Poor job market

[KeratinPearls]

Just wanted to give my two cents.

My friend who is board certified with three fellowships has sent in his CV to more than 20 places with maybe 3 responses but has not heard anything since. The other places he sent in his CV, he hasn't heard anything at all.

At the academic place where I am at I am hearing candidates with two to three felowships who are interviewing for ajob.

No longer can you complete a surgical pathology fellowship and be confident in finding a job, you have to do a GI/dermpath fellowship to feel competitive.

Sucks to be in medical school and training for 5-7 years and have difficulty finding a job.

---

Members don't see this ad.

 

[turtle1966]

Just wanted to give my two cents.

My friend who is board certified with three fellowships has sent in his CV to more than 20 places with maybe 3 responses but has not heard anything since. The other places he sent in his CV, he hasn't heard anything at all.

At the academic place where I am at I am hearing candidates with two to three felowships who are interviewing for ajob.

No longer can you complete a surgical pathology fellowship and be confident in finding a job, you have to do a GI/dermpath fellowship to feel competitive.

Sucks to be in medical school and training for 5-7 years and have difficulty finding a job.

The acceptance of this job situation as "normal" by many in the specialty is "cooked to perfection during residency and fellowship(s)" phenomenon so aptly named by a sage over 23 years ago!! Not much has changed since.

It is a "learned helplessness" and "do not squeak, lest you will appear a grumpy and unprofessional" attitude.

 

[mlw03]

The whining on here is rather pathetic at times. Any of you want struggling to find work want a guaranteed job for the next 20 years do 3 things: 1) complete a forensic pathology fellowship and pass the board exam 2) speak and write English well 3) not be a d-bag. Do those things, and you'll find work somewhere in the US or Canada for the next 20 years.

There is no right to work. Markets drive these things. Let a generation go by without competent people doing pathology (as almost happened up here) and see how the tables turn. Path residents (most of whom are Canadian) up here laugh at the notion of going to the US for crappier pay, far worse working conditions, and having to do multiple fellowships to have a chance to do that.

 

[KeratinPearls]

No one is whining. My friend could not find a job and I am posting about his experience. He is thinking about doing a fourth fellowship. He is also board certified if I may add.

My buddy is none of those things you mentioned. He is a US citizen from the west coast, is the nicest guy you could prob ever meet and he does not want to do forensics.

Forensics is not for everyone my friend. The job market is good for a reason. Doing autopsies everyday for me is quite depressing (gunshot victims, suicides).

I am not whining. I am just saying what is my buddy is experiencing.

 

[Napoleon1801]

Just wanted to give my two cents.

My friend who is board certified with three fellowships has sent in his CV to more than 20 places with maybe 3 responses but has not heard anything since. The other places he sent in his CV, he hasn't heard anything at all.

At the academic place where I am at I am hearing candidates with two to three felowships who are interviewing for ajob.

No longer can you complete a surgical pathology fellowship and be confident in finding a job, you have to do a GI/dermpath fellowship to feel competitive.

Sucks to be in medical school and training for 5-7 years and have difficulty finding a job.

Agree with you. I'm starting to see more and more folks that load up on 2+ fellowships. This is a definite trend I've noticed through training. Just getting a few interviews for jobs can be an ordeal in and of itself. People who are not cognizant of this are not searching for jobs right now.

 

[rollwithit]

Just wanted to give my two cents.

My friend who is board certified with three fellowships has sent in his CV to more than 20 places with maybe 3 responses but has not heard anything since. The other places he sent in his CV, he hasn't heard anything at all.

At the academic place where I am at I am hearing candidates with two to three felowships who are interviewing for ajob.

No longer can you complete a surgical pathology fellowship and be confident in finding a job, you have to do a GI/dermpath fellowship to feel competitive.

Sucks to be in medical school and training for 5-7 years and have difficulty finding a job.

What sort of intro or follow up is your friend performing? Not arguing whether or not it should be easy or not to find a job with 3 fellowships, but curious as to the scenario he/she is in. Responding to a job posting with a CV and an email is generally not successful. Your CV gets put in a stack for reference until the candidates who have been referred by mutual acquaintances are looked into first.

