Hyperinflationary collapse of Pathology (and healthcare in general)

[LADoc00]

Prediction: hyperinflationary spike in chemical reagents, finished goods and general healthcare supplies collapses pathology/healthcare which has inelastic income and cannot withstand any COGs increase.

Get out of the TC biz now. End is nigh.

PC clings to life a few years longer due to essentially no COGs but that will die off as well.

Discuss prep moves.

LADOC: crypto corporate bank account that automatically converts dollar income to a crypto basket.

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[Spikebd]

Eth and defi

 

[Doormat]

Cool. I can't wait to see the look on the GI docs' faces. One huge GI group in my town is just now investing in their own in-office histology lab. They have been content skimming a little $ off the top for the past decade using pass-through billing arrangements with out-of-state Quest/LabCorp owned pathologist groups. The GI docs feel now is the right time to start their own lab, buy equipment, hire their own pathologist, and hire a shady consultant from Florida (where else) to start up their in-office histology lab.

Talk about Schadenfruende.

 

[LADoc00]

Cool. I can't wait to see the look on the GI docs' faces. One huge GI group in my town is just now investing in their own in-office histology lab. They have been content skimming a little $ off the top for the past decade using pass-through billing arrangements with out-of-state Quest/LabCorp owned pathologist groups. The GI docs feel now is the right time to start their own lab, buy equipment, hire their own pathologist, and hire a shady consultant from Florida (where else) to start up their in-office histology lab.

Talk about Schadenfruende.

they are idiots, the podlab histo TC thing died like 3-4 years ago.

Will lose hundreds of k.

 

[SetecAstronomy]

Eth and defi

ALGO, BAT, and XLM

 

[WEBB PINKERTON]

POD labs ain't dead but they definitely on life support where I live. Many of the specialists around me are selling out to venture capitalists and are now forced to send their specimens to large core labs that service the VC owned practices.

I know I have been thinking about cancelling my order for Tesla Trucks for the lab couriers. Thinking about giving them some of my horses, drug free horses I may add.

 

[deleted314957]

Cool. I can't wait to see the look on the GI docs' faces. One huge GI group in my town is just now investing in their own in-office histology lab. They have been content skimming a little $ off the top for the past decade using pass-through billing arrangements with out-of-state Quest/LabCorp owned pathologist groups. The GI docs feel now is the right time to start their own lab, buy equipment, hire their own pathologist, and hire a shady consultant from Florida (where else) to start up their in-office histology lab.

Talk about Schadenfruende.

Having done a ton of GI path for about 25 yrs in FL that just makes my wine a little crisper and puts a smirk on my face!

 

[bauber]

ALGO, BAT, and XLM

ADA and THETA

 

[Spikebd]

ADA and THETA

SUSHI, REN

 

[AZpath]

POD labs ain't dead but they definitely on life support where I live. Many of the specialists around me are selling out to venture capitalists and are now forced to send their specimens to large core labs that service the VC owned practices.

I know I have been thinking about cancelling my order for Tesla Trucks for the lab couriers. Thinking about giving them some of my horses, drug free horses I may add.

VC is the big trend here to. There have been a number a urologists practices purchased in the region.
All the uro's had their own labs. They are now sending specimens to a central lab that they own out of state.

I don't know how this still is compliant with CMS rules.
I know that is ok to have the practice location and the pathologist at different locations if the path has a 0.75 FTE contract.
I am sure CMS never considered this scenario. It is crazy to call it POL


LA you have said this before. Perhaps LA a is too costly area to run a lab.
I am happy with owning the TC portion of the business.
I have only owned it since 2014 after the big TC cut. It still makes money.
My be I am just lucky.
The VC boys will spin off the path labs if they are not earning. Right now they are buying more lab space

 

[Doormat]

So awesome to hear many derm, GI, and uro practices are selling out to VC. This means that existing partners in these medical specialty groups are pulling up the ladders behind them so they can receive a monster payout.

New grads coming out of these competitive residencies will find fewer job positions where they can become business owners. Much like in pathology.

 

[Allegri]

I understand that law firms cannot be owned by non-lawyers. When did our profession miss that boat?

