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Why don't pathologist just get rid of their leadership, aren't they elected??? There has to be something that can be done to cut residency spots. Grow a spine.
Pathology Job Market
- Thread starter Soma13
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Why don't pathologist just get rid of their leadership, aren't they elected??? There has to be something that can be done to cut residency spots. Grow a spine.
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You can start by signing the petition and continue by forwarding the below links to all US pathologists you know:
http://www.ipetitions.com/petition/oversupply-of-pathologists-in-the-us
http://pathologistoversupply.weebly.com/about.html
https://www.facebook.com/pages/Oversupply-of-Pathologists-in-the-US/1548366392082748
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Some candidates are still talking about a pathologist shortage. Election opens today by the way...
http://www.cap.org/web/oracle/webce...=162557478794565&_adf.ctrl-state=15nbf8f53v_4
http://www.cap.org/web/oracle/webce...=162557478794565&_adf.ctrl-state=15nbf8f53v_4
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How does the electoral process work at the CAP? I notice that R. Bruce Williams is the "Candidate for President President-Elect". What is that meant to mean?
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Secret ballots and black and white smoke....It's very much like electing popes.
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Secret deals behind the backs of Pathologists happen because 90% of Pathologists are not fighters.
CAP, academia, clinical physicians and administrators all know that Pathologists behave as battered wifes: they do nothing in fear of losing damn job.
I guess we need more beatings.
CAP, academia, clinical physicians and administrators all know that Pathologists behave as battered wifes: they do nothing in fear of losing damn job.
I guess we need more beatings.
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Can someone explain how the CAP elections are any more important than determining the number of grains of sand on a beach in Alexandria, Egypt?
The CAP is unfortunately our "voice in Washington". This means that the proficiency testing revenues are at the forefront of lobbying, not the professional stature of our field.
To elect the same old-same old types into these positions (generally fuddy-duddy awkward old pathologists and academics) is to maintain the status quo. I am fairly certain that a good number of pathologists out there are dangerously inept, and that's because they a) lack the skill to actually learn medicine and b) come from programs that lack the will or resources to teach them. Yet they finish. I know, because I work with a few of these.
Keeping the same leadership means expansion of residency programs, a continued flood of FMG recruitment, and a sustained downward spiral of the professionalism of pathology.
New leadership can maybe shake up the current flawed counterproductive approach. If anything, the professional component of CAP should have nothing to do with the profit-driven component. Maybe that Eichenwald fella who scuttled the ABIM's MOC could do a few things with the CAP
Our "voice in Washington" , unfortunately, does not live on this planet. Yesterday I sent an email to Vance Gail MD, one of the officers of CAP. Below are my question and her response which she QC to all other important members of CAP. It is obvious that CAP will do nothing to address our concerns about hyper-production of un-employable pathologists. It seems that because there is a dearth of pathologists in genomics today, the time is ripe for increasing numbers of (all) pathologists !!! I suggest that you contact those "leaders" and let them know what is going on. Their emails are:
[email protected], [email protected], [email protected], [email protected], [email protected],
[email protected]
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F.N. to Vance Gail:
Dear Dr Vance Gail:
Please read the below link. We, the US Pathologists are concerned about our hyperinflation.
http://pathologistoversupply.weebly.com/about.html
Best regards,
F.N, MD
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Vance Gail to F.N.
Hello FN: Thank you for reaching out to me. I have thought about your questions and the concerns you may have. As you know, healthcare is changing so rapidly is makes my head spin. Non-physician providers are increasingly being utilized as physician extenders or replacements in primary care and in the specialty settings as well. I only see this increasing. How this plays out in pathology is not foretold but there will be a need for pathologists to consider new pathways for practice. This was the message of the Transformation, when we promoted areas such as genomic medicine and informatics. There is a dearth of pathologists in genomics and an increasing number of PhDs, so molecular pathology is ripe for increasing numbers of pathologists. Informatics is an area where pathologists should lead. We have the information and it is important to utilize and mine the data both inside and outside the electronic medical record. Population health is all about studying populations trends and preventative medicine. We should be leading this area. Telemedicine is also an area that should be stronger in pathology, to utilize pathologists both locally, regionally and state or multistate-wide and internationally.
