care Development Services, Inc. issued a client alert concerning the projected shortage of pathologists. The alert specifically addressed the future shortage of pathologists and reviewed a range of information. Their conclusion – there will be a shortage of pathologists and hospitals need to begin planning for this.

Much of the data in the report came from groups who are not part of pathology. In other words, they would not benefit from having more residents in training. For example, Bureau of Health Professions projects that the shortage of pathologists will be twice as large as the shortage of radiologists. The American Association of Medical Colleges also predicts a large decrease in the number of active pathologist. The Council on Graduate Medical Education raises the concern that there will be increased demands on pathologists, both anatomic and clinical, due to increased cancer diagnoses. The Journal of Clinical Oncology predicts an increase in the number of cancer cases in the next few years. Analyzes from these groups should directly address many posters who erroneously claim the only reason that academic pathology advocates for more pathologist is in training so that they can reap economic benefits. All of the references to the original literature are found in the report. It should be noted that the report did reference the recent Archives of Pathology and Lab Medicine paper.

Medical students considering a career in pathology should be assured that at the completion of their training there will be a need for their services.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

The report may be found here:
http://hcdsinc.com/documents/Client...epage-image-link&utm_campaign=website-updates

 

[gbwillner]

As someone who is in the leader group in our field, please be responsible for what you say because there will be people who believe you. Please enlighten us where the pathologist shortage is. We need jobs. Thanks.

What was irresponsible about BU's post? He clearly linked an article to it, explaining exactly what he meant. Contrast this to the rabid "the end is nigh" type posts we typically see here. It is a breath of fresh air by comparison.

I don't think you'll see anyone posting that everything is dandy right now in the field. But that does not negate any and all data and analyses that are contrary to the difficulties some people are having now.

 

[Inez2000]

What was irresponsible about BU's post? He clearly linked an article to it, explaining exactly what he meant. Contrast this to the rabid "the end is nigh" type posts we typically see here. It is a breath of fresh air by comparison.

I don't think you'll see anyone posting that everything is dandy right now in the field. But that does not negate any and all data and analyses that are contrary to the difficulties some people are having now.

Pathology is in a bad situation with far too many pathologists being trained for the number of new job openings. Predicting the future is dangerous business even with data. It is important for the current generation of medical students to know about the job market, and how it has been bad for years now. It may improve. It may not. But it is not fair to try and convince the next generation of medical students to go into pathology based on predictions that the job market will improve by the time they are done with residency and fellowship.

 

[turtle1966]

Pathology is in a bad situation with far too many pathologists being trained for the number of new job openings. Predicting the future is dangerous business even with data. It is important for the current generation of medical students to know about the job market, and how it has been bad for years now. It may improve. It may not. But it is not fair to try and convince the next generation of medical students to go into pathology based on predictions that the job market will improve by the time they are done with residency and fellowship.

As in Economy, entrusting your future in "predictions", you should expect an outsize reward; in my opinion, in the best of scenarios, pathologists will do "just OK" and no more.

The main foundation for the Prediction is the current "skewed age distribution" of pathologists.

Standing against it are:
a-over two decade old history of erroneous predictions,
b-common sense fact that past and present practice pattern can not be extrapolated to the future.
c-present generation of pathologists may decide to work much longer.

In spite of the foregoing, for those who love pathology, have subdued expectations and right temperament, the Field offers many advantages.

 

[Freddie Mercury]

In spite of the foregoing, for those who love pathology, have subdued expectations and right temperament, the Field offers many advantages.

I am a 3rd year medical student currently thinking of going into pathology (and radiology for that matter). I thank BU Pathology and even the "doomsayers" for their views because it does help us make decisions into pursuing a specialty. Your bolded points are why I am interested in the field, despite the problems I read about here and other sites.

 

[DermViser]

I am a 3rd year medical student currently thinking of going into pathology (and radiology for that matter). I thank BU Pathology and even the "doomsayers" for their views because it does help us make decisions into pursuing a specialty. Your bolded points are why I am interested in the field, despite the problems I read about here and other sites.