 

[WEBB PINKERTON]

I am seeing two trends in my area big time. VC buyouts and also health insurance companies are buying up physician offices at a fast pace as well. Just like VC, the health insurance companies also have large core labs that they send the specimens to so your path group is SOL.

 

[LADoc00]

So awesome to hear many derm, GI, and uro practices are selling out to VC. This means that existing partners in these medical specialty groups are pulling up the ladders behind them so they can receive a monster payout.

New grads coming out of these competitive residencies will find fewer job positions where they can become business owners. Much like in pathology.

This has been happening for now 4-5 years in derm, GI, urology, plastics, etc etc.

The boomers are cashing out now fully and will not leave a single penny of equity unrealized for any of the up and comers.

Private practice is definitely on life support.

 

[bronx43]

Lol, I was JUST talking to my friend about this exact dynamic in the clinical world.

Instead of COG, it's cost of labor for these bloated health systems. I'm seeing the non-clinical staff reach their boiling point - shorter fuses, more vocal about their dissatisfaction, etc. Unless governments en masse stop unemployment programs and reverse their effects on the labor market, I give it 3 months before health systems hemorrhage lower paid support staff. After all, why put up with an a**hole boss and ungrateful/demanding patients for crap wages, when Home Depot is offering higher pay.

These health systems/sand castles are going to get leveled by the incoming tide... I'll probably get wiped out with them, but at least I'll get my share of schadenfreude seeing smug admin get pinned against the wall by the hungry peasants.

 

[AZpath]

This has been happening for now 4-5 years in derm, GI, urology, plastics, etc etc.

The boomers are cashing out now fully and will not leave a single penny of equity unrealized for any of the up and comers.

Private practice is definitely on life support.

That's in pathology too although this started years ago with POLs etc.
The idea of a local pathologist is almost dead.

There has not been much written about VC's impact on pathology .
Will the new owners will cancel the local pathologist's contract ?
The specimens are sent to a new central lab often out of state
I would be very concerned if this is my niche.

 

[WEBB PINKERTON]

I have seen the local paths lose the contract every time. Same when the health insurance company takes over the physician office. No different than when hospitals buy up the practice.

 

[LADoc00]

Funny thing is there is so little money in glass now why are people still fighting over it??

To sign out 2K worth of slides probably would cost me 1800 in pathologist labor+overhead. 200 in profit here.. That's total trash tier.

Pile on the fact you would probably lose 300-400 bucks on the TC.

You might even be in the HOLE every day! hahahahaha

Glass is the business model of the unimaginative.

 

[AZpath]

Funny thing is there is so little money in glass now why are people still fighting over it??

To sign out 2K worth of slides probably would cost me 1800 in pathologist labor+overhead. 200 in profit here.. That's total trash tier.

Pile on the fact you would probably lose 300-400 bucks on the TC.

You might even be in the HOLE every day! hahahahaha

Glass is the business model of the unimaginative.

That's 10% net margin. Most hospital systems make 2-3%. Over 4% is considered great.

Path groups must be getting 40-50% of MC for TC in CA.
That is a loser. I have lots of MC patients and AZ Medicaid pays about 90% of MC.

I don't know if the low TC rates have hit the physician owned labs?
Will VC groups get MC rates or better on their TC.

Labcorp and Quest have always given away pathology to get higher paying tests

 

[LADoc00]

That's 10% net margin. Most hospital systems make 2-3%. Over 4% is considered great.

Path groups must be getting 40-50% of MC for TC in CA.
That is a loser. I have lots of MC patients and AZ Medicaid pays about 90% of MC.

I don't know if the low TC rates have hit the physician owned labs?
Will VC groups get MC rates or better on their TC.

Labcorp and Quest have always given away pathology to get higher paying tests

You are making incorrect comparisons. You cant compare something like a pathology group with a few million to 10 million in gross revenue that require INSANE amounts of micro management and sweat equity to a large, essentially autonomously operating corporate business that generates 500 million+ in gross annual sales.

Over 4% is not considered great at our scale business.

 

[AZpath]

You are making incorrect comparisons. You cant compare something like a pathology group with a few million to 10 million in gross revenue that require INSANE amounts of micro management and sweat equity to a large, essentially autonomously operating corporate business that generates 500 million+ in gross annual sales.

Over 4% is not considered great at our scale business.

