CAP Pathologist Leadership Conference

[KeratinPearls]

So there was a CAP Pathologist Leadership meeting over the weekend. Was anyone there who would like to talk about what was discussed during the workforce discussion?

Reading some of these tweets, a few things stuck out…

Apparently there is a pathology resident shortage? I LMAO at this. Dr Mills, around where I live there are 25-30 residents being put out every year (not including fellows). Jobs are very few. Few as in I can count the number of jobs on my one hand and you really think we need more residents? Really? Graduates, who want to stay in the area, are desperate to find jobs in the area because the market is tight.

You do know that Pathology is a haven for those IMGs who do not match into internal medicine to apply to right? Increasing the number of pathology residency spots will further degrade our field worsening both an already suboptimal job market and the quality of pathologists we graduate every year.

The barrier of entry of our field is approaching that of pediatrics and family medicine (if not already there) when it should actually be much higher considering the job we do.

Medical student advisors are recommending medical students not to go into Pathology? All of you medical students, is this the case at your schools? Hmmmm…I wonder why?

SERIOUSLY, WE NEED MORE PATHOLOGISTS?!?

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[Alteran]

I guess for CAP the solution to hitting rock bottom is to start digging.

 

[deleted314957]

Their perception of a shortage is affected primarily by how much work the academic attendings have to do. Until every AP path is doing AT LEAST 8,000 surgical/yr I don’t want to hear about it.

 

[SunBakedTrash]

Their perception of a shortage is affected primarily by how much work the academic attendings have to do. Until every AP path is doing AT LEAST 8,000 surgical/yr I don’t want to hear about it.

Half these clowns couldn’t sign out to save their lives.

 

[path24]

Just confirming this field has no future. Nobody needs a pathologist, they just want even cheaper labor.

Stay away med students. The job market is crap and will always be crap.

 

[KeratinPearls]

Half these clowns couldn’t sign out to save their lives.

We have a leadership problem in our field guys and girls. It’s plagued us for years. Leaders who are clueless who think MORE is better.

Funny thing is I asked one of those on the panel if they knew of any jobs back when I was looking for a job. Nada.

 

[gbwillner]

This is a complex issue and can't be resolved with one magic bullet fix, not even reducing the number of residency positions.

Another confounding variable is who "leadership" even is. CAP is a mishmash of different interests, and includes "pathology" leaders, but are more representative of the laboratory industry. The industry of pathology services needs meat for the meat grinder, so this is a legitimate problem for them. This is definitely way more of a problem for pathology than other specialties, but not all.

Let's say you are an experienced pediatrician and you move to a new town. Your options are to join an existing practice, or if you think the market can bear it, start a new office. The costs of doing so are relatively trivial. You work with insurers to negotiate rates to become a Par provider in that area, and they will bring business to you as you are taking new patients, and existing physicians may not be. Done.

How does this work in pathology? You move to a new area, and can join an existing practice if they are hiring, and their contracts are viable for services with nearby hospitals. Even if the market could bear it, could you start your own lab? You need millions up front to start one. Then you need to compete with the existing labs for contracts. Even if perchance you could pull it off and also fight off the national labs that can push that volume to dozens or hundreds of existing labs, you need to hire individuals and train them and validate your lab for an indeterminate amount of time before you can even process a single specimen. Unless you already own a practice and have access to this kind of cash, it becomes almost impossible. Even if you do it the time to profitability could be years.

There is a lot of money to be made in pathology. It just isn't typically made by pathologists.

 

[KeratinPearls]

Cutting the number of residency spots sure is a great start. Do we really need to train more residents at HCA or other no name community hospitals. No I don’t think so.

Cut the number of spots which will make the field more competitive to get into and you won’t get crappy applicants applying and getting in every year. Or even worse applicants whose hearts aren’t set on actually becoming a pathologist.

At the very least, put trainees in high volume academic places so they don’t graduate without knowing how to read a Pap smear.

Emulate dermatology. Their field has flourished over the years because they limit the numbers who match. What’s so special about Derm that makes it so competitive to get in. There’s nothing special about Derm. They just manage their field well.

 

[Alteran]

This is a complex issue and can't be resolved with one magic bullet fix, not even reducing the number of residency positions.

I agree with you. More the rule than the exception, our specialty plays out like a zero-sum game. For one pathologist or group to gain business, another must lose business.

