Shortage of Pathologists?

[pathstudent]

maybe the solution is for attendings to also gross specimens, and pathologists bill more for grossing. then maybe the excess of pathologists will be mitigated..

Pathologist can bill water the f they want. But Medicare dictates what you get paid and private insurance pays a multiplier of medicare depending on the contract ( a good contract would get you paid 1.5 times Medicare). If the patient is uninsured it doesn't matter what you bill because they won't be paying you except in rare instances.

Medicare pays $4 for grossing a specimen.

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[KCShaw]

..snip..
I'll refer those interested to the source of all knowledge in possession of mankind at present, Wikipedia
..snip..http://en.wikipedia.org/wiki/Prisoner's_dilemma

That's just about signature worthy.

 

[path24]

Residents gross....if institutions cared about educating residents, residents would be cutting back on their gross. Few attendings gross in practice, so why train residents on something they just need to be able to read about. (not saying get rid of grossing but a resident should just have to do a month or two) Residents are cheap labor and programs have no interest in paying for a pa.

30 jobs on CAP site!!! The other 570 job seekers this year...well good luck...haha.

If I was a clinician I would have the head of the path dept bringing me coffee every morning or I'll take my specimens elsewhere....its easy to courier/fedex anything to the massive supply of paths begging for business. Odds are i would be getting my starbucks.

I'll have to read that article again about shortages or maybe watch a powerpoint.....because those equal jobs. Hunting for a job is freaking depressing....only in pathology do doctors get to cold call for possible work.

Stay away from pathology, there is an obvious oversupply and no shortage even remotely on the horizon.

 

[scienceguy19]

So when it takes me 2 hours to gross a colon along with hunting for the 18 required lymph nodes, medicare only pays $4? That's so unfair.
i might as well fedex my unopened colon to india and have the grossing outsourced...

Pathologist can bill water the f they want. But Medicare dictates what you get paid and private insurance pays a multiplier of medicare depending on the contract ( a good contract would get you paid 1.5 times Medicare). If the patient is uninsured it doesn't matter what you bill because they won't be paying you except in rare instances.

Medicare pays $4 for grossing a specimen.

 

[2121115]

So when it takes me 2 hours to gross a colon along with hunting for the 18 required lymph nodes, medicare only pays $4? That's so unfair.
i might as well fedex my unopened colon to india and have the grossing outsourced...

No he is referring to a "gross only" specimen, such as synthetic mesh material.

 

[deleted314957]

So when it takes me 2 hours to gross a colon along with hunting for the 18 required lymph nodes, medicare only pays $4? That's so unfair.
i might as well fedex my unopened colon to india and have the grossing outsourced...

if it takes you 2 hours to gross ANY colon you need some work/instruction/time management skills/etc.

 

[pathstudent]

So when it takes me 2 hours to gross a colon along with hunting for the 18 required lymph nodes, medicare only pays $4? That's so unfair.
i might as well fedex my unopened colon to india and have the grossing outsourced...

If you grossed a colon cancer and didn't do a micro exam, yes you would be paid only $4. If you do a microscopic exam you can bill a 88309 which pays like 120 bucks or something like that for the gross and micro.

We don't do micros on amputations unless the clinician requests. We do gross only. So we get paid $4 instead of an 88309.

 

[scienceguy19]

it doens't take me 2 hours now but it did take me 2 hours the first time.

wow i thought the $4 dollars was a joke too... :/ how sad

If you grossed a colon cancer and didn't do a micro exam, yes you would be paid only $4. If you do a microscopic exam you can bill a 88309 which pays like 120 bucks or something like that for the gross and micro.

We don't do micros on amputations unless the clinician requests. We do gross only. So we get paid $4 instead of an 88309.

 

[pathstudent]

it doens't take me 2 hours now but it did take me 2 hours the first time.

wow i thought the $4 dollars was a joke too... :/ how sad

Well most gross only specimens take about 1 minute except for those ortho hardware or artificial heart valve specimes where you are trying to figure out how to describe it without sounding like a *****.

 

[scienceguy19]

hardware takes forever to dictate... and you have to dictate the serial number. sometimes you have 10 screws with 10 serial numbers. LVADs are a pain to dictate too

 

[KCShaw]

The op report (the nurse's portion is often already in the electronic system) should have the hardware's proper name or designation. I don't remember getting a lot of them, but I don't remember it being much more than "one intact metallic St. Blah bi-valve/rod/whatever with no visible defects, an engraved label representing "S/N 12345" (and possibly some generic A x B x C overall measurements), and scant adherent soft tissue" and that's about it. Things like LVAD's may need some comment about clots, etc. Unless there's a specific question you've been asked and feel you can answer it may not be in the pathologist's realm to biomechanically analyze or take niche detailed measurements of hardware. Experience may vary.