I agree bad comparison. Trying to insert a bit of irony into the conversation. Epic fail.... 🙂

 

[futuredoc331]

Very interesting to see so many comments about crypto in here. I'm actually considering leaving pathology residency to become a programmer with the goal of getting into blockchain development. Starting salaries appear to be in excess of 100k with potential to make much more with a few years of experience. I'd probably qualify for these jobs about the same time I'd be looking for attending positions.
I figure if I don't succeed in that goal I can try to get back into a family medicine residency.

Is this one of the craziest ideas you've seen on StudentDoctor?

 

[caffeinegirl]

Very interesting to see so many comments about crypto in here. I'm actually considering leaving pathology residency to become a programmer with the goal of getting into blockchain development. Starting salaries appear to be in excess of 100k with potential to make much more with a few years of experience. I'd probably qualify for these jobs about the same time I'd be looking for attending positions.
I figure if I don't succeed in that goal I can try to get back into a family medicine residency.

Is this one of the craziest ideas you've seen on StudentDoctor?

Not one of the craziest ideas seen on SDN. If you're looking at monetary compensation and stability, then programming is the way to go, if you are inclined to do it.

 

[WEBB PINKERTON]

Very interesting to see so many comments about crypto in here. I'm actually considering leaving pathology residency to become a programmer with the goal of getting into blockchain development. Starting salaries appear to be in excess of 100k with potential to make much more with a few years of experience. I'd probably qualify for these jobs about the same time I'd be looking for attending positions.
I figure if I don't succeed in that goal I can try to get back into a family medicine residency.

Is this one of the craziest ideas you've seen on StudentDoctor?

No, the pathologist who was cutting lawns was probably the craziest.

 

[futuredoc331]

No, the pathologist who was cutting lawns was probably the craziest.

Because he couldn't get a job?

 

[Spikebd]

Very interesting to see so many comments about crypto in here. I'm actually considering leaving pathology residency to become a programmer with the goal of getting into blockchain development. Starting salaries appear to be in excess of 100k with potential to make much more with a few years of experience. I'd probably qualify for these jobs about the same time I'd be looking for attending positions.
I figure if I don't succeed in that goal I can try to get back into a family medicine residency.

Is this one of the craziest ideas you've seen on StudentDoctor?

Let us know how it goes and report back. If youre Single without loans it’s much more feasible than if you were married with kids and in debt.

 

[deleted314957]

Let us know how it goes and report back. If youre Single without loans it’s much more feasible than if you were married with kids and in debt.

Single, without loans? Man, you could just take off and get a seasonal job as a pixie dust spreader on the tilt-a-whirl!

 

[mark-ER]

Maybe I am old school: VTIP and I-bonds ??

 

[octopusprime]

... pixie dust spreader on the tilt-a-whirl!

great stepping stone job for weight guessing or barking for the Yak woman.

 

[LADoc00]

To those who missed the crypto bandwagon on the way up last time, the time is coming. Look for entry point this fall.


PS- there is wayyyyyyyyyyyyyyy toooo much money sloshing around in non-AP work. I personally have dumped AP, I do it as purely hobby now and soon hopefully not even that.

 

[gbwillner]

To those who missed the crypto bandwagon on the way up last time, the time is coming. Look for entry point this fall.


PS- there is wayyyyyyyyyyyyyyy toooo much money sloshing around in non-AP work. I personally have dumped AP, I do it as purely hobby now and soon hopefully not even that.

LA, I've been a big fan of yours for years now, but it looks like you've been steadily losing your marbles since the pandemic started, highlighted by your talk about crypto.

Crypto is a system for negative wealth-redistribution only, wherein those that "buy in early" are rewarded by those that buy in later, and pay more for their "coins". It is a zero-sum game (actually, for Bitcoin it is a negative sum game since miners are always siphoning value out of the system). Another word for this is a pyramid scheme. It has no use case (beyond being used as the medium for a ponzi scheme) except for illegal activity. As long as the value perception goes up, everyone is happy. When it goes down, look out- you will all lose your shirts, unless you are the first to get out, and you will take everyone's money with you.