But I ask, is it too laborious and difficult for CAP to look at the actual efficiency and workloads of practicing pathologists before we start talking shortages??? And I'm not talking about these cockamamie poorly designed studies about "projected" workloads and resident numbers. I want to see actual CPT codes and/or RVUs per pathologist trends over the past 10 years. I also want to see turnaround time data and patient impact data - as in, did an extra day or two turnaround time actually affect patient care?

I feel that CAP has no standing at all to claim a pathologist shortage if it hasn't actually measured pathologist productivity over the past decade to see where the trend is heading and what effect it has on patient care. From those photos the OP posted, all I currently see on that panel are a group of predominately elderly pathologists pontificating about a solution to a problem that neither affects them nor probably even exists.

 

[HeyDalaron]

Didn't CAP, by their own admission, erroneously undercount the pathology workforce by 40%?

They're still whining about a shortage even after undercounting? Did they acknowledge the undercount or are they conveniently ignoring it?

What it looks like to me, as others have said above, is the CAP's interests are aligned with the corporate lab sector and not with the profession.

Breaking off from the CAP to start another pathologist-focused organization is the only solution that I can see. I don't think there's any way to change the CAP's focus.

 

[WEBB PINKERTON]

This is a complex issue and can't be resolved with one magic bullet fix, not even reducing the number of residency positions.

Another confounding variable is who "leadership" even is. CAP is a mishmash of different interests, and includes "pathology" leaders, but are more representative of the laboratory industry. The industry of pathology services needs meat for the meat grinder, so this is a legitimate problem for them. This is definitely way more of a problem for pathology than other specialties, but not all.

Let's say you are an experienced pediatrician and you move to a new town. Your options are to join an existing practice, or if you think the market can bear it, start a new office. The costs of doing so are relatively trivial. You work with insurers to negotiate rates to become a Par provider in that area, and they will bring business to you as you are taking new patients, and existing physicians may not be. Done.

How does this work in pathology? You move to a new area, and can join an existing practice if they are hiring, and their contracts are viable for services with nearby hospitals. Even if the market could bear it, could you start your own lab? You need millions up front to start one. Then you need to compete with the existing labs for contracts. Even if perchance you could pull it off and also fight off the national labs that can push that volume to dozens or hundreds of existing labs, you need to hire individuals and train them and validate your lab for an indeterminate amount of time before you can even process a single specimen. Unless you already own a practice and have access to this kind of cash, it becomes almost impossible. Even if you do it the time to profitability could be years.

There is a lot of money to be made in pathology. It just isn't typically made by pathologists.

So much truth in this post.

You can start your own businesses outside of pathology. Don't forget that people. Starting a lab is impossible but starting a doggy daycare, tree cutting service, nail salon, car wash etc is pretty easy.

 

[deleted314957]

Folks, cutting residencies is a “years down the road” solution. The ABP can do it next MAY ! Every other proposal just leads to years of jawboning and the same old .

 

[KeratinPearls]

So much truth in this post.

You can start your own businesses outside of pathology. Don't forget that people. Starting a lab is impossible but starting a doggy daycare, tree cutting service, nail salon, car wash etc is pretty easy.

I think you’re making it sound easier than it really is. We are younger pathologists who depend on our current pathology income. Going out to start your own business is HARD work. Then managing it is a whole different story. Managing employees and the headache that comes with it is no easy task. Unless you want to pull 80 hours a week (and a possible myocardial infarction) then go for it.

 

[octopusprime]

I think you’re making it sound easier than it really is. We are younger pathologists who depend on our current pathology income. Going out to start your own business is HARD work. Then managing it is a whole different story. Managing employees and the headache that comes with it is no easy task. Unless you want to pull 80 hours a week (and a possible myocardial infarction) then go for it.

Yeah there may be some successful entrepreneurs on here that made good business outside of pathology, but it's not as simple as fronting a bunch of money and "working hard." Many of us already work hard...and it's mentally frustrating that the solution to maintaining income or preventing further income loss would be to work harder in your non-pathology time simply to make up the difference.

Sure if you want to get rich, you're not going to do it in pathology, but many (most) of us don't want to spend our lives trying to get rich, we just want to NOT have to fight a daily battle to maintain an income stream.

What other fields, outside of medicine, deal with a literally annual several-% government-mandated decrease in income? Always found it hilarious when my financial planner would project my income 5, 10, 20 yrs out and would account for salary increases. There is no built-in COLA for private physicians.

