Supply/Demand Projections and Job Market Survey

[zao275]

Yes, this is yet another thread about this endless topic. However, this thread is about sharing DATA regarding projections of future supply/demand for pathologists and the current state of the job market. This data was presented at the spring joint session of the CAP House of Delegates and Residents Forum in San Antonio. You may or may not like or agree with the data, but in my opinion, it sure beats endless anecdotes that we always hear. At least someone is trying to look into these issues and figure out what is actually happening.

PDF of the meeting powerpoint slides is here: http://www.cap.org/apps/docs/pathology_residents/pdf/joint_session_presentation_slides.pdf

Job Market survey starts on page 59.

Supply/Demand projection starts on page 85.


Hope this is useful to some of you.

Best,

Jerad

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[raider]

Good, 94% agree that too few jobs are available. The remaining 6% are probably demented.

So what does CAP intend to do about this problem?

 

[zao275]

Did you read the projected supply/demand data (beginning on page 85)? If I understand correctly, this data suggests that although current supply slightly outweighs demand, demand should rapidly outpace supply beginning in the next 5 years or so. I do not understand the science behind this market research, nor am I qualified to comment on its veracity, but this is the data that was presented.

 

[raider]

Read it, sounded like the usual BS including my favorite "approaching retirement cliff".

My opinion of future predictions is that it is statistical BS and involves simplifying too many variables (including many not taken into account by the piece of crap churned out by low IQ types). If you have a low IQ you will believe this. Look at the freaking economic impact line(the yellow line). Laughable. I hope no-one paid these useless creeps for this misinformation. Let me tell you this right now all future predictions based on statistical models are NONSENSE. If you do not believe me, follow the predictions of stock market analysts (who are paid millions for this type of nonsense) and see how often they are completely wrong. more often than not betting AGAINST THE prediction (being a contrarian) is the way to be right. There are a gazillion other similar examples.

I would pay much much more attention to the present reality and confront the problem in real time. The weather people are right because they confine their predictions to a couple of weeks at most. Thats the best you can hope for.

But obviously, such BS is useful to detract from taking any "current" concrete steps. All it is, is a lame excuse for doing nothing or making the situation worse. Seen it and heard it all before.

Ignoring the "current reality" for some "future statistical projection" is beyond *****ic. You have to have an IQ of like 22 or lower to fall for such chicanery.

 

[pathstudent]

What is the summary about supply vs demand? It would be smart to aim for supply to be slightly less than demand. Better to have fewer people work longer and harder with increased income vs too many with less work.

 

[Entgegen]

Did you read the projected supply/demand data (beginning on page 85)? If I understand correctly, this data suggests that although current supply slightly outweighs demand, demand should rapidly outpace supply beginning in the next 5 years or so. I do not understand the science behind this market research, nor am I qualified to comment on its veracity, but this is the data that was presented.

I listened to the HOD audio presentation of this data on the CAP website a little over a week or so ago, and if I remember correctly they were basing the impending increase in demand on the increasing number of older baby boomers getting more testing as they age. So if they're projecting sharp increase in demand, the CAP may take a stance of "yeah it's tough right now but hang in there...it'll get better" and just advocate staying the course. Or worse, they may try to lobby to increase residency spots based on a coming pathology shortage that may or may not actually manifest itself. We'll see...

Also, I seem to remember a lot of mention of "this is just a small amount of data, we're not quite sure what it means yet, and we need more" on the audio. Not that I'm against gathering more data, but they may use this lack-of-sufficient-data as an excuse to do nothing.

 

[zao275]

What would all of you suggest should be done if, indeed, there is too much supply? I know that cutting residency spots is the main suggestion. But who would do that and how? Are we suggesting that CAP lobby with APC/PRODS or individual programs or even the ACGME to decrease the number of spots? ACGME sets the allowed number at each program. PD's at each program decide how many spots they choose to actually fill. CAP is not actually part of the equation, either to decrease or increase spots, if I understand correctly.

Raider's point is well taken (aside from the ad hominem arguments regarding low IQ) that future projections, especially long term, are often incorrect or unreliable.

 

[raider]

1. Start by acknowledging there is a problem.

2. Highlight the problem is a top priority.

3. Let ACGME Pathology RRC know about the problem. They can control the number by changing accreditation requirements (e.g. increasing number of surgicals each resident must look at etc. etc )and what not. Raising the bar, will deny many useless programs the accreditation they have. These junk programs should close down anyway. It is definitely doable if one is committed.

Saying that CAP cannot do anything is totally false.

By the way the site address for ACGME Path RRC is http://www.acgme.org/acWebsite/navPages/nav_300.asp, you can see who constitutes it and what it is all about. Maybe zao 275 you should consider membership (way to membership is listed on the webpage). There is a dire need for more proactive people with the right vision.

 

[yaah]

There needs to be a better way (or a more thorough way) of evaluating pathology programs and whether they are training residents adequately. Unfortunately, it's hard to use things like Boards passing rates or % in job placement, because people jump to different programs for fellowship and it's hard to weigh different factors. But there needs to be some way of evaluating residency programs so that the chaff can be discarded and the better programs allowed to continue (and not keep expanding!). Maybe all programs should have a required minimum defined volume, specimen load, etc. If you don't have enough specimens, you can't train residents. Perhaps unfair to the few small programs which do train excellent residents, but pathology unlike other fields requires high volume and variety in training to attain the best level of competence.

 

[raider]

I agree with yaah. Under 13,000 specimens (with 1/3 being placentas) and 15+ residents spending most of their time grossing. WTF!!! sort of training is this for people who on graduating will be making critical decisions that determine how a patient will be treated. If you do not get how bad this is: picture for a second this poorly trained newbie deciding whether your loved one has a spitz or a melanoma or an ADH vs. DCIS or the legion of very difficult problems that confront diagnosticians everyday. Diagnosis is a very difficult and critical area of patient care requiring much more training than a lot of other medical fields. Only the brightest, the best and the highly trained should be allowed to do it.