 

[lipomas]

Predicting the future is really hard. Predicting physician supply and needs is also very hard. Part of the reason why it's hard is that you need 4-5 years for any changes you make to have effect on the job market, and that is a best case scenario, not including years of modification and arguing and all that.

So if we cut residency spots sure that's great but it also won't take effect for 5 years. What if by that point there is clearly a need for more pathologists? Then it will take 5 years for any immediate changes to have effect. So in effect it's a ten year cycle. That's kind of nuts. That's also why simplistic arguments about how the job market sucks and residency spots need to be cut are way too simplistic.

I think what really needs to happen is that programs need to stop graduating crappy residents. In my opinion there is definitely NOT a shortage of pathologists. But there is what is approaching a shortage of quality pathologists.

 

[LADoc00]

Grossing makes no sense from a PC revenue prospective. Ive had all sorts of people tell me grossing is included in PC reimbursement and not TC, but never seen evidence to support that.

In my mind, if someone else is billing technical and you are billing PC, and you are doing the grossing, then you are an idiot.

 

[scienceguy19]

I predict that unless we cut the number of residency spots, there will be continual complaints about lack of jobs from residents

 

[2121115]

I predict that unless we cut the number of residency spots, there will be continual complaints about lack of jobs from residents

Haha. I think you are safe on that bet.

 

[smellycat]

Well most gross only specimens take about 1 minute except for those ortho hardware or artificial heart valve specimes where you are trying to figure out how to describe it without sounding like a *****.

Shiny, silver, 4 x 3 x 1 cm. Hard. Serial 12312124124. I see my face when I look at it. Gross only. = $4

 

[Joseph Ransohof]

I predict that unless we cut the number of residency spots, there will be continual complaints about lack of jobs from residents

If there are no jobs then people should avoid it like how they avoid nuclear medicine. Cut the number on residencies down and make room for more family med and internal residencies , I heard they are going to need some help in the future.

 

[Path or bust]

If there are no jobs then people should avoid it like how they avoid nuclear medicine. Cut the number on residencies down and make room for more family med and internal residencies , I heard they are going to need some help in the future.

In theory, yes that is the way it works in other specialties, even family medicine. However in pathology, FMGs fill those spots and academic medicine is quite happy with that, regardless. They actually want to INCREASE spots because of increasing volume at academic institutions.

Here is a PDF by Dr. McKenna from University of Michigan who says we'll have a huge workforce shortage. She advocates dramatically increasing residency positions.

www.pathology.ecu.edu/Public/graduate/SEAPC.pdf<cite>
</cite>

 

[mlw03]

very interesting presentation from Dr. McKenna. i'd not seen it before. i have a few thoughts:

1 - it strikes me as very narrow-minded, focusing primarily on the plight of the academic path department without worrying about the overall job market

2 - it advocates bringing on more residency spots, and the data to support needing more pathologists is very subjective at best.

3 - nothing is said about the current job market

4 - it makes assumptions that may or may not be true (plenty of pathologists will work past age 65)

In theory, yes that is the way it works in other specialties, even family medicine. However in pathology, FMGs fill those spots and academic medicine is quite happy with that, regardless. They actually want to INCREASE spots because of increasing volume at academic institutions.

Here is a PDF by Dr. McKenna from University of Michigan who says we'll have a huge workforce shortage. She advocates dramatically increasing residency positions.

www.pathology.ecu.edu/Public/graduate/SEAPC.pdf<cite>
</cite>

 

[Pathguy11]

In theory, yes that is the way it works in other specialties, even family medicine. However in pathology, FMGs fill those spots and academic medicine is quite happy with that, regardless. They actually want to INCREASE spots because of increasing volume at academic institutions.

