180 degrees

[LADoc00]

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background: been smoozing at some high level political functions and chatting up some DC type lobbyists who have been shooting me emails and briefs about the state of the economy, specifically how it relates to healthcare.

It is now my opinion we have *maybe* 10 good years left in terms of physician compensation. During the time following and slightly preceeding, we will undergo an "Access Crisis" where a large number of not for profit hospitals will go bankrupt, not one here or there in the ghetto but a 20% haircut across the board. This will result in massive unemployment and flood of work to those remaining healthy centers.

Post Access Crisis, costs will spiral even further for hospital services than we are seeing today resulting in massive cuts on the MD reimbursement side, on the order of 50%.

Why is this in the pathology section?? Good question.

I do not now believe it is in everyone's best interest to do fellowship training and especially more than 1 fellowship. I would urge everyone to take an expediated path to earning what they can now and SAVE it.

Folks this is straight up GENESIS 41. look that up and take it in.

 

[HCE]

background: been smoozing at some high level political functions and chatting up some DC type lobbyists who have been shooting me emails and briefs about the state of the economy, specifically how it relates to healthcare.

It is now of my opinion we have *maybe* 10 good years left in terms of physician compensation. During the time following and slightly preceeding, we will undergo an "Access Crisis" where a large number of not for profit hospitals will go bankrupt, not one here or there in the ghetto but a 20% haircut across the board. This will result in massive unemployment and flood of work to those remaining healthy centers.

Post Access Crisis, costs will spiral even further for hospital services than we are seeing today resulting in massive cuts on the MD reimbursement side, on the order of 50%.

Why is this in the pathology section?? Good question.

I do not now believe it is in everyone's best interest to do fellowship training and especially more than 1 fellowship. I would urge everyone to take an expediated path to earning what they can now and SAVE it.

Folks this is straight up GENESIS 41. look that up and take it in.

But doesn't this scenario presume that nothing changes during that 10 year period, e.g., laws, regulations, same airhead politicians? Or are you saying it is inevitable no matter what attempts are made to "fix" the problems?

and remember, when LADoc talks, people listen...

 

[Neddy]

But doesn't this scenario presume that nothing changes during that 10 year period, e.g., laws, regulations, same airhead politicians? Or are you saying it is inevitable no matter what attempts are made to "fix" the problems?

and remember, when LADoc talks, people listen...

Um, you probably shouldn't try to convince LADoc that the government will save us... 😉

 

[yaah]

Well, healthcare can't continue to grow exponentially as it is. The problem with "ten year models" is that they take into account current conditions, growth rates, etc, and try to predict based on current knowledge. They are rarely correct. It's not like people are going to NOT need doctors and expertise anymore. Eventually the system will decide what things are worth paying for (testing, diagnostics, expensive drugs that don't do much, etc) and what things aren't. Seems to me like a lot of the exponential spending increase is going to the increasing number of ancillary tests and specialization that people who are sick keep getting, as well as the specialized drugs that exist and the tests that are necessary to determine whether these drugs will work on an individual.

 

[sohsie]

background: been smoozing at some high level political functions and chatting up some DC type lobbyists who have been shooting me emails and briefs about the state of the economy, specifically how it relates to healthcare.

It is now my opinion we have *maybe* 10 good years left in terms of physician compensation. During the time following and slightly preceeding, we will undergo an "Access Crisis" where a large number of not for profit hospitals will go bankrupt, not one here or there in the ghetto but a 20% haircut across the board. This will result in massive unemployment and flood of work to those remaining healthy centers.

Post Access Crisis, costs will spiral even further for hospital services than we are seeing today resulting in massive cuts on the MD reimbursement side, on the order of 50%.

Why is this in the pathology section?? Good question.

I do not now believe it is in everyone's best interest to do fellowship training and especially more than 1 fellowship. I would urge everyone to take an expediated path to earning what they can now and SAVE it.

Folks this is straight up GENESIS 41. look that up and take it in.

Hey, its last week's parsha!

 

[Coastie]

Could be alot fewer years than that, as in, 1-2, depending on Hilldog/Osamabama and the other dems come '08.

I think you're a little pessimistic on the economic side: I'll compare backgrounds via PM if that's an issue.

I'd say our problems in medicine lie on the political side and how that relates to the economic side, not the economic state of the country. This is mostly of a function of the medical system being so controlled by the government...Which is a terrible thing. I'll take the Biblical reference, though.

background: been smoozing at some high level political functions and chatting up some DC type lobbyists who have been shooting me emails and briefs about the state of the economy, specifically how it relates to healthcare.