 

[gbwillner]

Emulate dermatology. Their field has flourished over the years because they limit the numbers who match. What’s so special about Derm that makes it so competitive to get in. There’s nothing special about Derm. They just manage their field well.

I disagree a bit here. There IS lots of special things about Derm that do not apply to pathology. First, Derm can get substantial revenue from even cash-only business because of people's vanity, making them less susceptible to payors and Medicare rates. I suspect there are more than a few Derm practices who don't even take insurance.

Second, the Derms control their own revenue. Fewer Derms mean less competition for that revenue. That's not how it is in Path. I suspect if there was a Path strike and they cut positions by 50% greatly increasing pathologist supply, you would NOT likely see the desired outcome. What would probably happen instead is:

1. Fewer confirmatory Dxs even taken, and decisions will just be rendered with Rads, mistakes taken as accepted error;
2. other mid-levels leveraged or PhDs to take up as much of the services as possible

I would not find it hard to believe that fewer paths may actually shrink path services, rather than increase demand and price. This is not a free market, reducing the supply often has little impact on price as ultimately it is determined by another immutable source, like CLFS and PFS.

Again, I am not saying that we should do nothing or not cut back residency positions. This may have a positive impact on physician salaries or agency. But it is not certain, and overdoing it could be catastrophic.

 

[WEBB PINKERTON]

Pathology needs to go interventional to survive maybe?

 

[Alteran]

2. other mid-levels leveraged or PhDs to take up as much of the services as possible

I would love to have a profitable side gig as an expert witness for all the mistakes they're going to make.

 

[deleted314957]

I disagree a bit here. There IS lots of special things about Derm that do not apply to pathology. First, Derm can get substantial revenue from even cash-only business because of people's vanity, making them less susceptible to payors and Medicare rates. I suspect there are more than a few Derm practices who don't even take insurance.

Second, the Derms control their own revenue. Fewer Derms mean less competition for that revenue. That's not how it is in Path. I suspect if there was a Path strike and they cut positions by 50% greatly increasing pathologist supply, you would NOT likely see the desired outcome. What would probably happen instead is:

1. Fewer confirmatory Dxs even taken, and decisions will just be rendered with Rads, mistakes taken as accepted error;
2. other mid-levels leveraged or PhDs to take up as much of the services as possible

I would not find it hard to believe that fewer paths may actually shrink path services, rather than increase demand and price. This is not a free market, reducing the supply often has little impact on price as ultimately it is determined by another immutable source, like CLFS and PFS.

Again, I am not saying that we should do nothing or not cut back residency positions. This may have a positive impact on physician salaries or agency. But it is not certain, and overdoing it could be catastrophic.

GB, the attorneys will see to issues 1 and 2.

 

[WEBB PINKERTON]

A lot of what we do is waste. Less paths would eliminate waste. You think you will be wasting time on ROSE for like 50 bucks an hour with less pathologists out there?

 

[gbwillner]

GB, the attorneys will see to issues 1 and 2.

It doesn't have to matter if that is true. I use Pap smears as a prototypical example. Decrease reimbursement lead to fewer paths reviewing Paps since it isn't worth the money to do. This did not drive up reimbursement- it created cyto techs being able to review Paps.

Second, there are already instances where Rads has replaced Path and where standard of care is to treat based on Rads Dx and no confirmatory tissue Dx is ever rendered. Yes, mistakes are made. But the standards of care are met, so legal exposure is minimal and settled.

 

[octopusprime]

A lot of what we do is waste. Less paths would eliminate waste. You think you will be wasting time on ROSE for like 50 bucks an hour with less pathologists out there?

Totally agree. I spend oodles of time up in endo; if GI and pulm value our immediate input so much, they'll go to bat for us; if not, not worth our time to sit there.

 

[KeratinPearls]

 

[SunBakedTrash]

View attachment 354194

 

[KeratinPearls]

View attachment 354197

Pray harder buddy!!!!!

 

[WEBB PINKERTON]

Totally agree. I spend oodles of time up in endo; if GI and pulm value our immediate input so much, they'll go to bat for us; if not, not worth our time to sit there.

Does anyone understand what the point of ROSE is? OK, I got some atypical cells/malignancy on a slide. That doesn't mean the future pieces you give me are going to have anything on them. It seems like the first bite in the best (typically) and you compromise it by smashing it on a slide. Wouldn't it just be better to forcep or needle the hell out of the lesion and put it in formalin and call it a day?