 

[2121115]

Honest advice - there are plenty of academic centers that will hire someone at around 75K to sign out surgical pathology as a "instructor" or whatever they call it. This is highly preferable to a third fellowship. Get some independent sign out experience. I'm not saying it is ideal. But it beats doing the 3 fellowship thing as far as job marketability.

 

[Johnny Sunshine]

My hope is to network with small community pathologists, get them to ask around to their colleagues, and perhaps find a small private job that way.

Many smaller, rural areas have big problems trying to attract pathologists, and often wind up having to pay beaucoup bucks in order to convince anyone to come out in the middle of nowhere to practice. If you're willing to do so, it could turn out good for you. If you can claim local family, or provide any other reason why you are actually interested in the region, all the better.

The problem is these smaller places don't know how to properly find applicants. They seem to mostly just ask around to their friends in the surrounding regions if anyone knows of someone looking to relocate, and so these rural openings can be difficult for you as an applicant to become aware of.

 

[Pathwrath]

Honest advice - there are plenty of academic centers that will hire someone at around 75K to sign out surgical pathology as a "instructor" or whatever they call it. This is highly preferable to a third fellowship. Get some independent sign out experience. I'm not saying it is ideal. But it beats doing the 3 fellowship thing as far as job marketability.

I second this. These poorly paid but usually hyperspecialized academic jobs are what's now available, and they are future of the profession, anyway. They are certainly the reason behind the big push to increase residency positions. Don't forget the big corporate labs as well.

 

[KeratinPearls]

Thanks for the help. I think this is useful information to all. I didnt mean to sound whiney more frustrated for everyone including my buddy. Ill pass on the info to him.

Pathwrath, what do you mean by these hyperspecialized academic jobs? Academics that only signout GI or head and neck? Never heard of this. Most academics I see do gen surgpath on top of their particular specialty.

Thanks all.

 

[mlw03]

No one is whining. My friend could not find a job and I am posting about his experience. He is thinking about doing a fourth fellowship. He is also board certified if I may add.

My buddy is none of those things you mentioned. He is a US citizen from the west coast, is the nicest guy you could prob ever meet and he does not want to do forensics.

Forensics is not for everyone my friend. The job market is good for a reason. Doing autopsies everyday for me is quite depressing (gunshot victims, suicides).

I am not whining. I am just saying what is my buddy is experiencing.

I don't know your friend, and have no reason to doubt what you're saying. And I agree it sucks *ss that the job market for diagnostic path is so poor. But I repeat - there is no right to work in a job one enjoys. Every choice we make as adult members of the job market is a reflection of our preferences. As long as there are people getting the job done adequately for low wages, the market will not change. Like I said above, a decade of 25% of residents being AMGs would change things, but for now, there's still enough Americans doing path residencies. I would not have done pathology had I not expected to go into forensic path.

 

[Tiki]

Look out---any minute now some obnoxious poster is going to pop up and blame your friend and say that he is obviously a bad pathologist.

The job market this year might be worse than last year, which is saying something.

 

[Silent Cool]

Still waiting for BU Pathology to pop up and tell ya'll about the wonderful intellectual satisfaction that Pathology affords a practicing doc.

On a more positive note, this is actually an golden opportunity for an enterprising and entrepreneurial Pathologist. Why? Because it is an opportunity for you to buy a lab/partner with one, and employ the tons and tons of desperate Pathologists out there seeking work. As long as you pay them well (ie, don't get too greedy, offer something better--eventually--than the Corp Pod labs), you can probably own a large chunk of the market.

Path labs for sale:

http://www.mergernetwork.com/medical-laboratories-for-sale/page-1

http://www.laboratoryforsale.com/

Start a comeback of entrepreneurial Pathology. The next revolution in science will occur in biotechnology and medicine. Many opportunities exist in the marketplace for an enterprising Pathologist who is willing to take risks. Aspire to be that person and profit.

 

[WEBB PINKERTON]

Entrepreneurial pathology. LOL. Those days are gone. Once evolution runs it course and the field can't attract anyone due to the bad working conditions, low pay and lack of opportunities things could change. But that could take a long time. Plus pathology is becoming like flying an airplane. Pathologists will just be pilots relying on ancillary testing for answers. The days of being a skilled morphologist are numbered.