More stringent requirement for programs. X number of specimens from derm, hem, molecular etc with faculty spending X amount of "dedicated" time teaching.

It is these "very lax" training requirements that have lead to the current lamentations about how woefully unprepared the new graduating residents are.

 

[yaah]

Only 1% took jobs working for other physicians (i.e pod labs). And only 6% for a commercial lab. That seems low to me given what people talk about on these forums.

I am also surprised that only 6% say they are "employed by a hospital." Perhaps new hires don't really have an understanding of their environment? There are many hospital-employee pathologists out there, and I think it would be more than 6%. Maybe some consider themselves "academic" though. It also doesn't really make sense that the "full time" and "part time" positions together exceed 100%. Are some people taking more than 1 job?

Somehow, CAP or whoever needs to contact these legions of unemployed pathologists (according to these forums, anyway) and survey them. Because according to this survey everyone got a job.

 

[cjw0918]

I never believe any of the surveys sponsored by pathology professional organizations. They have a vested interest in perpetuating this profession regardless of supply vs. demand issues and whether or not there are too few jobs. I cannot imagine any professional organization in any occupation coming out and saying that there are too few job opportunities with no relief in sight, even if it were the unequivocal truth. Law schools still collect massive tuition fees knowing full well their graduates can't find employment. I don't expect the professional organizations of pathology to want to confront our job market problems either. They exist for self-serving purposes, not to help solve the complicated problem of too few QUALITY jobs available for qualified pathology job-seekers.

 

[raider]

Fewer and better trained people is a win-win for all (except some unscrupulous PDs). These PDS were probably weak diagnosticians and are hanging on to their jobs by doing admin BS (since they cannot sign out sh-t).

 

[scienceguy19]

The most frequent concern we hear these days is the shortage of primary care physicians and impending severe shortage in the future. Now the government spends a lot of money to fund our residency programs. Perhaps they should reallocate the money used to fund some pathology spots to fund more primary care spots. That might be a better use of taxpayer dollars rather than training pathologists who have difficulty finding a job.

Even if we project an increase in demand of pathologists in the future, it still makes more sense to address the current problem (lack of primary care doctors, excess of pathologists).

 

[lurksalot]

Only 1% took jobs working for other physicians (i.e pod labs). And only 6% for a commercial lab. That seems low to me given what people talk about on these forums.

I am also surprised that only 6% say they are "employed by a hospital." Perhaps new hires don't really have an understanding of their environment? There are many hospital-employee pathologists out there, and I think it would be more than 6%. Maybe some consider themselves "academic" though. It also doesn't really make sense that the "full time" and "part time" positions together exceed 100%. Are some people taking more than 1 job?

Somehow, CAP or whoever needs to contact these legions of unemployed pathologists (according to these forums, anyway) and survey them. Because according to this survey everyone got a job.

Agree that the 6% seems a little low. However, remember even in academics, physicians aren't necessarily employed by the hospital. Here in Boston, for example, physicians on staff at MGH receive their paychecks from MGPO. Beth Israel Deaconess staff physicians are employed by Harvard Medical Faculty Physicians.

Several years ago when I was looking at jobs, only one of the jobs I was offered was a hospital employee job. But agree, 6% still seems low.

 

[DoctorMD1]

1. Start by acknowledging there is a problem.

2. Highlight the problem is a top priority.

3. Let ACGME Pathology RRC know about the problem. They can control the number by changing accreditation requirements (e.g. increasing number of surgicals each resident must look at etc. etc )and what not. Raising the bar, will deny many useless programs the accreditation they have. These junk programs should close down anyway. It is definitely doable if one is committed.

Saying that CAP cannot do anything is totally false.

By the way the site address for ACGME Path RRC is http://www.acgme.org/acWebsite/navPages/nav_300.asp, you can see who constitutes it and what it is all about. Maybe zao 275 you should consider membership (way to membership is listed on the webpage). There is a dire need for more proactive people with the right vision.

Could not agree more!!! I wonder what would be Dr. Gadner input regarding above.

 

[redapple123]

..............

 

[DIce3]

I wish that was possible as my wife is applying for an internal medicine residency. Three months of credit are available for doing a pathology residency. This would be fine with us as we just want her to get out of the rotating pathology slavery jobs circuit.

 

[Enkidu]

How about creating a bridge for trained pathologists to go to primary care by allowing them to do a truncated rotations in say 1 or 1.5 yr. This way I can see my pateints , refill HTN,DM,Cholesterol drugs and perform and read FNA's, biopsies etc. It is better to be dumb and have a job rather than smart ass and jobless.

I think you've brought up this idea before. It still doesn't make sense. Why primary care? That's not even related to pathology.

In any case, 100% of pathologists surveyed got a job and they're making more than primary care. I bet they're all happy that they don't have to spend their days refilling hypertension drugs.

There are plenty of ways that pathologists could branch out to see patients if they wanted (and if they get their act together). That in vivo microscopy stuff, they can probably get into genome interpretation and genetic counseling, transfusion medicine and cellular therapy... no need to volunteer to do school physicals and weight-loss counseling yet.

 

[BU Pathology]

Thank you for posting this information. An important aspect of this work that bears highlighting and repeating is:

Everyone got a job.

If you look carefully at slide #68, you will notice that
100% of the respondents were invited to at least 1 job interview
100% received at least one job offer
100% of respondents accepted the position

In other words:

Everyone got a job.

This should reduce the anxiety of medical students considering pathology as a career, who are concerned about the postings on the job market on this web site. There will be some who may disparage the survey saying that the jobs are not good enough, that not enough jobs are partner track, that free parking was not included. But at the results of the survey show,

Everyone got a job.

