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medical lab director salary

Discussion in 'Pathology' started by pathstudent, Aug 14, 2010.

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  1. pathstudent

    pathstudent Sound Kapital

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    Question.

    One of my residency friends (yes I have one or two) went into pp and he was telling me his group just renewed their contract with one of their hospitals. He said it was HCA hospital (some corporate chain of hospitals) and embedded in the contract was that the laboratory directing was worth 90 bucks an hour. And that the hospital paid them the percentage of medicare billing vs overall billing (as a DRG thing) but basically offset it by saying that it equalled the rent for their offices and furniture and stuff. So they got paid nothing for it. My friend, who is trying to learn this management aspect, said to one of his seniors, why don't they claim to work more hours in their timing studies to earn some extra money. He was told that if they did that, then the hospital admins would get the money back by increasing the charge for processing their outpatient cases for which the group was able to bill the global. I don't know if I explained it very well, but basically, his group has no chance of getting paid anything from the hospital administration.

    He told me he thought that 90 an hour was really low, but HCA says that is what the federal govt says a lab manager should get paid. He went on-line and on craigslist and found all these jobs/services that cost more than 90 an hour. Things like at home dog trainers ($95), speech therapists(120), Accupuncture ($100), reading tutoring ($60), Massage at a spa (100), Private golf lesson (110), balloon artists for birthday party (100), all make more than hospital laboratory medical directors. Well not tutors but the rest did.

    I think that 90 an hour must be from 1988 or something like that. Surely it should be a lot higher.

    Anyone have any comments, experience or insight into this?
  2. KCShaw

    KCShaw

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    Sounds like modern day business. Basically, either your friend's group gets shafted compared to a dog trainer or they risk losing the contract to someone willing to be. Usually a larger group which offsets being shafted on contracts by increasing volume and consolidating expenses, at least as long as any competition lurks around. Until the market for pathology services changes, or laws change/reimbursement made more clear (so one "has" to be paid appropriately), it's a hole we've dug as a profession and have to sit at the bottom of.

    That's not to say hospitals don't have their own problems, of course.
  3. 2121115

    2121115

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    I seem to recall getting laughed at one time for suggesting that PP's don't get paid for lab director duties except in certain states where the climate is more favorable.
  4. Parts Unknown

    Parts Unknown Fork tender

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    $90 an hour corresponds to approximately $180,000 per year, assuming a standard 40 hour work week. Not great, but not exactly chicken feed.

    The craigslist comparison above is annoying but invalid, as the speech therapist, golf coach, balloon artists, etc., are not working 40 hours per week. The reason they are charging so much is to offset many hours of not working. A dog trainer might feel lucky if he has 4 one-hour appointments in a day, and when you factor in travel time, lunch, etc., it may take 8 hours to do all of them. His effective billing rate just dropped to $47.50/hour for that day.
  5. pathstudent

    pathstudent Sound Kapital

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    Yeah no ****. That would be 180 k for working 8-5 fifty out of fifty-two. But the fact that obedience trainers can make mire per hour than a lab director shows they are of greater value. Also a busy speech therapist might be able to schedule forty hours a week. Personally I think that figure is way too low and should be closer to 150 or 200. And that 90 per hour isn't full time. They do timing studies and when you are busy doing ap or singing out outpatient you aren't getting paid by the hospital.

    I'm a hard ore academic and I have an infinitely better understanding of the private world that a future pp foc like u
  6. pathstudent

    pathstudent Sound Kapital

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    Yeah seriously you is so clueless. The admins have you calculate how many hours you spend managing the lab and then pay you whatever percentage of Medicare patients they get. So saying a med director makes 180 k a year is no different than saying a dog trainer makes 190 k a year or that a speech therapist makes 240 k s year.

    Your comment is moronic
  7. Parts Unknown

    Parts Unknown Fork tender

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    Yes, yes you are.
  8. Parts Unknown

    Parts Unknown Fork tender

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    I was merely pointing out why comparing hourly rates is not apples-to-apples. Sorry if you don't get it.

    Not if you breathe through your nose.
  9. pathstudent

    pathstudent Sound Kapital

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    Without being inflammatory, saying "180k a year isn't too bad", misses the point. Yes no one works 2000 hours a year as a dog trainer, but hospitals do not pay medical directors for 2000 hours of work either. Hospitals take calculate the time that their pathologists are actively managing the lab or serving a role as medical director. My friend says it includes, reviewing blood smears from the heme bench, giving tumor boards, being on a committee, answering a clinicians question etc... In my friend's case they figured the pathologists spend 550 hours a year managing the lab. So they take 90 times 550, then they multiply that by the percentage of medicare billing they do versus all billing. So basically you get 30% of 550 times 90. That amount of money goes to the pathologist out of Medicare Part A payments to the hospital as part of the DRG. The hopital then says that money equals your rent for your offices and supplies and such and calls it a wash.

