A career in pathology – information for medical students

[BU Pathology]

There is a concern that good medical students will not seriously consider pathology due to unfounded internet rumors. Information is being posted for 4th year medical students who are considering a career in pathology. These data are provided to give students accurate, verifiable information so that appropriate career decisions can be made.

Issue # 1 – Jobs
You will find useful information in the attached file, 2011 Job Market Survey CAP.pdf. The job market survey was based on responses from 905 pathologists, which is a much larger sample than the occasional postings on this website warning that no jobs are available. The job survey information starts with slide 61 which is actually slide #3. The entire slide deck was too large to upload, so those slides related to the job market were extracted.

Briefly, based on this survey last year done by the College of American Pathologists:
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
Data are found on slide 10, numbered 68

Issue #2 – Compensation (i.e. salary)
The majority of pathologists’ starting salaries (more than 80%) were in excess of $150,000 per year. These are salaries and do not include benefits such as health insurance.

Issue #3 – Satisfaction
Slide # 72 (actual 14) shows that 85% of pathologists were very satisfied or satisfied with their new position. Only 1% were very dissatisfied with their new job.

Issue #4 – Jobs in the future
We are concerned that there will be a shortage of pathologists in the future. With the Supreme Court ruling that upheld the Affordable Care Act it is anticipated that 32 million people will now have health insurance. There will probably be an expansion of needs for pathology services. Additionally, pathology has the third highest percentage of practitioners who are over age 55 in the year 2006 (Figure 6 from AAMC Workforce.pdf).

If you are a medical student considering a career in pathology be assured that there are excellent jobs for pathologists now. Every indication is that there will continue to be excellent jobs in the future. As a discipline we make substantial contributions to the health of the nation which will ensure our continued success.

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

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[bauber]

This is helpful. Thank you.

 

[KeratinPearls]

Hmm slide 13 shows perceived difficulty in finding a first position is due to availability of jobs with a WHOPPING 94% saying that too few jobs are available. Geez, this slide cannot be overlooked as well.

 

[mlw03]

As the two presidential candidates will show in the coming months, statistics can be made to say darn near anything. While Dr. Remick is obviously presenting factual data, a survey cannot measure (well) stress in finding a job nor can it present us comparing ourselves as a field to other areas within medicine.

While I wouldn't discourage a student from going into pathology, I would make sure they were not geographically restricted. At the end of the day, I think that is the single biggest factor (assuming competence and not being an a*$hole). If you're willing to move around North America, you'll find a job. If you're set on a specific locale, well, may the odds be ever in your favor.

 

[Xinlitik]

As the two presidential candidates will show in the coming months, statistics can be made to say darn near anything. While Dr. Remick is obviously presenting factual data, a survey cannot measure (well) stress in finding a job nor can it present us comparing ourselves as a field to other areas within medicine.

While I wouldn't discourage a student from going into pathology, I would make sure they were not geographically restricted. At the end of the day, I think that is the single biggest factor (assuming competence and not being an a*$hole). If you're willing to move around North America, you'll find a job. If you're set on a specific locale, well, may the odds be ever in your favor.

So, you're saying the path job market is like Hunger Games? God save us.

 

[flindophile]

One could interpret the rsesults of the CAP survey as showing:
1) each job seeker had ONE job offer
2) (out of desparation) each job seeker TOOK the ONLY job offer they had
This is not particularly encouraging

While I appreciate BU Pathology's attempt to elevate the disucssion from anecdote to evidence, the evidence base is not very good. The CAP surveys are flawed because they take a survey of a convience sample rather than a meaningful longitudinal survey students who enter residency. At the end of the day, we are interested in:

1. the number of residents who entered pathology who eventually obtained a position in pathology
2. some outcome measure (income, satisfaction, etc) of those who succeeded in obtaining a position.