Here is a PDF by Dr. McKenna from University of Michigan who says we'll have a huge workforce shortage. She advocates dramatically increasing residency positions.

www.pathology.ecu.edu/Public/graduate/SEAPC.pdf<CITE>
</CITE>

I found the presentation by Dr Kenna interesting but also agrees that the conclusions drawn based on population statistics and extrapolation does not necessarily reflect the nature of Pathology practices (especially AP work). Pathology is not like other clinical specialties in which there is a direct correlation between number of Patient's served and number of physicians needed for those patient's. Take family medicine for example. A family medicine doc can see a maximum "x" patient's in one day (obviously more with a PA but that is besides the point). If a family medicine group wants to expand to a patient population beyond their phsycian's maximum "x" then they will need to hire another physician/PA to see those patient's. Pathology is not like this. You may have a busy Pathology practice that acquires another contract or two which will mean you are serving even more patients. But more than likely this will just mean that the Pathologists in that practice will work a little harder. The work is more easily diffusable among Pathologists and thus there is a less direct link between the the number of Pathologists required to care for a given population. So when people try to use this sort of arguement about the baby boomers cause a huge shortage in Pathologists in the future, I want to laugh. That's is not to say that this population increase will not help the job market some (hopefully), in that it is easier to find a job of your choice. But then again I won't hold my breathe for this to happen. This whole thing is a gradual process anyway. It's not like one day we'll have a patient population boom paired with mass extinction of elderly Pathologists. But based on the current age demographics of practicing Pathologists I would not be surprised to improvement in the job market in 5-10 years. I mean the baby boomer Pathologist have to retire sometime...don't they ??? (seems like age 75 is the new 65 for retirement age).

 

[Joseph Ransohof]

I found the presentation by Dr Kenna interesting but also agrees that the conclusions drawn based on population statistics and extrapolation does not necessarily reflect the nature of Pathology practices (especially AP work). Pathology is not like other clinical specialties in which there is a direct correlation between number of Patient's served and number of physicians needed for those patient's. Take family medicine for example. A family medicine doc can see a maximum "x" patient's in one day (obviously more with a PA but that is besides the point). If a family medicine group wants to expand to a patient population beyond their phsycian's maximum "x" then they will need to hire another physician/PA to see those patient's. Pathology is not like this. You may have a busy Pathology practice that acquires another contract or two which will mean you are serving even more patients. But more than likely this will just mean that the Pathologists in that practice will work a little harder. The work is more easily diffusable among Pathologists and thus there is a less direct link between the the number of Pathologists required to care for a given population. So when people try to use this sort of arguement about the baby boomers cause a huge shortage in Pathologists in the future, I want to laugh. That's is not to say that this population increase will not help the job market some (hopefully), in that it is easier to find a job of your choice. But then again I won't hold my breathe for this to happen. This whole thing is a gradual process anyway. It's not like one day we'll have a patient population boom paired with mass extinction of elderly Pathologists. But based on the current age demographics of practicing Pathologists I would not be surprised to improvement in the job market in 5-10 years. I mean the baby boomer Pathologist have to retire sometime...don't they ??? (seems like age 75 is the new 65 for retirement age).

I agree with Pathguy 11 and Mlw3. Their answers are logical.

 

[pathstudent]

Completely agree. Her analysis is partially based on assumptions which are definitely false or possibly false.

I found the presentation by Dr Kenna interesting but also agrees that the conclusions drawn based on population statistics and extrapolation does not necessarily reflect the nature of Pathology practices (especially AP work). Pathology is not like other clinical specialties in which there is a direct correlation between number of Patient's served and number of physicians needed for those patient's. Take family medicine for example. A family medicine doc can see a maximum "x" patient's in one day (obviously more with a PA but that is besides the point). If a family medicine group wants to expand to a patient population beyond their phsycian's maximum "x" then they will need to hire another physician/PA to see those patient's. Pathology is not like this. You may have a busy Pathology practice that acquires another contract or two which will mean you are serving even more patients. But more than likely this will just mean that the Pathologists in that practice will work a little harder. The work is more easily diffusable among Pathologists and thus there is a less direct link between the the number of Pathologists required to care for a given population. So when people try to use this sort of arguement about the baby boomers cause a huge shortage in Pathologists in the future, I want to laugh. That's is not to say that this population increase will not help the job market some (hopefully), in that it is easier to find a job of your choice. But then again I won't hold my breathe for this to happen. This whole thing is a gradual process anyway. It's not like one day we'll have a patient population boom paired with mass extinction of elderly Pathologists. But based on the current age demographics of practicing Pathologists I would not be surprised to improvement in the job market in 5-10 years. I mean the baby boomer Pathologist have to retire sometime...don't they ??? (seems like age 75 is the new 65 for retirement age).

