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BU pathology BS
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I dont agree about a shortage of pathologists and the Affordable health care act. What do you expect from this source? If things in Mass are so great due to RomneyCare, why did UMASS sell out to Quest exactly?
D
deleted314957
I think that the projections of a shortage assume that a pathologist signs out 2500-3000 cases per year.
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You make a good point.
Up here in Canada, after a bunch of pathologists killed people, one of the big questions was "what is the maximum workload for pathologists before they become unsafe?". An interesting question, but one never posed to any other specialist physician(even surgeons who routinely work 40 hour straight shifts).
Pathologists occupy this strange niche of being considered automatons rife for bureaucratic meddling, and who are bereft of professional autonomy. I guess the academic types are also in line with this sort of thinking.
No wonder medical students avoid your field like the plague. It's not the subject matter, its the stature, the autonomy, and the low standards that keep people away.
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I think this is totally disrespectful and inappropriate.
The post I read that I disagree with is the p value of celebrities. I used to agree with him at one time, and thought that it is absurd how much money and attention they get and that they were just lucky to fall into their situations. But as I have gotten older I now realize I am wrong; athletes like Lebron, Magic, Tiger, etc..., singers like Katy Perry, Britney, Michael Jackson, and actors like Tom Cruise, Harrison Ford, Tom Hanks, etc... are the top 1% of 1% of 1% of 1% in their respective talents and that is why we admire them so much. The rest of us dwell in the mass of mediocrity. There was a Mets coach named Casey Stengel who famously said "Can't anybody here play this game?" about his struggling Mets team. The answer to his question is "almost nobody can" and that is why we view the few that can with god-like status. It is also why care more about who Tiger had an affair with or Britney Spears' mental breakdown more than we do about world hunger or kids with autism or povery in Mongolia, etc....
The post I read that I disagree with is the p value of celebrities. I used to agree with him at one time, and thought that it is absurd how much money and attention they get and that they were just lucky to fall into their situations. But as I have gotten older I now realize I am wrong; athletes like Lebron, Magic, Tiger, etc..., singers like Katy Perry, Britney, Michael Jackson, and actors like Tom Cruise, Harrison Ford, Tom Hanks, etc... are the top 1% of 1% of 1% of 1% in their respective talents and that is why we admire them so much. The rest of us dwell in the mass of mediocrity. There was a Mets coach named Casey Stengel who famously said "Can't anybody here play this game?" about his struggling Mets team. The answer to his question is "almost nobody can" and that is why we view the few that can with god-like status. It is also why care more about who Tiger had an affair with or Britney Spears' mental breakdown more than we do about world hunger or kids with autism or povery in Mongolia, etc....
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Well - it's the same question that is asked of residents and led to work-hour restrictions. As for attending physicians, they are presumably able to make decisions for themselves based on their malpractice risk of making mistakes when they don't get enough sleep.
Interestingly enough, there is a standard in forensic pathology about how many autopsies per year are considered unsafe (I think it's 250 or so). I suspect that it would be hard to come up with a number for surgical pathology, which is so much more varied in the types of specimens and how long they might take.
I obviously don't know, but I'd be surprised if there were no guidelines of this type for surgeons. There has to be some surgical body that suggests a safe number of procedures per year - at the very least there must be legal precedent relating to malpractice case history.
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I'm not sure that taking a personal shot at a pathology chairman is such a great idea. Pathology is a small world. Just be sure you are completely anonymous, or Dr. Remick could wreck your future. Think it is tough finding a job now? Try being on the bad side of an influential pathology chairman.
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Right. I hope all these posts are deleted. It is very disrespectful. It is good to have varying opinions.
I don't believe there is a shortage now, and if there is a shortage in the future, that would only help the field. I hope the chairman is right.
But as I have written before, this is all a moot point as the political trend is to movie towards primary care and away from specialists to reduce the cost of medicine. If new residency spots are to be created, they will go to peds, fp, IM, gyn etc....
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http://www.aacc.org/publications/cln/2013/february/Pages/Outreach.aspx#
No wonder UMASS sold out to Quest. CEO thinks the salad days are over for lab industry.