Get used to being an employee of Kaiser, some large Catholic/university chain, labcorp/quest or some in-office lab. That is your future.

If you got money to spend, dont buy some dying path lab. Go buy rental properties.

 

[turtle1966]

Like I said above, a decade of 25% of residents being AMGs would change things, but for now, there's still enough Americans doing path residencies. I would not have done pathology had I not expected to go into forensic path.

I am far removed, in time and space, from residency training, therefore, I ask:

(1) what is current percentage of AMG in pathology residencies?
(2) has the aforementioned percentage been stable or heading up or down?​

 

[Silent Cool]

Entrepreneurial pathology. LOL. Those days are gone. Once evolution runs it course and the field can't attract anyone due to the bad working conditions, low pay and lack of opportunities things could change. But that could take a long time. Plus pathology is becoming like flying an airplane. Pathologists will just be pilots relying on ancillary testing for answers. The days of being a skilled morphologist are numbered.

Get used to being an employee of Kaiser, some large Catholic/university chain, labcorp/quest or some in-office lab. That is your future.

If you got money to spend, dont buy some dying path lab. Go buy rental properties.

The market always picks winners and losers. There are many opportunities on the market. I'm no 'BU Pathology,' but I do know that opportunities abound. I also know that the stock market will always outperform real estate--thanks. The other problem is that Pathologists are a largely passive, non-risk-taking group.

The question remains: why don't you find opportunities to OWN something? You have to take risks, just the way that dentists do when they BUY a practice. My opinion is that you have been conditioned to have a guaranteed job (as most medical students are), instead of OWNING something. Look to own, and find opportunities to take your profession back.

 

[Pathwrath]

The question remains: why don't you find opportunities to OWN something? You have to take risks, just the way that dentists do when they BUY a practice. My opinion is that you have been conditioned to have a guaranteed job (as most medical students are), instead of OWNING something.

Well, I partly OWN a large refererence lab, and over the years it has indeed generated a lot of revenue. But BUYING a pathology lab--you know, with all those big machines--requires quite a bit more capital than BUYING a clinical practice with its four painted walls, receptionist and a patient list. And that entrepreneurial dentist is competing with other dentists in his area, not a bunch of multinational megalabs with truly grotesque economies of scale. And given that I've just experienced my first round of lab tech layoffs--ever--due to health care reform, I would sooner recommend a neophyte compost his money than pouring it into lab ownership.

Having said all that, I do take your point about pathologist passivity. When new pathologists are by and large content to trade their autonomy, income, and self-respect for regular limited work hours and restricted duties, there really is nothing to be done for them. Low expectations and low opportunities go hand in hand.

 

[Thrombus]

An entrepreneur minded person is making a huge mistake going into pathology at this time.

Pathology is becoming a great career for the assembly line worker, who does not appreciate a career/profession with leverage, and who would rather take homage in the "CAP" going to bat for him/her at the table and delivering table scraps for a few thousand dollars every year.

3-4 fellowships and no job. LMAO! Our group will be downsizing if anything and groups I know also are down on their numbers thanks to Obamacare. We will have less to do. Once the country runs out of borrowing capacity I would imagine we will really get hit while our fees and costs continue to rise. Run Forrest Run!

 

[Pathwrath]

Pathwrath, what do you mean by these hyperspecialized academic jobs? Academics that only signout GI or head and neck? Never heard of this. Most academics I see do gen surgpath on top of their particular specialty.

I'm showing my age. Once upon a time, academic pathologists were equipped to handle ALL AP/CP duties and subspecialty signouts were exotic. Now AP and CP are separate, and all AP academics must have their subspecialty. General surgical pathology is whatever your department hasn't recruited a subspecialist for yet. Dermpath, GI path, breast path, hemepath , cytopath, neuropath, uropath, etc--the academic wet dream is to get these all handled exclusively by fellowshipped "experts" and claim superiority over dumb community generalists. New academic pathologists gladly exchange income for the ease of restricted duties. There's no end to this.