The survey also covers the past 2 years, and it includes participants from US allopathic schools, osteopathic schools, and international medical schools. The results show:

Everyone got a job.

To those considering pathology as a career, you will find it rewarding, challenging and extremely satisfying. During a time period when unemployment in the United States rose dramatically, everyone finishing pathology training were successful in finding a position.

Daniel Remick, M.D.
Chair and Professor of Pathology
Boston University School of Medicine and Boston Medical Center

 

[raider]

Sure, everyone got a job.

As I said before, if you are ready to be a slave you will find a slavemaster in some sh-thole (probably away from your spouse and kids)who will abuse you to the max. ASK THE CURRENT GRADUATING LAWYERS? (They have got f--ked big time due to oversupply). I am sure none of the law schools told them about the oversupply. They just wanted them to sign up (smells like sort of a ponzi scheme to me?)Now, they have two choices : work for peanuts or be unemployed.

Ask yourself: Did I become this highly trained professional to be treated like this?

The answer (for those with an iota of talent and self esteem) is a Resounding no.

The most important piece of information was that 94% found they were TOO FEW JOBS (A SERIOUS AND UNDENIABLE OVERSUPPLY PROBLEM).

In todays cut throat business envoirnment that means SUPEREXPLOITATION OF TALENT (no other way around it;the business world is not charity it is dog eat dog; you give an inch they take a yard).

I do not understand what anyone is gaining from denying reality and why this is such a difficult concept to grasp that we have to discuss it ad nauseum???

I understand that the goal is to get "talent" in pathology. This is a laudable goal. However, the "talent" is smart enough to see if there is a problem. If we are to succeed in attracting talent we have to create a market envoirnment that attracts them (like dermatology, rad onc etc.). Dermatology had a "preceived" oversupply problem in the 90s. Positions were cut down. You see the beneficial results today. We have to learn from them and start thinking like them. Pathology is by far, the most interesting field in medicine (in my opinion) but the suboptimal job market is a huge negative which, like it or not, prevents "talent" from considering it as a possibility. Everyone desires respect, autonomy and financial rewards commensurate with the effort put in. If market forces are against you, this is not possible. And smart people (who we all desire as our current and future colleagues) will see through any manipulation to present facts in a way to entice them . Smart mice recognize traps vs. true rewards.

We have a serious oversupply problem. The only solution is to cut down on the number of graduating residents. In the long run, this will translate into better quality pathologists who will be getting rewards commensurate with their effort. Win-win.

Capish.

 

[scienceguy19]

Although the fact that the majority of people got a job may be encouraging (even so, the majority of people received only 1 job offer), the survey had a low response rate. We cannot rule out the possibility that people who did not complete the survey could not get a job.
It would be hard to believe that no one could no find a job.
Maybe they were too busy looking for jobs or to depressed to complete the survey.

I agree that 250 solid graduating pathologists a year does our specialty and patients more good than 500 graduating pathologists consisting of 100 solid pathologists + 400 mediocre pathologists. The reality is, the most intelligent people will be attracted to a field that has a solid job market. Why is anesthesiology so popular? Because it is intellectually demanding? No. Because if you look at at an anesthesiology job website (gaswork.com), there are hundreds of jobs.

When a podlab see a survey which states that the majority of pathologists got only one job offer, are they going to offer new graduates an attractive package? Probably not, since they know the graduates don't have many other options.

 

[Doormat]

I enthusiastically agree with those who are trying to reduce the supply of pathologists going forward. As much as I pat myself on the back for going into something that I enjoyed irrespective of prestige and economics, I can't ignore the powerful negative forces that are just decimating this field.

Every specialty has a right to complain to some degree. However, in my humble opinion pathology has sunk to profound lows that do not compare to any other medical speciality. A mid-level dermatology provider at a local private practice told me that 3-4 regional and national pathology labs have visited her practice in the past months to solicit business. The irony is that all have been turned away in favor of a planned in-office pathology lab. EMR donations, client billing, and other shady incentives offered by aspiring suitors were not enough -- these are kickbacks for amateurs. How about your own in-office lab with slides read by some clown hired for 8 hours a week? That's collecting 95% of all revenue associated with the entire biopsy process. It's like one monster kickback. A sales rep for our tissue processor company told me a regional rep sold so many miniature tissue processors last quarter that he got an all-expenses paid vaca to Hawaii.

I'm stunned to see stock price for LabCorp is approaching $100 per share. That is unbelievable given the current stock market environment. If quarterly profits and growth projections are on target, a whole lot more than 6% of pathologists will be working at these corporate labs (mills).

 

[raider]

The whole corporate "mess" is simply exploitation due to oversupply. If there were fewer pathologists these corporate entities would actually have to pay them "fairly" for the work they do. This would kill the money incentive and hence the corporate intrusion. Samething with the pod labs. With all these problems due to oversupply, it "baffles" me why the pathology organizations are silent on the oversupply issue. Is there some sort of collusion going on? or do we just suffer from uncaring and self absorbed leadership with very poor business sense who likes to talk about transformation but does not address real issues that would actually benefit all?

Why is the oversupply problem not being highlighted (even the survey had 94% participants decrying too few jobs?). What sort of evidence are we waiting for? What is actually going on?

It is very clear to me: the only real problem confronting pathology is oversupply. Addressing this problem in a direct manner would be the panacea for all our problems. There is a critical and urgent need to decrease the number of graduating pathologists, to treat this "plague", otherwise the havoc will continue and we will sink deeper and deeper till our very viability is questionable.

Now is the time to correct the mistake of our "thoughtless" forbears, so that the present and future generation of pathologists do not suffer this bullsh-t and we assume our "well deserved" role at the top of the food chain in medicine (unlike the present where we are just slaves to make money for the next slavemaster, be it a corporate entity, in-office lab or some academic institution).

Now is the right time, everyone is receptive to increasing positions in primary care. All we need is to voice the oversupply problem. The money funding excess pathology residencies can go to primary care residencies. Win-win.