It is now my opinion we have *maybe* 10 good years left in terms of physician compensation. During the time following and slightly preceeding, we will undergo an "Access Crisis" where a large number of not for profit hospitals will go bankrupt, not one here or there in the ghetto but a 20% haircut across the board. This will result in massive unemployment and flood of work to those remaining healthy centers.

Post Access Crisis, costs will spiral even further for hospital services than we are seeing today resulting in massive cuts on the MD reimbursement side, on the order of 50%.

Why is this in the pathology section?? Good question.

I do not now believe it is in everyone's best interest to do fellowship training and especially more than 1 fellowship. I would urge everyone to take an expediated path to earning what they can now and SAVE it.

Folks this is straight up GENESIS 41. look that up and take it in.

 

[Anna Plastic]

Could be alot fewer years than that, as in, 1-2, depending on Hilldog/Osamabama and the other dems come '08.

I think you're a little pessimistic on the economic side: I'll compare backgrounds via PM if that's an issue.

I'd say our problems in medicine lie on the political side and how that relates to the economic side, not the economic state of the country. This is mostly of a function of the medical system being so controlled by the government...Which is a terrible thing. I'll take the Biblical reference, though.

I think LADoc is pretty much in the ballpark with this estimate. And I'll be happy to compare sources in PMs should you care to as well.

But for public review, here is an interview from David Walker, head of the GAO. If this doesn't give you pause, I'm not sure what will:

www.newsweek.com/id/70378/page/1

The problems in our health care system are far from being solely on the political side. As Mr. Walker said in the article, "We have a failure of leadership in America, and it is a bipartisan problem". I'm very much concerned that even concerted political action will not stem the tide. I would take LADoc's advice to heart. The best advice I can give to residents: get out of debt asap, avoid new debt like the plague, and do what you can to earn/save money.

I've dramatically changed the course of my career path in the last few months based on the writing on the wall. I may be wrong, but I'm certainly not in doubt my actions are absolutely necessary.

 

[b&ierstiefel]

I've dramatically changed the course of my career path in the last few months based on the writing on the wall. I may be wrong, but I'm certainly not in doubt my actions are absolutely necessary.

Oh yeah? How so? 😀

 

[pathstudent]

background: been smoozing at some high level political functions and chatting up some DC type lobbyists who have been shooting me emails and briefs about the state of the economy, specifically how it relates to healthcare.

It is now my opinion we have *maybe* 10 good years left in terms of physician compensation. During the time following and slightly preceeding, we will undergo an "Access Crisis" where a large number of not for profit hospitals will go bankrupt, not one here or there in the ghetto but a 20% haircut across the board. This will result in massive unemployment and flood of work to those remaining healthy centers.

Post Access Crisis, costs will spiral even further for hospital services than we are seeing today resulting in massive cuts on the MD reimbursement side, on the order of 50%.

Why is this in the pathology section?? Good question.

I do not now believe it is in everyone's best interest to do fellowship training and especially more than 1 fellowship. I would urge everyone to take an expediated path to earning what they can now and SAVE it.

Folks this is straight up GENESIS 41. look that up and take it in.

Could we refuse to accept such a cut?

Also it is worth pointing out that supposedly an 88305 was once reimbursed by medicare for around $80 (many years ago). Now is is closer to $35.

If it gets slashed to $15, hopefully we will have other things that we can do to make money on.

 

[DarksideAllstar]

If it gets slashed to $15, hopefully we will have other things that we can do to make money on.

Like autopsies? Particularly for when we start refusing to read biopsies and resections because they are going to pay us like $0.05 and the patients end up dying.

 

[schrute]

Like autopsies? Particularly for when we start refusing to read biopsies and resections because they are going to pay us like $0.05 and the patients end up dying.

though there will always be the tools willing to work for pennies...which sucks a big one.

 

[Anna Plastic]

Oh yeah? How so? 😀

PM me--I'll be happy to share.

 

[Arctic Char]

i can't say i have much input on these issues, but as a student almost dead certain to enter pathology, i'd really appreciate to read more on this and to have this discussion continue . . . keep talking, or PM me some good stuff . . .

thanks all

cheers

 

[yaah]

I don't think they are necessarily referring to pathology specifically, it's more medicine in general. Anything that affects reimbursement, etc, is going to affect every specialty except for the superficial ones which will continue to grow as humans focus more and more on their personal appearance. The fears alluded to above is that this will be a compensation based effect, because hospitals will have to cut expenses in some fashion.

But there are a lot of variables to sort through as well as a lot of time for things to change or be modified. Medicine is always going to be well compensated as a profession, the question is more of "how well."