 

[malchik]

I am a new academic pathologist with subspecialty, but I would take expanded duties if it meant more income. And it is not just academics that is demanding subspecialty. Getting harder to find a job without a specific area of expertise.

 

[path24]

I look forward to the even worse job market in the coming years....all while we are in our "shortage" years. Haha.
We are a year out from the "shortage" and b/c with three fellowships struggles to get work. Anyone who believes or agrees with the "shortage" want to explain that? CAP posts few crappy jobs...scientist, histotech, hr specialist. Actual path jobs 20?

Fellows: have years of fellowships lined up.
Residents: jump ship and do a different residency (even fourth years, the math still works that late)
Med students: don't remotely consider pathology (only when you are done, then you can hire one for cheap to make extra bank)

cap, ascp, academics...etc. will continue to be dishonest. They want free labor and money. The care nothing about future employment.

 

[Pathwrath]

I am a new academic pathologist with subspecialty, but I would take expanded duties if it meant more income. And it is not just academics that is demanding subspecialty. Getting harder to find a job without a specific area of expertise.

I'm glad to hear it, but I really think you are in the minority. When even seasoned academics look forward to the happy day they can pawn off everything but their subspecialty, most young pathologists who've spent four years just getting a fellowship certainly do not want the stress. And even if they feel motivated when fresh out of training, a few years of limited signout will kill any inclination to develop new skills.

You are right about it being a buyer's market in pathology across the board.

 

[KluverB]

Get used to being an employee of Kaiser, some large Catholic/university chain, labcorp/quest or some in-office lab. That is your future. ...

Or not.... http://pathologyblawg.com/pathology...ratories-laying-off-44-employees-main-office/

 

[gbwillner]

Look out---any minute now some obnoxious poster is going to pop up and blame your friend and say that he is obviously a bad pathologist.

The job market this year might be worse than last year, which is saying something.

Yes, I think it will be worse. With cuts inevitable, private insurers are already adjusting their reimbursements accordingly. As contracts come up for negotiations insurers will pay less for sure in line with medicare rates, so everybody is pretty much in panic mode right now across the board. This is happening at academic centers right now. Even though they get good rates from insurers in general, insurers are forcing renegotiations or ending current contracts. I don't think things really get better until the uncertainty ends.

BTW I don't think this is specific to our field in any way. The only winners are going to be the primary care fields.

 

[pathstudent]

Yes, I think it will be worse. With cuts inevitable, private insurers are already adjusting their reimbursements accordingly. As contracts come up for negotiations they will pay less for sure, so everybody is pretty much in panic mode right now across the board. This is happening at academic centers right now. Even though they good rates from insurers in general they are forcing renegotiations. I don't think things really get better until the uncertainty ends.

Totally agree. Reimbursement is in a free fall. Any reasonable group, department or reference lab would be completely foolish to not go lean as possible until we know when we have hot bottom.

I thought the Aca was going to be good for us by creating more insured patients but their ability to cut payments to at or below costs is frightening.

 

[Path or bust]

Just wanted to give my two cents.

My friend who is board certified with three fellowships has sent in his CV to more than 20 places with maybe 3 responses but has not heard anything since. The other places he sent in his CV, he hasn't heard anything at all.

At the academic place where I am at I am hearing candidates with two to three felowships who are interviewing for ajob.

No longer can you complete a surgical pathology fellowship and be confident in finding a job, you have to do a GI/dermpath fellowship to feel competitive.

Sucks to be in medical school and training for 5-7 years and have difficulty finding a job.

It's very interesting to see when some of us posted our difficulty with the job market, you slapped it down and said all was fine. What goes around, comes around.

 

[Kilgoretrout 65]

I am far removed, in time and space, from residency training, therefore, I ask:

(1) what is current percentage of AMG in pathology residencies?
(2) has the aforementioned percentage been stable or heading up or down?​

Last I saw the number of AMGs was going up. I like path but can't understand why a young person would do it today.

 

[Sulfinator]

So, KeratinPearls, are you on the job hunt, yourself, now? You having any more luck than your friend?

What about you, Napoleon?