 

[deleted314957]

as an older ( 60 yo) pathologist i could easily do twice the billable work that i do. i am sure not breaking my ass and from what i know from peers it is pretty much the same. the work is interesting, intellectually stimulating and pays well. you are not going to see retirements nearly at the scale that cops, post office folks, industrial folks, etc. my bro-in-law is in telecommunication sales and he can't wait to retire.

 

[Tissue issue]

I found the presentation by Dr Kenna interesting but also agrees that the conclusions drawn based on population statistics and extrapolation does not necessarily reflect the nature of Pathology practices (especially AP work). Pathology is not like other clinical specialties in which there is a direct correlation between number of Patient's served and number of physicians needed for those patient's. Take family medicine for example. A family medicine doc can see a maximum "x" patient's in one day (obviously more with a PA but that is besides the point). If a family medicine group wants to expand to a patient population beyond their phsycian's maximum "x" then they will need to hire another physician/PA to see those patient's. Pathology is not like this. You may have a busy Pathology practice that acquires another contract or two which will mean you are serving even more patients. But more than likely this will just mean that the Pathologists in that practice will work a little harder. The work is more easily diffusable among Pathologists and thus there is a less direct link between the the number of Pathologists required to care for a given population. So when people try to use this sort of arguement about the baby boomers cause a huge shortage in Pathologists in the future, I want to laugh. That's is not to say that this population increase will not help the job market some (hopefully), in that it is easier to find a job of your choice. But then again I won't hold my breathe for this to happen. This whole thing is a gradual process anyway. It's not like one day we'll have a patient population boom paired with mass extinction of elderly Pathologists.

Completely agree- all the more reason to wait until (or if) the job market ever improves before we start increasing residency slots.

But based on the current age demographics of practicing Pathologists I would not be surprised to improvement in the job market in 5-10 years. I mean the baby boomer Pathologist have to retire sometime...don't they ??? (seems like age 75 is the new 65 for retirement age)

Another good point- and that 10 year difference means over 6,000 more new pathology residents (~600 new path residents/year).

And FWIW, in the 90's we were also told of an upcoming pathologist shortage and I was hopeful then as you are today that the job market would improve in 5-10 years. Didn't happen.

.

 

[Joseph Ransohof]

as an older ( 60 yo) pathologist i could easily do twice the billable work that i do. i am sure not breaking my ass and from what i know from peers it is pretty much the same. the work is interesting, intellectually stimulating and pays well. you are not going to see retirements nearly at the scale that cops, post office folks, industrial folks, etc. my bro-in-law is in telecommunication sales and he can't wait to retire.

Their is an assumption from Individuals in my class that pathologist do not earn enough to live comfortably. So I did check Medscape Annual income report. The analyst failed to mention the income of pathologist. I know people say it is not about money but thats cognitive dissonance speaking when they say that. I have provided a link to anyone who wants to check it out.

http://www.medscape.com/features/slideshow/compensation/2011

 

[yaah]

Their is an assumption from Individuals in my class that pathologist do not earn enough to live comfortably. So I did check Medscape Annual income report. The analyst failed to mention the income of pathologist. I know people say it is not about money but thats cognitive dissonance speaking when they say that. I have provided a link to anyone who wants to check it out.

http://www.medscape.com/features/slideshow/compensation/2011

That's weird because I just took a medscape income survey a few weeks ago. Maybe they didn't get enough respondents to give real data. Pathologists might not be as active on medscape as other specialties. Who knows.

 

[2121115]

Their is an assumption from Individuals in my class that pathologist do not earn enough to live comfortably. http://www.medscape.com/features/slideshow/compensation/2011

Many pathologists don't. However, many live very comfortably. There is huge difference between the low end and the high end. The tricky part is avoiding the low end and getting to that high end.

 

[cjw0918]

I've seen lots of pathologists in his age range who feel the same way. They enjoy their work, aren't killing themselves, so why would they leave?? It just sucks for the younger generation because the old guys are hogging the few remaining decent jobs. I think LA once said we needed mandatory retirement at age 65. Ha ha.
The only retirements I've seen have been due to declining health. Hell, I know one guy s/p heart transplant, with CLL, and other co-morbidities who's still at the scope. No one seems to leave just to retire. They gotta have a reason.

 

[dr4n6]

One of my former colleagues was in his upper 70's, who I clearly do not think was working for the money and worked until the week before he died as a result of a GBM. The guy was even taking call up until two weeks before his death.

