Is it just me or does it seem like every academic medical center in the US is looking for pathologists?
http://www.pathologyoutlines.com/Jobs/jobs.html
http://www.pathologyoutlines.com/Jobs/jobs.html
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They all want cytopathologists! No one seems to want to do cyto in an academic setting. Cyto is a weird fellowship. Seems like a lot of people do the fellowship and then don't want to do it anymore, or at least they don't want it as their career focus. I have never really been able to figure that out. There are many who really love cytology and do want to do it, but they seem to be the minority.
IF academic med centers try to incentivize pathologists based on profit AND cytopath yields minimal profit, then academic pathologists would have to be idiots to do it. This is very different than in a private group where cytopath might be an essential part of the services and although not well compensated, the guy doing cyto gets the same partnership cut.
Look at UCSF for example, Leboit and Tim C. makes over 1.5 million a year per. An untenured cytologist at SF General makes....get this 80K a year!! MAYBE you make associate prof and can pull down 240K....maybe. But the disparity is insane. Meanwhile, there are private groups where the income is say a modest 400K per partner, no one at Leboit level but no one eats crap at 80K either.
Where would you work as a cytopath?
Look at UCSF for example, Leboit and Tim C. makes over 1.5 million a year per. An untenured cytologist at SF General makes....get this 80K a year!! MAYBE you make associate prof and can pull down 240K....maybe. But the disparity is insane. Meanwhile, there are private groups where the income is say a modest 400K per partner, no one at Leboit level but no one eats crap at 80K either.
Where would you work as a cytopath?
These guys rake it in because they have a reputation for being the best in the world at what they do. Leboit is an editor of the WHO Skin tumors book.
I'm sure this brings in a few consults internationally. Not sure how much WHO authors make in other subspecialties.
I know that derm pays more regardless but being in a position where you are THE consult person for any subspecialty will likely allow you to generate inordinate amounts of cash compared to your average pathologist. You likely get book deals and may have private practice connections as well. I'm sure the Epstein's, Goldblum's, Fletcher's, Vardiman's, of this world make a generous living as well.
....kind of like coaching football for Michigan vs. Eastern Connecticut State University.
THey don't get paid based on their reputation. They make a lot because they loot at a lot of 88305s all day long. Now as far as consults go, they probably do "bill" a large sum for those, but if the patient has insurance, there is a CPT code for a pathology review and it doesn't pay as much as it does for reading it the first time. They might make a nice chunk of change from consult cases that other pathologists send in, where someone like LADOC pays them their consult fee to look at his difficult melanoma vs. Spitz in a ten year old.
But my guess is the bulk of their money is made from getting a percentage of the technical and professional component of the many tissue biopsies sent to UCSF for them to read.
Pathology compensation is non-logical. Let's say a urologist takes 12 prostate biopsies from 12 different areas of the prostate. If he takes all the left ones and puts them in the "left side" container, and all the right ones and puts them in the right side container, you as pathologist can bill two 88305s (= ~$70-75). If he puts each one in its own container you can bill for 12 88305s (= ~$420-450). So for looking at the same tissue, you can make a lot more money simply based on how it is packaged. Weird, huh?
Now let's say you have a pancreas/duodenum specimen. If you get two bowel margins, a bile duct margin and a pancreatic body margin, you can charge for performing 4 frozen sections. Then you can bill an 88309 for the specimen (maybe you make 250 for all your work doing the frozens, grossing it and reading it out.) If the surgeon takes the margins in the OR and sends them up separately in their own containers for frozen section, you can then bill for all the frozens, bill the 88309 for the main specimen and then bill for each of the permanents on the frozen sections and make more money. Again, it doesn't make sense because the first way is harder (taking the margins yourself) but you make less money. It is all about the container.
So I've been wondering... I have an interest in infectious disease research (ok, I have a PhD in it), and almost all my interviews have suggested I should go down the CP road and do clinical micro, etc, for the obvious connection there. However I really enjoy the work I've done in anatomic path thus far, but obviously there aren't just a lot of "ID expert" surgical pathologists (von Lichtenberg comes to mind)... I know there's not a huge demand, but it seems that the potential for positioning oneself as an expert in the field would be huge (since there's virtually no one doing it), and the possibility for carving out a niche exists... and yes, I'm interested in Academics. I know no private practice would ever have need of an ID path person. 🙂
Anyway, just some musings I've had... apparently there are 5 or so applicants interested in ID related research this year, so maybe there will be a bunch of us by the time I'm looking at jobs.
BH
There is such a thing as an Infectious Disease Pathology organization - they have a companion society meeting at the USCAP every year, and they also have an evening specialty conference (at least for now they do). So I am sure they would be welcoming a resident who shows interest if you went to their sessions, and could provide more info.
In terms of consults and $ making, the big names in terms of consults use their reputation and their tendency to draw consults to leverage more money out of their institutions. Epstein makes a lot of money. So does Sharon Weiss. But you have to get to that level of fame and respect before you truly start to see that level of compensation. They are also invited to speak at various places all the time, and many of them, particularly foreign conferences, are likely to pay very well as a "stipend." So yes, while it is true that many academics don't get paid based on their reputation, many do.