Sent from my iPhone using SDN Mobile

 

[Silent Cool]

Last I saw the number of AMGs was going up. I like path but can't understand why a young person would do it today.

Residency crunch.

 

[TheTao]

The only winners are going to be the primary care fields.

Until they get replaced by NP's, PA's, and DNP's.


NO field of medicine is "safe" until the dust settles on Universal Healthcare.

 

[turtle1966]

Until they get replaced by NP's, PA's, and DNP's.


NO field of medicine is "safe" until the dust settles on Universal Healthcare.

You ignore the reality of Pathology, i.e., we have an unethical leadership hell-bent in selling us out for their filthy lucre!

 

[Gut Shot]

to not go lean as possible until we know when we have hot bottom.

Mmmmm, hot bottom.

I thought the Aca was going to be good for us by creating more insured patients but their ability to cut payments to at or below costs is frightening.

The scorched Earth changes to reimbursement are coming from the RUC via CMS - they do not rely on the legislative mandates in the ACA and were inevitable. Things are not going to turn around until it is evident that the current reimbursement rates are unsustainable. And if the corporate labs find a way to make them sustainable, well, time to move to Sweden.

 

[scienceguy19]

so how is the job market this year? People getting offers? I was told last year that it was the nadir in terms of jobs and that things would begin turning around...

 

[2121115]

so how is the job market this year? People getting offers? I was told last year that it was the nadir in terms of jobs and that things would begin turning around...

That was before the G-codes replaced the 88342. Now practices really don't have a good idea what their incomes will be going forward, only that it will be significantly less. Particularly if you are in a high complexity practice, which would be more dependent on the 88342. This is slowing down the job market considerably right now.

 

[ygdrasil]

My hope is to network with small community pathologists, get them to ask around to their colleagues, and perhaps find a small private job that way.

Many smaller, rural areas have big problems trying to attract pathologists, and often wind up having to pay beaucoup bucks in order to convince anyone to come out in the middle of nowhere to practice. If you're willing to do so, it could turn out good for you. If you can claim local family, or provide any other reason why you are actually interested in the region, all the better.

The problem is these smaller places don't know how to properly find applicants. They seem to mostly just ask around to their friends in the surrounding regions if anyone knows of someone looking to relocate, and so these rural openings can be difficult for you as an applicant to become aware of.

This is exactly how I got a lovely private practice job in the Midwest. I politely badgered the local pathology group where my in-laws live during residency (+1 year of SP fellowship). Now I'm two hours away from decent restaurant/theater/concert/club/airport, but other than that, I'm living the dream.

 

[2121115]

Now I'm two hours away from decent restaurant/theater/concert/club/airport, but other than that, I'm living the dream.

*** drop cup ***

 

[pathololology]

This is exactly how I got a lovely private practice job in the Midwest. I politely badgered the local pathology group where my in-laws live during residency (+1 year of SP fellowship). Now I'm two hours away from decent restaurant/theater/concert/club/airport, but other than that, I'm living the dream.

Haha!

 

[WEBB PINKERTON]

Nothing wrong with working in a rural area. Keeps competition down and many small towns have that Us vs Them mentality and love to do business local. It can be like stepping back in time to the 1950s. And people actually pay their bills!

 

[DermViser]

Just wanted to give my two cents.

My friend who is board certified with three fellowships has sent in his CV to more than 20 places with maybe 3 responses but has not heard anything since. The other places he sent in his CV, he hasn't heard anything at all.

At the academic place where I am at I am hearing candidates with two to three felowships who are interviewing for ajob.

No longer can you complete a surgical pathology fellowship and be confident in finding a job, you have to do a GI/dermpath fellowship to feel competitive.

Sucks to be in medical school and training for 5-7 years and have difficulty finding a job.

So sad that in such a vibrant specialty such as Pathology, that the situation is like this. I think it's even worse, when the heads of academia who post on SDN saying that somehow it's bc those people who aren't getting jobs are incompetent or give a Pauline Kael like comment that no one they know doesn't have a job. Talk about throwing salt in a wound.