Pathology will always be essential for medicine and healthcare, however it will also need to adapt to the current environment and that change is occurring now.
Happy to discuss further.
Regards,
Gail
Honestly.
Informatics is better done by computer programmers, not pathologists.
Genomics is better suited for PhDs since it is a primarily non-clinical laboratory discipline.
Vance Gail's response does not make sense and does not address the current, and continuously ongoing issues regarding oversupply and overrecruitment of inept foreign trained physicians to substandard residency programs.
I am fairly sure that the MD officers of the CAP just go along with what their MBA "big dogs" want them to go along with. Groupthink.
Informatics is better done by computer programmers, not pathologists.
Genomics is better suited for PhDs since it is a primarily non-clinical laboratory discipline.
Vance Gail's response does not make sense and does not address the current, and continuously ongoing issues regarding oversupply and overrecruitment of inept foreign trained physicians to substandard residency programs.
I am fairly sure that the MD officers of the CAP just go along with what their MBA "big dogs" want them to go along with. Groupthink.
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I have no doubt that the CAP has an agenda, which involves furthering their own interests. If you read through the president elect's statement of goals he makes this quite clear. However, if he and all the other CAP officers receive enough complaints from pathologists then they might start worrying about a mutiny, which is not in their interests. This might finally make them realize that they need to do something to improve the job market.
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Mutiny among army of 18 thousand US Pathologists ? That would be a miracle. American Pathologists today behave and feel the same as US Blacks did in 1800's and US Gays in 1950's...
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Wow. Really? Slavery and oppression?
"Please stop flogging us CAP, just let us get back in our Mazzaratis and we'll do as we are told"
Re: molecular/genomics- you are dead wrong on that and path NEEDS to develop those fields. Otherwise oncology will and we may truly end up as useless as Nuclear med
"Please stop flogging us CAP, just let us get back in our Mazzaratis and we'll do as we are told"
Re: molecular/genomics- you are dead wrong on that and path NEEDS to develop those fields. Otherwise oncology will and we may truly end up as useless as Nuclear med
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Did you see last months nejm articles about genetic characterization of gliomas? They are close to obviating much of expert neuropathology. It sort of doesn't matter who is doing the molecular testing. And there won't be any need to look for subtle features with the histology for classification.
It is not like heme path where morphology, flow and genetics are needed to make diagnoses with gliomas you just need to identify it as a glioma, grade it high (4) or low (2,3) test it for tert, idh1, and 1p/19q and that gives a far superior classification for prognosis. Oligo vs astro doesn't matter, histologic subtypes are irrelevant, grade 2 vs grade 3 doesn't matter.
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If that's the concern, how does recruiting half of your contingent from places like Vladivostok and Baghdad to little community programs like in Albany solve this problem? I doubt they're doing high-end molecular diagnostics in buttf-ck nowhere Kentucky, and I doubt those FMGs are being recruited for their brilliance.
The CAP would be better off lobbying for a shutdown of all the programs that don't offer molecular. We'd probably end up culling the herd by half. They're not doing that though, which leads me to believe that cornering the market on molecular is not the CAP's primary goal.
All evidence points towards the CAP keeping pathologist labor plentiful and therefore cheap, which is not beneficial to patients or the profession but certainly very good for large laboratory corporations and hospitals who want to be able to hire cut-rate physicians and control their work. These large entities are the primary income source for the CAP, and thus the CAP answers to them and not the professional membership.
After residency I refused to join CAP and will continue to do so until it starts to represent professionals.
I don't know any pathologists in Mazzerratis. I do know a few radiologists who drive them.