 

[Enkidu]

The whole corporate "mess" is simply exploitation due to oversupply. If there were fewer pathologists these corporate entities would actually have to pay them "fairly" for the work they do. This would kill the money incentive and hence the corporate intrusion. Samething with the pod labs. With all these problems due to oversupply, it "baffles" me why the pathology organizations are silent on the oversupply issue. Is there some sort of collusion going on? or do we just suffer from uncaring and self absorbed leadership with very poor business sense who likes to talk about transformation but does not address real issues that would actually benefit all?

Why is the oversupply problem not being highlighted (even the survey had 94% participants decrying too few jobs?). What sort of evidence are we waiting for? What is actually going on?

It is very clear to me: the only real problem confronting pathology is oversupply. Addressing this problem in a direct manner would be the panacea for all our problems. There is a critical and urgent need to decrease the number of graduating pathologists, to treat this "plague", otherwise the havoc will continue and we will sink deeper and deeper till our very viability is questionable.

Now is the time to correct the mistake of our "thoughtless" forbears, so that the present and future generation of pathologists do not suffer this bullsh-t and we assume our "well deserved" role at the top of the food chain in medicine (unlike the present where we are just slaves to make money for the next slavemaster, be it a corporate entity, in-office lab or some academic institution).

Now is the right time, everyone is receptive to increasing positions in primary care. All we need is to voice the oversupply problem. The money funding excess pathology residencies can go to primary care residencies. Win-win.

The problem with decreasing the number of residency spots is that it creates a risk of undersupply if demand grows as projected. This might create a situation where midlevels of some kind position themelves to make headway into pathology. This is what has happened in psychiatry.

Of course, the situation in psychiatry seems better than the situation in pathology, but to be charitable to pathology organizations they may be trying to avoid this by preventing an undersupply.

 

[WEBB PINKERTON]

I enthusiastically agree with those who are trying to reduce the supply of pathologists going forward. As much as I pat myself on the back for going into something that I enjoyed irrespective of prestige and economics, I can't ignore the powerful negative forces that are just decimating this field.

Every specialty has a right to complain to some degree. However, in my humble opinion pathology has sunk to profound lows that do not compare to any other medical speciality. A mid-level dermatology provider at a local private practice told me that 3-4 regional and national pathology labs have visited her practice in the past months to solicit business. The irony is that all have been turned away in favor of a planned in-office pathology lab. EMR donations, client billing, and other shady incentives offered by aspiring suitors were not enough -- these are kickbacks for amateurs. How about your own in-office lab with slides read by some clown hired for 8 hours a week? That's collecting 95% of all revenue associated with the entire biopsy process. It's like one monster kickback. A sales rep for our tissue processor company told me a regional rep sold so many miniature tissue processors last quarter that he got an all-expenses paid vaca to Hawaii.

I'm stunned to see stock price for LabCorp is approaching $100 per share. That is unbelievable given the current stock market environment. If quarterly profits and growth projections are on target, a whole lot more than 6% of pathologists will be working at these corporate labs (mills).

Labcorp, quest, bioreference labs and Ameripath are gonna be in a world of hurt since POD labs/point of care testing are the future. Pathologists are gonna HAVE to see patients as technology changes. The days of sitting in a cubicle many miles away are coming to an end. People need to accept that.

 

[scienceguy19]

I agree completely!

In the most simplistic terms, the following sequence of events happens:

1) The insurance companies pay an amount (R = revenue) for the services that pathologists provide

2) Companies look for opportunities to make/maximize a profit.
Profits of companies = revenue - Costs

3) Pathologists are in oversupply. Companies can pay pathologists a lower income because pathologists have no other employment opportunities.
Labor costs from the companies' perspective go down.

4) Profits of companies = Revenue - (LOW COSTS) = HIGH PROFIT OPPORTUNITY

5) Companies open up labs as they see this as a great opportunity to make $$$$


Imagine a different (ideal) scenario.
If pathologists were in demand, then labor costs would go up. Then, Profits of companies = Revenue - (HIGH COSTS) = LOW PROFIT OPPORTUNITY.
The companies would then have little incentive to cash in, open up hundreds of labs in the country, and exploit pathologists.


I know some people will dismiss all of this and say that all specialties in medicine have a worse outlook than in the past. But I beg to differ that the problem we pathologists face is unique. What other field has corporations eating away at the reimbursements insurance companies give us? We get screwed over by both insurance companies and corporations, a double whammy. And it's too bad people can't understand the simple economics of supply and demand. While pathology organizations are sitting around doing nothing to address to problem and releasing hardly reassuring surveys of the job market, corporations are probably lobbying to increase the number of pathology residency spots to profit even more off us.

If a survey says that 94% of pathologists are decrying too few jobs, then representatives of pathology organizations should do something. After all, shouldn't pathology organizations heed to the concerns of their constituents and be democratic?


Having too few primary care physicians/gynecologists//general surgeons/physicians who does biopsies but too many pathologists is bad public policy. It's like running a grocery store with 1 person stocking the shelves, 4 cashiers, 10 store managers, 30 marketing executives and 40 executive board members. The person stocking the shelves is working his butt off while the successive people are sitting around doing nothing, because the limiting factor for their workload is the person before them.

The whole corporate "mess" is simply exploitation due to oversupply. If there were fewer pathologists these corporate entities would actually have to pay them "fairly" for the work they do. This would kill the money incentive and hence the corporate intrusion. Samething with the pod labs. With all these problems due to oversupply, it "baffles" me why the pathology organizations are silent on the oversupply issue. Is there some sort of collusion going on? or do we just suffer from uncaring and self absorbed leadership with very poor business sense who likes to talk about transformation but does not address real issues that would actually benefit all?

Why is the oversupply problem not being highlighted (even the survey had 94% participants decrying too few jobs?). What sort of evidence are we waiting for? What is actually going on?