You are free to make decisions how you choose. However, making career decisions, based on those who are academicians (much less a Chairman) who know nothing about the job market outside of their own institution, is foolish.

 

[unemployedpath]

You are free to make decisions how you choose. However, making career decisions, based on those who are academicians (much less a Chairman) who know nothing about the job market outside of their own institution, is foolish.

True. Especially from someone who has a very good reputation of promoting pathology by providing biased (or even deceptive) information about the job market. Be very careful. Have you read previous posts from someone who wants to switch to primary care at PGY-4 in path???

 

[AZpath]

Figure don't lie but liars can figure...

I look at simple things for the job market now. Number of applicants per advertised position. Number of openings listed nationally. Rural openings. How long does it take employer to fill a open position. Amount of extra pay given to locum tenens. Salary trends for new hires. Sign on bonuses etc. Number of applicant reporting trouble finding a job or relocating. The number of pathologists doing second fellowships. Compare this to other specialties and you will have a clear answer.

If your a med student or resident and want a unbiased opinion, contact a recruiter that specializes in pathology.

 

[gbwillner]

True. Especially from someone who has a very good reputation of promoting pathology by providing biased (or even deceptive) information about the job market. Be very careful. Have you read previous posts from someone who wants to switch to primary care at PGY-4 in path???

You are off base. BU has said nothing biased nor deceptive. He is providing a counter to endless posts about how our field is terrible and should be avoided at all costs. And he's doing it with data and others' published works. And his statements are hardly anonymous.

If anyone should be avoided I think it's someone with 5 posts and a name like "unemployed path". Someone with an axe to grind or is downright a troll.

I've been in the field for a few years now, and have seen negative changes to the job market. This has been palpable in academia and private practice. However, being part of a major academic medical center I can tell you that these negative changes are across the board, with path getting it harder than most with the most recent rounds of cuts. I cannot tell you with any certainty what will happen in the future, but I think things will improve as volume increases. I think the job situation improves, but we are all going to work harder for less pay. We all are.

 

[unemployedpath]

You are off base. BU has said nothing biased nor deceptive. He is providing a counter to endless posts about how our field is terrible and should be avoided at all costs. And he's doing it with data and others' published works. And his statements are hardly anonymous.

If anyone should be avoided I think it's someone with 5 posts and a name like "unemployed path". Someone with an axe to grind or is downright a troll.

I've been in the field for a few years now, and have seen negative changes to the job market. This has been palpable in academia and private practice. However, being part of a major academic medical center I can tell you that these negative changes are across the board, with path getting it harder than most with the most recent rounds of cuts. I cannot tell you with any certainty what will happen in the future, but I think things will improve as volume increases. I think the job situation improves, but we are all going to work harder for less pay. We all are.

Lucky you to have a job. You can enjoy your life now. Be sure to save enough for retirement, which may come sooner than you expect.

Pathology is a sunken ship. Anyone who says there is or there will be a prosperous market is simply a liar. Market is very saturated. Yeah, "everybody" has a job, but what job!

 

[gbwillner]

Yes, lucky me and everyone else I know.

 

[yaah]

You are free to make decisions how you choose. However, making career decisions, based on those who are academicians (much less a Chairman) who know nothing about the job market outside of their own institution, is foolish.

Yes, it's much more informative to trust the anonymous rantings of internet forum posters.

 

[KLPM]

Yes, it's much more informative to trust the anonymous rantings of internet forum posters.

Medicine has taught me to trust no one! I have trust issues now!

 

[turtle1966]

Yes, lucky me and everyone else I know.

Contextual translation: "me job oink! oink! me good oink! oink! oink!"

 

[Silent Cool]

This information is for medical students concerning a career in pathology.

In June, 2014, the group Health Care Development Services, Inc. issued a client alert concerning the projected shortage of pathologists. The alert specifically addressed the future shortage of pathologists and reviewed a range of information. Their conclusion – there will be a shortage of pathologists and hospitals need to begin planning for this.

