An important issue that no one is discussing

[zao275]

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Reading SDN pathology forum over the years, I see one glaring omission in discussion topics: I don't think there is enough discourse over the number of pathologists being trained and the overall state of the job market. Surely someone out there must have an opinion on this. Please discuss.

 

[MOHS_01]

 

[turtle1966]

Obviously the OP has been busy working, working, working.....

Your teaching videos are good and innovative!!

 

[MetroPath]

That is the ONLY issue that is being discussed here!

 

[jp123ok]

Yeah and it is mainly being discussed by people who know nothing about it. ie non-pathologists

 

[Path or bust]

Yeah and it is mainly being discussed by people who know nothing about it. ie non-pathologists

Nope, not true at all. There are several attending pathologists here who discuss this all the time, I'm but one.

 

[zao275]

No, I was completely being facetious. Not serious at all (but I love the joker image). It just seems like every thread here is about that topic. I thought I might lighten the mood with a ridiculous post.

 

[Sulfinator]

No, I was completely being facetious. Not serious at all (but I love the joker image). It just seems like every thread here is about that topic. I thought I might lighten the mood with a ridiculous post.

Unfortunately it won't help. Ridiculous posts are a dime a dozen here, yet the mood remains generally sour.

 

[icpshootyz]

Yeah and it is mainly being discussed by people who know nothing about it. ie non-pathologists

(Waiting for vistaril to chime in about how rich his gastroenterologist fiance is getting on the backs of pathologists)

 

[MOHS_01]

(Waiting for vistaril to chime in about how rich his gastroenterologist fiance is getting on the backs of pathologists)

I knew of client bill from derm path. I avoided it on moral grounds - apparently I am in the minority. What I did not know, however, was the money changing hands - not just for derm, but for urology. Wow - FML. I was almost ill when I learned of what my urology classmates earned off the back of their employed path and XRT guys. If it's not criminal, it should be.

 

[icpshootyz]

I knew of client bill from derm path. I avoided it on moral grounds - apparently I am in the minority. What I did not know, however, was the money changing hands - not just for derm, but for urology. Wow - FML. I was almost ill when I learned of what my urology classmates earned off the back of their employed path and XRT guys. If it's not criminal, it should be.

Couldn't agree more, my friend. I don't think any of us pathologists can argue too much against a true TC/PC arrangement where the clinicians own the lab and bill the TC. But to ALSO bill the PC, and only give a fraction to the pathologist physician doing the PC work seems really shady to me as well. Especially when you're talking about a non-pathologist billing services that can only be rendered by a board-certified pathologist. Hard to call it anything other than stealing. May currently be legal stealing, but it's stealing.

 

[Thrombus]

Couldn't agree more, my friend. I don't think any of us pathologists can argue too much against a true TC/PC arrangement where the clinicians own the lab and bill the TC. But to ALSO bill the PC, and only give a fraction to the pathologist physician doing the PC work seems really shady to me as well. Especially when you're talking about a non-pathologist billing services that can only be rendered by a board-certified pathologist. Hard to call it anything other than stealing. May currently be legal stealing, but it's stealing.

No it is called the commoditization of our field due to market forces. It is no different than megalab stuffing the pockets of shareholders and CEO's off our backs. It is no different than practices where there are 2 senior partners and 50 employee pathologists.

Market forces will crush us especially when a segment of our profession is insulated to some degree from the market as they receive labor that they are reimbursed for in the name of pathology trainee.👎thumbdown👎mad:😡

My theory: You end the government subsidy that comes along with a resident and you will begin to get an appropriate number of well-trained trainees every year done in an EFFICIENT manner.

 

[WEBB PINKERTON]

No it is called the commoditization of our field due to market forces. It is no different than megalab stuffing the pockets of shareholders and CEO's off our backs. It is no different than practices where there are 2 senior partners and 50 employee pathologists.

Market forces will crush us especially when a segment of our profession is insulated to some degree from the market as they receive labor that they are reimbursed for in the name of pathology trainee.👎thumbdown👎mad:😡

My theory: You end the government subsidy that comes along with a resident and you will begin to get an appropriate number of well-trained trainees every year done in an EFFICIENT manner.

It's easy to be critical of urologists and GI docs because of how they exploit us but NEVER forget what the old guard of pathology did to you guys. THEY ruined this profession probably more than anyone. The senior partners from some of the past labs I have worked at made out like bandits, threw us unfortunant employees under the bus. Then they have the nerve to continue working well into their 80s. All of them are a bunch of greedy cowards.