 

[ScubaV]

So much truth in this post.

You can start your own businesses outside of pathology. Don't forget that people. Starting a lab is impossible but starting a doggy daycare, tree cutting service, nail salon, car wash etc is pretty easy.

Webb getting a call for an emergency frozen on a tree stump while managing his car wash.

 

[gbwillner]

Didn't CAP, by their own admission, erroneously undercount the pathology workforce by 40%?

They're still whining about a shortage even after undercounting? Did they acknowledge the undercount or are they conveniently ignoring it?

What it looks like to me, as others have said above, is the CAP's interests are aligned with the corporate lab sector and not with the profession.

Breaking off from the CAP to start another pathologist-focused organization is the only solution that I can see. I don't think there's any way to change the CAP's focus.

Meh, this has been discussed and is debunked. Not that they didn't "undercount" pathologists, but that their methodology for counting was always flawed, so the comparisons of y/y pathology output being relatively decreased (or not increased) was not inappropriate.

That said, there was a lot of assumptions with that data. You can show FTEs are actually down (this is what they did), but that doesn't necessarily mean a shortage. This is because reimbursement is also down, and in response pathologists are more likely to just work more instead of hiring more and everyone having a lower income.

 

[deleted314957]

Does anyone understand what the point of ROSE is? OK, I got some atypical cells/malignancy on a slide. That doesn't mean the future pieces you give me are going to have anything on them. It seems like the first bite in the best (typically) and you compromise it by smashing it on a slide. Wouldn't it just be better to forcep or needle the hell out of the lesion and put it in formalin and call it a day?

In most all situations i eventually told then to squirt it in cytolyte so we would have a thin prep and cell block. no time to sit there.worked fine.

 

[octopusprime]

Does anyone understand what the point of ROSE is? OK, I got some atypical cells/malignancy on a slide. That doesn't mean the future pieces you give me are going to have anything on them. It seems like the first bite in the best (typically) and you compromise it by smashing it on a slide. Wouldn't it just be better to forcep or needle the hell out of the lesion and put it in formalin and call it a day?

Depends...
NSCLC staging: if station 7 node is positive, they can essentially stop there, don't need to waste time doing a bunch of other nodes.
Also more and more pulm procedures that rely on CT / fluoro for guidance that requires some feedback.
Most of these lesions are accessible via thin needle not forceps, so you're rolling the dice just blocking everything.

EUS: Pancreatic lesions are better assessed with cytology...putting it in a cell block isn't going to help.

thyroid: i think most people prefer 3-4 passes as a min/standard, but our QNS rate is essentially zero in house vs the office-performed FNAs that we get as consults.

I begrudgingly see the need for ROSE, but the reimbursement is horrible for the time spent. There are plenty of instances where it's not needed, but our pulmo docs are pretty good about respecting our time...it's more of the cumulative volume and low reimbursement that's frustrating.

 

[WEBB PINKERTON]

Depends...
NSCLC staging: if station 7 node is positive, they can essentially stop there, don't need to waste time doing a bunch of other nodes.
Also more and more pulm procedures that rely on CT / fluoro for guidance that requires some feedback.
Most of these lesions are accessible via thin needle not forceps, so you're rolling the dice just blocking everything.

EUS: Pancreatic lesions are better assessed with cytology...putting it in a cell block isn't going to help.

thyroid: i think most people prefer 3-4 passes as a min/standard, but our QNS rate is essentially zero in house vs the office-performed FNAs that we get as consults.

I begrudgingly see the need for ROSE, but the reimbursement is horrible for the time spent. There are plenty of instances where it's not needed, but our pulmo docs are pretty good about respecting our time...it's more of the cumulative volume and low reimbursement that's frustrating.

My pulmonologists NEVER stop if a previous station is positive. They go to other stations and ask which one is best for extra passes for cell block or forcep biopsies. 🙄

Most of my bronchs go this way: They give me virtually acellular bloody FNA slides and a brushing that might show some atypical cells. I ask for forcep biopsies which I make touch prep. First touch prep shows malignancy. So it would have been fine if they just put that in formalin to begin with. The ROSE was virtually useless. Just call us if you can't forcep the lesion should be the rule.