Much of the data in the report came from groups who are not part of pathology. In other words, they would not benefit from having more residents in training. For example, Bureau of Health Professions projects that the shortage of pathologists will be twice as large as the shortage of radiologists. The American Association of Medical Colleges also predicts a large decrease in the number of active pathologist. The Council on Graduate Medical Education raises the concern that there will be increased demands on pathologists, both anatomic and clinical, due to increased cancer diagnoses. The Journal of Clinical Oncology predicts an increase in the number of cancer cases in the next few years. Analyzes from these groups should directly address many posters who erroneously claim the only reason that academic pathology advocates for more pathologist is in training so that they can reap economic benefits. All of the references to the original literature are found in the report. It should be noted that the report did reference the recent Archives of Pathology and Lab Medicine paper.

Medical students considering a career in pathology should be assured that at the completion of their training there will be a need for their services.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

The report may be found here:
http://hcdsinc.com/documents/Client...epage-image-link&utm_campaign=website-updates

I'm inclined to say you are a complete i d i o t, but from my understanding Pathologists are generally smart people, so I'm not really sure what to make of your posts.

 

[Silent Cool]

Academic bubble.....

@BU Pathology

 

[path24]

In other words, we are basing our numbers on the current oversupply and it looks like the massive oversupply may decrease slightly. Luckily the oversupply is so huge, pathologists will still struggle to find work.

No way there is a shortage. Trying to find a job in this field is a nightmare.

 

[WEBB PINKERTON]

The pathologist surplus all these years has created a fake market. We all know that there is a ton of waste in this field that many of us rely on to have a job. We seriously could get rid of 50 percent of the pathologists out there and the country would be fine IF we clean this field up. Then maybe guidelines will be followed, paths will quit being exploited by other specialists etc. This field needs to be operating at a shortage, not a surplus especially with so much change coming.

The more pathologists we continue to pump into this saturated market, the higher health care costs are for the public.

 

[Thrombus]

I'm inclined to say you are a complete i d i o t, but from my understanding Pathologists are generally smart people, so I'm not really sure what to make of your posts.

Bu pathology is incredibly patronizing and as you said is either incredibly stupid and bankrupt in all economic intuition or takes medical students for a bunch of fools. I suspect the latter. This paper pretty much summarizes his previous academic don's false convulsion/narrative.

When/if the federal govt money dries up in the forms of subsidized residents, generous grants which amount to minimal productivity/benefit, and state funding for these institutions is scrutinized, those 50-100 person academic departments that could be run by 3-10 productive pathologists will be in for a huge awakening and the bubble of oversupply will really wreak havoc.

 

[LADoc00]

Guys we are becoming a Pathology Internet version of Clint Eastwood out of Gran Turino...lets try to be civil to each other.

Although I did get a nice morning chuckle from reading the BU pathology residency roster..I think one AMG grad total? wow.

On the flipside, BU pathology seems to be such a beacon of hope to the oppressed peoples of the Earth they are willing to make the life risking journey from Tehran and Pyongyang to get there...

 

[DermViser]

Yes, it's much more informative to trust the anonymous rantings of internet forum posters.

Sorry, but we've gotten to the point where med students deserve to know. Pathology is a wonderful field. It's too bad that Path has allowed it to become commoditized and has allowed residency training programs to spring up from nowhere.

 

[DermViser]

Guys we are becoming a Pathology Internet version of Clint Eastwood out of Gran Turino...lets try to be civil to each other.

Although I did get a nice morning chuckle from reading the BU pathology residency roster..I think one AMG grad total? wow.

On the flipside, BU pathology seems to be such a beacon of hope to the oppressed peoples of the Earth they are willing to make the life risking journey from Tehran and Pyongyang to get there...

Yup, I was surprised too at BU no less!! He can't even convince his own med students to do path. How sad. Which AMG grad? She's a fellow.