 

[Thrombus]

It's easy to be critical of urologists and GI docs because of how they exploit us but NEVER forget what the old guard of pathology did to you guys. THEY ruined this profession probably more than anyone. The senior partners from some of the past labs I have worked at made out like bandits, threw us unfortunant employees under the bus. Then they have the nerve to continue working well into their 80s. All of them are a bunch of greedy cowards.

I don't necessarily begrudge them either. They were taking advantage of market conditions as most would. I do begrudge those who assume the role of leadership and who either are willingly destroying the profession by commoditizing all young pathologists or who have their heads in the sand and are not competent enough to see it.

In the right market conditions, pathologists should be aggressively recruited during residency and should be competent to function well after residency. Neither of these is happening as is the rule in most other fields.

This whole idea of having residents sit on chemistry/microbiology or some other mindless rotation is so archaic that I am not sure the Greeks are doing it anymore.

 

[rollwithit]

No it is called the commoditization of our field due to market forces. It is no different than megalab stuffing the pockets of shareholders and CEO's off our backs. It is no different than practices where there are 2 senior partners and 50 employee pathologists.

Market forces will crush us especially when a segment of our profession is insulated to some degree from the market as they receive labor that they are reimbursed for in the name of pathology trainee.👎thumbdown👎mad:😡

My theory: You end the government subsidy that comes along with a resident and you will begin to get an appropriate number of well-trained trainees every year done in an EFFICIENT manner.

While I agree that market forces are at play and subsidized labor causes market distortions, I'm a little confused about your 2 partner / 50 employee pathologist example. Market forces work both ways. If 2 people are making a killing off 50 employed pathologists and nobody is giving those two any heat in the form of competition, well that's on the 50 employees for not giving the existing partners anything to think about.

What's stopping a handful of those employees from getting together and and starting a different model practice with more partners / less potential individual income? At least a few of the employees should have excellent relationships with the key players in the local market where they could be a threat to pull away from their existing employer and provide some competition. If nobody wants to do that and the employees are comfortable with their employment relationship with the existing partners (i.e. less money / less risk as an employee), then what is there to complain about? The two partners getting rich in this example are bearing a lot of risk because their model should be easily toppled. Make them uncomfortable or enjoy that they pay you 200k and 8 weeks vacation.

 

[Thrombus]

While I agree that market forces are at play and subsidized labor causes market distortions, I'm a little confused about your 2 partner / 50 employee pathologist example. Market forces work both ways. If 2 people are making a killing off 50 employed pathologists and nobody is giving those two any heat in the form of competition, well that's on the 50 employees for not giving the existing partners anything to think about.

What's stopping a handful of those employees from getting together and and starting a different model practice with more partners / less potential individual income? At least a few of the employees should have excellent relationships with the key players in the local market where they could be a threat to pull away from their existing employer and provide some competition. If nobody wants to do that and the employees are comfortable with their employment relationship with the existing partners (i.e. less money / less risk as an employee), then what is there to complain about? The two partners getting rich in this example are bearing a lot of risk because their model should be easily toppled. Make them uncomfortable or enjoy that they pay you 200k and 8 weeks vacation.

No.Compete.Contract.Clause.👍👍

 

[rollwithit]

No.Compete.Contract.Clause.👍👍

Leave, then come back and make noise. Non-competes can't last forever. Or someone from out of the region sets up shop. If 2 people can convince 50 people to be profited off of, there is room for competition. If 2 people can maintain that, it shouldn't be because there aren't others wanting some of that action.

 

[Thrombus]

Leave, then come back and make noise. Non-competes can't last forever. Or someone from out of the region sets up shop. If 2 people can convince 50 people to be profited off of, there is room for competition. If 2 people can maintain that, it shouldn't be because there aren't others wanting some of that action.

Its all about who has the contract my friend.

When you get your big boy pants, come back and rejoin the discussion. I am not sure you have been in the real world of pathology.

 

[rollwithit]

Its all about who has the contract my friend.

When you get your big boy pants, come back and rejoin the discussion. I am not sure you have been in the real world of pathology.

That's fine. Play the victim. If you want a contract, get it. These things don't fall in your lap. Not in pathology. Not anywhere in medicine. Not anywhere in life.

 

[2121115]

that's fine. Play the victim. If you want a contract, get it. These things don't fall in your lap. Not in pathology. Not anywhere in medicine. Not anywhere in life.

lol

 

[WEBB PINKERTON]

You tell him Thombus.

Reminds me of that scene in Goodfellas.

"Now go home and get your shine box".

