Advice to a resident thinking of switching to path

[exPCM]

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These are responses from a current thread on the physician only website Sermo to an anesthesiology resident thinking of switching to pathology:
1. I'm a 70 year old pathologist, now doing locum tenens practice. I would not advise anyone to become a pathologist today. The job market has been bad for thirty years now, and I see little evidence that it's getting better. The short, regular hours and the absence of more than minimal night and weekend call make pathology attractive, but only if you have a job. Right now subspecialists, particularly dermatologists, are whittling pathology away, but I think that in the not too distant future it'll be done by non-physicians. We pathologists desperately need to re-invent our specialty, and I don't see it happening.

The best thing about pathology is that nobody knows what it is we do. The worst thing about pathology is that nobody knows what it is we do. - Other than that, what I like about pathology is that almost every day I see something I've never seen before.

2. biggest risk I see is that it is so damn easy to make a machine that will scan all the specimen and digitize it and send it to India in a jiffy ......... where it can be read 24x7 and reported back in a jiffy

3. 1) this is why we have books and colleagues. Yes, there are a huge number of possible diagnoses but in real practice you use a subset of them frequently. If you specialize (in say, neuropath) that subset becomes even smaller.

2)I'm really not sure how obamacare will affect pathology. One could argue if patients have insurance pathologists are more likely to be paid. Since we can't pick our patients, if they are uninsured/no pay...we get stuck with unpaid bills.

As for telepathology, I don't see slide digitization sending work overseas any time soon. The bigger threat currently I believe is "pod labs" where borderline competant pathologists are hired to read biopsies for a small fee per slide. Plus, not everything can be digitized. Someone will still have to do gross disection, supervise the blood bank, perform autopsies etc.

3) three best...1 decent work hours and relatively easy call
2 don't have to deal with difficult/needy/drug seeking patients
3 "instant gratification" when making a diagnosis

three worst...1 you can't just open up your own practice, you depend on too many support people (histologists, cytotechs, med techs)
2 you usually end up working for someone else (the big Path groups like Ameripath (aka the devil), labcorp etc)
3 your production and compensation aren't really under your control at all.

4) for surgical pathology the work hours are primarily M-F when the OR is operating (8-5 or so). Weekend call can be variable, usually pretty light. Clinical pathology (especially blood banking) can have more extended hours but many issues can be handled by phone. I've found taking vacation to be fairly easy if you are in a group of pathologists. I suppose anesthesia is similar in that once a case is done, you're done with it.

I love pathology. It's intellectually challenging and satisfying, allows for a relatively normal life outside of work and pays decently.

4. FORGET PATHOLOGY AS A SPECIALTY! switch to IM ( internal medicine). I personally have had 15 of the worst years of my life trying to find a permanent position. nor am I alone. I have colleagues from all background,sall schools-US and foreign,all skill levels that have had difficulty. the problem is that they oversupplied them. too many training progmas. the leaders at CAP and ASCP live in a fantasy world and refused to accept that people would not retire. they deluded themsleves thinking hemepath fellowships were the answer. now after confidential surveys they realize that the goofed. not only are the fellows of hemepath too focused and they cannot use that level of expertise at the community hospital level, but they do not know any clinical pathology. the only solution is to close training prgrams. for those academics that can not get an R-O-1 grant have them teach MS degree programs in experimental pathology. but nothing related to service work. there are already too many in residents or fellows holding on by a thread or working for sub standard pay. they dream that someone shall die and they get their practice. they shall not.so try another field .try internal medince and then try clinical hematology or dermatology if you like diagnostic work and minimal patient contact. but forget pathology. I get too many cold calls from all levels--academic to remote private practice--still trying to get a job. forget it. you will be sorry.my only consolation is that with this economy the budgets shall be cut in many academic programs run by state funding ( e.g.Wisconsin,Alabama,Nevada,California,NY,NJ,Ohio,Michigan,Florida,South Carolina). it will lead to layoffs ,closing of programs,or those in the program can stay but no new residents added to them. so eventuallly these outfits shall be closed.automation shall clean out the programs for med tech's ( MT ASCP) so it will not really be a field that I recommend for anyone. brought on by simple stupidity. if you had a photocopy machine jammed with paper,you do not continue to feed it paper. you shut it down and rest the engine. evidently most academics lack this common sense. too bad. it once was beautiful field..forget it try IM ( internal medicine)

5.Path and rad are the two most vulnerable specialties to "farming out" in the 21st century. And it IS coming to a theater near you. Won't necessarily be digitized, but WILL involve competent histotechs doing slide prep/review/image transfer to competent pathologists overseas.