It is very clear to me: the only real problem confronting pathology is oversupply. Addressing this problem in a direct manner would be the panacea for all our problems. There is a critical and urgent need to decrease the number of graduating pathologists, to treat this "plague", otherwise the havoc will continue and we will sink deeper and deeper till our very viability is questionable.

Now is the time to correct the mistake of our "thoughtless" forbears, so that the present and future generation of pathologists do not suffer this bullsh-t and we assume our "well deserved" role at the top of the food chain in medicine (unlike the present where we are just slaves to make money for the next slavemaster, be it a corporate entity, in-office lab or some academic institution).

Now is the right time, everyone is receptive to increasing positions in primary care. All we need is to voice the oversupply problem. The money funding excess pathology residencies can go to primary care residencies. Win-win.

 

[raider]

Well, you can read below what CAP says about reducing/redistribution of residency positions (I do not think it will really matter because the way things are GME funding is going to get cut anyway at the government level and hopefully a large number of path residency positions will find themselves without funding and hence close down; in the 1990s a similar thing happened and a number of useless pathology residency programs were closed down providing temporary relief to the graduating pathologists struggling in a saturated market; it was congress who saved the abysmal job market then not CAP or anyother so called path organization). I think the CAP must have a very strong and powerful lobby of Program Director type pathologists (not diagnosticians who actually make their living by being doctors) whose salary is entirely dependent on GME funding and this leads to a conflict of interest and prevents CAP from doing the right thing.


Policymakers Proposal: Policymakers are now considering a re-distribution of currently unused residency training slots to promote primary care and general surgery, and in addition, they are considering altering incentives to create payments for physicians in residency training in outpatient care settings and support resident participation in non-care activities, such as research.
CAP Position: While we understand the need to support more residencies in primary care and generalist physicians, the CAP is concerned that this option creates disincentives for training and education programs in specialty care. Similarly, while incentives for training in outpatient settings could provide greater latitude in terms of developing rotations to educate physicians, including pathologists, in ambulatory care settings and better account for resident resource utilization, the CAP remains concerned that any cuts in GME funding as a result could weaken the financial condition of teaching hospitals and adversely impact hospital-based physicians.
The CAP advocates full funding of Graduate Medical Education (GME) positions and removal of the limit on Medicare-supported GME slots to address reductions in resident physician duty hour shifts to ensure patient safety and meet the needs of anticipated workforce shortages in the future. Federal GME programs do not currently support residents participating in non-patient care, non- hospital based activities. The CAP would support exploring ways to provide more flexibility in GME funding under the Medicare program.

 

[scienceguy19]

Wow. I'm shocked that the CAP is against reducing the number of pathology residency spots. I thought they're supposed to represent most pathologists. I guess special interest groups do have a strong influence...

Well, you can read below what CAP says about reducing/redistribution of residency positions (I do not think it will really matter because the way things are GME funding is going to get cut anyway at the government level and hopefully a large number of path residency positions will find themselves without funding and hence close down; in the 1990s a similar thing happened and a number of useless pathology residency programs were closed down providing temporary relief to the graduating pathologists struggling in a saturated market; it was congress who saved the abysmal job market then not CAP or anyother so called path organization). I think the CAP must have a very strong and powerful lobby of Program Director type pathologists (not diagnosticians who actually make their living by being doctors) whose salary is entirely dependent on GME funding and this leads to a conflict of interest and prevents CAP from doing the right thing.


Policymakers Proposal: Policymakers are now considering a re-distribution of currently unused residency training slots to promote primary care and general surgery, and in addition, they are considering altering incentives to create payments for physicians in residency training in outpatient care settings and support resident participation in non-care activities, such as research.
CAP Position: While we understand the need to support more residencies in primary care and generalist physicians, the CAP is concerned that this option creates disincentives for training and education programs in specialty care. Similarly, while incentives for training in outpatient settings could provide greater latitude in terms of developing rotations to educate physicians, including pathologists, in ambulatory care settings and better account for resident resource utilization, the CAP remains concerned that any cuts in GME funding as a result could weaken the financial condition of teaching hospitals and adversely impact hospital-based physicians.
The CAP advocates full funding of Graduate Medical Education (GME) positions and removal of the limit on Medicare-supported GME slots to address reductions in resident physician duty hour shifts to ensure patient safety and meet the needs of anticipated workforce shortages in the future. Federal GME programs do not currently support residents participating in non-patient care, non- hospital based activities. The CAP would support exploring ways to provide more flexibility in GME funding under the Medicare program.

 

[pathstudent]

It seems that the moral of the story is that on the bright side everyone that finishes pathology can get a job, which is good especially when you consider that a huge percentage of Americans are suffering and unemployed.

It also seems that a lot of these jobs consist of being a clinical instructor making 80-90k, being an assistant prof making 130-150k or being employed in "burn em and turn em" private practices or being employed by corporate labs. It seems that this frustrates a lot of people.

Not sure how this will work out.

 

[veo1]

The CAP advocates full funding of Graduate Medical Education (GME) positions and removal of the limit on Medicare-supported GME slots to address reductions in resident physician duty hour shifts to ensure patient safety and meet the needs of anticipated workforce shortages in the future.

Amazing. We need more pathology residents to ensure patient safety. Who are they trying to fool? Truth is they need for residents for the slave labor grossing camps they call residency. Let's be honest, how essential are residents to services besides grossing in residency? We've been waiting for these "anticipated workforce shortages" for the past 10+ years. Guess what....its not coming!

 

[scienceguy19]

Several years back when I was a student, the program director at my medical school said there were plenty of jobs in pathology. If the average pathology resident gets 1 job offer, I wouldn't consider that to be 'plenty of jobs'.

