?!@#$

[LADoc00]

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Situation: LADOC forms corporation. Corporation bids for contract, LADOC is in a good position to win said contract. Unfortunately Hospital A has decided to send the proposal across the globe to every pathology group from here to Lichenstein.

Now these pathology groups want LADOC to join them...why hell would I do that? So your group can pilfer half my income and serve me warmed glasses of 'STFU'?

Please tell your groups to stop calling me.

There is almost no point to joining a larger group unless you can work out call coverage to benefit you....letting some other group do your billing is asking to have your balls removed by a rabid wolverine.

 

[pathdawg]

There is almost no point to joining a larger group unless you can work out call coverage to benefit you....letting some other group do your billing is asking to have your balls removed by a rabid wolverine.

I am not sure that I completely agree with that, LA. A potential benefit to joining a larger group (or merging groups) is that there is strength in numbers. A large group can better deal with insurance companies (and thus negociate more favorable rates) than could individuals or small groups. The way I see it, the greatest enemy that hospital groups face is not other hospital groups; its the large commercial labs (Quest, Labcorp, etc). Consolidated groups can better compete with these souless evil forces. You as an individual (or a small group) has virtually no shot, IMHO.

 

[LADoc00]

I am not sure that I completely agree with that, LA. A potential benefit to joining a larger group (or merging groups) is that there is strength in numbers. A large group can better deal with insurance companies (and thus negociate more favorable rates) than could individuals or small groups. The way I see it, the greatest enemy that hospital groups face is not other hospital groups; its the large commercial labs (Quest, Labcorp, etc). Consolidated groups can better compete with these souless evil forces. You as an individual (or a small group) has virtually no shot, IMHO.

Im actually working on a plan so that small pathology groups that want to stay independant can work in a collective bargaining agreement with insurance companies and not violate the anti-trust laws. This could be done similar to joing buying groups for purchasing. I will say from the contracts end, a small, lean mean group may end up doing much better with insurance companies by simply being able to avoid signing punative contracts. A larger group would be under way too much pressure to sign from clients and the hospital.

I have a fairly good idea of what groups are bring in throughout California, it ranges from 200 up to 650K for general (non founding) partners, but there are single guys, single operators hiding out in rural areas making much more. They are working their ass off but they are also retiring in 10-15 years.

 

[Nilf]

Im actually working on a plan so that small pathology groups that want to stay independant can work in a collective bargaining agreement with insurance companies and not violate the anti-trust laws. This could be done similar to joing buying groups for purchasing. I will say from the contracts end, a small, lean mean group may end up doing much better with insurance companies by simply being able to avoid signing punative contracts. A larger group would be under way too much pressure to sign from clients and the hospital.

Can you explain why you think this is the case? Why wouldn't a smaller group be under similar pressures? What 'punitive contracts' did you have in mind, and why would they differentially affect groups that are of different sizes?

 

[PathOne]

Join Ameripath. It's the Wave of the Future! 😀

 

[LADoc00]

Can you explain why you think this is the case? Why wouldn't a smaller group be under similar pressures? What 'punitive contracts' did you have in mind, and why would they differentially affect groups that are of different sizes?

I *think* that when insurance companies start hemorrhaging money for pathology services they really go after the elephants first and the mice second. If you have a monster 20+ man group that is billing $10 million a year to Blue Cross, the insurers see that a nice juice target for reduction. They are less likely to go after a smaller <1million/yr one man practice, but that is just what Im seeing so far, Im no expert. In terms of negotiating rates for bigger group, there is no real economy of scale when doing so for medical services, meaning I dont sense (and I could be wrong) an entity like Blue Shield/Blue Cross cares if I am a single lone gun or in a 5 man group when they set the reimbursement in contracts. The most important thing *seems* to be not getting into bed with a contract in the first place, then BS/BC has to pay your customary rate not the contract rate. Of course Medicare will pay you whatever they feel like regardless if you are a 1 man group or a 100 man group, it doesnt matter.

that is my initial survey of the battlefield at least. I see pretty much no point other than call for a larger group. Maybe intradepartmental consultation, but figure even big groups still send out things like melanomas, tough lung cases etc. to academic centers.

Cons:
Loss of autonomy
Loss of rapid movement on new markets because you need to get the approval of that many more people
Loss of ability to modulate income vs. time off
Increased "monetary profile" getting the attention of insurers


Pros:
Less call, theoretically
More expertise to draw on

Also realize that in a group of more than 3 pathologists, one+ guy/girl will always be dragging ass and doing less than their share.

 

[Nilf]

I *think* that when insurance companies start hemorrhaging money for pathology services they really go after the elephants first and the mice second. If you have a monster 20+ man group that is billing $10 million a year to Blue Cross, the insurers see that a nice juice target for reduction. They are less likely to go after a smaller <1million/yr one man practice, but that is just what Im seeing so far, Im no expert. In terms of negotiating rates for bigger group, there is no real economy of scale when doing so for medical services, meaning I dont sense (and I could be wrong) an entity like Blue Shield/Blue Cross cares if I am a single lone gun or in a 5 man group when they set the reimbursement in contracts. The most important thing *seems* to be not getting into bed with a contract in the first place, then BS/BC has to pay your customary rate not the contract rate. Of course Medicare will pay you whatever they feel like regardless if you are a 1 man group or a 100 man group, it doesnt matter.

that is my initial survey of the battlefield at least. I see pretty much no point other than call for a larger group. Maybe intradepartmental consultation, but figure even big groups still send out things like melanomas, tough lung cases etc. to academic centers.