6.AND automated pathology is coming to a theatre near you; quality digitalized slides are the standards today. The future will be no need for morphology but rather proteomics and Genomics to determine CANCER DIAGNOSIS--much more sensitive and provides better prognostication, than waiting on diagnosis by current morphology standards, of LARGE UNTREATABLE tumors to grow and metastasize. That is the future of pathology my friend. I have advised all of my kids away from medicine, because it will be run more so by NON-physicians in the future, and the pay will be mediocre at best, almost like teachers are getting currently.

7.I am not path, but as a dermatologist, I must say that I do not envy the dermpaths that I use. The competition is nationally no matter where you are. Local derms everywhere are approached by dermpaths everywhere, including across the nation.

Many dermpaths work with huge groups that can afford to client bill, which I do not do and do not agree with. I don't think that I should get a cut of the dermpath that I send to; however, that is just me.

Point being, competition seems way too fierce. Dermatopathology is a fascinating field, but can't say I'd recommend it...

8.I love Pathology, but I'm in my 50's and a partner in a group of community pathologists. I would not recommend switching now. I see a future where PA's and histotechs do all the gross and slide work with digitalization to India. Once they figure out how to get the PA to do the frozen section and send the image, we're doomed! The job market has been poor for decades and will only get worse (unless you want to move to a third world country).

9.The future of pathology will be heavily influenced by the advances in tumor genetics. For a pathologist to be in demand in the future, he or she will need to be highly skilled in the interpretation of genetic analysis of tumors. Those pathologists who do not master these new skills will be downgraded to the status of medical technologists and will see their pay and working conditions impacted negatively.
Look at what has happened to airline pilots over the last 10 years. They have gone from high status/high pay positions to starting salaries of 15K. With the coming changes brought on with "health care reform" why should we expect physicians to fare any better. Pathologists will be among the first physicians to experience this downgrade as the job supply/demand ratio is unfavorable and many of our fellow doctors regard us more as technologists than physicians.
The advice I would give to any young person just beginning their career in medicine is to go into a specialty where you will be able to offer very high quality service to a small number of patients for a fee that reflects the level of skill and training you have to offer.

10.don't forget, there are PhD's- pathologists who will probably know tumor genetics a way that is a lot more sophisticated than an MD, who just went through medical school and did a lackluster Residency or fellowship; just in my mind will not be able to speak the jargon of medical genetics unless one is graduate school level (PhD) sophisticated. Your point is perfectly stated, and I have indicated in the past posts, as long as other doctors refer to us as "medical technologists" and not physicians, I see doom and gloom in our near future of cost containment in health care. Any time you can provide diagnostic tests for pennies on a dollar, it will meet the mustard of becoming the standards of care; i.e. tumor markers, genomics, proteomics five dollars or less to run a serology test for those, coming in the near future.

 

[Parts Unknown]

How many of those responses did you write? 🙄

In all seriousness, I'm surprised at the level of fear regarding digitization.

 

[exPCM]

How many of those responses did you write? 🙄

Zero.

 

[Parts Unknown]

Zero.

Glad to see your sense of humor hasn't changed.

 

[rollwithit]

I have a couple of generic thoughts. However, I'm not a Pathologist, I could be way off base here - I casually glance most of the specialty boards from time to time just out of curiosity. Feel free to set me in my place...

1) It seems that one of the positives that I gather from the comments is that Pathology is intellectually stimulating, while presenting new and different scenarios every day. But, at the same time, there is a worry that the profession is going to be outsourced to competent Indian physicians with a quick turnaround time. Aren't these conflicting viewpoints? If the positives of the field are the "curve balls" you have the deal with, then why would you feel threatened by outsourced labor? Cheap outsourced labor relies on highly-standardized and low-judgment work. Highly subjective analysis is rarely ever cheap. And if it is, the results would be sub-par. I feel people are over estimating the ease that a diagnostic skill could be easily outsourced.