D
deleted314957
All that "population health, population trends,preventive health, data mining, informatics" Crap sounds like what MPH's do
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No, its the clinical interpretation of complex data from high complexity molecular testing, applied to your patient (or your oncologist's patient), in light of the tumor stage and histology, and clinical history of the patient. Is there anyone better suited than the pathologist for this role?
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Can a molecular laboratory really analyze a specimen without looking at it first? What if there is no tumor on the submitted block? How do you lose the pathologist? Now maybe you need to pay two pathologists to look at the same specimen, one to make the diagnosis and send it to be tested, and one to verify for the molecular laboratory that the tumor is there? From my experience, non-pathologist clinicians send inappropriate specimens out all the time (e.g. cell block material from a case where only the FNA smears are diagnostic material). Saying you didn't find a mutation in normal or non-existent tissue when you are presumed to be testing tumor is not good patient care, and I imagine may be grounds for a lawsuit.
Molecular pathology is the future of pathology( if there is one). Everyone advertises genomics for cancer treatment.
The match and the percentage of American grads in residency has always shown pathology is not a very interesting choice.
CAP could change this but they are way behind. Education needs to be fully reorganized.
We have to address both our numbers and the training. Detailed pattern recognition via pushing glass may be come less important.
So far we given clinicians and large corporations a cheap and willing work force for most general pathology skills.
The match and the percentage of American grads in residency has always shown pathology is not a very interesting choice.
CAP could change this but they are way behind. Education needs to be fully reorganized.
We have to address both our numbers and the training. Detailed pattern recognition via pushing glass may be come less important.
So far we given clinicians and large corporations a cheap and willing work force for most general pathology skills.
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US Pathologists simply have no balls to change the rules of game. 18 thousand Pathologists produced a bit over 60 signatures on oversuuply petition. The 99.7% of US Pathologists obviously enjoy being underdogs.
So be it.
Amen.
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That petition is a joke...Quit trying to get people to sign it.
Agreed. There are far too many unprofessional grammatical errors on it that it just would further stereotype pathologists as the FMGs who couldn't match radiology.
Do Webb Pinkerton and Over9000 have better alternative ?
I don't really care too much about it anymore. I'm leaving pathology.
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Same here. I'm gonna milk this until the teet runs dry. Then it is onto plan B.
Did I read that right ? Starting a new career (retraining) is easyer than signing a petition?
BTW, petition is not my brain child, but I signed it anyway. It is not perfect, but better than doing nothing.
If we do not get politically involved to protect our interests, others will. And believe me, they will not work in our favor.
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Best thing to do is get some other businesses going on the side. 20+ years ago I started buying farmland. I wouldn't advise doing that now as farmland values are inflated. Buy rental properties instead. Having other sources of income is a must due to the lack of job security.
Don't put all your eggs in the pathology basket. As others have pointed out, waste is keeping this field going and new payment methods will cause accessions to drop.
Working as a pathologist has the feel of owning a bookstore or record shop in the late 90s. You can see the end is near and you better be preparing for it.
Don't put all your eggs in the pathology basket. As others have pointed out, waste is keeping this field going and new payment methods will cause accessions to drop.
Working as a pathologist has the feel of owning a bookstore or record shop in the late 90s. You can see the end is near and you better be preparing for it.
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Pathology exists outside the circle of time, in medicine. We're going to be totally safe from the doom and gloom that you're spouting. In fact, with the aging population (not to mention the net loss in practicing pathologists in the coming years), Pathology will experience a boom in accessions across the board. Life is good.
Lol. I can't tell if this is sarcasm or naïveté. Perhaps I am getting too old and senile.Pathology exists outside the circle of time, in medicine. We're going to be totally safe from the doom and gloom that you're spouting. In fact, with the aging population (not to mention the net loss in practicing pathologists in the coming years), Pathology will experience a boom in accessions across the board. Life is good.
There will be no "net loss" for pathologists as the residency mills are cranked up in order to keep dinosaur academia on life support and the CAP and ABP bureaucracies thriving while our long lost profession becomes further and further commoditized.