 

[Silent Cool]

I've said it before and I will say it again. The problem is that inter-state health insurance commerce doesn't exist. Allow people to purchase health insurance across state lines and the problems will vanish. Patients and doctors will benefit/profit, and insurance companies will suffer.

 

[gbwillner]

I've said it before and I will say it again. The problem is that inter-state health insurance commerce doesn't exist. Allow people to purchase health insurance across state lines and the problems will vanish. Patients and doctors will benefit/profit, and insurance companies will suffer.

What is the rationale? I assume that when interstate insurance begins, companies will just renegotiate their contracts with physicians to lower reimbursements across the board to maintain profits and market share.

The only "real" solution is for physician services to provide the insurance themselves or make them non-profit entities.

 

[WEBB PINKERTON]

Some of the large hospital chains are getting into the insurance business.

Only a shortage could improve pathology. As long as there is this massive surplus, the race to the bottom will continue......

 

[gbwillner]

Some of the large hospital chains are getting into the insurance business.

Only a shortage could improve pathology. As long as there is this massive surplus, the race to the bottom will continue......

I disagree. I don't think a shortage will really improve much unless the way we get paid drastically changes. Reimbursements getting cut is the BIGGEST reason for the job problems. People are not hiring because they can't afford it- and they themselves have to work 30% more just to overcome the cuts to 88305. A shrinking applicant pool won't change that fact. You won't be getting better employment opportunities because there is no magical pool of money to draw a better salary from.

 

[Thrombus]

I disagree. I don't think a shortage will really improve much unless the way we get paid drastically changes. Reimbursements getting cut is the BIGGEST reason for the job problems. People are not hiring because they can't afford it- and they themselves have to work 30% more just to overcome the cuts to 88305. A shrinking applicant pool won't change that fact. You won't be getting better employment opportunities because there is no magical pool of money to draw a better salary from.

How do you think one obtains leverage in negotiations?

 

[gbwillner]

How do you think one obtains leverage in negotiations?

I'm not saying it wouldn't have an effect, I'm just saying its not the only thing that will improve pathology. All business decisions regarding hiring a pathologist, I imagine, are a combination of cost and quality. Some of us come at a premium regardless based on experience and training, and are less affected by the "glut". If all trainees are essentially the same, a reduction of applicants will affect chances of getting a job AND the compensation. But they are not the same. Regardless, unless there is more money being put into the system, there is no reason to suspect more money would be coming out of the other end, which is my point.

 

[turtle1966]

I disagree. .......... Reimbursements getting cut is the BIGGEST reason for the job problems. People are not hiring because they can't afford it- and they themselves have to work 30% more just to overcome the cuts to 88305. A shrinking applicant pool won't change that fact. You won't be getting better employment opportunities because there is no magical pool of money to draw a better salary from.

Starring: Hungry Johnny, a pathologist in the last months of his third fellowship, AP/CP + 2 sub-specialty boarded + soon to be 3rd sub-specialty board eligible, but deemed not good because has failed to land one of the plentiful jobs destined for the "good candidates".

Pizza Day at Home:
Johnny: Dad, I have no seat at the table and I am very hungry!!

Dad: Well, Johnny, it is a very complicated issue, you may not be able to understand it. They have just downsized our pizza. So you will have to wait till they give us a larger pizza, or till one of us tires out from so much chewing or drops dead!!

 

[Pathwrath]

All business decisions regarding hiring a pathologist, I imagine, are a combination of cost and quality. Some of us come at a premium regardless based on experience and training, and are less affected by the "glut". If all trainees are essentially the same, a reduction of applicants will affect chances of getting a job AND the compensation.

This sounds very reassuring to new well-trained pathologists hoping for an edge in a tight market, but I'm sorry, I don't agree with it at all. At all. I can no longer keep track of all the business my group has lost over the years from underselling by mediocre megalabs. Protestations of quality mean very little to clinicians driven by their bottom line, and in my experience they are in the majority. We tried--once--to resist yet another round of payment cuts by a GI scope mill by reminding them of our fellowshipped quality and extra-special service, and we were promptly replaced by a fulltime quack willing to work for peanuts. All of this is glut-driven.