Also, you need a basis for comparison. The bottom line question is, "What is the cost effectiveness of entering a pathology residency program". I don't know the answer and, unfortunately, I don't think the CAP surveys provide any insight. One needs to critically evaluate published statistics. Just because something has been "published" does not mean it is correct or useful. In particular, the CAP survey is not peer reviewed and I shudder to to think of the reviews it would receive if it were submitted to a journal on labor economics. The point is that there is good evidence and bad evidence. The anecdotal evidence on SND is not good. I am not sure the CAP survey is any better.

 

[BU Pathology]

It should also be noted that several pathologists received multiple job offers. The survey data show that one 42% received multiple offers. The other year 44% of pathologists looking for employment received multiple job offers.

 

[Substance]

More than fifty per-cent of graduates having only one job offer at the end of residency is piss-poor compared to all other specialties save for nuclear medicine.

The fact is the demand for pathology is so great that it allows for corporate control. The overtraining of pathologists that is often spoken about on this forum favors corporate cost-cutting by increasing supply. These things - high demand allowing for corporate encroachment, and lowering the value of the providers - de-professionalize your field.

I would suspect your fearless leaders at the CAP are more in line with corporate interests than professional ones.

Radiology is encountering a similar fate. Hopefully they will lobby strongly to avoid it, though I have my doubts.

 

[Thrombus]

I would like to see this survey:

1. Do you have enough work or would you like more?

2. Are you being exploited (is someone making more money off your work than you are)?

I do not personally know any pathologist who would not take more work that they can get PAID for. It is a war out there in trying to acquire specimens. Our group has to fight them off every day it seems. No sane person (or a person without secondary gain) would say that this market is not saturated for years to come.

 

[KeratinPearls]

If you want to know the private practice market you have to talk to someone like LADoc, a practice owner, or those working in private practice. If you want to know about the academic job market, talk to those in academics.

 

[mlw03]

So, you're saying the path job market is like Hunger Games? God save us.

Hopefully it's not quite that bad, but glad you enjoyed the reference. I think findophile's points are spot on and don't have anything to add. Med students need to very carefully evaluate all of the information available to them in deciding if a career as a pathologist is right for him/her.

 

[schrute]

We are concerned that there will be a shortage of pathologists in the future. With the Supreme Court ruling that upheld the Affordable Care Act it is anticipated that 32 million people will now have health insurance. There will probably be an expansion of needs for pathology services. Additionally, pathology has the third highest percentage of practitioners who are over age 55 in the year 2006 (Figure 6 from AAMC Workforce.pdf).

Aside from the other issues on which people have and will continue to opine, I find this last one disturbing particularly from the assessment that the ACA (if it lasts) is going to be a boon for pathologists.

Simply adding 30+ million people from the uninsured pool to the insured pool does nothing to address "access" to healthcare, let alone any sort of guarantee these people will use their new found "health insurance" or utilize healthcare in any more of a long-term capacity than "free ER" visits.

Assuming this magic 32 mil will "probably" result in expanded need for pathology service is nothing short of an assumption that the stars will align.

Even if this magic 32 mil DID result in a huge expansion of pathology needs, there's no way it will result in fair compensation. We'll see expedited reimbursement decline and a larger population of trainees fighting for table scraps, with corporate positions becoming the mainstay

The average age of pathologists being 55 means nothing; there's not going to be a mass exodus of seasoned comfortable old-timers just handing over the reins to the next generation. Sure these positions will open up, but only after they have been sold to corporate entities as the feasibility of increasing volume to offset income losses reaches a breaking point, the point at which it makes more sense for a large corporate entity to manage the work flow.

No offense, but I am not as cheerful as I look at the forecasts as declared from he ivory towers of academia & financial security.

I realize that's a bit on the cynical side, but somewhere between cynicism and blind optimism lies caution, and that's what I'd ultimately recommend for anyone considering a career in pathology, let alone medicine in general, or any career that has astronomical education costs that outpace inflation, high stress & high burn out rates, and compensation that is contingent on highly politicized & debatable tenets (eg. universal healthcare) and that evoke serious philosophical debate. It's a decision I'm happy with, and many others as well, but it's a decision that has undoubtedly gotten more difficult as our healthcare system (and medicine) has evolved.