 

[Over9000]

The major issue I have with the article linked by Dr. Remick is that it was penned by a corporation that has a profit-driven incentive to saturate the market with pathologists. More pathologists means that the corporation can drop income paid to pathologist employees, thereby increasing profits. Simple ECON 101. Supply and demand.

Though I have read Dr. Remick's posts as being a reliable source of information in the past, something about this one is suspect. I chalk it up to a mistake, but it may be a reflection of academic pathology's blindness to economic matters and stubbornness in holding an opinion: the general thought in academia is that there is a shortage, and anything written by anyone in support of it is considered reliable information while anything written in the opposite direction is irrelevant. The article linked is clearly unreliable (unscientific) and biased (written by a corporation who will profit from an oversupply). It's like Coca-Cola writing an article about how sugar is good for you.

As for the composition of residents in Dr. Remick's program, I chalk that up to a lack of interested good AMGs in combination with a high IMG application contingent with GME funding considerations as top priority, just like every other program.

The comments by GBwillner are interesting as well. Though he has a job, and their friends/colleagues do too, he also has an elite pedigree (HMS, BWH, MGH etc.) which makes his perspective on the overall job market not entirely applicable to most pathologists.

If I were to recommend pathology to medical students, I would tell them to only attend elite institutions for residency, where the name will carry them and professional networks will be extensive. Mid and low-range programs should be avoided because of the tight job market.

In short: pathology is the best job in medicine, provided you can find one.

 

[rollwithit]

Ah, the usual suspects here to save the day with name calling and dooms day predictions.

Will you folks ever realize you are you own worst enemy and do nothing to actually address your concerns? The more you rant and name call, the more your stance gets shoved to the side as bitter and biased. Think of better ways to frame your argument and sway decision makers. Despite having likely valid points and areas for improvement, you come across angry and bitter and are likely to be discounted (Gran Torino reference is spot on).

 

[Over9000]

Sorry, but we've gotten to the point where med students deserve to know. Pathology is a wonderful field. It's too bad that Path has allowed it to become commoditized and has allowed residency training programs to spring up from nowhere.

AMG med students already know, which is why most pathology residents are IMGs.

 

[DermViser]

AMG med students already know, which is why most pathology residents are IMGs.

I'm talking about medical students who genuinely loved their Histology and Pathology courses and may not know the realities of Pathology, the residency.
People used to go into fields based on intellectual love of it. That's no longer possible, unfortunately.

 

[DermViser]

On the flipside, BU pathology seems to be such a beacon of hope to the oppressed peoples of the Earth they are willing to make the life risking journey from Tehran and Pyongyang to get there...

Some of those residency pictures were scary to me.

 

[Over9000]

I'm talking about medical students who genuinely loved their Histology and Pathology courses and may not know the realities of Pathology, the residency.
People used to go into fields based on intellectual love of it. That's no longer possible, unfortunately.

How true that is. Pathology is non-stop problem solving with very little if any of the paperwork that bogs down most other specialties(though this may change with the unfortunately widespread adoption of synoptic reporting). Nevertheless, you're right. People nowadays choose fields for money, competitiveness and job security and we are probably all worse off because of it.

 

[DermViser]

How true that is. Pathology is non-stop problem solving with very little if any of the paperwork that bogs down most other specialties(though this may change with the unfortunately widespread adoption of synoptic reporting). Nevertheless, you're right. People nowadays choose fields for money, competitiveness and job security and we are probably all worse off because of it.

You're not understanding me. Pathology is a wonderful specialty. There are so many areas of it that are wonderful for medicine and science. It truly is an awesome field. However, it doesn't do a medical graduate any good if he is unable to get a job or pay off his loans after residency.

 

[Over9000]

You're not understanding me. Pathology is a wonderful specialty. There are so many areas of it that are wonderful for medicine and science. It truly is an awesome field. However, it doesn't do a medical graduate any good if he is unable to get a job or pay off his loans after residency.