At a dinner, if you're told there is plenty of food to go around, you expect there to be leftovers. If you want chicken, you should be able to eat as much chicken as you want. If you want vegetables, there should be plenty. The job situation in pathology is like barely having enough food on the table. Maybe the veggies lover had to settle for beef. Maybe the sweets person had to settle for asparagus. Although people ate enough for their nutritional requirements, they didn't eat what they wanted. There was not 'plenty' of food to go around.

Yes we should be grateful to have any job at all compared to some unfortunate others. But many graduates at my college had numerous job offers. Medical school and residency is 8 years more training than a college graduate not to mention costs $200,000 more, not including the opportunity cost of not having income during 4 years of med school. I would hope to have more job offers than a college graduate.

 

[Arctic Char]

I'm particularly perplexed about the considerable blip in the chart in 2014 predicting some surge in demand due to "economic growth" (page 89)

CAP is aware we're just coming out of a recession, right? Curious

 

[zao275]

Thanks for the great discussion everyone. I think a lot of excellent points have been made. What I like about this thread is that regardless of viewpoint, we are mostly discussing actual data rather than anecdotal stories of my best friend's daughter's husband can't find a pathology job.

A few comments:

-To those who suggest that the pathology organizations are not trustworthy and are only turning out surveys in an attempt to placate the masses rather than actually figure out real issues, I must admit I don't understand the reasoning in your thinking. CAP, for example, is made of practicing pathologists (most of whom are the "diagnostician" types, not just academics and PD's, raider!). They are not like a law school that makes more money per lawyer trained. What do these pathologists who are leaders in CAP stand to gain by a surplus of pathologists? They need jobs too, as they actually work as pathologists. They are not employed by CAP. And what does CAP itself stand to gain by having a surplus of pathologists? Membership fees are a pittance and do not provide any substantial income for these organizations. I understand the desire to find a scapegoat, but it doesn't help anyone. To say that CAP or ASCP are not doing enough about the problem is one thing, but to suggest they are covering it up for their own selfish interests is absurd. Then again, maybe I have just drunk the kool-aid...

-The suggestion that training programs are training too many residents for the sake of having cheap labor is, at least, plausible; whether or not it is actually true is another matter. Certainly, there is some conflict of interest there, but I know many great PD's and would have a hard time imagining that they are intentionally doing this.

-Does anyone have details on exactly how the dermatology specialty reduced their number of spots? That would be interesting to discuss.

-Surveys are always difficult, especially in getting a high percentage of respondents. However, I would imagine that the jobless would be the most interested in filling out a survey for the satisfaction of providing damning evidence against the job market that left them jobless. Yet these folks never seem to materialize. I hear about them but have not met one yet.

-I think the take home is that most of us will get jobs, but an improved market may provide more job options and more negotiating/earning potential.

-Raider, I might consider getting involved with the RC one day. I think it is an important group that great influences our specialty. I would note that my former PD is the current chair of the pathology RC, and I cannot think of a more kind, ethical, and wise person to be in that position.

-I think it is easy for all of us as individuals to be hasty and say "the organizations should just do this or that". Believe me, my personality is just that way. I want to go out there and just fix problems, take action, and get the job done. But large organizations do have to be more cautious about what they do. As an individual, my actions will be overlooked if something goes wrong. But if an organization makes a wrong move, it could prove more disastrous down the road. After working on committees and getting to sit in on the CAP Board of Governors meetings this year, I am beginning to understand the need for cautious contemplation before decisive action. I still have a lot to learn.

I appreciate the time and effort you have all made at generating concrete ideas for improving our job market. For my part, I will continue to discuss these issues with CAP leadership, particularly the comments and suggestions made by all of you.

 

[raider]

Zao,
I think you have the right attitude for future leadership. I do not want to believe that the organizations are uncaring of the plight of recent graduates. But it seems like the bad job market has been an issue for pathologists since the 1990s (check this old webpage out http://members.tripod.com/runker_room/ap/ap_jobs.htm;I know it has been posted multiple times before but maybe some of the new ones to the forum may still benefit from this history) and no concrete agenda has been put forward to address it. If so many people have been complaining for so long, there must be some truth to it (you do not see this kind of behaviour in other specialities). My question is why is there silence on this issue from the organizations????

I will post some links later on regarding the "preceived" oversupply of dermatologists in the 90s and how cutting down residencies at that time has made the field more attractive than ever for medical grads. Pathology is a small field we need to keep it small to attract quality people.

 

[Crossed Path]

What do these pathologists who are leaders in CAP stand to gain by a surplus of pathologists? They need jobs too, as they actually work as pathologists.

The main issue seems to be generational, or the haves vs the have-nots. I suspect that most people (in CAP, for example) who could push to reduce the number of pathology spots are themselves older, experienced pathologists. The current group of older pathologists came up in a time when training was rigorous (residents actually made calls on frozens and fellowships seemed to function as they do today in other specialties), seemingly few people became pathologists, and reimbursement was generous. They are the ones who own the practices (except that many of them seem to have sold them and made a lot of money), and they continue to work - pathologists get better with age. There is no personal incentive for them to work to reduce training spots - in fact, it's the opposite, since they continue to benefit from an abundance of young pathologists who will work hard amid job uncertainty with little chance of achieving the same success that they themselves earned.

I strongly suspect that if you looked into the higher ups in these organizations, you would find that some of their groups provide pathologists in pod labs for gastros or uros. In the end, will they be more concered about the future of pathology as a field or the careers of future young pathologists, than they are about the prospect of keeping their own gravy train rolling? OK, let's stop laughing now.

Raider's points, albeit inartfully stated (occasionally), are essentially correct. We should strive for excellence - both in our training across the board and in our job prospects.