And most important, working Pathologists will do absolutely nothing to reverse that trent. Except, maybe, complain and feel sorry for themselves.
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What I can't understand is why pathologists are so meek and unwilling to try and change the status quo. I'd be interested in people's opinions.
Because they have learned that the best approach to keep a job is to kiss asses of almighty surgeons, other clinicians and administrators. They are happy to play the role of a child and back stab colleague Pathologst. Sad, but true.
Self-interest.
The field is made up of low-end physicians. Lots of low-quality FMGs and AMGs. They probably feel as if pathology is their only shot and are desperate enough that they'll accept whatever conditions are placed upon them. With the oversupply, opportunities are scarce, making the conditions even worse.
That's one reason why I'm getting out. The field is very unprofessional.
I would have to agree with this. We have to deal with both as there is a competing medical system that employs low budget FMG's and poorly trained, just graduated AMG's. I cannot read many of the FMG's reports and some of the other specialists I deal with say that they wonder if the FMG's even went to medical school. The just graduated AMG's are obviously poorly trained and have limited skills in surgical pathology. They may know how to present powerpoint presentations on a recent study, tell me how the chemistry analyzer works, but are ill suited for practice. Unfortunately, this kind of practice is going to discredit the whole field. I blame academic pathologists on this plague.
Low quality AMG and FMG are the consequence of the oversupply, not the cause. Too many people have been trained for decades.
Academic centers and CAP know very well that working Pathologists will do ABSOLUTELY NOTHING to stop this overproduction...
And if anyone would try, most of Pathologists will not join them. They will find an excuse not to expose themselves: bad English, not enough data, anectotal evidence.... you name it.
So, abuse will go on. Too many meek people with no balls afraid of everything...
It's a vicious cycle and it is not going to change. The only thing one can change is themselves.
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I can understand why academic pathologists are too scared to complain about all the over-training: (1) If the residents go then they will have to do more work. (2) They may be concerned about their job security if they "rock the boat".
What I don't understand is why pathologists allow the CAP to act against their interests.
What I don't understand is why pathologists allow the CAP to act against their interests.
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FMG'S AND PATHOLOGY: FANTASY AND REALITY
I am a middle aged US graduate working in Pathology for about 30 years. I do work in commercial setting.
Recently our Laboratory chain let go five US graduates who were all solid professionals aged 48 to 62. Three of them were brilliant graduates of Ivy League programs. Five well trained US graduates were replaced by (only) three junior FMG's, two from China and one from India. Their diagnostic skills are poor, their English skills are a disaster.
Man in charge of change was a 32 y old American born administrator with a BA. He is not an MD and has no MBA, but is obedient member of corporation. His main skill is the ability to squeeze more work out of "his slaves - the working Pathologists". Each of the three new Pathologists is paid only one half of what the fired one made. And all of the rest have to work harder in order to compensate for diminished number of less capable MD's. No one is complaining in fear of joining the five fired members.
Our young administrator who can now hire and fire well trained doctors told others that he prefers to work with FMG's because they complain less and are easier to lead.
The corporation rewarded the almighty administrator with a fat bonus.
Welcome to America.
I am a middle aged US graduate working in Pathology for about 30 years. I do work in commercial setting.
Recently our Laboratory chain let go five US graduates who were all solid professionals aged 48 to 62. Three of them were brilliant graduates of Ivy League programs. Five well trained US graduates were replaced by (only) three junior FMG's, two from China and one from India. Their diagnostic skills are poor, their English skills are a disaster.
Man in charge of change was a 32 y old American born administrator with a BA. He is not an MD and has no MBA, but is obedient member of corporation. His main skill is the ability to squeeze more work out of "his slaves - the working Pathologists". Each of the three new Pathologists is paid only one half of what the fired one made. And all of the rest have to work harder in order to compensate for diminished number of less capable MD's. No one is complaining in fear of joining the five fired members.