 

[b&ierstiefel]

PM me--I'll be happy to share.

Thank you for your message...just a warning, my response was lengthy (not because I disagree with you)...we're in a similar boat.

Cheers.

 

[b&ierstiefel]

It's hard to predict anything for sure; yes there are too many variables in the equation...but what's being said these days by more and more people is less than cheerful. These are warning signs and we would be stupid to not acknowledge them. One can simply brush things off and wait for things to happen or we can take action now to position ourselves in better situations. I'm grappling with this now. We're gonna be looking for jobs soon, man. Oy crikie!

I don't think they are necessarily referring to pathology specifically, it's more medicine in general. Anything that affects reimbursement, etc, is going to affect every specialty except for the superficial ones which will continue to grow as humans focus more and more on their personal appearance. The fears alluded to above is that this will be a compensation based effect, because hospitals will have to cut expenses in some fashion.

But there are a lot of variables to sort through as well as a lot of time for things to change or be modified. Medicine is always going to be well compensated as a profession, the question is more of "how well."

 

[ygdrasil]

It is now my opinion we have *maybe* 10 good years left in terms of physician compensation.

I guess that effectively answers the frequent residency interview question: "Do you see yourself going into academics or private practice?"

 

[pathstudent]

I guess that effectively answers the frequent residency interview question: "Do you see yourself going into academics or private practice?"

Yeah academics is even smarter to go into. You don't have to worry about all the bull****.

Did you know that medicare is going to slash physician compensation 10% in 2008. All insurance companies will follow the same 10% cut as their contracts are based on a percentage of medicare. So all private practice doctors will be taking a 10% cut in pay next year. Academic ones won't.

It is ridiculous that they can just expect physicians to take pay cuts like that. Congress passes all these stupid pork-barrel projects, but they don't give a crap about doctors. Like I said an 88305 used to pay over 80 dollars, now it will be headed toward 30, depending on what state you live in.

Academics or Kaiser is definitely the way to go. These medicare cuts will eventually trickle down in those arenas too, but it won't be as abrupt as taking a 10% pay cut in one year.

 

[Gut Shot]

Did you know that medicare is going to slash physician compensation 10% in 2008.

This happens every year, and then right before the deadline they grant a reprieve and give a tiny increase. As the AP reported two days ago, we're getting 6 months of a 0.5% increase in reimbursement before the issue is once again revisited.

 

[pathstudent]

This happens every year, and then right before the deadline they grant a reprieve and give a tiny increase. As the AP reported two days ago, we're getting 6 months of a 0.5% increase in reimbursement before the issue is once again revisited.

That's good news for docs.

 

[gungho]

This happens every year, and then right before the deadline they grant a reprieve and give a tiny increase. As the AP reported two days ago, we're getting 6 months of a 0.5% increase in reimbursement before the issue is once again revisited.

yep, every year there is the reimbursement-cut sword hanging over everyone's head, then the various lobbying groups go to work, get the cut rolled back to a miniscule increase so everyone is happy. that's not to say that one year it won't work and the sword will then fall. that would be interesting.

 

[Gut Shot]

that's not to say that one year it won't work and the sword will then fall. that would be interesting.

I almost wish it would fall. The ensuing disaster might finally spur some decent, long term reform.

 

[malchik]

Yeah academics is even smarter to go into.

Academics or Kaiser is definitely the way to go. These medicare cuts will eventually trickle down in those arenas too, but it won't be as abrupt as taking a 10% pay cut in one year.

Strictly from a pay standpoint, an abrupt 10% drop from a private practice average of 250k vs. a slightly more stable salary of about half that in academics is an argument in favor of the latter?

 

[Coastie]

That's good news for docs.

Bad news for docs. Just illustrates how beholden we are to the government, and how medicine is basically America's greatest experiment in economic fascism. Next stop, pure socialism or more capitalism. You decide!

 

[Daddydoc]

What I find frustrating is that they screw around with this same issue every year instead of actually trying to fix the real problems. It makes everyone happy to not get a pay cut, and so distracting them from larger issues. But hey, its not like the government could fix any problems even if they tried. 😡

 

[l&usibari]

I'm already thinking about hiding euros, bars of soap, cans of coffee and bottles of liquor in my attic to trade for food when the **** goes down. My question for you, LADoc, is, for someone grappling in residency with the decision to go AP-only or stay AP/CP, how would you answer with the quote below in mind? Finish as quickly as possible in order to make money, even if it ultimately limits your options down the road?

background: been smoozing at some high level political functions and chatting up some DC type lobbyists who have been shooting me emails and briefs about the state of the economy, specifically how it relates to healthcare.