CPT coding itself seems to be an artform. Technically, you can bill for separate specimens within a single specimen if the surgeon notes it as being important. Like, if you get an IVC resection for leiomyosarcoma that includes kidney and part of liver, there are ways that it would be legal to bill separate codes for all 3 parts. I don't fully understand it, though. And based on the official rules, you can bill two 88309s for cystoprostatectomy specimens, because the prostate is not really an "incidental" specimen. I agree with pathstudent though, it is totally non logical. A liver bx is an 88307, but breast and prostate and 88305 even though you do more levels on each and perhaps may spend more time looking at them. A skin bx is 88305 whether it is for a 1 second BCC diagnosis or a tricky MF.
In terms of consults and $ making, the big names in terms of consults use their reputation and their tendency to draw consults to leverage more money out of their institutions. Epstein makes a lot of money. So does Sharon Weiss. But you have to get to that level of fame and respect before you truly start to see that level of compensation. They are also invited to speak at various places all the time, and many of them, particularly foreign conferences, are likely to pay very well as a "stipend." So yes, while it is true that many academics don't get paid based on their reputation, many do.
CPT coding itself seems to be an artform. Technically, you can bill for separate specimens within a single specimen if the surgeon notes it as being important. Like, if you get an IVC resection for leiomyosarcoma that includes kidney and part of liver, there are ways that it would be legal to bill separate codes for all 3 parts. I don't fully understand it, though. And based on the official rules, you can bill two 88309s for cystoprostatectomy specimens, because the prostate is not really an "incidental" specimen. I agree with pathstudent though, it is totally non logical. A liver bx is an 88307, but breast and prostate and 88305 even though you do more levels on each and perhaps may spend more time looking at them. A skin bx is 88305 whether it is for a 1 second BCC diagnosis or a tricky MF.
Quick and Interesting exercise:
I want someone to calculate the number of surgical biopsies, ie 88305s you would need to sign out per year to match the 3.5 million+ compensation the dermpath faculty(Phil and Tim are 3.05mil of that) at UCSF get.
In doing so, please take into account 8% for billing and another 30% for benefits.
Assumption one: Figure average collections for each 88305 is the standard SF medicare reimbursement of around 125% Medicare (40 dollars) or 50 bucks per.
How many DERM surgicals would they need to process each year to match their wages from the State of California?
Hint: the number is immense.
Then I want our UCSF residents to tell us how many surgicals dermpath actually signed out in 2007.
I want someone to calculate the number of surgical biopsies, ie 88305s you would need to sign out per year to match the 3.5 million+ compensation the dermpath faculty(Phil and Tim are 3.05mil of that) at UCSF get.
In doing so, please take into account 8% for billing and another 30% for benefits.
Assumption one: Figure average collections for each 88305 is the standard SF medicare reimbursement of around 125% Medicare (40 dollars) or 50 bucks per.
How many DERM surgicals would they need to process each year to match their wages from the State of California?
Hint: the number is immense.
Then I want our UCSF residents to tell us how many surgicals dermpath actually signed out in 2007.
113k. $50 * 62% (at 38% overhead) = $31 per 88305 3.5M/31 =113k.
I think your assumptions are too generous..
Im giving them the benefit of the doubt and making the assumption they are getting to bill for the pro fees or 88305-26 and not paying overhead for the TC UCSF Med Center is getting. Im also making the bold assumption they are actually collecting 100% of their billed fees, which is ludicrous and way overly generous.
I would assume they are not getting a share of the TC, UCSF would have to be run by complete fools to do that, but who knows tigers run loose in SF.
It comes out to around 98K/year to cover their wages+benefits.
Then assume 52 weeks*5 days/wk signout - government holidays(usually 19/yr in California)=241
98000/241=407 specimens a day.
THERE IS NO WAY, NO WAY IN HEAVEN THEY SIGN OUT 407 CASES/DAY.
From the UCSF website:
25K is all the surgicals for UCSF. SO, Dermpath is doing supposedly 4x that volume of the entire rest of the surg path staff?!
Folks, I officially call SHENANIGANS.
And California is going bankrupt.
I would assume they are not getting a share of the TC, UCSF would have to be run by complete fools to do that, but who knows tigers run loose in SF.
It comes out to around 98K/year to cover their wages+benefits.
Then assume 52 weeks*5 days/wk signout - government holidays(usually 19/yr in California)=241
98000/241=407 specimens a day.
THERE IS NO WAY, NO WAY IN HEAVEN THEY SIGN OUT 407 CASES/DAY.
From the UCSF website:
25K is all the surgicals for UCSF. SO, Dermpath is doing supposedly 4x that volume of the entire rest of the surg path staff?!
Folks, I officially call SHENANIGANS.
And California is going bankrupt.
The whole state? or just UCSF? They charged me $22 to park there for < 8 hours, how could they be going bankrupt? 🙂
Interesting heads up in the ID path association Yaah, thanks. Oddly enough it appears I know quite a few people who are members yet they don't have a website or anything so I'd never come across them in all my google searches. Wonder what the society does (besides get together at USCAP)...
BH
We have one attending who specializes in ID in AP. Also, one of our residents will be doing the ID path fellowship that is shared between Emory and the CDC (see below). It's a new program, which looks to be quite awesome.
http://pathology.emory.edu/Forms/CDCEmory_ID_Path_Fellowship.pdf
http://pathology.emory.edu/Forms/CDCEmory_ID_Path_Fellowship.pdf
I've never signed out with the Dermpath people here, but I have heard that it is quite a setup that they have over at Mt Zion and that they move a lot of glass- a lot. Maybe one of my co-residents perusing this thread can give some insight on how many cases per day are signed out on that service.
Indeed it does... I'm familiar with it and I have met Dr. Zaki before, super nice guy. Emory is definitely high on my list. 😀
