Archives article on workforce in December 2013 issue

[2121115]

So the most recent Archives has a workforce study which concludes that our field needs an 8% increase in pathology residency positions in order to fill the projected need and prevent a workforce shortage.

Not sure what to say.

Sigh.

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[Thrombus]

All these people have a vested interest in maintaining resident supply as they get HUNDREDS OF THOUSANDS per resident.

BIAS!

Plus they have no background in forecasting economics and have made no effort in looking at current workplace conditions or efficiency.

I have seen academic places that employ 10 pathologists for the work that 1 private pathologist does. They have no clue how to work hard or be efficient or work under current NON-SUBSIDIZED conditions

 

[deleted314957]

All these people have a vested interest in maintaining resident supply as they get HUNDREDS OF THOUSANDS per resident.

BIAS!

Plus they have no background in forecasting economics and have made no effort in looking at current workplace conditions or efficiency.

I have seen academic places that employ 10 pathologists for the work that 1 private pathologist does. They have no clue how to work hard or be efficient or work under current NON-SUBSIDIZED conditions

Amen! At the end of my career I was signing out 12-15 thousand ACCESSIONS ( most 2-5 part average) per year. Look at the ads for academic jobs. eg.-14 paths, 3 PhD's 12 residents. Place does 22,000 accessions per year! This specialty has done it to themselves. We gave away anatomic path years ago when we made buckets on the clin path side and now we get nothing from either side. We made our own bed and now we are not just laying in it----we have shi- in it.

 

[Glass Pusher]

I remember reading this in its online early release a few months ago and was at first excited to see that CAP was at least actually investigating the workforce issues for pathologists...and then you read it. While I think for the most part, most of their extrapolations and calculations are correct, it becomes clear that their motive is to maintain residency positions. What (beyond pure cynicism) makes me say that? The biggest reason: they seem to completely neglect/take for granted/assume/don't care to investigate whether the current amount of pathologists is appropriate for the population. They seem to just kind of write off that assumption by citing 30-40 year old papers in the first paragraph. If your model is entirely based on a number representing a glut (or shortage) of pathologists, projecting a "need" for the same relative number of pathologists in the future is completely nonsensical. You would think establishing and validating this number would be paramount to running a predictive model as all of your numbers are erroneous if this assumption is wrong.

A couple of other things of interest to people on here from the paper. They clearly show in the big bar graph that there has been a rather significant over-production of pathologists for the current year and the all preceding years included. So much so, in fact, that to balance out the oversupply of pathologists in those 5 years, you have to get to the first "retirement cliff" year of 2020 before these numbers even come close to balancing out. They also conveniently chose to start their line graph below this bar graph comparing supply and demand in 2014...after years of real data showing a gross oversupply of pathologists. I've read through the article now 2 or 3 times and am pretty sure this current oversupply (that suddenly stops when they start making up the data) is never mentioned in the text. Someone must have screwed up when they forgot to delete those real data years from the bar graph showing an oversupply.

I will be interested to see their demand predictions in complementary work that's coming out later. Maybe they can put some that accreditation gravy-train money towards hiring McKinsey to do it and get it done right.

 

[pathstudent]

Pray they are right brothers and sisters. There is no chance of them increasing funding for pathologists as they are trying to reduce specialists and increase primary care. Pray for the shortage. It is our only hope.

 

[yaah]

Is this the same study we were posting about a few months ago, maybe when it was released pre-publication? Or is this a different study? Don't have time to look right now. I remember thinking in the previous study that the data were interesting but there was a lack of insight into whether current numbers and workload was actually an accurate representation of reality or future predictions.

 

[Pingu]

It is the same study. The one where they say that an FTE pathologist is 50 hours per week and don't get into case volume or any other metric that truly matters.

 

[yaah]

OK yeah, still haven't read it but I have a major problem with studies that are making large assumptions about future pathologist workload and FTE when there is so much unknown about the future.

 

[Glass Pusher]

Was checking out the USCAP 2014 program today and came across this sure-to-be maddening piece of propaganda about the "upcoming pathologist shortage" at the Housestaff specialty meeting:

"Pathology Workforce Projections: What Can We Count On?"

Being that Barbara McKenna, one of the leading spin-masters in the pathologist shortage campaigns is directing it, I can be certain the emphasis will be on this and ignore an audience of residents/fellows scrambling to find another fellowship instead of accepting one of the "numerous" job offers they most likely have.