 

[WEBB PINKERTON]

I'm suprised BU Pathology didnt put anything about how "personalized medicine" was gonna create even more jobs! I think i've been hearing that load of **** about as long as the looming mass pathologist retirement.

I seriously dont see how anyone who has been working in pathology can recommend it to anyone. If they close some programs and get the numbers back WHERE THEY SHOULD BE, maybe things will change.

The hunger games analogy is pretty darn funny.

 

[cjw0918]

I love my private practice job, but I was VERY fortunate to get it. I worry for the residents that I helped train in my former academic job. I hope that they will be able to find DECENT (NOT exploitative or slave-labor) type positions. I am particularly worried for the ones that work very hard and will make excellent pathologists. They deserve to find something worthy of their efforts and I'm not sure they will, esp the ones determined to stay in this locale.

The crappy ones, I honestly have no idea what will become of them. They stand no chance in the real world. I believe it would have been a service to them by the PD to steer them into another specialty. But God forbid we tell people the truth!

As for surveys, I would not take them as gospel. Med students, talk to path residents and fellows and see what they say. Do not listen to anyone that has not attempted to look for a job in the last few years, esp not people in ivory towers who don't live in reality.

 

[Pathwrath]

My take on the survey is that a pathology residency by itself is now essentially useless for employment.

I am not reassurred that one third of residents are now completing two or more fellowships. I am certain that that percentage was far lower twenty years ago and that it will only increase with time.

 

[deleted314957]

My take on the survey is that a pathology residency by itself is now essentially useless for employment.

I am not reassurred that one third of residents are now completing two or more fellowships. I am certain that that percentage was far lower twenty years ago and that it will only increase with time.

it WAS far lower. the vast majority of my peers in the early 80's were just ap/cp.

 

[HerrTex]

it WAS far lower. the vast majority of my peers in the early 80's were just ap/cp.

was there an intern year in the 80's?

 

[NuckingFuts]

Med students, talk to path residents and fellows and see what they say. Do not listen to anyone that has not attempted to look for a job in the last few years, esp not people in ivory towers who don't live in reality.

I can tell you from first-hand knowledge that even some folks coming out of supposed ivory towers are finding the job market a bit distasteful. I'm not sure if that's because they're geographically limited, socially challenged, etc. though.

 

[KCShaw]

People did fellowships back in the day, they just called it a credentialing year. Has total time spent in training really changed that much on average, or are we just seeing it differently?

It wasn't all that long ago that immuno's just didn't exist for the masses. With that among other things, the learning-load has gone up while residency time has actually gone down with the elimination of the credentialing year (which I believe originally was supposed to be an intern year at the beginning, but became most commonly used as a pseudofellowship year at the end).

 

[LADoc00]

I have been told of a future shortage of Pathologists since literally 1995, it has never materialized nor will it.

What instead will happen is a guy who had been comfortably doing 3000 cases a year, will do 4000 or 5000 or ???

The upper limit of what a seasoned Pathologist can sign out is nowhere in site, we could lose almost 1/2 of all US Pathologists and absorb the volume if the other 1/2 decided to no longer be lazy...

 

[mlw03]

I have been told of a future shortage of Pathologists since literally 1995, it has never materialized nor will it.

What instead will happen is a guy who had been comfortably doing 3000 cases a year, will do 4000 or 5000 or ???

The upper limit of what a seasoned Pathologist can sign out is nowhere in site, we could lose almost 1/2 of all US Pathologists and absorb the volume if the other 1/2 decided to no longer be lazy...

Care to elaborate, LA? Are you saying most private practice community pathologists could be signing out a lot more cases than they do now? If so, why? Are people seriously spending too much time futzing around online and not enough time looking at cases in 2012? Too much administrative stuff?