2) Even if outsourcing diagnostic skills were practical (logistically), don't you think that patients and/or hospitals would feel a little uncomfortable knowing that such a critical part of patient care was being taken care of on the other side of the globe? Quality Control sounds like a nightmare in that scenario. How do you gain assurance that diagnostics are being managed by competent individuals with adequate resources? Plus, think like a lawyer, I'm assuming it's pretty tough to sue an Indian physician (or anyone under different jurisdiction) thousands of miles away for malpractice. I doubt hospitals/labs/etc. are willing to accept the risk they can't directly manage themselves. I guess this could be a reality at some point in time, but it could only be achieved if the vast majority of pathology services were monopolized by massive corporate labs. Only they would be able effectively manage cheap distant labor and absorb the risks associated with it. The optimist in me would like to think the chances of that ever happening are very low.

3) I gather from the comments in this thread and others that Pathology is overdue for a few changes to benefit the profession. That's likely true, but what specialty isn't?. However, I don't think it's valid at this point to assume that pathology will fall by the wayside like call centers or manufacturing of standardized goods.

 

[Gene_]

The CAP Audioconference today painted a rosy picture for the pathology job market compared to other specialties, backed by some convincing data.

 

[Parts Unknown]

So let's see. Of 10 responses (by 9 people):

- Three (2, 5, 8) think we're screwed because of outsourcing.
- Three (6, 9, 10) think we're screwed because of tumor genetics.
- One non-pathologist (7) who contradicts the dermpath = $$$ mantra.
- One older pathologist (1) who sounds reasonable and think the job market sucks.
- One pathologist (3) who sounds reasonable and likes pathology.
- One guy (4) who might have been having a stroke while typing.

An interesting slice of life, to be sure.

 

[lipomas]

Anyone care to explain to me why radiology is not more threatened by digital outsourcing than pathology is? Radiology films are many many many times smaller and much easier to send over the internet. I mean, hell, all the films here are digitized, anyone can look at them if they have access to the records.

We occasionally look at slides over the computer here, it takes about 10x longer and it is more expensive (you still have to make the slides the same way, and have to buy the equipment to scan them in and present them to the internet). The only thing that is variable is who is on the other end (the professional component). And the professional component is a minor factor, relatively, in the cost of a specimen. The drawbacks of slide scanning are that the quality, while pretty good, is not the same.

Why is radiology "immune" to this (i.e. a great career, everyone should do it!) while pathology is doomed?

Why is radiology "immune" to advancing technologies that replace human interpretation, while pathology is not? These arguments, while they have some validity, do not make sense when people simultaneously use them to denigrate pathology and say radiology is a better field.

Hemepath is a good example. Technology has revolutionized hemepath. Molecular diagnosis and cytogenetics are critical and are often done primarily by non-pathologists. Has this decreased pathologist workload? No! It has somehow seemingly managed to increase it. CML used to be CML. Then they discovered 9;22. Then they found cases of CML that are negative for 9;22. Then they found a molecular test for BCR/ABL. Now they have cases that are negative for that because it's a funky translocation partner. This is not straightforward. It's easy to say that the future of medicine is sticking a needle into something and shoving it into a black box which will spit out diagnosis, prognosis, and best treatment within 35 seconds, but is this really practical in the foreseeable future? We have to do our best to respond to new technologies, integrate them as appropriate, etc, even develop them. But we don't just give up because theoretically we might have to. And if this is all true, why do you even need an internist or a surgeon or a dermatologist? People could just breath into a genetic analyzer or wave their skin under a light, bypassing the gatekeeper clinician. YOU CAN'T HAVE IT BOTH WAYS PEOPLE. If medicine is doomed, then it is NOT JUST PATHOLOGY.

p.s. Gene - what was the convincing data?

 

[Gene_]

p.s. Gene - what was the convincing data?

Basically, the speaker demonstrated the increasing need for physician services of all specialties. For pathology specifically, the average pathologist is 55 years old, and there has been a limited increase in pathologists-in-training compared to other specialties.