 

[Pathguy11]

Their is an assumption from Individuals in my class that pathologist do not earn enough to live comfortably. So I did check Medscape Annual income report. The analyst failed to mention the income of pathologist. I know people say it is not about money but thats cognitive dissonance speaking when they say that. I have provided a link to anyone who wants to check it out.

http://www.medscape.com/features/slideshow/compensation/2011

The people in your medical school class are misinformed. Most Pathologists I know are doing just fine financially. There are plenty of other salary surveys online that you can find to get a ballpark idea. Another comment earlier is also true though that there is a huge variation between earning based on years in practice, practice setting, partnership, etc. I wish more people believed what what those in your med school class thought because then there would be less people going into Path. I actually heard just the opposite when I was in medical school and that was a small part of the attraction to the field. Now that I am starting practice I feel that the "numbers" that attracted me early on are for the most part true.

Pathguy11

 

[2121115]

I've seen lots of pathologists in his age range who feel the same way. They enjoy their work, aren't killing themselves, so why would they leave?? It just sucks for the younger generation because the old guys are hogging the few remaining decent jobs. I think LA once said we needed mandatory retirement at age 65. Ha ha.
The only retirements I've seen have been due to declining health. Hell, I know one guy s/p heart transplant, with CLL, and other co-morbidities who's still at the scope. No one seems to leave just to retire. They gotta have a reason.

Exactly. Being a partner in a traditional private pathology practice is too good of a job to retire. Think about it. Why would you leave? Hey, you own the practice right? Why not just hire someone else to do the grunt work and live off the fat of the land? Especially when there are plenty of people willing to do the grunt work for less money than the revenue they generate. If I owned my practice I would probably hire 8 part time pathologists to sign out all the cases while I network with admin a few days per week, run a few tumor board for face time, and play golf.

In fact, this is also exactly how many academic centers are set up. The underlings who sign out the cases come and go, make less than 130K and get burned out fast, while a select few make it up the food chain and get "off service research time"(aka do no real work), make better $$$, and go to meetings. If it weren't for pathologist oversupply, this model couldn't exist. But that's life.

 

[pathstudent]

I've seen lots of pathologists in his age range who feel the same way. They enjoy their work, aren't killing themselves, so why would they leave?? It just sucks for the younger generation because the old guys are hogging the few remaining decent jobs. I think LA once said we needed mandatory retirement at age 65. Ha ha.
The only retirements I've seen have been due to declining health. Hell, I know one guy s/p heart transplant, with CLL, and other co-morbidities who's still at the scope. No one seems to leave just to retire. They gotta have a reason.

Old pathologists never retire. They just slide away. I completely disagree with mandatory retirement age. Given the future of America, the economy,medicine and pathology, I will be working until I drop dead.

 

[deleted314957]

i can only speak for myself but when i became a partner in pp i made average 600k/yr in 1992 dollars. than we sold(or as path student would say) hosed young pathologists. since then my salary has been comparable to a general orthopod. i sure can't bitch. and, as an aside---most all doctors will poor-mouth when asked about income and seriously low ball any survey. myself and any colleague i have discussed it with agree. why the hell would i tell the public how much i make?

 

[pathstudent]

Exactly. Being a partner in a traditional private pathology practice is too good of a job to retire. Think about it. Why would you leave? Hey, you own the practice right? Why not just hire someone else to do the grunt work and live off the fat of the land? Especially when there are plenty of people willing to do the grunt work for less money than the revenue they generate. If I owned my practice I would probably hire 8 part time pathologists to sign out all the cases while I network with admin a few days per week, run a few tumor board for face time, and play golf.
life.

It might work but surgeons and othe docs aren't stupid. If they realized you just hired a bunch of douches who don't their stuff, your group will lose its contract.

 

[levels x3]

Many pathologists don't. However, many live very comfortably. There is huge difference between the low end and the high end. The tricky part is avoiding the low end and getting to that high end.

Huh? Many pathologists don't live comfortably? You know full-time pathologists working for under 50k a year? Don't misunderstand, I wouldn't do this job for much less than what I make now (way...way more than 50k). Too much liability, too much stress. But let's realistically define the word "comfortable". If you do know full-time attending pathologists who can't make rent and put food on the table, then I don't really know what to say.

 

[levels x3]

as an older ( 60 yo) pathologist i could easily do twice the billable work that i do. i am sure not breaking my ass and from what i know from peers it is pretty much the same. the work is interesting, intellectually stimulating and pays well. you are not going to see retirements nearly at the scale that cops, post office folks, industrial folks, etc. my bro-in-law is in telecommunication sales and he can't wait to retire.