 

[deleted314957]

People did fellowships back in the day, they just called it a credentialing year. Has total time spent in training really changed that much on average, or are we just seeing it differently?

It wasn't all that long ago that immuno's just didn't exist for the masses. With that among other things, the learning-load has gone up while residency time has actually gone down with the elimination of the credentialing year (which I believe originally was supposed to be an intern year at the beginning, but became most commonly used as a pseudofellowship year at the end).

i came in before that "5th" clinical year was required but because i was Navy i did a surgical internship. that "5th" year did not last long and was often bastardized. sub speciality fellowships right out of residency in my time period were not common. probably less than 20-25%. i did one because 1) it was job security/insurance if general path went to hell (did forensic) 2) it was the AFIP/Baltimore M.E.office sponsor and 3) it did not increase my military obligation if i did it immediately after my residency. i am sure that has changed.

immunos were just starting ti kick in during my residency. we had the "big three" keratin, s-100, vim and "lca" ( now known as cd-45)

 

[deleted314957]

I have been told of a future shortage of Pathologists since literally 1995, it has never materialized nor will it.

What instead will happen is a guy who had been comfortably doing 3000 cases a year, will do 4000 or 5000 or ???

The upper limit of what a seasoned Pathologist can sign out is nowhere in site, we could lose almost 1/2 of all US Pathologists and absorb the volume if the other 1/2 decided to no longer be lazy...

if i do 8000/yr i feel like i am on vacation

 

[deleted314957]

Care to elaborate, LA? Are you saying most private practice community pathologists could be signing out a lot more cases than they do now? If so, why? Are people seriously spending too much time futzing around online and not enough time looking at cases in 2012? Too much administrative stuff?

they could be signing out FAR MORE! I sure did as a partner in PP and now.
i see ads from outfits with 8 path who advertise 18,000 surgs and a commensurate # of cytos. i always say they must keep a rotating foursome of bridge and the other 4 do the work! i think lots of paths don't know the definition of work.

 

[thefifteenth]

whats the job market like for path residents who train at top programs?

 

[Substance]

if i do 8000/yr i feel like i am on vacation

This here is what is missing in a lot of medicine.

Path and rads are very similar. Why can a rad blow through tens of thousands of studies in a year where a path can only do 3000? Not only that but paths don't do nights and rarely do weekend work. They got it way easier, and seem to do less work on average, which is why they are seen as less valuable.

Part of the oversupply problem is probably due to people not wanting to pick up the slack.

 

[2121115]

I love my private practice job, but I was VERY fortunate to get it. I worry for the residents that I helped train in my former academic job. I hope that they will be able to find DECENT (NOT exploitative or slave-labor) type positions. I am particularly worried for the ones that work very hard and will make excellent pathologists. They deserve to find something worthy of their efforts and I'm not sure they will, esp the ones determined to stay in this locale.

The crappy ones, I honestly have no idea what will become of them. They stand no chance in the real world. I believe it would have been a service to them by the PD to steer them into another specialty. But God forbid we tell people the truth!

As for surveys, I would not take them as gospel. Med students, talk to path residents and fellows and see what they say. Do not listen to anyone that has not attempted to look for a job in the last few years, esp not people in ivory towers who don't live in reality.

I agree 100%.

The true issues here are 1) over supply and 2) lack of adequate training. As for 1) the CAP obviously thinks there aren't enough pathologists so there you go.

Number 2 is a tougher issue. Pathology residents listen up - YOU HAVE TO TRAIN YOURSELF TO SIGN OUT CASES. Plain and simple. No one is going to train you to be ready to go to battle on your own after 4 years. Do what you have to do to train yourself. Pathology is the only field where you spend 4 years as a glorified medical student and then go straight from medical student to attending level in terms of responsibility. There is a reason jobs generally want you to have experience, because when you finish "training" you have never signed out a case or taken true responsibility for a case. That is the fault of people who "teach" at these academic centers, but that is the way it is and you have to deal with it. Your program couldn't care less what happens to you after you walk out the door, because there are new residents walking in ready to gross. You are alone, on your own, with only the skills you got on your own. Don't assume you will just all of the sudden as a 4th year be able to sign out cases.