If you are considering crypto, ask yourself this: when was the last time a valuable asset/equity/commodity/security required anyone to "shill" or market to the world they will get rich with it? Amazon doesn't need anyone to "hype" their stock for it to have value. For crypto, however, it only has more value if more suckers buy in. The entire market is built on FOMO- getting people to buy this thing for fear of missing out on gains (as LA's post suggests), and this is done by manipulating the market and perceptions of the market. You cannot trust anything about this market or these coins as they are primarily moved by fraud and manipulation.

Lastly, if blockchain ledgers truly are revolutionary for finance, let the technology organically demonstrate it's value rather than buying tokens that are likely to be rendered worthless later. It's far more likely that the ledger is used with digital USD controlled by the FED than that the US adopts any of the existing coins out there, most of which are entirely controlled by private parties or companies (including Bitcoin).

 

[coroner]

LA, I've been a big fan of yours for years now, but it looks like you've been steadily losing your marbles since the pandemic started, highlighted by your talk about crypto.

Yeah, but he made some really entertaining Covid-19 apocalyptic/conspiracy threads like these...gotta love ol' LA

Fiasco in the making? | Student Doctor Network Communities

Next act in the theater of the absurd: Tiger gets coughed on, now has COVID-19? | Student Doctor Network Communities

Convalescent plasma useless and high titer IgG non-protective? | Student Doctor Network Communities

Government is full of crap on COVID-19 testing | Student Doctor Network Communities

Will the COVID-19 Ag test "break through" be even more of a trainwreck than the ab test?? | Student Doctor Network Communities

Getting worried about the language of racism in healthcare... | Student Doctor Network Communities

Why no one has any trust in medicine and science in regards to COVID-19 now... | Student Doctor Network Communities

The Rona is getting spicy now, time for us pathologist to go full WFH, peace out clinical colleagues! | Student Doctor Network Communities

 

[bauber]

It has no use case (beyond being used as the medium for a ponzi scheme) except for illegal activity.

Sorry but this is the lamest argument. Cold hard cash has never been used for illegal activity, right? You can buy non-illegal stuff with crypto if you want.

If you are considering crypto, ask yourself this: when was the last time a valuable asset/equity/commodity/security required anyone to "shill" or market to the world they will get rich with it? Amazon doesn't need anyone to "hype" their stock for it to have value. For crypto, however, it only has more value if more suckers buy in. The entire market is built on FOMO- getting people to buy this thing for fear of missing out on gains (as LA's post suggests), and this is done by manipulating the market and perceptions of the market. You cannot trust anything about this market or these coins as they are primarily moved by fraud and manipulation.

It's new exciting tech and of course there are scams by people taking advantage of that fact, but there are also legitimate projects using blockchain technology in an attempt to innovate. It's not black and white like you're implying here. The behavior of people on the internet doesn't invalidate legitimate innovative projects. How else are they going to "organically demonstrate value" except by going through development cycles? The fact that a tradable token is associated with a project doesn't make it a ponzi scheme. Only fools are out there saying crypto isn't risky or has no downside as an investment.

 

[LADoc00]

I dont want to get into a full on "what is the blockchain and what is it good for" argument. That is a huge topic. Definitely be educated before you invest in anything.

I think the human race in general is looking for a "perfect asset type for the storage of wealth" and there is NO perfect answer. Its not gold, property, stocks, bonds, cash or crypto so pick your poison. None of them are perfect. All are fraught with incredible peril. Caveat Emptor.

I just try to diversify so if one class defecates the proverbial bed, I can retain wealth in other classes. That is it. Im definitely not trying to be uber rich, only trying to peace out from the daily grind as soon as possible.

Look at the stuff we value: diamonds, metals, bits of cloth/paper called cash/currency, all of it is an illusion. Its merely a trust compact. Look at what we do for a living: we do work in the HOPES of repayment. You could drop half a day into a surgical path case and make nothing. You could miss your kids' softball games and get NADA. Every second we spend in the pursuit of pathology/medicine has an opportunity cost that must be carefully weighed and measured.

 

[gbwillner]

Sorry but this is the lamest argument. Cold hard cash has never been used for illegal activity, right? You can buy non-illegal stuff with crypto if you want.