This is key. I am 32 yo, in practice for 2.5 years in a 5 person group. 3 of my partners are between 60 and 65 yo. I'm catching up to them in terms of productivity, but really, mikesheree is right. Some of them could do twice what I do without breaking a sweat. I swim in a sea of cortisol, while they garden and play golf. With a few more years, I'll be able to absorb that volume too though. That's what experience gets you.

In contrast to mikesheree's comments, those partners are looking to retire in the coming years, some soon. They just want to slow down and do other things. But following with what has been said, we won't need to replace the first retiree. We would the second. There will not be a 1 to 1 replacement of pathologists going forward. But soon enough, all 3 will go, and the 2 of us left aren't going to want to deal with our volume, not to mention the resulting every other week call schedule.

I don't really know what this means for the future job market. In training, I was told that 3-4k surgicals per pathologist was a good target. I think that has gone up already. With adequate support staff (which I...arrgh...don't have...) I could do more than that now. Someday soon though, we will be looking to hire...and there must be other groups like mine out there.

 

[Joseph Ransohof]

Will bad credit ruin once chances to get into a program? will good credit help?

 

[mlw03]

Will bad credit ruin once chances to get into a program? will good credit help?

i've not heard of a program running credit checks on a residency applicant.

 

[mlw03]

It might work but surgeons and othe docs aren't stupid. If they realized you just hired a bunch of douches who don't their stuff, your group will lose its contract.

How sure are you of this? As in, how does the urologist know you made the right diagnosis on their specimen? Didn't miss a small focus of prostate CA? Gave the resection specimen the right Gleason/Furman grade? Evaluated the margins all correctly? We all know the interobserver variability in path is quite high - how does a clinician know if something is slightly off? Agree you can't hire a bunch of totally incompetent pathologists, but how would a clinician spot a semi-competent one?

 

[pathstudent]

How sure are you of this? As in, how does the urologist know you made the right diagnosis on their specimen? Didn't miss a small focus of prostate CA? Gave the resection specimen the right Gleason/Furman grade? Evaluated the margins all correctly? We all know the interobserver variability in path is quite high - how does a clinician know if something is slightly off? Agree you can't hire a bunch of totally incompetent pathologists, but how would a clinician spot a semi-competent one?

Because enough stuff goes out for review that they can easily and quickly get a good idea how competent the pathologist is. Plus docs don't like having multiple people rotate through a department too often. The feedback will eventually get to the admins and then if it continues the heat will be put on the pathologist holding the contract

 

[pathstudent]

i can only speak for myself but when i became a partner in pp i made average 600k/yr in 2002 dollars. than we sold(or as path student would say) hosed young pathologists. since then my salary has been comparable to a general orthopod. i sure can't bitch. and, as an aside---most all doctors will poor-mouth when asked about income and seriously low ball any survey. myself and any colleague i have discussed it with agree. why the hell would i tell the public how much i make?

Completely agree. I don't trust salary surveys at all, no matter who publishes it If they were based on tax returns then I would have more faith in them.

 

[deleted314957]

This is key. I am 32 yo, in practice for 2.5 years in a 5 person group. 3 of my partners are between 60 and 65 yo. I'm catching up to them in terms of productivity, but really, mikesheree is right. Some of them could do twice what I do without breaking a sweat. I swim in a sea of cortisol, while they garden and play golf. With a few more years, I'll be able to absorb that volume too though. That's what experience gets you.

In contrast to mikesheree's comments, those partners are looking to retire in the coming years, some soon. They just want to slow down and do other things. But following with what has been said, we won't need to replace the first retiree. We would the second. There will not be a 1 to 1 replacement of pathologists going forward. But soon enough, all 3 will go, and the 2 of us left aren't going to want to deal with our volume, not to mention the resulting every other week call schedule.

I don't really know what this means for the future job market. In training, I was told that 3-4k surgicals per pathologist was a good target. I think that has gone up already. With adequate support staff (which I...arrgh...don't have...) I could do more than that now. Someday soon though, we will be looking to hire...and there must be other groups like mine out there.

I believe you are right on the money. When I retire ( and no immediate plans) there will be no new hire. It will tighten the schedule for the "floats" who cover during vacations,CME, etc. but our field is really getting leaner and meaner.
Someone recently stated a figure of 3000-4000 surgicals per year.
I am stunned--for a number of years i did 11,000/yr, although most were quite routine but if I did 4k/ year now i would finally have time to read "War and Peace"
as I sat in my scan recliner at work. I do about 8500 very general per year.