 

[mlw03]

And how does one do that when academic attendings don't allow it. Even fellows seem to only get limited autonomy. I agree this is a huge failure of current pathology training in the us.

 

[malchik]

This here is what is missing in a lot of medicine.

Path and rads are very similar. Why can a rad blow through tens of thousands of studies in a year where a path can only do 3000? Not only that but paths don't do nights and rarely do weekend work. They got it way easier, and seem to do less work on average, which is why they are seen as less valuable.

Part of the oversupply problem is probably due to people not wanting to pick up the slack.

Do you have any idea what you're talking about?

 

[deleted57552]

And how does one do that when academic attendings don't allow it. Even fellows seem to only get limited autonomy. I agree this is a huge failure of current pathology training in the us.

The ultimate obstacle to this is ACGME. Some fellowship programs are able to have their fellows sign out frozens and cases if they "secede" from the ACGME accreditation umbrella. Some institutions have done this. Applicants should be wise to ask this question when they visit institutions. Unfortunately, fellowships geared towards training in board-certifiable subspecialties have to be ACGME accredited, as I am told. But if anyone knows differently, that would be good to know.

 

[Pathwrath]

People did fellowships back in the day, they just called it a credentialing year. Has total time spent in training really changed that much on average, or are we just seeing it differently?

It wasn't all that long ago that immuno's just didn't exist for the masses. With that among other things, the learning-load has gone up while residency time has actually gone down with the elimination of the credentialing year (which I believe originally was supposed to be an intern year at the beginning, but became most commonly used as a pseudofellowship year at the end).

The credentialing year was intended to be purely clinical. From my experience, toward the end of its dubious existence it was used as time-off to study for boards and make-up scope time for time wasted doing research to get into fellowships. I think calling it a pseudofellowship year is very generous.

The amount of material to learn has definitely increased, but that applies equally to medicine across the board and no one has proposed increasing the number of years to obtain the M.D., for example, or the amount of time to complete any other residency. I think it's an excuse.

 

[mlw03]

The ultimate obstacle to this is ACGME. Some fellowship programs are able to have their fellows sign out frozens and cases if they "secede" from the ACGME accreditation umbrella. Some institutions have done this. Applicants should be wise to ask this question when they visit institutions. Unfortunately, fellowships geared towards training in board-certifiable subspecialties have to be ACGME accredited, as I am told. But if anyone knows differently, that would be good to know.

But even this means you've having to wait until fellowship to have any real responsibility. Is there no way for residents to have some, as in many other specialties such as surgery, IM, peds, etc. I have a friend in rad onc and he says he has similar issues.

This issues comes up occasionally on here, and it does relate back to this topic. Yes there are jobs out there, but I imagine plenty of groups are reluctant to take someone fresh out of fellowship if they can avoid it because they know it'll take that pathologist a bit of time to become comfortable with their newfound autonomy. This is something I'm currently experiencing in my first job.

 

[LADoc00]

if i do 8000/yr i feel like i am on vacation

No one in Cali doing general surg path does 8K+/yr with very FEW exceptions (there is one guy I dont know if he still alive that rocks 12K/yr).

Derm and GI only..yes.

8K of general surg path + a good medical directorship fee is a f'ing fortune Mike.

You should take us all out to Ruth's Chris sometime bro. With that sort of cash flow Mike, I expect you to be partying with Martin Sheen and Prince Harry at the Bellagio on weekends..

To put that in perspective, if every pathologist in Cali did 8K surgical/year, we would need only 3/8 the number of pathologists we have currently working full time...

 

[LADoc00]

they could be signing out FAR MORE! I sure did as a partner in PP and now.
i see ads from outfits with 8 path who advertise 18,000 surgs and a commensurate # of cytos. i always say they must keep a rotating foursome of bridge and the other 4 do the work! i think lots of paths don't know the definition of work.

