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I will offer a different opinion. Spend your time in residency and fellowship on becoming a diagnostically good pathologist and on developing social skills, networking skills, and hospital committee work. Yes, you need a basic knowledge of CPT coding and billing, but it is not rocket science and you are not going to walk out of residency on June 30 and be doing billing for a private group on July 1st. You will, however, be meeting new colleagues (pathology and clinical) and signing out cases. Your value to the practice at that point is how much you don't mess up a specimen and how much people like you. Negotiating contracts with 3rd party payors at that point is low down the list.

Now, with that said, you need to know about billing in training for one simple reason, and that is your job search. You need to be able to size up the job in your head, calculate the number and type of specimens, and multiply by the expected reimbursement to get an idea of the $$ side of things. For instance, what is the difference between what they are paying you and the revenue you are generating? Or, is the figure they quoted you for what the partners make consistent with the specimen volume and number of pathologists? This is very easy for some jobs. For an outpatient lab that sees only GI or derm, you know the 88305 $$ and you know the specimen volume you'll be signing out. Pretty simple math. This harder with general group practices, but you need to ballpark it. This is also complicated by the payor mix, but you can ballpark it based on known Medicare rates.

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I will offer a different opinion.
Now, with that said, you need to know about billing in training for one simple reason, and that is your job search. You need to be able to size up the job in your head, calculate the number and type of specimens, and multiply by the expected reimbursement to get an idea of the $$ side of things. For instance, what is the difference between what they are paying you and the revenue you are generating? Or, is the figure they quoted you for what the partners make consistent with the specimen volume and number of pathologists? This is very easy for some jobs. For an outpatient lab that sees only GI or derm, you know the 88305 $$ and you know the specimen volume you'll be signing out. Pretty simple math. This harder with general group practices, but you need to ballpark it. This is also complicated by the payor mix, but you can ballpark it based on known Medicare rates.

Agreed 212115. What I mean by practice management is not the nitty gritty, but you should know enough to assess the financial viability of your group, and what you are worth. You will now be able to do this without understanding split (TC vs PC) vs global billing, changes in CMS reimbursement, and the payor mix of the patient population (ie. HMO, PPO, Medicare, etc). You should understand test margins, cost-benefit analyses of bringing in more tests, employees, infrastructure etc (or at least the strategic plan of the practice/company). You should also know understand the market and competition (a basic SWOT) as well as the group's standing in hospital administration/contracts, etc. And finally, understand how you are getting paid compared to everybody else. I know this may seem like basic knowledge to those in out in practice, but to a graduating fellow, this is all new and crucial to long term viability in the community private practice environment.
 
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Do you know any family practitioners? Because what I said is accurate where I live.

I know of two trainees in my program (a fellow and a resident) who were both practicing family docs who left their profession because things were so bad in family medicine and retrained in pathology. And they did so knowing the current state of the pathology market. One of them was telling me that after paying her medical school loan, her car (which was an entry level Toyota sedan by the way), and house, she didn't have any money for food. She would have to work urgent care just to have a little extra each month.
 
Exactly. Things may improve for primary care in the future (possibly at the expense of specialists) but it is unlikely to be a hugely lucrative profession unless you can find some sort of niche or entrepreneurial aspect you can excel at (or you are willing to check your morals and ethics somewhat).

The way of funding medical education in this country (huge loans and high tuition) is going to have to come to a head at some point soon given declining physician pay. It is still tenable for many specialist physicians who will be making >$250-300k but unknown how long that will last. And part of the problem is that people most likely to go into primary care TEND to be (but definitely not exclusively) people who cannot afford medical education without significant loans. Those who can afford it tend to (but not always) want lucrative specialties. The solution will probably be either 1) expansion of ancillary professionals like PAs and NPs to take over a lot of primary care or 2) forgiveness of loans for people doing primary care.
 
I know of two trainees in my program (a fellow and a resident) who were both practicing family docs who left their profession because things were so bad in family medicine and retrained in pathology. And they did so knowing the current state of the pathology market. One of them was telling me that after paying her medical school loan, her car (which was an entry level Toyota sedan by the way), and house, she didn't have any money for food. She would have to work urgent care just to have a little extra each month.

At least in primary care you can do side projects and make extra cash. Lot of large employers are starting health care clinics, at least in my area, and they are being staffed by family docs. In pathology about the only thing you can hope for is doing some locum work. There is no reason a family doc can't make a decent living. The demand is there unlike pathology. The ones crying poor need to take a freaking business class. Our situation in pathology is FAR worse.

The problem with pathology is going to be the high unemployment rate if residency spots arent reduced dramatically. Salaries may stay decent but that don't mean anything, if you can't find a job to begin with.
 
Arguing over whether PC is worse than path is a matter of opinion; they are both not worth the trouble.

Since there are so many fields out there that present less hassle in practice, students should not consider either of them. They should aim for fields that are a little bit competitive.
 