I think I am understanding you just fine. We're saying the same thing: even if you like a field, going into it is a bad idea if the job market or reimbursement environments are challenging. Essentially, one is putting job/money considerations above personal interest.

 

[deleted480308]

I'm talking about medical students who genuinely loved their Histology and Pathology courses and may not know the realities of Pathology, the residency.
People used to go into fields based on intellectual love of it. That's no longer possible, unfortunately.

exactly...facing $300k in debt, I don't get to ignore job market

 

[DermViser]

exactly...facing $300k in debt, I don't get to ignore job market

Yup. Can't help anyone as a physician, if you can't be employed as one.

 

[LADoc00]

Some of those residency pictures were scary to me.

We dont need that DV, they are fellow pathologists with feelings and likely very fine human beings. But I would agree with general sentiment that if AMGs are NOT seeking residency positions there, then the program should close given that is taxpayer funded through Medicare to begin with.

But damn, SDN path is getting really harsh. You almost have to some serious street smarts to survive posting in this 'net hood'.

 

[DermViser]

We dont need that DV, they are fellow pathologists with feelings and likely very fine human beings. But I would agree with general sentiment that if AMGs are NOT seeking residency positions there, then the program should close given that is taxpayer funded through Medicare to begin with.

But damn, SDN path is getting really harsh. You almost have to some serious street smarts to survive posting in this 'net hood'.

Sorry, I'm referring to the quality of the photos. They looked more like passport photos. It's scary that even a highly academic medical school in Boston can't even attract their own students to their pathology program. Something must be really wrong: i.e. malignant faculty, etc.

 

[WEBB PINKERTON]

Many of those residents will be heading to a in-office lab or slide mill near you... Those names look eerily similar to the names that popped up when I played around with that Medicare billing website.

 

[yaah]

There is so much hyperbole and pessimism on here. Everything negative becomes blown up x 1000 and everything positive is dismissed as irrelevant or biased. Someone said it above- you guys are basically caricatures now, very hard to take seriously. It is seriously like listening to politicians. Everything is someone else's fault, and everything is evidence that you are right, even if it seemingly goes contrary to supporting your opinion.

Many posters act as if the pathology job market is like the market for new lawyers or something. A difficult job market is not the end of the world. Things are not going to be handed to you, ok? If you want things handed to you and your main response to difficulty is going to be throwing up your hands or going on the internet to rant, then go do something else. If you want to be a pathologist, be a pathologist. Quality pathologists are always needed. I too wish there weren't so many programs pumping out graduates who are subpar, but that is the reality right now. It doesn't mean abandon all hope ye who enter here.

 

[turtle1966]

Everything negative becomes blown up x 1000 and everything positive is dismissed as irrelevant or biased.

The above statement is blown up 10 x 90,000,000,000 times!!!

 

[AZpath]

I think these predictions are crap.

We don't know tomorrows work volumes. Much of pathology is pushing glass.
That could drop radically or continue to increase along with molecular testing.
We just don't know.

As a profession we don't understand the employment market and how to manage it's risks.
There is a wide band of uncertainty.

One thing we should recognize is that we don't control our volumes.
Right now clinicians do. The new trend is to control volumes from insurers and CMS.

How about the following scenario from the volume side. I am not saying this will happen but it is one of many logical outcomes
that our leadership should consider.

Insurance and CMS makes IOP unprofitable or illegal on fee for service basis.
They get out of the business in our area. A lot the work heads back to the hospital. We all open a bottle of champagne !

A year later we are working more under ACO and other bundled contracts that include the same specialties.
We notice the biopsies in these fields are now down 50% and falling rapidly.

As we speak to clinicians in these fields we find that there are all kinds new articles and guidelines suggesting they biopsy less to save costs.
Of course these are shared saving and they now have incentives drive the number of tests down.

Our group then decides that our most junior employees need to be cut because we all have way to much free time.

The story is repeated across the county, number unemployed pathologists rise sharply.

It know it is gloom and doom but this the kind of risk we do face. The futures is the future but the risk is present now.
How do we prepare for risk?