It is now my opinion we have *maybe* 10 good years left in terms of physician compensation. During the time following and slightly preceeding, we will undergo an "Access Crisis" where a large number of not for profit hospitals will go bankrupt, not one here or there in the ghetto but a 20% haircut across the board. This will result in massive unemployment and flood of work to those remaining healthy centers.

Post Access Crisis, costs will spiral even further for hospital services than we are seeing today resulting in massive cuts on the MD reimbursement side, on the order of 50%.

Why is this in the pathology section?? Good question.

I do not now believe it is in everyone's best interest to do fellowship training and especially more than 1 fellowship. I would urge everyone to take an expediated path to earning what they can now and SAVE it.

Folks this is straight up GENESIS 41. look that up and take it in.

 

[LADoc00]

I'm already thinking about hiding euros, bars of soap, cans of coffee and bottles of liquor in my attic to trade for food when the **** goes down. My question for you, LADoc, is, for someone grappling in residency with the decision to go AP-only or stay AP/CP, how would you answer with the quote below in mind? Finish as quickly as possible in order to make money, even if it ultimately limits your options down the road?

Would complete AP/CP and head to the lowest cost of living area I could possibly stand, someplace deep rural where you can leverage the disconnect between healthcare pay and local C.O.L. equivalency if that makes sense...for example
Path in SF makes 250K, guy in Cheyenne makes 300K, 3 bucks in Cheyenne buys you probably around 1 buck of lodging, food and services in the Bay Area, so your col is 3x. Live absolutely meagerly, home no greater than 700-800K, which in Wyoming is like a flipping mansion and save money in commodity backed investments.

Your pay WILL drop, but your cuts will be far less steep at least initially. I predict the COL multipliers for those in rural areas to begin growing from around 2-3x to 5x in the next 5-10 years. May even go as high as 10x when crap really hits the fan.

Basically I would stay out of high pop urban areas almost indefinitely and for lots of reasons. Reasons far beyond COL.....

Im starting to hear rumors of low yield backpack nukes getting trekked up through the Sonora desert into SoCal, so definitely stay the hell out of LA/San Diego.

 

[gungho]

Im starting to hear rumors of low yield backpack nukes getting trekked up through the Sonora desert into SoCal, so definitely stay the hell out of LA/San Diego.

Really? That dovetails nicely with the report i got from a guy who knows a guy who knows that W is an al qaeda sleeper.

 

[Neddy]

Im starting to hear rumors of low yield backpack nukes getting trekked up through the Sonora desert into SoCal, so definitely stay the hell out of LA/San Diego.

I dunno, I thought 24 was kinda played out by season 6.

 

[pathgrrl]

Live absolutely meagerly, home no greater than 700-800K

Really, only 700K? Good Lord! -- I might have to give up my indoor pool. LMAO

 

[mcfaddens]

Really, only 700K? Good Lord! -- I might have to give up my indoor pool. LMAO

Im taking it that you didnt understand that post? b/c your reply makes little sense

 

[twinkles]

Yeah academics is even smarter to go into. You don't have to worry about all the bull****.

Academics or Kaiser is definitely the way to go. These medicare cuts will eventually trickle down in those arenas too, but it won't be as abrupt as taking a 10% pay cut in one year.

Really? I would take that as a strong reason that pathologists should not just go into private practice, but go into a practice situation where there is as much global billing as possible, and avoid practices that just do professional billing. After all, the academic and Kaiser guys still aren't coming close to the private guys even after a 10% cut. And while I don't know much about it, I would think cuts that affect all of medicine affects academic centers and Kaiser groups, too.

 

[ZZPath]

The federal govt does risk bankruptcy within our working lifetimes - expanding the money supply to fund an umpteen trillion dollar future social benefits liability will threaten our currency/savings/retirements. So, start working as soon as you can, and save some of that money in other major currencies/ foreign securities. Although places like Southern Cal would be a ton of fun for a career, there are advantages to a general path job in the middle America small towns -
The smaller communities really need the docs- the docs are appreciated.
Real partnership tract jobs, and less time to partnership - the rural groups can't afford the funny business that the city groups pull off on a regular basis. Lose a good pathologist and another might not come around again for many years. This is critical - find one of these gem jobs right out of training and you don't waste time - just think of all that salary plus compound interest you lose out on with some wasted years in a phony "partnership-tract" job in the city - could be a few million....(pronounce this in the Doctor Evil voice).
Like LADoc said, your savings potential is expanded enormously in the small towns. You can spend part of that savings in the big city on weekends. Our salaries are going to take a double whammy sometime in the near future - less reimbursement AND less purchasing power for each dollar.
Less competition from the big city groups - if you are outside their courier reasonable driving range. The big city guys will get desperate when reimbursement really starts declining - so the further out, the better.
Lower volume, less hectic days on the job - for more pay (usually immediately but certainly after partnership).
Don't know about the backpack nukes - probably low risk in our lifetimes - but the whole economy changes if we are attacked in that way. Path services would probably be last on any list of any govt spending priorities.
Anyway, all you trainees out there looking for jobs - do your homework on any groups you're considering. Contact as many previous employees as you can and ask the important questions.