Yup..
I had a group call ME asking desperately for more pathologists because their 4 staff were holding down a "whopping" 10K cases/year (*sarcasm*)...

I told the practice manager to tell the Pathologists to go to work! That pitiful volume output is disgraceful.

Strangely its seems common all over the US.

I think I can handle 10K surgicals a year if I had a healthy Uro/GI/Derm mix in there.

 

[WEBB PINKERTON]

The pathologists at labs with 10,000 surgicals and 3 or 4 paths probably only "work" 2 weeks a month. There are still a few of these places around but not much longer. This country could EASILY get by with probably 2/3 the number of paths we currently have.

 

[KeratinPearls]

No one in Cali doing general surg path does 8K+/yr with very FEW exceptions (there is one guy I dont know if he still alive that rocks 12K/yr).

Derm and GI only..yes.

8K of general surg path + a good medical directorship fee is a f'ing fortune Mike.

You should take us all out to Ruth's Chris sometime bro. With that sort of cash flow Mike, I expect you to be partying with Martin Sheen and Prince Harry at the Bellagio on weekends..

To put that in perspective, if every pathologist in Cali did 8K surgical/year, we would need only 3/8 the number of pathologists we have currently working full time...

It's Charlie Sheen not Martin Sheen, LA. Martin is the old timer, I believe. LOL.

 

[LADoc00]

It's Charlie Sheen not Martin Sheen, LA. Martin is the old timer, I believe. LOL.

Oh yea! Whoever the crazy dude is.

 

[KCShaw]

I used to think the problem with letting path residents do more sign-out, or true co-signing only, was because too many surgeons act on the first hint of anything out of the pathology department without waiting for a true final or phone call or whatever. But really that's a bit of a crock, as it's not that hard for a resident to enter everything for a case, hand over the slides to the attending, and sit back while the attending co-signs or corrects. This is how most of 3rd/4th year should be going. But many academic attendings don't think of themselves as efficient enough for this to work -- as it is, many sign-out days can take most of the day (certainly variable, but still), and few are willing to wait for the resident to look, dictate, and dictations to show up in the system before they can start looking at cases themselves. Doesn't mean it can't work, but most programs just don't try hard enough to -make- it work.

 

[schrute]

Oh yea! Whoever the crazy dude is.

You must have a sweet gig--no way I'd stomach 9% state income tax.

 

[yaah]

# of cases per year is really variable. In our group some people only sign out about 1500-2000 a year because a lot of their cases are 20+ slides. Others sign out upwards of 15,000 (but they are almost totally subspecialized). Subspecialization has increased the average number of cases per pathologist, although numbers for many have gone down.

I don't know where the limit is. The limit would have to be reached with true, total subspecialization. But unless a group is huge they can't do that.

 

[2121115]

In our group we keep track of blocks signed out, rather than cases.

 

[HerrTex]

I have been told of a future shortage of Pathologists since literally 1995, it has never materialized nor will it.

What instead will happen is a guy who had been comfortably doing 3000 cases a year, will do 4000 or 5000 or ???

The upper limit of what a seasoned Pathologist can sign out is nowhere in site, we could lose almost 1/2 of all US Pathologists and absorb the volume if the other 1/2 decided to no longer be lazy...

so not only is the field saturated but saturated with lazy people? so pathologists they take more on cases that will decrease the need for more pathologists?

 

[LADoc00]

so not only is the field saturated but saturated with lazy people?

Ummm yah basically Im afraid.

 

[LADoc00]

I don't know where the limit is. The limit would have to be reached with true, total subspecialization. But unless a group is huge they can't do that.

I heard (perhaps a tall tale) during training that the world record for sign outs was held by a single German dermpath who SO'd 100K cases in 1 year. Obviously with massive fellow help (or perhaps an army of fellows?)

That would be upper limit for spec. sign out I imagine.