    So yes 180k a year wouldn't be so bad but hospitals do not pay pathologists like that. They do it as described above. We just thought it was funny that obedience trainers and kids party entertainment has a higher hourly rate than medical directors for HCA hospitals.
  10. TMZ2007

    TMZ2007

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    So 30% of 550 hours x $90/hr? Or $1237 per month. And that gets counted as rent and overhead for hospital-provided supplies and other expenses...? It doesn't sound beyond the pale when you put it that way. Does a medical director generate $1200 a month in expenses?

    Although I imagine the retort, "The hospital would eat those expenses if there were a high demand for pathologist services", would also be appropriate. :rolleyes:
  11. pathstudent

    pathstudent Sound Kapital

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    Yeah I guess it isn't much money to worry about anyway.
  12. Granular

    Granular

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    This raises several questions:

    What happens if the cost of supplies or office rent goes up? Will the pathologists have to pay the hospital for the privilege of directing the lab?

    Do other doctors in the hospital have to pay for their use of the OR, ED, etc, or are these charges limited to the pathologists? I am guessing the cost of the radiologists office and computer are not assessed to the doctor.

    Overall, the practice probably should just accept this situation, particularly if the deal is linked with other financially beneficial arrangements. If the practice were compensated too well for laboratory directing, the hospital could go out and find fellowship-trained PhDs to run the lab (allowed under CLIA) who would probably work for a fraction of the cost of a pathologist. I think the PhD oversupply is worse than the pathologist oversupply. The PhD lab director would be somewhat limited (cannot do tumor boards or review blood smears), but she could certainly run the chemistry and micro parts of the lab, answer clinician questions, etc.
  13. Freak

    Freak ASA Member

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    So are tumor boards and blood smears the only restrictions on PhD lab managers?

    The bigger question I am asking is what is the value-added to the hospital for an MD lab director.
  14. pathstudent

    pathstudent Sound Kapital

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    Likely better able to interact with the medical staff.
  15. KCShaw

    KCShaw

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    By way of having medical knowledge and understanding, yes. An MD/DO/MBBS/whatever-medical-doctor-degree has a generally better understanding of the importance of clinical correlation with a laboratory result, its relevance, interpretation as it applies to a patient, and the general difficulties of practicing clinical medicine -- as compared to the average PhD. They can be medical directors. They are better founded to argue for or against adding or removing tests, because of how they do or do not apply to the patient population in question. Basically, IMO, they are better founded to address essentially everything except possibly technical issues with a specific test or series of tests specific to the particular subfield of a given PhD, and average salary. The same things a good med tech can address just about as well. What I don't think is taken into consideration by the average hospital administration is the potential savings an MD-type can create as a laboratory director -- if they have and utilize enough power to sway the ordering of certain tests in certain settings, change certain things to send-outs, or bring in certain tests, based on clinical utility and efficiency rather than because it's the expensive new hotness or is so old everyone does it for no good reason.

    There are some very good PhD's working in a clinical setting, who have taken pains to bridge the gap between their science background and the medical setting they're in. But still.
  16. mikesheree

    mikesheree

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    Generally, we do professional component billing for in-patient non-medicare/medicade patients at a pretty low rate (~ avg $15-20)
    Collections rates are prettr shi**y. Recent court decisions in IL and FL have been pretty favorable toward this practice.. We get nada from the hospital for PC for medicare/medicare which the IG has said "MAY" constitute fraud and abuse due to anti-kick back language but they have never come out strongly so the hospital(s) can blow it off for now because of the very loosley structured language.. In reality, if you want an exclusive contract to do the AP for a hospital you may well get REALLY screwed as far as any money concerning lab medical director compensation is concerned. If you bitch too much, they will find a willing slave to replace you. The PC ( professional component) billing seems to be very geographically determined. Thankfully the appelate courts are generally symphatetic to it.
  17. pathstudent

    pathstudent Sound Kapital

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    I have heard that CP billing used to be quite a good source of income but that the insurance companies have basically quit reimbursing for it, and that you can bill the patient but it isn't good to be too aggressive about collecting from the patient as it can piss the admins off.
  18. KCShaw

    KCShaw

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    I've heard a lot of rumors about the good ol' days of CP, though never really researched it properly. Mainly heard over the years that so many CP's were self-referring, ordering and billing additional tests & panels without approval from clinicians, etc., that the world eventually came crashing down on them to stop and prevent it. Supposedly it was a huge cash cow back in the day, but that part of it collapsed and being a CP ceased to be so lucrative, so the numbers of pure CP's dwindled.

    But, really, IMO the absurd difference between who gets billed what for the SAME test/procedure/diagnosis/etc., vs what is actually collected on average, is one of the most laughable things in the universe. Right up there with hyenas giving birth through their urethra.
  19. mikesheree

    mikesheree

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    In the "good old days" just before i started my residency in the pre-1983(?) TRFRA days, I was told by a mentor that "any money you make in pathology will be made from the clinical lab. Any reputation you make in pathology will will be made from surgical pathology."

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