 

[yaah]

Basically, the speaker demonstrated the increasing need for physician services of all specialties. For pathology specifically, the average pathologist is 55 years old, and there has been a limited increase in pathologists-in-training compared to other specialties.

That argument has never been that convincing to me. Pathologists now sign out far more cases than they did years ago, so a lot of the growth in the field has been assumed by current pathologists working harder (or becoming more efficient via specialization). This is harder to do in other fields, cutting out tumors isn't really any faster than it was years ago, so growth requires more physicians. For some reason national orgs never seem to grasp this point. The group I work in has essentially the same number of pathologists it did many years ago, yet specimen volume has doubled.

 

[KluverB]

Why does everyone think that there are enough pathologists in India, specifically, and overseas in general, to do this kind work? I've seen the numbers, but I couldn't find the original data just now. A quick google search gave the following...

http://inctr.ctisinc.com:9000/sites/InCTR/Education/Eighth%20INCTR%20Meeting/Manzoor%20Ahmed.pdf

Just look at the first few slides to see that the rest of the world simply doesn't have the man power to sign out American cases. I suppose the manpower may be cheaper, so they could make more money signing out US cases at the cost of not signing out their own. But to transfer/download all that data halfway across the world will also require infrastructure, which can't be cheap.

Bottom line, the surplus of US pathologists could perhaps be "farmed out" to sign out cases around the world??? 😎


ps. If someone does have the per country pathologist #'s handy, could you please post. Thank you.

 

[exPCM]

That argument has never been that convincing to me. Pathologists now sign out far more cases than they did years ago, so a lot of the growth in the field has been assumed by current pathologists working harder (or becoming more efficient via specialization). This is harder to do in other fields, cutting out tumors isn't really any faster than it was years ago, so growth requires more physicians. For some reason national orgs never seem to grasp this point. The group I work in has essentially the same number of pathologists it did many years ago, yet specimen volume has doubled.

👍👍👍

 

[MOHS_01]

That argument has never been that convincing to me. Pathologists now sign out far more cases than they did years ago, so a lot of the growth in the field has been assumed by current pathologists working harder (or becoming more efficient via specialization). This is harder to do in other fields, cutting out tumors isn't really any faster than it was years ago, so growth requires more physicians. For some reason national orgs never seem to grasp this point. The group I work in has essentially the same number of pathologists it did many years ago, yet specimen volume has doubled.

I have failed to understand this as well. It seems to me that most specialties are having to do more work now to generate the same revenue, and even more to generate the same profit. I'm not sure about you all, but I tire of having my work systematically devalued year in and year out.... and I don't see the joy in the promise of "more work" to make up for "less pay". 😕😕

 

[Gene_]

That argument has never been that convincing to me. Pathologists now sign out far more cases than they did years ago, so a lot of the growth in the field has been assumed by current pathologists working harder (or becoming more efficient via specialization). This is harder to do in other fields, cutting out tumors isn't really any faster than it was years ago, so growth requires more physicians. For some reason national orgs never seem to grasp this point. The group I work in has essentially the same number of pathologists it did many years ago, yet specimen volume has doubled.

The practice of pathology everywhere seems to have changed a lot in the last 10-15 years to enable pathologists to sign out more cases. The biggest change is probably that attendings don't gross anymore. The pathologists, as you stated, also work much harder than they used to. But, at my institution, the pathologists either don't want to or can't work any harder than they currently do (about 4000 surgicals plus cytology and academic responsibilities). The recent increase in pathology specimens at our institution has resulted in the hiring of 3 additional staff. Prior to 3 years ago, it had been at least 10 years since any new staff were hired. Maybe we're at the point now where additional specimens will equal more jobs.

 

[Entgegen]

Maybe we're at the point now where additional specimens will equal more jobs.

It will be interesting to see which scenario will win out, and what the ultimate outcome will be. Will an increase in specimens lead to more jobs, or will the (seemingly impending) drop in physician reimbursement lead to less hires?