Our young administrator who can now hire and fire well trained doctors told others that he prefers to work with FMG's because they complain less and are easier to lead.
The corporation rewarded the almighty administrator with a fat bonus.
Welcome to America.
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Well hopefully that lab will lose business...oh yea that's right we work in a commodity business where few care about the quality of work.
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This is the same concept as hiring illegal immigrants to pick watermelon under that baking Georgia sun for rock bottom wages because the average American wouldn't do it for less than 20 bucks per hour. The immigrants usually work harder and do a better job, but an American could do just as well if fairly compensated. In this case, the big businesses (corporate labs/hospital networks) are exercising free market capitalism at the expense of the laborers (physicians/pathologists) just as the agriculture companies/farm owners are...
I think you touched on a key point. The over supply in our profession means that pathologists have very little control of corporate structures.
In the past , our practices were driven by the pathology group's skill and its interaction with local physicians.
More and more economics are driving our business to the lowest common denominator. It is dominated by insurance contracts, patients wanting the cheapest price or a group of clinician's wanting a piece of the action.
They all see pathology as a commodity that can traded upon for extra cash. When labor is cheap it is so so easy to do.
Multiple distant laboratories are very detached from the community so the major pathology disasters and quality problems never get noticed. A standard hospital medical staff is longer involved .
Most clinicians don't have a clue about quality. They are more satisfied by glossy picture filled reports and a free meal from a sexy lab rep than an accurate diagnosis. I suspect this can only get worse.
Large and small pathology groups will be sold to corporations that often don't provide lab services much less health care to real patients.
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But you see- that's just it. Not everyone is convinced that there is a significant problem. And it's not that they are delusional- they are smart and reasonable people and are not convinced. What would convince them is the very thing you flippantly deride- evidence.
I think many people in our field consider these to be tough times in light or reimbursements being slashed, a lack of research funding, and commoditization of physician roles in health care. But I don't think this is specific to pathology and can be felt in virtually all practices types. The issue is not whether things are bad or could be better, but are they disproportionately worse than they are for everyone else? I don't think many will agree that it is as bad as portrayed in this thread or this board. As stated over and over again, many of us (probably most) don't know any unemployed pathologists, have only done one fellowship, are make a good living. That is not to say that we don't think things could be better. I don't think there is much resistance to the idea that we may benefit from fewer residency positions. As stated many times by reasonable people on this board, the numbers used to calculate expected need for additional pathologists is highly flawed. But this too can come at a cost- if volumes do increase and we cannot handle them, be prepared to see other professionals take our responsibilities or see a decreased need for our services.
The fact is, path has been more competitive that IM, peds, and other specialties (it is about average for Step scores and AOA). It is not the "bottom of the barrel" of applicants as has been stated over and over. Maybe in general it does attract more passive/introverted types. I have seen many in our field. But they can be found in many other specialties as well.
It is also true that, as a smaller specialty, mostly run by megalabs or independent path groups that contract with hospitals when one ventures outside of academia, getting a job is much different than for many other specialties. That's just the way it is. Perspective residents need to know this. Don't expect hospitals to give you a contract your second year out at a residency fair- it won't happen. Be prepared to network and make friends to secure employment. Get into the best program you can, because it does matter. Also as a smaller specialty, there are fewer positions available at any one place. So if there are 5 path positions in your town and they are not hiring, you can either take up gardening or interior decorating and stay put or grow a sack, pack up your **** and move to work in the field you have been training for for the last 8+ years. If you don't see that last step coming it's on you.
The country has been changed, no doubt. We used to reward American workers now both political parties are sellouts to the corporate globalists. They have American workers including professionals right where they want them, at the mercy of big government and big bureaucracy and big administration.
If training programs slashed the number of PGY1 in Pathology for 50% to only 300 new positions per year, than:
1) Better candidates (US or Foreign) would enter the field
2) The level of Pathology services would improve
3) Administrators would not be able to treat Pathologists as slaves
4) Teaching hospitals would have to hire more PA's for cutting specimens and other scutwork
Academia and CAP should find the way to obtain federal funds not related to training.