Is it? Please, by all means tell me how you bought lunch with crypto yesterday- oh yeah, you didn't "want" to. Crypto has the potential to do some stuff, but it actually sucks at it. In basically all possible use cases, it is like cash, or credit cards, or Venmo/Paypal with extra steps and costs. Oh yeah, and woopsie, you lost your key/got hacked/had your money on an exchange that suddenly disappeared and you lost everything!!! so sad.

It's new exciting tech and of course there are scams by people taking advantage of that fact, but there are also legitimate projects using blockchain technology in an attempt to innovate. It's not black and white like you're implying here. The behavior of people on the internet doesn't invalidate legitimate innovative projects. How else are they going to "organically demonstrate value" except by going through development cycles? The fact that a tradable token is associated with a project doesn't make it a ponzi scheme. Only fools are out there saying crypto isn't risky or has no downside as an investment.

Development cycles do not require suckers to buy worthless items to give them value. Development comes first, then once value is demonstrated it gains adoption. Then it has value. And if that value only comes to first adopters, then it will never be accepted by anyone else. All current cryptos are Ponzis. It does not mean the tech doesn't have potential uses- but what those even ARE cannot be readily explained.

The prime value of crypto today is hopium.

 

[gbwillner]

I think the human race in general is looking for a "perfect asset type for the storage of wealth" and there is NO perfect answer. Its not gold, property, stocks, bonds, cash or crypto so pick your poison. None of them are perfect. All are fraught with incredible peril. Caveat Emptor.

I just try to diversify so if one class defecates the proverbial bed, I can retain wealth in other classes. That is it. Im definitely not trying to be uber rich, only trying to peace out from the daily grind as soon as possible.

This is part of the problem, IMO, just classifying crypto as just some other vehicle for investment as part of a diversified portfolio. Why not put baseball cards or tulips on that list? Why not "Red 47" at roulette? Or 4*7*31*17*12*23 at the lotto? These can all get you huge returns!!!!

Crypto value is entirely driven by fraud and market manipulation. That manipulation drives FOMO, which further escalates the price. That's it. You can say you are in it for the "tech" but that has not driven valuation. If there really were any fundamental value to crypto there would be no shills. It would sell itself. It does not- it requires suckers to buy your bags. Those are the mechanics of crypto. There is no regulation at crypto exchanges, who actively trade against their own clients. People trade on huge margins where almost all liquidity is fake money used to pump up crypto prices. Even if you are on coinbase and you know you have deposited real USD for trading in your account, they allow trading with USDT, which most offshore exchanges use as a USD substitute pegged 1:1 despite it being KNOWN that USDT is printed out of thin air. This means your USD is already gone. USDC is no different.

 

[coroner]

Why not "Red 47" at roulette?

Well, that's a surefire loser...the wheel only goes up to 36 😜

 

[LADoc00]

This is part of the problem, IMO, just classifying crypto as just some other vehicle for investment as part of a diversified portfolio. Why not put baseball cards or tulips on that list? Why not "Red 47" at roulette? Or 4*7*31*17*12*23 at the lotto? These can all get you huge returns!!!!

Crypto value is entirely driven by fraud and market manipulation. That manipulation drives FOMO, which further escalates the price. That's it. You can say you are in it for the "tech" but that has not driven valuation. If there really were any fundamental value to crypto there would be no shills. It would sell itself. It does not- it requires suckers to buy your bags. Those are the mechanics of crypto. There is no regulation at crypto exchanges, who actively trade against their own clients. People trade on huge margins where almost all liquidity is fake money used to pump up crypto prices. Even if you are on coinbase and you know you have deposited real USD for trading in your account, they allow trading with USDT, which most offshore exchanges use as a USD substitute pegged 1:1 despite it being KNOWN that USDT is printed out of thin air. This means your USD is already gone. USDC is no different.

The value of the US dollar is literally PURE MANIPULATION. Aside from treasuries, the dollar note is a fiction, a pure myth we tell each other so people dont put a shotgun in their mouth and pull the trigger when they realize they have worked their entire lives for a pile of useless dollars that no longer even buy a fast food hamburger!

We have federal reserve system so corrupt they literally fabricate TRILLIONS (not even billions anymore..) on balance sheets and gaslight us that is acceptable and we shouldnt ask for a single penny more in the Medicare fee schedule.