At least in primary care you can do side projects and make extra cash. Lot of large employers are starting health care clinics, at least in my area, and they are being staffed by family docs. In pathology about the only thing you can hope for is doing some locum work. There is no reason a family doc can't make a decent living. The demand is there unlike pathology. The ones crying poor need to take a freaking business class. Our situation in pathology is FAR worse.

The problem with pathology is going to be the high unemployment rate if residency spots arent reduced dramatically. Salaries may stay decent but that don't mean anything, if you can't find a job to begin with.

Do most of you agree with this high unemployment rate stuff?

Webb do you happen to know the current average age of a pathologist?
 
If you have CAP membership (login for the website), you can look their new "2014 Practice Characteristics Survey."

http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=/portlets/contentViewer/show&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=statline/index.html&_state=maximized&_pageLabel=cntvwr

It has a lot of information regarding current demographics of pathologists in practice.

Thanks, I knew the answer (not the exact answer but I have heard it in the past and knew the close range). I just think it is funny how Webb and others go around this forum screaming bloody murder and probably do not have any info to back up their claims.
 
Who cares what the average age of a pathologist is? You can work till you are in your mid 80s, if you aren't put out to pasture (willingly or unwillingly).

You know any other meaningless statistics? :prof:
 
Do most of you agree with this high unemployment rate stuff?

Predicting the future is obviously not easy.

Personally, I doubt there will ever be a "high" unemployment rate - but note that this depends on your definition of what high is. To some people 2% would be high. To others more like 5% or 10%. To me, anything above a trivial number is high. 5% is much too high. There will never be full employment even in a great market because there will always be people unemployed either by choice (which some studies don't even count as unemployed) or because of failure to qualify for some reason (failing boards, losing license, substance abuse, whatever), or because of being selective (only wanting to work in one city part time, etc). What percentage of that is acceptable? I have no idea. I don't know what is optimal or even current.

But a lot of posters here raise important points about the future. Pathology is undergoing a lot of consolidation as smaller groups either merge or are bought out (or have the rug pulled out from under them) by either large academic centers, or reference labs. There are many areas in healthcare that are relatively more protected than others. There are trends that only affect parts of the market. So it is basically impossible to generalize to everyone. The market for academics will always be different than for private groups. Other trends include private groups essentially disappearing in favor of an employment model or a multispecialty group practice, which can be a hybrid between being employed and being autonomous.

It does seem hard to believe that the current supply of pathologists as defined by residency/fellowship graduation numbers is not too much for the market to handle. Pathology keeps becoming "more efficent" as defined by more cases per pathologist, in part due to specialization, in part due to technology, and in part due to working harder. Some of this is probably nearing maximum efficiency though, there is only so much efficiency you can gain by squeezing more. So the supposition is that we do not need as many pathologists in the future as we did in the recent past. A lot of number crunching goes on which tries to predict number of needed pathologists based on anticipated specimen load with an aging population. This is way too simplistic and unhelpful.

That is considered with the data that some put out which shows increasing average age of pathologists with likely decreasing numbers as these older people begin to retire. Many of them have put this off, but they can't keep putting it off, eventually the population will age out. The bigger question, which is not being asked as much, is what the proper supply of pathologists that is needed for the current situation, let alone the future. Only the naive would say that current FTE and workload will be constant over the next 20-30 years. Are the numbers of pathologists in practice likely to decline? Yes. Is a shortage likely to develop? That is FAR less certain.

As patients pay more in copayments and deductibles, this is going to change healthcare a great deal. How and to what extent? That is the key concept. Figure that out, and you could win a nobel prize.
 
Who cares what the average age of a pathologist is? You can work till you are in your mid 80s, if you aren't put out to pasture (willingly or unwillingly).

You know any other meaningless statistics? :prof:

You CAN work into your 80s if you are healthy, but the vast majority don't. The CAP survey that just came out listed 1.4% of pathologists over the age of 75. Only 3.4% total over 70. That is not an overwhelming number. I don't think that will change a lot. I think the anticipated retirement age changes, thus when you're 40 you think you'll retire around 60-65. As you get closer to 65 it bumps up to 70. But it rarely goes beyond 70.
 
Who cares what the average age of a pathologist is? You can work till you are in your mid 80s, if you aren't put out to pasture (willingly or unwillingly).

You know any other meaningless statistics? :prof:

So the current average age is over 60 right now, correct me if I am wrong...may seem meaningless to you, but to those of us that understand how old people live, the big picture isn't the doom and gloom you claim day in and day out around this forum.
 
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Predicting the future is obviously not easy.

Personally, I doubt there will ever be a "high" unemployment rate - but note that this depends on your definition of what high is...

Yaah, always nice to hear from you. I started this conversation because if you go around the path forums on here over the last few years it seems like a few people are screaming about "no money, no jobs, no future" rinse and repeat. I have not found this to be the case at all. Will be entering fellowship this year, there is a great chance I have a job lined up already, granted this is rare. Maybe my program is lucky, but I know all of the graduates because of the closeness of my program and none had a problem getting a job and one they liked. Almost all of them had more than a few offers, but they did the smart thing and opened themselves up and looked around. Obviously there are a lot of factors, but its not all like you read about in here that's for sure.
 
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