 

[raider]

The main issue seems to be generational, or the haves vs the have-nots. I suspect that most people (in CAP, for example) who could push to reduce the number of pathology spots are themselves older, experienced pathologists. The current group of older pathologists came up in a time when training was rigorous (residents actually made calls on frozens and fellowships seemed to function as they do today in other specialties), seemingly few people became pathologists, and reimbursement was generous. They are the ones who own the practices (except that many of them seem to have sold them and made a lot of money), and they continue to work - pathologists get better with age. There is no personal incentive for them to work to reduce training spots - in fact, it's the opposite, since they continue to benefit from an abundance of young pathologists who will work hard amid job uncertainty with little chance of achieving the same success that they themselves earned.

I strongly suspect that if you looked into the higher ups in these organizations, you would find that some of their groups provide pathologists in pod labs for gastros or uros. In the end, will they be more concered about the future of pathology as a field or the careers of future young pathologists, than they are about the prospect of keeping their own gravy train rolling? OK, let's stop laughing now.

Raider's points, albeit inartfully stated (occasionally), are essentially correct. We should strive for excellence - both in our training across the board and in our job prospects.

Good and insightful post.

 

[cjw0918]

Agree with Crossed Path. CAP not evil per se, but why should they care about us??

 

[path24]

You would think the AMA would be looking out for our best interest.....Obamacare, most docs seemed to be against it, but that didn't stop the AMA. I don't see how the CAP is any different. The CAP wants to certify every lab in the world, a business that wants to grow, membership income is low because they want the numbers...it looks good. They can say they represent pathologists, hence look at all our members. The job market problem has been going on for decades. No way am I buying a CAP survey without seeing all the details.

Fewer pathologists gross these days, has that been transferred to pathology residency programs. Giving residents less gross and more scope time. Maybe at rare programs, but my guess would be a no. My program has actually increased gross time.

My friends in pathology struggle to find jobs, while my friends in other specialities have to change their contact info because of the constant harassment from recruiters.

There is a reason why there is no amerirads, amerisurgeons.....etc

 

[scienceguy19]

Older generational pathologists do benefit most from the current job market. They can offer lower salaries with little opportunity for partnership to junior pathologists due to the lack of better job opportunities elsewhere.

Unfortunately, junior pathologists cannot just open up their own practices to compete with older pathologists (as in the case of office based physicians). There are too many barriers to entry, such as the contractual arrangements/obligations between hospitals and pathology groups, high cost of capital to open a lab, and unestablished reputation among doctors who will send specimens.

So the biggest winners are the older generational pathologists and the MBAs who run the corporations employing pathologists. Even worse, the chairman of labcorp is a lawyer!

 

[scienceguy19]

I also disagree that we need more pathology residents to ensure patient safety. In fact, i would argue the opposite.

I've seen a few too many instances of incompetency among residents. I wouldn't want certain residents to read biopsies on my family members when they are attendings. For the sake of patient safety, I would rather those residents not be accepted to pathology residency. Unfortunately, due to the numerous residency spots, lower caliber students are able to match into pathology, a field which requires above average intelligence among medical graduates (in my opinion). Yes perhaps these individuals don't deserve jobs, but why bother training them in the first place?

Amazing. We need more pathology residents to ensure patient safety. Who are they trying to fool? Truth is they need for residents for the slave labor grossing camps they call residency. Let's be honest, how essential are residents to services besides grossing in residency? We've been waiting for these "anticipated workforce shortages" for the past 10+ years. Guess what....its not coming!

 

[raider]

Older generational pathologists do benefit most from the current job market. They can offer lower salaries with little opportunity for partnership to junior pathologists due to the lack of better job opportunities elsewhere.

Unfortunately, junior pathologists cannot just open up their own practices to compete with older pathologists (as in the case of office based physicians). There are too many barriers to entry, such as the contractual arrangements/obligations between hospitals and pathology groups, high cost of capital to open a lab, and unestablished reputation among doctors who will send specimens.

So the biggest winners are the older generational pathologists and the MBAs who run the corporations employing pathologists. Even worse, the chairman of labcorp is a lawyer!

Unfortunate but true state of affairs. I would think after the survey which showed a "very tight market" some kind of action (94% people stating too few jobs is not something that one can ignore; imagine someone with a seriously sick child who has to be near one of the big academic centers for treatment, they cannot just go to some podunk place) is warranted (other than making dubious predictions of future undersupply). Why do we have to keep on suffering like this? I think we need better leadership truly focused on improving the field (not on making money through QA/QC type stuff). The current situation (pathologists at the mercy of unscrupulous elements be they academic centers,pod labs, in-office labs and private practices) shows a complete and utter failure of leadership. We have to create an envoirnment where there is a win for all not just certain elements. That is good leadership. Transformation makes sense if the top most agenda is correcting the oversupply problem.

The top two agenda items of transformation should be:

1. Correct oversupply problem by reducing residency positions (make the requirements of accreditation more stringent---end result better prepared graduates and better job market).

2. Get rid of loopholes in Stark law (allowing AP as in-office tests) and kill the in-office AP labs.

I believe, correcting (1) would have a dramatic impact on the field and would take care of most other problems.

 

[WEBB PINKERTON]

I agree 100 percent Raider. Getting rid of loopholes in the Stark law AND fighting for direct billing would make a huge difference. I really hope in-house labs can be killed. It is clearly self referral. Reminds me of the pain clinics in Florida that have in house pharmacies. If Obama was really serious about cutting health care costs, this would be in the new health care plan. You know urologists are ordering a heck of lot more tests (FISH especially) since they profit from it. Joe Plandowski can defend it all he wants but it clearly is leading to more health care costs.

I fear we have waited to long and the cancer has spread to far to be cured. Hope I am wrong. If the lab industry improves I may scratch my plans for retiring young. I just cant imagine working in this disrespected field many more years.

 

[BU Pathology]

There are several encouraging aspects to this survey for those considering a career in pathology, and some discouraging aspects.

First, for the discouraging:
94% of respondents thought that there were too few jobs available (slide 71)

Academic pathologists earn less than private practice pathologists (slide 78).