Any suggestions? What do Pathologists need to start behaving like "real doctors" (ENT, dermathologists etc). Hope not a brain transplant.
1) Better candidates (US or Foreign) would enter the field
2) The level of Pathology services would improve
3) Administrators would not be able to treat Pathologists as slaves
4) Teaching hospitals would have to hire more PA's for cutting specimens and other scutwork
Academia and CAP should find the way to obtain federal funds not related to training.
Any suggestions? What do Pathologists need to start behaving like "real doctors" (ENT, dermathologists etc). Hope not a brain transplant.
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One of the biggest reasons I'm working on leaving the field is that there is an overarching lack of identity as true physicians in pathology. I think this is what causes pathologists, particularly the academic ones who hold the strings of training programs, to have devil-may-care attitudes regarding pathology resident recruitment - as if the primary purpose of pathology is research, not diagnostic patient care. If you look at resident rosters at most programs, they resemble wet-bench research laboratories rather than residency programs. The fact that pathology training does not include a clinical year further cements this attitude of non-physicianship.
To echo older pathologist's comment, I've worked with non-boarded, board-ineligible FMG pathologists coming from totalitarian countries who were hired because they were pliable and cheaper. They're about as skilled as you think.
Patient perception is a big factor as well. We're a robotic machine that analyzes the specimen. If they knew that their diagnoses were being sold to the lowest bidder (who is often also the least qualified to practice) and that the root of what we do comes down to a judgment call, such acceptance of weak skill would not be so widespread.
The job market is the manifestation of the problem, but it isn't the problem in and of itself. It's a symptom. The real problem is that our field has been wholly deprofessionalized and commoditized, and that its leadership is either busy further commoditizing it, or placing head-in-sand with an "I got mine" attitude as they do their nth brown-stain study to be published in a 0.04 impact factor journal.
Since its obvious that our representatives have incentives to work against the best interests of the field, I know that waiting for change or fighting for it is futile. So I'm going back to train in something else.
To echo older pathologist's comment, I've worked with non-boarded, board-ineligible FMG pathologists coming from totalitarian countries who were hired because they were pliable and cheaper. They're about as skilled as you think.
Patient perception is a big factor as well. We're a robotic machine that analyzes the specimen. If they knew that their diagnoses were being sold to the lowest bidder (who is often also the least qualified to practice) and that the root of what we do comes down to a judgment call, such acceptance of weak skill would not be so widespread.
The job market is the manifestation of the problem, but it isn't the problem in and of itself. It's a symptom. The real problem is that our field has been wholly deprofessionalized and commoditized, and that its leadership is either busy further commoditizing it, or placing head-in-sand with an "I got mine" attitude as they do their nth brown-stain study to be published in a 0.04 impact factor journal.
Since its obvious that our representatives have incentives to work against the best interests of the field, I know that waiting for change or fighting for it is futile. So I'm going back to train in something else.
Yes, go ASAP and train somewhere else. You have no energy to do anything for the practice of pathology. You are totally resigned and useless for any action.
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You need to start a GOFUNDME account to go along with that petition. Let's help the unemployed and underemployed pathologists out there and also use the money to fight for our profession.
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....
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Every profession is a commodity, the same is true for doctors. ENT's, Dermathologists and other "resptected" profiles are commodity in demand, Pathologists are commodity in surplus. If there was a surfeit of ENT's and Dermathologists begging for jobs, the attitude of administrators towards them would change. If Pathologists were in demand the same would happen.
Of course our representatives have no incentive to work for our interest, why should they? They know very well that majority of Pathologists have personalities of Over9000, Webb Pinkerton, Thrombus etc... Pathologists behave similar to discriminated minorities.
When flying to Europe few weeks ago I saw movies Milk and Selma and asked myself when Pathologists will change accordingly? I guess, after my death if ever...