Cons:
Loss of autonomy
Loss of rapid movement on new markets because you need to get the approval of that many more people
Loss of ability to modulate income vs. time off
Increased "monetary profile" getting the attention of insurers


Pros:
Less call, theoretically
More expertise to draw on

Also realize that in a group of more than 3 pathologists, one+ guy/girl will always be dragging ass and doing less than their share.

BTW... How many 'lone rangers' do you know? (don't count these salaried Judases who work ad hoc for a GI/GU or derm clinicians). Nobody I know started of solo after residency, and I haven't heard of anybody practicing solo after years of working for a group/academic center/path mill. So far, my impression was that solo pathologists are nearly extinct species, unless you are a big gun in one area maybe.

 

[LADoc00]

BTW... How many 'lone rangers' do you know? (don't count these salaried Judases who work ad hoc for a GI/GU or derm clinicians). Nobody I know started of solo after residency, and I haven't heard of anybody practicing solo after years of working for a group/academic center/path mill. So far, my impression was that solo pathologists are nearly extinct species, unless you are a big gun in one area maybe.

I never knew of any and all the sudden Ive started running into them, not just in rural areas but in big urban centers as well. They keep a very very low profile, for good reason. They dont seem to congregate at society meetings, conferences etc. They operate exclusively at the shadowy fringe, but they are sure as hell there, in very nice places too(I dont want to be specific, but very exclusive retirement/vacation spots), at small community hospitals, maybe doing 20-30 cases/day.

 

[EUA]

Also realize that in a group of more than 3 pathologists, one+ guy/girl will always be dragging ass and doing less than their share.

Good lord. Truer words were never spoken.

 

[EUA]

I heart double posts.

 

[CameronFrye]

BTW... How many 'lone rangers' do you know? (don't count these salaried Judases who work ad hoc for a GI/GU or derm clinicians). Nobody I know started of solo after residency, and I haven't heard of anybody practicing solo after years of working for a group/academic center/path mill. So far, my impression was that solo pathologists are nearly extinct species, unless you are a big gun in one area maybe.

I haven't heard of any "lone rangers" but I know of at least one of our previous residents who joined a two man group (one of the partners was retiring) in a semi-rural area. He did not have a fellowship, but his starting salary was higher than any of the starting salaries I've seen mentioned on this site. Of course, he works his ass off and has lab director responsibilities.

 

[LichensteinPath]

Vwee at Lichtenstein Pathology Corp. (LPC) are pleased to announce contract with new partner in U.S. State of California. Euro exchange rate allow us many opportunity for multiple lap dance episodes with hospital ministers. Tableside thinprep exam with Heizölrückstoßabdämpfung device most impressive. Look forward we do for most glorious servicing to new California customer.

 

[RyMcQ]

Look forward we do for most glorious servicing to new California customer.

Dude, don't cross a fake German accent with a fake Chinese accent. It is disorienting.

 

[LADoc00]

Dude, don't cross a fake German accent with a fake Chinese accent. It is disorienting.

This is a section of an actual email I got from a Pathologist looking for a job:

Hello me name is (deleted). I am looking at your pathology group. I like California, you lucky. Maybe I should move to California too, hehehehehe. I am a board certified pathologist from the prestigious university program of (deleted). I have hold many jobs in pathology including quality control for (deleted corporate name). I have good communication including speak to surgeons and doctors.

Other than the deleted info, that is pretty much what I was sent along with a CV.

Of course that goes into the hall of fame for my corp.

 

[djmd]

Other than the deleted info, that is pretty much what I was sent along with a CV.

Of course that goes into the hall of fame for my corp.

So are you going to contact me about my inquiry, or not? You don't the fact that I "have good communication including speak to surgeons and doctors."?

At least they didn't included email in their good communication set.
Seriously who would write "hehehehehe" in a job letter/email.

 

[juddson]

LAdoc - nobody here knows who you are or where you live. Why don't you just tell us what kind of coin you are pulling down in your current practice model. Make me feel better or give me a good swift kick in the balls - I can take it.

Judd

 

[LADoc00]

LAdoc - nobody here knows who you are or where you live. Why don't you just tell us what kind of coin you are pulling down in your current practice model. Make me feel better or give me a good swift kick in the balls - I can take it.

Judd

Alot.

 

[juddson]

Alot.

North of 250k?

Judd

 

[djmd]

North of 250k?

HAHAHAHAHA!

Hahahahaha....
Had to search for this thread...
http://forums.studentdoctor.net/showthread.php?t=304366

 

[LADoc00]

North of 250k?

Judd

What I make is irrevelant to what you can make. As we have discussed many times, there are and always will be have and have not pathologists. Those making 150K for Kaiser and business-types making 7-figures. In terms of actually being able to sign out continously with no vacation/no day off, pathology caps out at between 1.5-2 million/yr gross but that is totally non-sustainable.

In terms of being a solo business man though, I think a spirited young pathologist can learn alot by being in a mercenarial group for a few years then striking out on their own, maybe in a low key rural area and focusing on outpatient (read😳utreach) biopsies.