Now for the encouraging aspects
Everyone got a job in the past 2 years (slide 68)

100% of respondents received at least 1 job offer (slide 68)

69% of U.S. medical school graduates felt it was not difficult to find a job (slide 69).

95% reported that they were very satisfied to neutral with their new job (slide 72).

84% reported that the annual starting salary was more than $150,000.00 (slide 77).

And just so that everyone is clear, the data from 221 survey respondents shows that
Everyone got a job in the past 2 years (slide 68)

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

 

[raider]

Among respondents, the most recent year's first- job-seekers rated their difficulty in finding a position higher than those in the prior year.


From bad to worse. Wonder what sort of compromises were made (money?geographic location? respect? autonomy? etc. etc.). Wonder when will the pain reach the intolerable threshold?

 

[pathstudent]

There are several encouraging aspects to this survey for those considering a career in pathology, and some discouraging aspects.

First, for the discouraging:
94% of respondents thought that there were too few jobs available (slide 71)

Academic pathologists earn less than private practice pathologists (slide 78).

Now for the encouraging aspects
Everyone got a job in the past 2 years (slide 68)

100% of respondents received at least 1 job offer (slide 68)

69% of U.S. medical school graduates felt it was not difficult to find a job (slide 69).

95% reported that they were very satisfied to neutral with their new job (slide 72).

84% reported that the annual starting salary was more than $150,000.00 (slide 77).

And just so that everyone is clear, the data from 221 survey respondents shows that
Everyone got a job in the past 2 years (slide 68)

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

om

Completely agree with you BU Pathology, but what I take away from a lot of these posts is that there are a lot of bad jobs out there, or, to put another spin on it, a lot of residents have unrealistic expectations about their future jobs. Pathology is heavily commoditized and a lot of entities (corporations, other physicians, senior pathologists) seem to be be making a lot of money of the work of young pathologists. But that is how the world works. The days of medicine being a genteel profession are long gone. Now it is a ruthless cutthroat battle to obtain wealth.

 

[raider]

We need to correct the oversupply problem to attract talent.

Ask yourself what makes the ROAD specialities so attractive??? Reasonable "workload' and "fair" pay.

The only reason for this is an excellent demand to supply ratio of graduates, who have the upper hand in job negotiations.

What is stopping pathology from being the "next" radiology?

Answer: OVERSUPPLY.

Every successful system has REDUNDANCY BUILT IN IT. A market that has a 1:1 ratio of applicants to jobs is an EPIC FAILURE. It allows no wiggle room. End result COMPROMISE for applicants and WIN FOR BAD JOBS. A successful job market has many jobs per applicant so the applicant can choose the best job, and more importantly the LESS STELLAR JOBS HAVE TO IMPROVE THEIR OFFERING CONDITIONS to be filled.

We should strive for the top of the food chain in medicine. No longer prey for any entity (academic centers, in-office labs, corporate labs) that chooses to enslave us. We should be the lion, not the gazelle. We should be making the rules, they should be accommodating us not vice versa. New generation, new rules (the older generation has "failed" us). The baby boomers lacked foresight and our responsible for our current predicament, let the millennials not say the same about us. The baby boomers have turned ROGUE (due to lack of available opportunities due to "their" failed policies) and are now DEVOURING the young.Instead, of SYMBIOSIS we have PARASITISM by the old leeches.

This problem needs to be rectified by cutting residency positions in pathology NOW. Give the money to primary care. This is "true" transformation.

 

[scienceguy19]

Need more data?

According to washington university,
http://residency.wustl.edu/medadmin...00b99e6658de1a2e86256f8f00743537?OpenDocument
pathology was downgraded to a low competitiveness specialty as of 2011. I also noticed that the number of total residency positions increased from 2010 to 2011. We are failing to attract the best applicants. This does a disservice to our field.

Give the positions to primary care. The shortage of doctors is primarily in primary care. When patients have a medical complaint, they go to primary care doctors. No use having extra pathologists hunting for employment while primary care doctors have piles of work.

 

[yaah]

I'm not sure pathology fails to attract the best candidates - pathology attracts great candidates. There is just a mismatch between number of great candidates and number of spots (number of spots outnumbers great candidates). Thus, it is "less competitive." Less competitive does not mean we are failing to attract the best candidates. I don't necessarily buy the argument that by making pathology "more competitive" you are somehow going to increase the number of great candidates who want to go into it. I think that would have a minor impact, not like dermatology.

Pathology is a different field because there is no patient contact, and a lot of people are not going to consider it no matter what the benefits. So while your points are legitimate, I think you overblow this particular one. I personally agree there are too many pathology residency spots.

Giving them to primary care, not sure if that will help. Primary care spots already go unfilled - it isn't as though the problem with primary care is a shortage of residency spots. It's a shortage of people who want to go into it.

 

[pathstudent]

I'm not sure pathology fails to attract the best candidates - pathology attracts great candidates. There is just a mismatch between number of great candidates and number of spots (number of spots outnumbers great candidates). Thus, it is "less competitive." Less competitive does not mean we are failing to attract the best candidates. I don't necessarily buy the argument that by making pathology "more competitive" you are somehow going to increase the number of great candidates who want to go into it. I think that would have a minor impact, not like dermatology.

Pathology is a different field because there is no patient contact, and a lot of people are not going to consider it no matter what the benefits. So while your points are legitimate, I think you overblow this particular one. I personally agree there are too many pathology residency spots.

Giving them to primary care, not sure if that will help. Primary care spots already go unfilled - it isn't as though the problem with primary care is a shortage of residency spots. It's a shortage of people who want to go into it.

Completely agree with your last point. Even if I could make as much or a little more doing primary care, I wouldn't go into it as primary care totally sucks. Subspecialization is inherently more interesting. Now if I could pull 7 figures doing FP, then it is a no brainer, but that will never be the case.