 

[NuckingFuts]

Obviously with massive fellow help (or perhaps an army of fellows?)

Although he did have an army of fellows, at any given s/o the key was him having 2 active fellows, dubbed a pitcher and a catcher. The pitcher, who would sit to his right, would place the slide on his microscope stage, he'd render a diagnosis in record time without flinching, and then the slide would quickly be removed by the catcher sitting to his left. This process would repeat like rapid fire.

Legendary.

 

[Substance]

I heard (perhaps a tall tale) during training that the world record for sign outs was held by a single German dermpath who SO'd 100K cases in 1 year. Obviously with massive fellow help (or perhaps an army of fellows?)

That would be upper limit for spec. sign out I imagine.

That's about 300 cases daily counting months as 28 days, with no vacation.

Is that a lot per day for dermpath? Is dermpath usually biopsies which are one or two slides, and the speed of the signout is dependent on mostly your knowledge rather than on other tests? Is that an unreasonable number?

 

[pathstudent]

I heard (perhaps a tall tale) during training that the world record for sign outs was held by a single German dermpath who SO'd 100K cases in 1 year. Obviously with massive fellow help (or perhaps an army of fellows?)

That would be upper limit for spec. sign out I imagine.

I heard now that USADA is done with Lance they are going after that dude.

 

[KCShaw]

That's about 300 cases daily counting months as 28 days, with no vacation.

Is that a lot per day for dermpath? Is dermpath usually biopsies which are one or two slides, and the speed of the signout is dependent on mostly your knowledge rather than on other tests? Is that an unreasonable number?

Depends on the cases, which depends on the derms/surgeons who send you stuff. Relatively more derm cases are non-tumor &/or only a slide up to 3. Relatively more derm cases are low power pattern recognition which can be signed out fairly rapidly in a formulaic/macro style. But others are more difficult, and some time should be taken to look under higher power, etc. Someone who gets a lot of excisions/re-excisions for melanoma probably is going to take longer to do the same number of "cases" or blocks/slides versus someone who gets a bunch of clinic punch biopsies for various rashes.

It sounds like quite a lot to maintain over an extended timeframe, but some people are faster than others. That comes out at, what, 84 seconds per case over 7 hours (gotta have lunch, right?) essentially every weekday including most holidays. I've learned not to take numbers too much at face value, but it can be a red flag. The problem isn't solely moving the glass and deciding on diagnoses, it's also reviewing the case information, dictating, reviewing for typos, and actually finalizing the case too, which for diagnostically simple cases can take the majority of one's time. And, y'know, someone still has to gross and process the da** things.

Additional testing can slow the turnaround for a specific case, but not necessarily decrease one's total caseload over the course of a year so long as the time spent ordering and interpreting the additional study(ies) doesn't take long (though usually there's some pontification required). But it's not like you have to stop looking at every other case until those results get back, so the workflow keeps moving.

 

[lipomas]

The pathologists at labs with 10,000 surgicals and 3 or 4 paths probably only "work" 2 weeks a month. There are still a few of these places around but not much longer. This country could EASILY get by with probably 2/3 the number of paths we currently have.

Yikes there is a lot of weirdness on here.

Well yes, pathologists at labs with 10,000 surgicals and 3-4 paths SOUNDS like they are underworked, but not really if you have any concept of how pathology in small hospitals works.

You need to have people there to run the labs, review QC, all the admin stuff, attend all the meetings you have to attend, cover frozens, cytology stuff. Plus all the stuff that is "easy" to sign out is probably already siphoned off so your 10,000 cases includes a sizeable number of larger or complicated cases. And if you're a small group you might not think it's worth paying for a PA to gross. And people have to go on vacation and get CME.

So yes, if you break down all the numbers you could send out those 10,000 surgicals and 1-2 pathologists could easily sign them out. But you are ignoring most of what a general pathologist in a small group actually does with their day.

STOP SPREADING MISINFORMATION ABOUT THINGS YOU CLEARLY KNOW NOTHING ABOUT.