 

[cmz]

It's all completely operator (rads, pulm, etc) dependent. We've stopped going to thyroid FNA at one hospital. The radiologist will usually do 3-4 passes per nodule and be done with it. If they can't get it in 3-4 passes, then good luck. They likely weren't going to get it in passes 5+. I've told them before that Bethesda I exists for a reason. Of course, radiology was hesitant to do FNA w/o pathology on-site, but I've assured them that if they start to see a lot of non-diagnostics we will jump back in. Since we've taken ourselves off the thyroid ROSE service, we've actually had very few non-diags and I've shown the rads chief a report of all of our cases and who the radiologist was in each instance. The easy fix was to remove the radiologist who gets all of the non-diagnostics off that service. These are all scheduled outpatient procedures, so finding a way to get the right operator on site should never be an issue.

Regarding EBUS for pulm folks, I see us there more to guide them to make sure we get enough diagnostic tissue. We're being asked more and more these days to offer additional ancillary testing on these cancer cases. These are requests coming from the Oncologists and it's been a challenge to make sure we get enough tissue. Often when the pulmonologist does strike gold, we tell them to keep doing more FNA passes to put directly in alcohol for our cellblock. It sucks to be there but it's definitely necessary in my eyes. The reimbursement is bad for everyone, including the pulmonologist. I think that the folks who don't see ROSE for EBUS as something that is necessary are often the ones understand very little about their role in patient care pertaining to this procedure.

 

[cmz]

My pulmonologists NEVER stop if a previous station is positive. They go to other stations and ask which one is best for extra passes for cell block or forcep biopsies. 🙄

Most of my bronchs go this way: They give me virtually acellular bloody FNA slides and a brushing that might show some atypical cells. I ask for forcep biopsies which I make touch prep. First touch prep shows malignancy. So it would have been fine if they just put that in formalin to begin with. The ROSE was virtually useless. Just call us if you can't forcep the lesion should be the rule.

This all sounds like your pulmonologists are just bad at this procedure.... it's not an easy thing to do. Are the guys you worked with trained in their fellowship to do this or was this something they picked up at a weekend course somewhere? Where I am at, one or two of the pulm guys actually had a lot of training during fellowship for EBUS. The older pulms learned it on the job. You can tell who is more efficient and has a higher success rate. I might spend literally 10-15 mins with the pulm who has had good EBUS training versus the 1-1.5 hrs with the other guy.

 

[WEBB PINKERTON]

This all sounds like your pulmonologists are just bad at this procedure.... it's not an easy thing to do. Are the guys you worked with trained in their fellowship to do this or was this something they picked up at a weekend course somewhere? Where I am at, one or two of the pulm guys actually had a lot of training during fellowship for EBUS. The older pulms learned it on the job. You can tell who is more efficient and has a higher success rate. I might spend literally 10-15 mins with the pulm who has had good EBUS training versus the 1-1.5 hrs with the other guy.

I think they are fine at what they do but needles just don't have great yield on a fair number of lung nodules. It's not their fault. They nail it with the forceps virtually every time. Forceps outperforms needle consistently. I have 10s of thousands of cases that help me come to this conclusion.

Guardant 360 will be replacing the need for ROSE I would think at some point. Our oncologists order this regardless if there is enough tissue or not. 10 years from now we will look back and say "remember standing around doing all that useless ROSE procedures that we didn't get paid for?" I could have cut down a tree for 2 grand in that time.

 

[HeyDalaron]

Meh, this has been discussed and is debunked. Not that they didn't "undercount" pathologists, but that their methodology for counting was always flawed, so the comparisons of y/y pathology output being relatively decreased (or not increased) was not inappropriate.

That said, there was a lot of assumptions with that data. You can show FTEs are actually down (this is what they did), but that doesn't necessarily mean a shortage. This is because reimbursement is also down, and in response pathologists are more likely to just work more instead of hiring more and everyone having a lower income.

My understanding of the issue is that they didn't include pathologists who identified themselves as anything other than AP or APCP (and maybe FP?) in the physician database, which would exclude dermatopathologists, cytopathologists etc., thereby resulting in a miscount of approximately 40% of total pathologist manpower. Am I misunderstanding? It's been a long time since I've looked at this.

 

[Alteran]

My understanding of the issue is that they didn't include pathologists who identified themselves as anything other than AP or APCP (and maybe FP?) in the physician database, which would exclude dermatopathologists, cytopathologists etc., thereby resulting in a miscount of approximately 40% of total pathologist manpower. Am I misunderstanding? It's been a long time since I've looked at this.