 

[gbwillner]

No.Compete.Contract.Clause.👍👍

Thrombus is right... Luckily most non-compete clauses last only a year or so, and are restricted to a geographical location specified in the contract. You don't HAVE to have it in your employment contract, and it's something you can negotiate up-front. But if you did not you are bound by those limitations, and breaking the clause can cost you BIG.

I have not had to deal with this clause personally, but if it was presented I would attempt to strike it from the contract, or at least negotiate it down in geographic size such that if I did plan to start up my own business I could still operate in the same city (although maybe across town). I bet most employers would rather negotiate that clause than salary.

 

[Thrombus]

Thrombus is right... Luckily most non-compete clauses last only a year or so, and are restricted to a geographical location specified in the contract. You don't HAVE to have it in your employment contract, and it's something you can negotiate up-front. But if you did not you are bound by those limitations, and breaking the clause can cost you BIG.

I have not had to deal with this clause personally, but if it was presented I would attempt to strike it from the contract, or at least negotiate it down in geographic size such that if I did plan to start up my own business I could still operate in the same city (although maybe across town). I bet most employers would rather negotiate that clause than salary.

I can tell you most employers will not let you touch that clause.

I know groups that own major cities in the country. If you want to work there you can join on their terms.

Will Big Hospital keep steady group with 50 pathologists or will Big Hospital roll the dice with young, inexperienced pathologist.

You can tell who has and who hasn't put on their big pathologist pants. 🙄😉😀

 

[rollwithit]

Thrombus is right... Luckily most non-compete clauses last only a year or so, and are restricted to a geographical location specified in the contract. You don't HAVE to have it in your employment contract, and it's something you can negotiate up-front. But if you did not you are bound by those limitations, and breaking the clause can cost you BIG.

I have not had to deal with this clause personally, but if it was presented I would attempt to strike it from the contract, or at least negotiate it down in geographic size such that if I did plan to start up my own business I could still operate in the same city (although maybe across town). I bet most employers would rather negotiate that clause than salary.

Yeah, you don't have to sign a contract including one. You can negotiate it. Of course, an oversupply of potential employees makes it harder to negotiate. The strength of non-compete clauses also varies significantly state to state and some do not apply even if you do sign one. Of course, this is depending on how reasonable or unreasonable the terms are.

The reality is that many pathologists don't have any issues signing one so it becomes common in contracts. It seems the flavor of recently trained physicians these days is skewed toward being an employee and less towards being a business owner. But these are also people that really have no intention on ever bearing the risk/burden of running a business, so it's almost a moot issue for these folks. They will sign a non-compete no questions asked because they never anticipate competing.

I guess you run into problems when you have physicians that want the low risk / stability of being an employee, but also expect quick invitation to the land of milk, honey, and equity shares simply because they are smart and/or have worked hard. Sorry, but business doesn't work that way. There is a divide between highly skilled and well compensated service providers and those that can sustain and grow a business. Why bring another owner into the equation if they excel in the latter?

Anyhow, I'm digressing. My original point was there is room to shake a market up if there's a 2 partner / 50 employee model involved. Yes, I'm fully aware of these novel concepts of contracts, non-competes, etc. I just don't understand the "woe-is-me" and bitter attitudes because this is reality. These aren't new tools for running businesses and certainly aren't unique to the world of pathology. It happens everywhere. Deal with it.

 

[MOHS_01]

No.Compete.Contract.Clause.👍👍

Those do not preclude you from forming a union.

 

[WEBB PINKERTON]

I love how this thread turned into a discussion of the job market.

The thread needs some people to post how much their buy-in was to become a partner. It would be good for prospective students to see that.

 

[Thrombus]

Those do not preclude you from forming a union.

If some candidate even hinted at joining a union, negotiating a no compete clause out, or anything in the like, a group with a presence would immediately terminate the interview for all intensive purposes and find another candidate who is one of 100.

There are possible ways to attempt to undercut for contracts and it is being done. But this only expedites the professions race to the bottom.

 

[MOHS_01]

If some candidate even hinted at joining a union, negotiating a no compete clause out, or anything in the like, a group with a presence would immediately terminate the interview for all intensive purposes and find another candidate who is one of 100.

There are possible ways to attempt to undercut for contracts and it is being done. But this only expedites the professions race to the bottom.

No -- once you're in. It's the 50 employed bitches toiling away in the lab who should collectively discuss matters.

You cannot win a race to the bottom with bottomfeeders like LabCorp, etc, in the game. 🙁

It's "intents and purposes", btw -- not "intensive". 🙂

 

[2121115]

?.. for all intensive purposes....

OMG. Your redneck side is showing.

LOL

 

[Thrombus]

OMG. Your redneck side is showing.

