As an aside, I think it's time to stop quoting that tripod thing. It's nearing 10 years old which is a lifetime in medicine. I find it personally difficult to figure out all these data and job market issues. Too many pathologists? Perhaps, but lots of people are hiring. Too many subpar pathologists?
THere are a lot of powerful pathologists out there - many of them have no connection with residency programs and no real impetus to keep flooding the market with unemployable people. So why would no organization be proposing this at all? Why does it only come from 10 year old websites?
I must respectfully disagree. I think that those who choose to ignore history are more likely to repeat it.
Many pathologists have seen where we are heading:
June 2005
An oversupply
The article "From hunt to hire—tips for landing that just-right job" (April 2005, page 14) reminded us of the skills needed to find a good job. Unfortunately, it will not change the difficult job market for today's graduates. When I started my residency, we were told there was a shortage of pathologists and job prospects were good, but that is not the case and it never will be. It's simple: There are more residency programs and pathologists in the market than are needed, and we can see the outcome of this in many of the problems we are facing.
Why can other physicians direct bill? There are too many pathologists competing for a limited number of specimens. Why can hospitals relentlessly reduce our pay in our contract for Part A reimbursement? Because they can easily find an alternative to cover the service. Why will commercial laboratories soon dominate the outpatient anatomic pathology specimen market? They can hire someone at a less favorable income. Why do many graduates do second and third fellowships? There are too few jobs for them. Why is our locum tenens pay rate only half that of the radiologists? More pathologists than radiologists are available for this type of work.
If we don't solve this oversupply problem, it will only worsen because more and more pathologists are entering the market, and two classes of residency graduates will finish training together next year.
Ming Cao, MD
Pathologist
Flint Clinical Pathologists PC
Flint, Mich.
In the April issue of CAP TODAY (page 6) are several letters about client billing. Robert Hubbard, MD, is on target, but all the contributors raise valid observations. To paraphrase Clinton, "It's the oversupply, stupid!"
I retired in 1997 as chairman of a three-person group in a Philadelphia community hospital. Deals were made behind closed doors with HMOs whereby the hospital collected the technical fees for anatomic pathology but we were not permitted to bill for Part B services. My group experienced a drastic cut in our modest Part A remuneration for administration, supervision, and teaching. We operated a successful school of medical technology of which I served as medical director and, along with my associates, gave my share of lectures. After I retired and the students graduated, the program was terminated as not being "cost-efficient." A year or two after my retirement, the Philadelphia Inquirer published an article listing the salaries of the Philadelphia and surrounding area hospital CEOs. Obviously our Part A reduction and that of other hospital-based departments helped fund the inflated salary at the hospital where I worked.
During the 1990s my friends in urology and neurosurgery knew that residency programs in their specialties had already been reduced—an action that pathology should have taken. Reimbursement for Part B services has been steadily declining and all pathologists working in that arrangement will slide backward in income. Our friends in radiology have advantages: First, the reimbursements are better, and, second, every service qualifies as part B and those studies far outnumber what is available to us. Again, basic economics.
During my early years as a pathologist there was good-natured jesting between "town and gown" pathologists.
It doesn't require an advanced degree in common sense to acknowledge that academia has a different agenda (namely cranking out residents) from the grunts in community hospitals. In my early days I enjoyed reading the Alvan G. Foraker, MD, stories published in Pathologist magazine about the harried Job Plodd, MD, pathologist at Podunk General Hospital. They were classics then and fit well in today's environment.
William J. Warren, MD
Furlong, Pa.
Economics and client billing
Though I cannot speak to the personality types of today's pathology graduates, I believe that the economic situation Louis Wright, MD, describes in the February issue (On client billing, a voice in the wilderness [February 2005]) can better be explained by simpler and more common sense observations.
In the dog-eat-dog environment that modern medicine has become, our clinical colleagues abuse us for their own financial gain simply because they can. With everyone in medicine fighting over fewer and fewer resources, it is inevitable that physicians will be pitted against one another. Simple supply and demand means too many pathologists are chasing too few specimens. With large commercial laboratories offering outpatient anatomic pathology at absurdly low rates, the average hospital-based pathologist simply cannot compete. Dr. Wright encourages us to participate more in hospital committees and tumor boards. Most of the pathologists I know are active and engaged with their clinical colleagues, but I have noticed that most of the radiologists I have worked with are reluctant to get involved with tumor board and other such activities. Their economic situation is quite different from ours simply because there is a significant shortage of radiologists.
Our more practical friends in radiology and anesthesiology cut back their residency slots and now have the leverage to demand appropriate compensation and respect. The problems facing pathology today require practical solutions based on sound economics, not wistful longing for a golden age that has long since passed.
Robert J. Hubbard, MD
Community Hospital of San Bernardino
San Bernardino, Calif.
http://www.cap.org/apps/cap.portal?...etters.htm&_state=maximized&_pageLabel=cntvwr
http://www.cap.org/apps/cap.portal?...tters.html&_state=maximized&_pageLabel=cntvwr
. There is a GLUT of pathologists and it's getting worse.