That is my understanding. The AMA which provided the data to CAP didn't know that hemepaths, dermpaths, cytopaths, etc. were also pathologists and therefore counted them separately. And yes, it was about a 40% undercount in the total pathology workforce.

Just as a reminder to all reading, all of CAP's prior workforce studies were published using the erroneous data. That would make sense because the shortage they keep mentioning almost certainly coincides with the older generation of pathologists who are only AP/CP moving out of practice (the so-called shortage) while the increasing number of new graduates, >95% who do a fellowship, were being misclassified by the AMA as something other than a pathologist and not reflected in the "total number of pathologists" AMA data.

 

[octopusprime]

so how the hell does this stupid myth keep perpetuating? who uncovered that the AMA data supplied to the CAP was a 40% undercount? were there retractions or corrections in the myriad of publications that bemoan the looming shortage?
what a load of garbage.

 

[deleted314957]

They want to crank out more pathologists AND stop medicare cuts.

Forget my previous ideas re a clinical internship. Let’s just require ECON 101 for entry into the field.

 

[gbwillner]

My understanding of the issue is that they didn't include pathologists who identified themselves as anything other than AP or APCP (and maybe FP?) in the physician database, which would exclude dermatopathologists, cytopathologists etc., thereby resulting in a miscount of approximately 40% of total pathologist manpower. Am I misunderstanding? It's been a long time since I've looked at this.

The issue is not the undercount, but the assessment of the "shortage". The undercount is correct (in that it happened as Alteran cites above), but the issue is how this data was misinterpreted. The assumption was that the AAMC stating a shortage comparing 2017 to 2019 data was wrong because AAMC was undercounting pathologists by 40%, and that this suggested a huge surplus. In reality, the data did neither. This is because both the 2017 and 2019 data sets used the "undercount", so there really was a possible "shortage" of the partial pathologist count.

The relevant study identifying the undercount is here:

Reevaluation of the US Pathologist Workforce Size

This analysis assesses the accuracy of current pathologist workforce estimates in the US by examining why divergency appears in different published resources.

jamanetwork.com

 

[gbwillner]

They want to crank out more pathologists AND stop medicare cuts.

Forget my previous ideas re a clinical internship. Let’s just require ECON 101 for entry into the field.

They should have thought about that before they rammed PAMA though Congress.

 

[HeyDalaron]

The issue is not the undercount, but the assessment of the "shortage". The undercount is correct (in that it happened as Alteran cites above), but the issue is how this data was misinterpreted. The assumption was that the AAMC stating a shortage comparing 2017 to 2019 data was wrong because AAMC was undercounting pathologists by 40%, and that this suggested a huge surplus. In reality, the data did neither. This is because both the 2017 and 2019 data sets used the "undercount", so there really was a possible "shortage" of the partial pathologist count.

The relevant study identifying the undercount is here:

Reevaluation of the US Pathologist Workforce Size

This analysis assesses the accuracy of current pathologist workforce estimates in the US by examining why divergency appears in different published resources.

jamanetwork.com

I am unsure of how you are arriving at this conclusion. I skimmed the article you linked and the most that I could take from it is that prior workforce models are inaccurate and there may or may not be a shortage. It seems pretty noncommittal.

The anecdotes from this forum and from my own personal experience tend to align with the absence of a shortage, instead pointing towards a possible oversupply situation.

Were it my problem to fix I'd start with how the ACGME approves pathology residency spots. They need to be more stringent in my opinion.

 

[Med Director New England]

The shortage myth is an academic idea (only)
if GME cuts pathology training to reflect demand of quality applicants - mostly good things will follow.

Also the Metter study should be retracted. The major finding which was trend of decreasing pathologist - was really only a trend toward sub-specialization within pathology not fewer total pathologists.

 

[Med Director New England]

The issue is not the undercount, but the assessment of the "shortage". The undercount is correct (in that it happened as Alteran cites above), but the issue is how this data was misinterpreted. The assumption was that the AAMC stating a shortage comparing 2017 to 2019 data was wrong because AAMC was undercounting pathologists by 40%, and that this suggested a huge surplus. In reality, the data did neither. This is because both the 2017 and 2019 data sets used the "undercount", so there really was a possible "shortage" of the partial pathologist count.