LOL

5,10,15,50 employee pathologists in different years of service pulling a coup quietly discussing things would likely lead to the ouster of a few them. Remember most likely have families involved in said communit and risks are high.

I certainly do not see surgeons and other specialties exploited to this degree.

Next time I attempt to write a term paper with my thumbs on my phone with autocorrect I will know where I can find good grammar police and spellcheckers.

 

[yaah]

Non-competes are very common, it depends somewhat on the state you are in and the environment. They make sense for a lot of pathology groups to have. Essentially it comes down to trust - do you trust the group to treat you like one of them? To me, if you are hesitant to sign a non-compete with a certain group you may also think about whether the group is worth joining. It is not just pathology groups that have these. I know of many urology, surgery, medicine groups that have them.

My buy in was trivial. very low five figures.

Thrombus is definitely right, I would say, about how you are likely to have more success negotiating salary than the existence or terms of a non-compete.

 

[icpshootyz]

No buy-in here. Short probation period, then ladder-type salary increases (70%, 80%, etc) for several years until becoming 100% partner, full share.

 

[pathstudent]

My buy in was trivial. very low five figures.

.

Your "buy-in" was the reduced pay you received for the first 2-3 years. I am sure it was over 500,000.

 

[WEBB PINKERTON]

No buy-in here. Short probation period, then ladder-type salary increases (70%, 80%, etc) for several years until becoming 100% partner, full share.

The buy-in at the first group I worked for was 400,000

 

[pathstudent]

No buy-in here. Short probation period, then ladder-type salary increases (70%, 80%, etc) for several years until becoming 100% partner, full share.

Again, your "buy-in" is the 30% they took, the 20% etc...until you were given equal share.

 

[icpshootyz]

Again, your "buy-in" is the 30% they took, the 20% etc...until you were given equal share.

True. Much easier to stomach that way then to have to shell out several hundred grand up front. Plus they get to know me before deciding to keep me or make me full partner. Seems like a better way to go than just letting someone fork over the buy in money and then being stuck with them.

 

[yaah]

Your "buy-in" was the reduced pay you received for the first 2-3 years. I am sure it was over 500,000.

🙄 It wasn't that much.

 

[2121115]

I had to show up one day with a check for $250,000 written to the group. Then I had to pray that we hung on to our outpatient accounts (at a good rate) long enough to make my $$ back, before I ever saw a cent of net gain from becoming a partner. Takes a while to make back $250K in after-tax money - trust me.

 

[pathstudent]

🙄 It wasn't that much.

Really? Either they paid you mad pay out of residency or partners don't make that much in your practice.

 

[pathstudent]

I had to show up one day with a check for $250,000 written to the group. Then I had to pray that we hung on to our outpatient accounts (at a good rate) long enough to make my $$ back, before I ever saw a cent of net gain from becoming a partner. Takes a while to make back $250K in after-tax money - trust me.

Did they give you less than partner pay your first couple years? If so, add that to the buy in.

I only had to pay 100 For my stock, but I was only paid 1/3-1/2 partner salary my first couple years.

 

[yaah]

Really? Either they paid you mad pay out of residency or partners don't make that much in your practice.

My starting pay was relatively high, and it increased substantially each year. Partners are well compensated.

You are right in a sense that the reduced comp for first 3 years is in some ways a buy in. But I didn't really think of it that way and neither do most people. Most people think of what 212115 said, bringing a check in. I did not have to do that. The share was just taken out of my total comp at the end of the year. But my group is somewhat different I guess. Very ethical and collegial. Probably why no one ever leaves.

 

[icpshootyz]

But my group is somewhat different I guess. Very ethical and collegial. Probably why no one ever leaves.

Same here 🙂

There are good groups out there, groups not run by money-hungry slave drivers looking to squeeze riches out of you for their own benefit. My group is very collegial and equal. There's options for part-time if you want less hours, no call, and even specialty sign-out. When you make full partner that is the top of the ladder, there's no owners sitting above you raking it in. Very glad to be where I am and I have every intention of staying here for my career.

 

[pathman124]

So, how much did you all pay out of pocket in buy in's - that is, not counting decreased pay pre-partnership and the like. What did you have to pay in cash/check out of your bank account in order to become a partner? 2121115 has said $250k, and yah has said $10K. Anyone else want to chime in?

 

[pathstudent]

So, how much did you all pay out of pocket in buy in's - that is, not counting decreased pay pre-partnership and the like. What did you have to pay in cash/check out of your bank account in order to become a partner? 2121115 has said $250k, and yah has said $10K. Anyone else want to chime in?

My buy-in was 100 (purely symbolic to obtain my stock in the P.C.).