 

[Parts Unknown]

The practice of pathology everywhere seems to have changed a lot in the last 10-15 years to enable pathologists to sign out more cases. The biggest change is probably that attendings don't gross anymore. The pathologists, as you stated, also work much harder than they used to. But, at my institution, the pathologists either don't want to or can't work any harder than they currently do (about 4000 surgicals plus cytology and academic responsibilities). The recent increase in pathology specimens at our institution has resulted in the hiring of 3 additional staff. Prior to 3 years ago, it had been at least 10 years since any new staff were hired. Maybe we're at the point now where additional specimens will equal more jobs.

This is the same dynamic that was at play in radiology over the past 10-20 years. When scan times dropped the number of orders for imaging increased. For a number of years the existing radiologists compensated for the increased workload, but eventually the limit was reached and new hiring had to take place. There was also the double whammy that a bunch of old timers got burned out.

Of course, the blossoming of the rads job market wouldn't have occurred without favorable reimbursement for all the new procedures they got into. So it should be in our specialty. We focus on the staffing half of the equation, but a lot more pathologists could be accommodated if revenue streams improved. Hopefully that will happen for all this diagnostic technology that we're supposed to be embracing.

 

[Pathwrath]

AND automated pathology is coming to a theatre near you; quality digitalized slides are the standards today. The future will be no need for morphology but rather proteomics and Genomics to determine CANCER DIAGNOSIS--much more sensitive and provides better prognostication, than waiting on diagnosis by current morphology standards, of LARGE UNTREATABLE tumors to grow and metastasize. That is the future of pathology my friend. I have advised all of my kids away from medicine, because it will be run more so by NON-physicians in the future, and the pay will be mediocre at best, almost like teachers are getting currently.

I don't see morphology going away anytime soon. It's cheap, accurate and resilient for both neoplastic and non-neoplastic diagnoses. The bells and whistles of molecular testing will be an adjunct and not a replacement.

I wouldn't discount the future outsourcing of our profession, however. Biopsies are already flying across state lines to the lowest bidder.

 

[Gyric]

There are numerous ways to protect a practice from outsourcing threats, the pathologists who adapt and figure this out prosper, the ones that don't, post about how miserable they are.

 

[Isa2010]

What about evidence based medicine?
In my newbie experience I've seen that you need to save the slides, what about a re-evaluation? What if you need to prove that tissue was processed?
I think is a time consuming task...

 

[Pathwrath]

There are numerous ways to protect a practice from outsourcing threats...

Other than underselling?

Enlighten me, please.

 

[pathstudent]

Other than underselling?

Enlighten me, please.

I was going to make a joke about how at least they will never outsource autopsies. But then I remembered that article I read about the ex-diener who started 1800-autopsy. He sets up the autopsy and then pays some chump pathologist to sign it out. I remember it saying he made in the low six figures. Even autopsy techs figured out how to hustle pathologists and earn a good living. How do pathologists stand a chance against a team of Harvard MBAs and their millions of venture capital?

Here is an old article from the new york times in 1998 about him. The one I read was more recent like couple years ago. Supposedly he does really well.

Autopsy Technician Turns Adversity and an 800 Number Into Success
dead provide Vidal Herrera and his family with a good living.

Mr. Herrera is the founder and owner of Autopsy/Post Services, a company that performs autopsies and other postmortem tasks for private citizens searching for peace of mind or grounds for a lawsuit after a loved one has died. The minimum fee for an autopsy is $2,000. The price can exceed $5,000 when other services, such as medical photography, are added.

This being Los Angeles, Mr. Herrera also has been a consultant to television and movie productions.

To reach him, prospective customers dial 1-800-AUTOPSY.

''Business is great,'' Mr. Herrera said the other day as he drove around the streets of Los Angeles, his telephone number and a list of the services he provides plastered on the side of his white van. ''We do about 900 autopsies a year,'' 100 of them on bodies flown in from out of state.

Next on Mr. Herrera's agenda is a plan to sell franchises, including the right to use 1-800-AUTOPSY. ''The population is getting older,'' he said. ''It's a good investment.''

Mr. Herrera is doing so well because hospitals across the country have drastically reduced the number of autopsies they perform. According to the American Medical News, a publication of the American Medical Association, before 1960 half the patients who died in hospitals underwent autopsies at no charge to their estate. Today, autopsies are performed on 10 percent or fewer of the bodies. Even in teaching hospitals, the figure is only about 12 percent.