 

[yaah]

You do realize that workforce projection is a crucial thing for pathology societies to focus on, right? If you think the methodology is so flawed perhaps you should actually do something about it instead of just dismissing it. I agree that a lot of the recent studies about the workforce issue have been flawed, mostly in attempting to project what an actual pathologist "workload" will be in several years. But the actual "number of bodies" data is really hard NOT to dispute. Just look at the actuarial data. So if you have objections maybe try coming at it from the former angle. Or is your hope that other people will do this for you?

 

[Glass Pusher]

You do realize that workforce projection is a crucial thing for pathology societies to focus on, right? If you think the methodology is so flawed perhaps you should actually do something about it instead of just dismissing it. I agree that a lot of the recent studies about the workforce issue have been flawed, mostly in attempting to project what an actual pathologist "workload" will be in several years. But the actual "number of bodies" data is really hard NOT to dispute. Just look at the actuarial data. So if you have objections maybe try coming at it from the former angle. Or is your hope that other people will do this for you?

Yaah, as per your previous post, you hadn't even read the study. Perhaps you should actually read the study before you defend it. No one here is arguing that there will be less people in the USA in 15 years nor that many pathologists will retire. This is basically what CAP's report amounts to. That still doesn't change the simple fact that if there are too many pathologists currently in the US and you're basing all of your projections on on this number, without even the slightest degree of validation that the current number of pathologists does not meet an over/under-supply, all your numbers are wrong from the start. Your entire model is meaningless and contributes nothing. I'm not dismissing it because my gut/experiences/current situation tells me it's wrong, I'm disagreeing with it because it is poorly performed work that they are using to represent all pathologists at a legislative level.

My hope would've been that they would have contracted an independent organization that knows what they were doing to perform this analysis. Like it or not, pathology has a serious job situation in the minds of applying medical students and this probably affects the future quality of the field nearly to the extent of declining reimbursements. Your thinly veiled personal attacks do nothing to enhance the argument.

 

[pathstudent]

You do realize that workforce projection is a crucial thing for pathology societies to focus on, right?

Why is that crucial? What if they didn't do any "workforce projection". What would happen? Would there be 100,000s of tonsils and gallbladders thrown into the dumpster because no one is there to do a gross-micro on them?

The real reason it is "crucial" is to make sure that Pathology gets the biggest slice of government funding possible.

 

[yaah]

Yaah, as per your previous post, you hadn't even read the study. Perhaps you should actually read the study before you defend it. No one here is arguing that there will be less people in the USA in 15 years nor that many pathologists will retire. This is basically what CAP's report amounts to. That still doesn't change the simple fact that if there are too many pathologists currently in the US and you're basing all of your projections on on this number, without even the slightest degree of validation that the current number of pathologists does not meet an over/under-supply, all your numbers are wrong from the start. Your entire model is meaningless and contributes nothing. I'm not dismissing it because my gut/experiences/current situation tells me it's wrong, I'm disagreeing with it because it is poorly performed work that they are using to represent all pathologists at a legislative level.

My hope would've been that they would have contracted an independent organization that knows what they were doing to perform this analysis. Like it or not, pathology has a serious job situation in the minds of applying medical students and this probably affects the future quality of the field nearly to the extent of declining reimbursements. Your thinly veiled personal attacks do nothing to enhance the argument.

Holy cow, you didn't even read my posts. Where in that post was I defending the study? I was defending the purpose of such a study because it is quite important to try to get a handle on these things. In actually I was criticizing it (part of it, anyway) because projecting workforce needs is quite difficult. I have said this more in other posts. Like I said, projecting workforce needs should rely MORE on things like anticipated workload, actual job duties and time commitments, as opposed to pure numbers. Pure numbers are only helpful if the actual future job is identical to current practice, but at the same time pure numbers do provide some useful data. You know, people on these forums really need to do a better job of not jumping to conclusions about what people post. And it really isn't in dispute that the actuarial data does show an marked reduction in future # of pathologists. Note that I am NOT saying current numbers are appropriate.

 

[yaah]

Why is that crucial? What if they didn't do any "workforce projection". What would happen? Would there be 100,000s of tonsils and gallbladders thrown into the dumpster because no one is there to do a gross-micro on them?

The real reason it is "crucial" is to make sure that Pathology gets the biggest slice of government funding possible.