The relevant study identifying the undercount is here:

Reevaluation of the US Pathologist Workforce Size

This analysis assesses the accuracy of current pathologist workforce estimates in the US by examining why divergency appears in different published resources.

jamanetwork.com

Wrong

 

[Med Director New England]

Meh, this has been discussed and is debunked. Not that they didn't "undercount" pathologists, but that their methodology for counting was always flawed, so the comparisons of y/y pathology output being relatively decreased (or not increased) was not inappropriate.

That said, there was a lot of assumptions with that data. You can show FTEs are actually down (this is what they did), but that doesn't necessarily mean a shortage. This is because reimbursement is also down, and in response pathologists are more likely to just work more instead of hiring more and everyone having a lower income.

Incorrect
Sorry to be blunt

 

[SunBakedTrash]

were there retractions or corrections in the myriad of publications that bemoan the looming shortage?

Pretty sure there are entire academic careers based off these publications.

 

[gbwillner]

I am unsure of how you are arriving at this conclusion. I skimmed the article you linked and the most that I could take from it is that prior workforce models are inaccurate and there may or may not be a shortage. It seems pretty noncommittal.

The anecdotes from this forum and from my own personal experience tend to align with the absence of a shortage, instead pointing towards a possible oversupply situation.

Were it my problem to fix I'd start with how the ACGME approves pathology residency spots. They need to be more stringent in my opinion.

I think you are misunderstanding my intent. This paper I present does NOT suggest a shortage. It only points out the work presented by AAMC (the work that did suggest a shortage) was incorrect and undercounted pathologists. This paper was misrepresented as suggesting OVERSUPPLY, which it also does not do. It really doesn't comment on either, as you state, and I tried (maybe not well) to imply with "the data did neither"[identify surplus or shortage]. I only included it as a reference since it was mentioned.

 

[gbwillner]

Incorrect
Sorry to be blunt

So blunt it is not informative. To be clear, the comments on relative shortage apply to the AAMC data, not this paper. As discussed ad nauseum, there really is no good data to suggest oversupply OR shortage. only anecdotes.

 

[HeyDalaron]

The shortage myth is an academic idea (only)
if GME cuts pathology training to reflect demand of quality applicants - mostly good things will follow.

Also the Metter study should be retracted. The major finding which was trend of decreasing pathologist - was really only a trend toward sub-specialization within pathology not fewer total pathologists.

I agree. That study should be officially retracted. I'm wondering why it hasn't been.

 

[Doormat]

I feel New England is 100% correct. The pathologist shortage myth is perpetuated by academic pathologists.

CAP tries to be a big tent and advocate for all pathologists. This is very difficult , if not impossible, to do. The job market is a mosaic of academics, private practice, corporate lab, and in-office pathologists. The interests of these subgroups are often not aligned.

 

[octopusprime]

The notion that a "shortage" or "oversupply" can be simply calculated with tabulation of numbers and projections is a farce.

These are the facts:
1.) Academic centers WANT current or increased numbers of residents because:
a.) it reinforces the idea that respective institutions are competitive, relevant and important;
b.) it is cheaper to increase pathology training positions than hire PAs;
c.) decreasing resident spots is a sign to institutional GME offices that said pathology department is losing volume and hence revenue.
2.) Corporate labs WANT current or increased numbers of residents because it creates a cheaper labor force. This is purely economics; they care about the bottom line not the profession of pathologist physicians.
3.) The ability to find non-academic and non-corporate positions is increasingly hard for graduating residents, who in turn extend their training by increasing periods of time to make themselves more competitive.
4.) There is a MASSIVE disconnect regarding practice expectations, attitudes and perceptions when comparing academic to private pathology.
5.) Given the choice between an academic center paying "X" dollars, a corporate lab paying "X - 1.5X" dollars, or a private gig paying "2X - 3X" dollars, the overwhelming majority of applicants would choose the third option were it not for intense geographic restriction, underlying interest in academic pathology, or family/social reasons.
6.) The idea that retiring pathologists and new pathologists equals a 1:1 job ratio is a farce. Not all retiring pathologists occupy a full-time position, and the loss in revenue from decreasing reimbursements and corporate competition necessitates that not all positions would be filled in the first place.
7.) CMS rates go down every year; sometimes private rates go up, but overall revenue streams are tied to volume not value, and it is a constant battle to maintain revenue streams.

I don't see how a massive shortage can be foreseen unless being delusional, dishonest or both.

 

[octopusprime]

unrelated...where did YAAH go? haven't seen him in a long time.