 

[WEBB PINKERTON]

There is no doubt that the rise of the in-office labs and client billing for FAR below medicaid have gotten much worse due to the oversupply. This affects everyone no matter how competent you are.

We also have no clue what the "true" market is for pathologists because of all the waste that comes from the oversupply. Lot of unnecessary biopsies being performed, guidelines not being followed.

 

[gbwillner]

This sounds very reassuring to new well-trained pathologists hoping for an edge in a tight market, but I'm sorry, I don't agree with it at all. At all. I can no longer keep track of all the business my group has lost over the years from underselling by mediocre megalabs. Protestations of quality mean very little to clinicians driven by their bottom line, and in my experience they are in the majority. We tried--once--to resist yet another round of payment cuts by a GI scope mill by reminding them of our fellowshipped quality and extra-special service, and we were promptly replaced by a fulltime quack willing to work for peanuts. All of this is glut-driven.

The money issue transcends pathology. The clinicians are getting cheap because they are being squeezed as well. Everyone is looking for cheaper alternatives to everything right now to maintain their profits. Since we don't have access, in general, to the patient directly we will always bear the brunt of this. At the end of the day, even without glut you and I and everyone would be getting the short end of the stick right now. If it wasn't the quack it would be another megalab across the state line that would come in and do the business that you were too expensive for. If we had the opposite problem and there were too few pathologists who could negotiate better contracts, clinicians would look for ways to eliminate the need or payment for those services, like on CP billing. It's the Red Queen hypothesis, in a way. Again, I'm not saying that the "glut" isn't having a negative effect on the marketplace (far from it), but that it is definitely not the only factor at work and can't be blamed for everything. With ACA, volume should increase across the board. Wouldn't this make the "glut" disappear? But does ANYONE think ACA is a good thing and will fix our problems here? We all know the increase volume will come at lower compensation, meaning people will just work harder for the same pay and the increased volume will not erase the glut. Isn't the lack of reimbursement, then, an equal, if not bigger problem since it forces our colleagues in other departments to undercut us?

 

[Substance]

The money issue transcends pathology. The clinicians are getting cheap because they are being squeezed as well. Everyone is looking for cheaper alternatives to everything right now to maintain their profits. Since we don't have access, in general, to the patient directly we will always bear the brunt of this. At the end of the day, even without glut you and I and everyone would be getting the short end of the stick right now. If it wasn't the quack it would be another megalab across the state line that would come in and do the business that you were too expensive for. If we had the opposite problem and there were too few pathologists who could negotiate better contracts, clinicians would look for ways to eliminate the need or payment for those services, like on CP billing. It's the Red Queen hypothesis, in a way. Again, I'm not saying that the "glut" isn't having a negative effect on the marketplace (far from it), but that it is definitely not the only factor at work and can't be blamed for everything. With ACA, volume should increase across the board. Wouldn't this make the "glut" disappear? But does ANYONE think ACA is a good thing and will fix our problems here? We all know the increase volume will come at lower compensation, meaning people will just work harder for the same pay and the increased volume will not erase the glut. Isn't the lack of reimbursement, then, an equal, if not bigger problem since it forces our colleagues in other departments to undercut us?

The lack of reimbursements is a big problem, indeed, but I was under the impression that pathologists were still getting hosed even before the cuts.

The CAP postures that ACA is a good thing, but as you said, with the declining reimbursements, it just means that pathologists will work twice as much for half the pay,as will most other specialists.

I would say that, in addition to the ACA, the glut is probably the major factor in driving down pathologist revenues. As for your example of the megalab, I think that it would certainly not happen in the absence of a glut, since the megalab would probably not be able to find someone willing to work for their paltry sums.

This would be less of an issue if it wasn't so blatantly obvious that pathology is being staffed with multiple individuals who have no business being in medicine at all - a bunch got their degrees from offshore degree mills for chrissakes! Clearly their recruitment is serving some sort of ulterior profit-driven motive, probably due to megalab influence on the CAP or whatever. The fact that crappy academic and most community programs recruit low-functioning FMG/Carib residents as cheap alternatives to PAs is just a convenient run-off from the true purpose of the oversupply.