This is like an argument over religion, your myth isnt more convincing than my myths just because you think my myths are fiction....

Im "eyes wide open" about this stuff, but I can see you still hold to your fiction like its a truth.

The core issue of this thread is that healthcare services are paid out in increasing worthless dollars so even the 6-8% fee schedule cuts are immaterial next to a 30% drop in purchasing power. Hyperinflation DESTROYS healthcare. It obliterates it quicker than Godzilla stepping on an apartment building.

 

[gbwillner]

Cold hard cash has never been used for illegal activity, right?

The value of the US dollar is literally PURE MANIPULATION. Aside from treasuries, the dollar note is a fiction, a pure myth we tell each other so people dont put a shotgun in their mouth and pull the trigger when they realize they have worked their entire lives for a pile of useless dollars that no longer even buy a fast food hamburger!

Whataboutism is not a good investment strategy.

I'm sure we can argue about the merits of monetary policy and the mistakes made, but that's a far cry from crypto. It's like curing a toothache by sawing your head off.

 

[deleted314957]

I really don’t see crypto as an investment. I have a trivial amount in an account just to “have the account”.
I prefer investments with some historical predictability that pay dividends and appreciate in value ( common stocks)
and I lend a little money ( bonds). 1/2 of 1% is in a variety of precious metals just to have them. I don’t expect them to do anything. Very boring but it has worked very, very well.

Open a crypto account, put in 5k and forget it.

Nothing changes folks. There are 2 and only 2 emotions that drive crypto: fear and greed.

 

[WEBB PINKERTON]

You are 1%ers. Start businesses, buy property, create an empire and go rural. Don't run shine though.

 

[gbwillner]

I really don’t see crypto as an investment. I have a trivial amount in an account just to “have the account”.
I prefer investments with some historical predictability that pay dividends and appreciate in value ( common stocks)
and I lend a little money ( bonds). 1/2 of 1% is in a variety of precious metals just to have them. I don’t expect them to do anything. Very boring but it has worked very, very well.

Open a crypto account, put in 5k and forget it.

Nothing changes folks. There are 2 and only 2 emotions that drive crypto: fear and greed.

Crypto is not an investment because it does not have any fundamental value. Sure, your account value CAN go up and yield returns, but it is not due to any material component of crypto and entirely driven by speculation of the coin. I would compare it more to gambling. You can make money putting $5K on "red" in roulette, and profit. No one considers that an investment.

There are a lot of comparisons of crypto to stocks, but these are fundamentally different. Buying stocks means literally buying an equity stake in a company (as dilute as it may be). There is underlying value in that company in terms of revenues, cash flow, assets, etc. Buying 1 BTC does not mean you own 1/21,000,000 of Bitcoin. It means literally nothing. You don't own anything except a string of random characters. Right now people are willing to pay you approx. $30K for that random string. At some point they will not.

I will also add one of the major forces driving FOMO is the projection of value by misusing existing financial terms like "Market Cap". This is a meaningless term in crypto, but it drives the narrative of trillions of dollars of value in this space. Market Cap refers to the equity value of all shares outstanding of a company based on current market rates- meaning how the market values a company. The calculation is simple- current share price x shares outstanding. Transposing this concept to crypto was easy, but also meaningless. This is why there is $1 T "valuation" in bitcoin. But bitcoin is not a company, and does not have equity, so the term does not apply. In fact, >70% of all BTC transactions today are done with USDT (Tether) as the trade, which is "pegged" 1:1 is USD. And there are $62B USDT in circulation, which is mostly just made up (Tether now claims for every 1 USDT there is $0.03 in reserves). That means that for the $1T Bitcoin market, >70% of transactions are driven by a currency that has had a total of $1.9B of actual money put into it.

 

[deleted314957]

Well, now they are coming out with bitcoin ETF’s and with this comes REGULATION. The feds are going to regulate the hell out of this and in a short period, any security that you think the “ block chain” gives you will be gone like a fart in the wind.

 

[gbwillner]

Well, now they are coming out with bitcoin ETF’s and with this comes REGULATION. The feds are going to regulate the hell out of this and in a short period, any security that you think the “ block chain” gives you will be gone like a fart in the wind.

They've been saying this for years, but the SEC continuously rejects it.
I don't think it ever happens.