 

[docbiohazard]

Don't know about the backpack nukes - probably low risk in our lifetimes - but the whole economy changes if we are attacked in that way. Path services would probably be last on any list of any govt spending priorities.

I dunno, radioactive fallout = increased incidence of malignancy = increased sample volume for surg path/hemepath... 😀

BH

 

[Matte Kudesai]

The federal govt does risk bankruptcy within our working lifetimes - expanding the money supply to fund an umpteen trillion dollar future social benefits liability will threaten our currency/savings/retirements. So, start working as soon as you can, and save some of that money in other major currencies/ foreign securities. Although places like Southern Cal would be a ton of fun for a career, there are advantages to a general path job in the middle America small towns -
The smaller communities really need the docs- the docs are appreciated.
Real partnership tract jobs, and less time to partnership - the rural groups can't afford the funny business that the city groups pull off on a regular basis. Lose a good pathologist and another might not come around again for many years. This is critical - find one of these gem jobs right out of training and you don't waste time - just think of all that salary plus compound interest you lose out on with some wasted years in a phony "partnership-tract" job in the city - could be a few million....(pronounce this in the Doctor Evil voice).
Like LADoc said, your savings potential is expanded enormously in the small towns. You can spend part of that savings in the big city on weekends. Our salaries are going to take a double whammy sometime in the near future - less reimbursement AND less purchasing power for each dollar.
Less competition from the big city groups - if you are outside their courier reasonable driving range. The big city guys will get desperate when reimbursement really starts declining - so the further out, the better.
Lower volume, less hectic days on the job - for more pay (usually immediately but certainly after partnership).

There is nothing keeping the smaller hospitals and partnerships from going bellyup.... even in rural areas. I foresee factories undercutting prices and also going into digitizing slides. They will likely provide everything needed.. kind of like a Walmart married to FED EX model.

When reimbursement goes down even further, sheer volume linked to super standardization, mechanization, RFID is what will make an affordable bottom line. Samples will be picked up in factory vans...in factory containers... taken to factory processing centers with PA's grossing, then processed(stained, digitized and subspecialized)......Trainees will flock to factory jobs because they will be paid at least something for all that training. Principled pathologists will easily prostitute themselves to keep the lifestyle that they think they should have.

"See you at the factory man"....🙁🙁

 

[pathstudent]

There is nothing keeping the smaller hospitals and partnerships from going bellyup.... even in rural areas. I foresee factories undercutting prices and also going into digitizing slides. They will likely provide everything needed.. kind of like a Walmart married to FED EX model.

When reimbursement goes down even further, sheer volume linked to super standardization, mechanization, RFID is what will make an affordable bottom line. Samples will be picked up in factory vans...in factory containers... taken to factory processing centers with PA's grossing, then processed(stained, digitized and subspecialized)......Trainees will flock to factory jobs because they will be paid at least something for all that training. Principled pathologists will easily prostitute themselves to keep the lifestyle that they think they should have.

"See you at the factory man"....🙁🙁

That might be the case for outpatient things, but inpatient stuff has to the local path group as part of the contract. (those would include gi bx and any biopsy done in the hospital).

Also, clinicians can send outpatient stuff wherever they want. They don't care what the pathologist "charges". If you have the ability to befriend the clinicians they will send the stuff to you, just the an internest refers his patients to a certain urologists or orthopedist. Moreover, I think technically you can't legally charge less than medicare reimbursement (if you are going to take medicare patients).

I think you are being way too pessimistic, but even if you are not, at least we will always have autopsies.

 

[Matte Kudesai]

I think you are being way too pessimistic, but even if you are not, at least we will always have autopsies.

I am being pessimistic ?????

 

[HRantz]

I am being pessimistic ?????

Don't worry, Matte Kudesai, you aren't going to die.

 

[Matte Kudesai]

Don't worry, Matte Kudesai, you aren't going to die.

Thanks RANTZ I feel better. Hopefully we will have more than just autopsies though.