Because in an profession like medicine the actual numbers of physicians are quite important for statistical and planning purposes. And numbers of physicians are difficult to alter in a timely fashion. It isn't retail work - you can't just suddenly realize there's a need for more people and hire more. It takes college + med school + residency to train a physician. If you open more spots in medical school to increase physicians you will not see any real effect for 7+ years. That is why planning long term is so crucial. And in order to plan long term, you need to actual analyze data and crunch numbers.

If you really think the the major problem with "too few pathologists" if such a thing ever does exist in the future is lack of bodies to process 88304 specimens then I think I really can't help you any further.

 

[Glass Pusher]

Holy cow, you didn't even read my posts. Where in that post was I defending the study? I was defending the purpose of such a study because it is quite important to try to get a handle on these things. In actually I was criticizing it (part of it, anyway) because projecting workforce needs is quite difficult. I have said this more in other posts. Like I said, projecting workforce needs should rely MORE on things like anticipated workload, actual job duties and time commitments, as opposed to pure numbers. Pure numbers are only helpful if the actual future job is identical to current practice, but at the same time pure numbers do provide some useful data. You know, people on these forums really need to do a better job of not jumping to conclusions about what people post. And it really isn't in dispute that the actuarial data does show an marked reduction in future # of pathologists. Note that I am NOT saying current numbers are appropriate.

No, I read your posts quite well and found it very hard to see anything in them that criticized THIS study. Everything was a generalization regarding criticisms of shortcomings of market studies as a whole, which makes it look like you are purposefully avoiding a direct criticism, whether you intend to or not. I actually agree with you on nearly all points you make about the difficulties in addressing future workforce issues. It's hard and takes a lot of resources and skills. I understand this. However, the problem still remains that this study, performed by the CAP, the most powerful lobbying agency in pathology, drafted this study with the direct aim of increasing/maintaining current levels of residents and it essentially consists of reworked and rehashed demographic data. The upcoming counterpiece on demand will likely (as they've already tipped their hat to a great extent in this article) emphasize an aging population and increased insurance coverage due to the ACA, i.e., increased demand and lowered supply projections. Again, demographic projections that we all know and have been reported by others and no one is questioning. You are right that this is important.

Demographic projections, however, do not equal workforce projections--Bottom line. Passing them off as workforce projections, as CAP is doing, is either lazy (at best) or deceitful (at worst). In effect, it would be similar to the UAW performing a workforce study in the early 70's correctly showing that the US population is rising, their workforce is aging and more cars are going to be driven so they need higher wages and more workers, while completely ignoring automation and Japanese competition in their analysis. In other words, worthless.

 

[pathstudent]

Because in an profession like medicine the actual numbers of physicians are quite important for statistical and planning purposes. And numbers of physicians are difficult to alter in a timely fashion. It isn't retail work - you can't just suddenly realize there's a need for more people and hire more. It takes college + med school + residency to train a physician. If you open more spots in medical school to increase physicians you will not see any real effect for 7+ years. That is why planning long term is so crucial. And in order to plan long term, you need to actual analyze data and crunch numbers.

If you really think the the major problem with "too few pathologists" if such a thing ever does exist in the future is lack of bodies to process 88304 specimens then I think I really can't help you any further.

But why is that the job of cap, ascp etc. it sounds like something that should be done by the government. What else is to be concluded by a study performed by people whose departments are partially funded by the government except that "we need more funding".

I read the article and it made feel quite hopeful.

If there are fewer pathologists it will a win win for everyone. It will be good for the working pathologists and good for society via cost savings.

 

[yaah]

Well, perhaps CAP and ASCP receive funding from the govt to conduct such studies? No idea. But I would suspect that this is also one of the few things for which government would say it isn't their responsibility to take the lead on. Govt does depend on many many private agencies to provide them with data to base policies on. They don't have any expertise or knowledge about it. If the CAP and ASCP don't jump in, then the govt will listen to other people, most of which would be from other specialties or industries who most certainly do not have significant pathologist representation or opinion.

I would agree though that I don't think the political prospects are very good for increasing GME and/or research funding, at least in the near future. I suppose that could change but I tend to doubt it. Every dollar of new spending tends to be quite critically analyzed these days (existing spending not so much). I suspect the CAP is trying to be careful to even suggest that reducing any funding would be a good thing, in the hopes that it will be at least preserved. But I also tend to think that perhaps they should just be a bit more honest about pathologist need and demand, getting ahead of the game instead of always being advocates of increasing funding. Because if they are advocating increased funding now when the excess demand doesn't really exist, then their calls for increased funding in 5-10 years are going to be ignored all the more.