 

[malchik]

How sure are you of this? As in, how does the urologist know you made the right diagnosis on their specimen? Didn't miss a small focus of prostate CA? Gave the resection specimen the right Gleason/Furman grade? Evaluated the margins all correctly? We all know the interobserver variability in path is quite high - how does a clinician know if something is slightly off? Agree you can't hire a bunch of totally incompetent pathologists, but how would a clinician spot a semi-competent one?

At our residency there are big name surgeons who love this pathologist who is young and has a good rapport with them, but she is overly confident and gets a lot of cases wrong. The surgeons either don't know or don't care.

 

[veo1]

Here is a PDF by Dr. McKenna from University of Michigan who says we'll have a huge workforce shortage. She advocates dramatically increasing residency positions.QUOTE]

There is a serious disconnect between how our leadership view the current situation and what is really going on here in the trenches. I'll repost a comment of mine from another thread with regards to this topic as I think its relevant to this topic:

'The scary part is that during an interview I sat down with a department chair who basically explained the above situation to me. He furthermore indicated that former residents/fellows from his program that he has maintained contact with have expressed their frustration with the job market. The craziest thing is that he said that he believed that we need to increase the number of residency positions in pathology given the increase in the number of medical school graduates, arguing "Where will all of the foreign graduates go with the increase in American graduates?". I was shocked. This was a very bright department chair at an academic institution whose program has mostly foreign grads. Simply unreal. Our profession shouldn't exist to supply foreign medical graduate residency positions.'

Yet another individual with no clue and failing to see the big picture. These people are leading our profession! We need to address these issues in the appropriate forum so that these people can see the reality of the current job market. Many of you have expressed the fact that despite future retirements the workload will just be taken up by pathologists currently in practice. The rules that dictate supply and demand in other specialties simply don't apply to ours. Why don't people realize this?

 

[Path or bust]

Here is a PDF by Dr. McKenna from University of Michigan who says we'll have a huge workforce shortage. She advocates dramatically increasing residency positions.QUOTE]

There is a serious disconnect between how our leadership view the current situation and what is really going on here in the trenches. I'll repost a comment of mine from another thread with regards to this topic as I think its relevant to this topic:

'The scary part is that during an interview I sat down with a department chair who basically explained the above situation to me. He furthermore indicated that former residents/fellows from his program that he has maintained contact with have expressed their frustration with the job market. The craziest thing is that he said that he believed that we need to increase the number of residency positions in pathology given the increase in the number of medical school graduates, arguing "Where will all of the foreign graduates go with the increase in American graduates?". I was shocked. This was a very bright department chair at an academic institution whose program has mostly foreign grads. Simply unreal. Our profession shouldn't exist to supply foreign medical graduate residency positions.'

Yet another individual with no clue and failing to see the big picture. These people are leading our profession! We need to address these issues in the appropriate forum so that these people can see the reality of the current job market. Many of you have expressed the fact that despite future retirements the workload will just be taken up by pathologists currently in practice. The rules that dictate supply and demand in other specialties simply don't apply to ours. Why don't people realize this?

I think it's really unfortunate. The fact is that we have a lot of "type B" passive people who think things are just fine because it doesn't really affect them. They would rather do nothing as our specialty is taken apart piece by piece by Labcorp, Quest, Ameripath and pod labs. We help those corporations by oversupplying/saturating the market.

I like to compare it to the current state of affairs in our country with regards to our national debt. Congress only looks to fulfill the needs of today's society, their districts and what they see as important. There is no outlook to the future and the tremendous debt we will leave future generations.

 

[Tissue issue]

Wandered over to the ENT forum as I had a random chat with an ENT surgeon recently out into practice. I quickly came across this quote:

"At any given time, there are between 2500-3500 positions in the US available for ENT's. It's a buyer's market. You're the buyer. You're no longer competing against 600 people for 250 positions. It's the other way around. We should be selling ourselves to you to get the best of you out there."

 

[pathstudent]

Wandered over to the ENT forum as I had a random chat with an ENT surgeon recently out into practice. I quickly came across this quote:

"At any given time, there are between 2500-3500 positions in the US available for ENT's. It's a buyer's market. You're the buyer. You're no longer competing against 600 people for 250 positions. It's the other way around. We should be selling ourselves to you to get the best of you out there."

And aren't there only like 200 ents coming out each year? And it soon could be fewer if they really want to reduce the number of specialists and increase the number of family practice docs and pediatricians.