Among the reasons for the decline are that cost conscious hospitals no longer want to perform the free service and they fear being sued for misdiagnoses.

''Even with the high degree of medical sophistication, autopsies can undercover a previously unknown cause of death,'' said Dr. Ron Spark, a pathologist at the Tucson Medical Center and spokesman for the College of American Pathologists, a professional group. ''At least 20 percent to as high as 30 percent of autopsies, various studies show, uncover undiagnosed problems.''

Dr. Spark said many hospitals are laying off pathologists, who sometimes go to work for themselves or with people like Mr. Herrera, who has been in business since 1988. Because Mr. Herrera is not a doctor, it is illegal for him to perform an autopsy by himself. He has a network of 13 doctors who conduct the procedures on a case-by-case basis, at mortuaries, assisted by Mr. Herrera or his full-time autopsy technician, Steve Hansen. The doctors get half of Mr. Herrera's fee. Mr. Herrera's wife also works in the business. They have two sons.

But Mr. Herrera is no hearse chaser. He tells prospective clients that in most cases autopsies are not necessary, that everyone dies, especially when the body is too old, or the heart is too weak. ''But so many people want to sue that they don't listen,'' he said.

A woman called recently wanting an autopsy performed on her 92-year-old mother, who had died in a local hospital. The daughter was suspicious, Mr. Herrera said, because her mother had ''been doing fine, working in her garden two days before she died.''

Did she smoke? Mr. Herrera asked as he routinely does before taking a case. Yes, the daughter said, for 40 years. She also had high blood pressure, diabetes, shortness of breath and headaches.

''I think they killed her,'' the daughter insisted.

Mr. Herrera is not the only entrepreneur to see opportunity on the cold steel of an autopsy table. Businesses like his have sprung up in other cities, including Chicago and Tacoma, Wash. ''But our 1-800 number gives us an advantage,'' Mr. Herrera said. ''People remember it.''

They certainly notice it. Almost every time Mr. Herrera stopped at a traffic light or when he pulled over for lunch last Friday, people stared and pointed at his van.

Jane Weber, owner of Northwest Autopsy Services in Tacoma, has been in business for about two years. Last year, her company did 35 autopsies. When she started, she heard about Mr. Herrera and his catchy number but it did not inspire her.

''People used to chuckle about it,'' Ms. Weber said. ''It was like, 'Anything goes in L.A.' That wouldn't work so much in the Northwest. It's more conservative here.''

Mr. Herrera, 46, learned the trade as an autopsy technician and then as an investigator for the Los Angeles County Coroner's office. He would probably still be there if he had not ruptured three disks in his back in 1984 when he was lifting a dead woman who weighed 284 pounds. Four years later, disabled and desperate for work, he started his business.

At first, people often hung up on him when he told them his business was in Boyle Heights, a largely Latino neighborhood on the city's East Side. Business picked up considerably, he said, when he changed his business address to Brentwood, a West Side neighborhood populated by the rich and famous.

''It's amazing what a change in your ZIP code can do for you,'' Mr. Herrera said. ''Instant credibility.''

But his new office is a small metal and glass box in the Brentwood Mail Box Center. He conducts most of his business affairs from his van.

Though Mr. Herrera has felt discrimination, he said he knew from firsthand experience that racial differences are only skin deep.

''To me,'' he said, ''a body is a body, especially after you cut them open.''

But Mr. Herrera gets downright evangelical when he starts talking about the ''positive side of death.''

''When you die you can help someone by donating your organs and your tissues,'' he said. ''The dead can save the living. They sure saved me.''

Photo: Vidal Herrera, the owner of Autopsy/Post Services, a Los Angeles company that performs autopsies, attracts attention when he drives his company van, which features his toll-free number, 1-800-AUTOPSY. (Monica Almeida/The New York Times)

 

[2121115]

I personally have had 15 of the worst years of my life trying to find a permanent position. nor am I alone. I have colleagues from all background,sall schools-US and foreign,all skill levels that have had difficulty. the problem is that they oversupplied them. too many training progmas. the leaders at CAP and ASCP live in a fantasy world and refused to accept that people would not retire. they deluded themsleves thinking hemepath fellowships were the answer. now after confidential surveys they realize that the goofed. not only are the fellows of hemepath too focused and they cannot use that level of expertise at the community hospital level, but they do not know any clinical pathology.

Just *wow* on so many levels. At what point does someone think a hemepath fellowship is the answer to all their problems? LOL!

All of this person's colleagues have had trouble finding a permanent position? LOL again.

There may certainly be an oversupply of pathologists and the job market is surely not as good as other fields. But, outside of a few metropolitan areas, it isn't that bad either.

 

[lipomas]

There are numerous ways to protect a practice from outsourcing threats, the pathologists who adapt and figure this out prosper, the ones that don't, post about how miserable they are.

While that is partially true, at some point whoever is sending the biopsy to you stops caring about quality if the price is right. Sad, but true. Now, if the quality is abysmal, that will always matter. But to many clinicians there are three tiers of pathologist: 1) Superstar experts, always right, there are very few of these; 2) Pathologists who get most cases right but you still have to send a case out to #1 once in awhile; 3) The pathologist that is bad. Again, since at least 90% of pathologists would fall into the second category, there is only so much you can do.

Now, you are right, patholoigsts can make themselves more important to the hospital or practices by doing things that other groups don't do, or by having better customer service, or other things. But these only go so far. At some point $$$ is always king for the vast majority of routine cases.

 

[yaah]

While that is partially true, at some point whoever is sending the biopsy to you stops caring about quality if the price is right. Sad, but true.

That is definitely true. If you ask administrators, they of course will blather on about quality. But cost has a huge impact.

 

[Whiskeyjack]

I was privy today to an email from the PRODS mailing group. It is so disheartening to see what the leaders in the pathology training programs (the apparently top ones in the country) have to say and how keen they are to increase residency spots. YES INCREASE the spots. They are planning to campaign for more funding for residency spots to counter the SHORTAGE of pathologists. Only one PD from a community program told them to get their heads out of their arses and we know they won't be listening to him.

I was so upset that I wondered if there was any legal recourse to make them halt this madness or at least prompt some REAL outside, independent body to assess the JOB market.

I would share this email if anyone is interested. PM me.

 

[path24]

Free govt money and labor force....why would they care about the job market?

90+ pathologists applied for a job on pathoutlines.....the truth/reality is they don't care.

 

[Gene_]

Free govt money and labor force....why would they care about the job market?

👍

 

[yaah]

I guess I am really curious where the data about a "shortage of pathologists" comes from. I'm sure there is a shortage of certain types of academic pathologists (a lot of those are niche fields), but there certainly doesn't seem to be a shortage overall.

 

[2121115]

I guess I am really curious where the data about a "shortage of pathologists" comes from. I'm sure there is a shortage of certain types of academic pathologists (a lot of those are niche fields), but there certainly doesn't seem to be a shortage overall.

The data I saw came from an ASCP member who is a faculty member at Michigan. McKinna, I think, is the name? It was basically extrapolated from data predicting an overall shortage of physicians. Her slide show predicted exponential increases in surgpath specimens and her comments were something like "who is going to gross them" and "how can we handle the increased sign out load".

 

[Dral]

[/positivity] Read almost any paper on cutaneous Melanoma published over the last few years...they all have the big picture message of: "We figured out this really cool ancillary test to diagnose Melanoma, but it's not 100%, so we still have to rely on histology" Really, misdiagnosing Melanoma is how people get sued. Are we to think that some computer generated algorithm to replicate the reliability of an experienced brain and pair of eyes will be developed anytime soon? Doubtful imo. It follows that no person will allow a computer or someone in some other country to make pathological decisions on such a thing anytime soon as well. [/positivity]

 

[pathstudent]

I guess I am really curious where the data about a "shortage of pathologists" comes from. I'm sure there is a shortage of certain types of academic pathologists (a lot of those are niche fields), but there certainly doesn't seem to be a shortage overall.

You should ask that guy to forward his email. In the PRODS minds the shortage of pathology residents is almost an emergency that is ready to destroy the field.