Just checked nrmp data. there are 283 positions in ent at least last year. Interesting to note that more us med students apply for ent than apply for pathology (which has almost twice as many spots) and therefore ent fills almost 100% with mags while pathology fills 50%with amgs.

 

[Substance]

And aren't there only like 200 ents coming out each year? And it soon could be fewer if they really want to reduce the number of specialists and increase the number of family practice docs and pediatricians.

Just checked nrmp data. there are 283 positions in ent at least last year. Interesting to note that more us med students apply for ent than apply for pathology (which has almost twice as many spots) and therefore ent fills almost 100% with mags while pathology fills 50%with amgs.

This is not a surprising statistic, which probably has a lot to do with there being too many residency spots. Pathology has never been popular with medical students for a lot of reasons which may include:
1. Percieved low reimbursement
2. Percieved low autonomy
3. Perceived low respect on the hospital hierarchy
4. They've never heard of pathology
5. Autopsies
6. The stigma of being a lab weirdo
7. Histology exposure in medical school is boring as heck
8. Too many residency programs that are IMG magnets

Notice how I did not say "no patient contact"; radiology, which is a similar field, has no problem finding AMGs to fill spots.

I think that your field should cut residency spots in half and cut IMG spots down to 1% of what they are now.

 

[pathstudent]

And hasn't Dr. Mckenna been reading the newspapers? We need more family practice docs and pediatricians. Specialists such as pathologists are overutilized and contribute to the increasing cost of medicine.

It is very irresponsible to advocate increasing the number of specialists when the overall health of the nation is going into the toilet and primary care is in such dire shortage and costs are skyrocketing.

 

[UMDdoc]

That is overly extreme.

First off, your second paragraph applies to every field of medicine except perhaps cosmetics. Everyone is getting squeezed - why do you think clinicians are coming after pathology (and even radiology) as a revenue source? Medicine is changing everywhere - there are a lot of delusional thoughts out there from people entering medicine as a career with the assumption that they are going to have a great, low stress, high pay job guaranteed wherever and whenever they want it. Doesn't work that way. If you get into a high-demand field (like say, Ophtho) you can often write your own ticket but in order to do that you not only have to deal with everything that goes into getting to that point, but you also have to deal with an awful lot of stuff that comes with this demand. A lot of people hate this and want out. So would you, probably, based on your analysis.

I really wonder if anyone who posts such negative things on these forums ever actually talks to any other clinicians. "A bright future in another field practicing medicine, making money, and setting the terms of your career." Are you serious? There are tradeoffs everywhere.

Your other points are valid - but to be fair, who on earth would ever recommend entering a career that you haven't thought seriously about? Who does this? You have to consider everything that goes into it. There are jobs in pathology. They are not always where you want them, when you want them. This sucks but it's reality. And it is not limited to pathology. Even radiology grads are having trouble.

I wouldn't change my career path. I have a great job in the exact city I wanted. Clearly, the timing worked out well for me, but I also know from being in my job for 3 years that there are vast, vast differences among people looking for jobs. The good candidates will almost certainly end up doing well. It may take moving around or "settling" for awhile until the right job opens up, but again, this also happens in every other field.

When you are analyzing pathology and whether it is a future career, you have to be honest about the limitations but you also have to be very cautious to not overblow the aspects of other careers that you find appealing while minimizing the problems. As well as paying attention to the future of the field and what your role in it will be. Yes, you will have to work hard to be successful. Things aren't just going to open up for you unless you get lucky. This is news to people?

Thanks for the encouraging post amongst the fields of dread on this forum. I am planning to match to pathology next month. I hope to match where there are derm or heme fellowships as those are my primarly desired fellowships. I worked at both a private owned (mom & pop) lab as well as the evil L**Corp, prior to entering medical school. I don't think alot of the pathologist out there realize the the problems in other popular specialties like ER, Rads, and Anesthesia. Many of the staff often gripe about their current situation. It appears that the grass is always greener on the other side no matter what specialty you choose. I, for one, have no desire to practice anything but pathology and I am finishing from a well respected school, and hope to have a successful career in my future. I also understand that when you choose your specialty you have to play by the rules of the game. In this game, there are several exploitative practices as well as a demand to move wherever jobs are available. I plan to do this as well and hopefully avoid any exploitation through selection of a great residency with ample fellowship opportunities. I am curious if the majority of posters are AP only, and if that is contributing to lack of employment opportunities.