"Why sell a highly respected outreach operation just when the market is booming? According to UMass CEO John OBrien, its only a matter of time before once healthy profits for hospital outreach labs begin to deflate. The way he sees it, they may have already peaked, and thats why it seemed like a smart move to sell off his outreach business now, OBrien told CLN. Quest and other big players in the market are betting on OBriens being right and have laid out plans for growth that forecast an expanding lab sector that nevertheless becomes increasingly consolidated and competitive. They expect a market ruled by sustained cost pressures that will deflate what they see as a hospital outreach testing bubble.
OBrien, who helped shape the healthcare reform plan in Massachusetts that inspired President Obamas Affordable Care Act, said he had long anticipated that hospital outreach testing and other areas would struggle in the post-healthcare reform era. He began warning the UMass Medical Center board several years ago that lab outreach and other programs would need to be reevaluated. We knew that eventually there would be truly crushing pressure on health systems to get their costs down, he said. Medicare and commercial payers have an imperative to push down prices, and as this moves forward, the big health systems like ours can no longer expect to continue extracting higher prices in the lab and other areas. Quite frankly, those days are gone.
No wonder UMASS sold out to Quest. CEO thinks the salad days are over for lab industry.
"Why sell a highly respected outreach operation just when the market is booming? According to UMass CEO John OBrien, its only a matter of time before once healthy profits for hospital outreach labs begin to deflate. The way he sees it, they may have already peaked, and thats why it seemed like a smart move to sell off his outreach business now, OBrien told CLN. Quest and other big players in the market are betting on OBriens being right and have laid out plans for growth that forecast an expanding lab sector that nevertheless becomes increasingly consolidated and competitive. They expect a market ruled by sustained cost pressures that will deflate what they see as a hospital outreach testing bubble.
OBrien, who helped shape the healthcare reform plan in Massachusetts that inspired President Obamas Affordable Care Act, said he had long anticipated that hospital outreach testing and other areas would struggle in the post-healthcare reform era. He began warning the UMass Medical Center board several years ago that lab outreach and other programs would need to be reevaluated. We knew that eventually there would be truly crushing pressure on health systems to get their costs down, he said. Medicare and commercial payers have an imperative to push down prices, and as this moves forward, the big health systems like ours can no longer expect to continue extracting higher prices in the lab and other areas. Quite frankly, those days are gone.
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So what are you predicting, exactly? Do you think an increase in clinical residencies positions will improve the situation in pathology?
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NO I am saying the current focus would be on increases in primary care doctors.
If there were a shortage of pathologists, it would give us clout which would help our position in negotiations and would prevent the pathologists who sign out cases for urologists at 10cents on the dollar from having to do so.
And let's be honest even if there were a shortage of pathologists, it is not like the health of the country would take a nose dive. It is not like there would be breast biopsies and lumpectomies getting thrown away. We would get to them sooner or later. Maybe every hernia sac and every gallbladder doesn't need a gross micro.
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Poor PathResident2 got scared and took his/her link down. 🙁
Here is my favorite quote in the December 2012 Future Shortage of Pathologist section
"The difference between the demand (an additional 5400 pathologists) and the supply (1000 pathologists) means that there will be a national shortage of 4400 pathologists by the year 2020. This extensive report details the methodology used to make these projections."
We better keep all those old sellouts in the field to meet that demand.....
Here is my favorite quote in the December 2012 Future Shortage of Pathologist section
"The difference between the demand (an additional 5400 pathologists) and the supply (1000 pathologists) means that there will be a national shortage of 4400 pathologists by the year 2020. This extensive report details the methodology used to make these projections."
We better keep all those old sellouts in the field to meet that demand.....
D
deleted314957
O.K., I'll stick around. And I think he pulled his post because he was embarrassed. No need to demean anybody, particularly Dr. Remick.
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Yaah please delete this thread. It is very disrespectful.
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One scenario where our leadership in pathology could be correct about a shortage of pathologists is if we abandon the current reimbursement system.
Currently you are incentivized to work harder because if you do more you make more. Which seems appropriate for pathology because it is not like we are sending patients for procedures and making money off it. We don't effect the volume of care a patient gets, but if we are willing to do a bigger volume of cases (i.e. sign out 5,000 cases instead of 3,000 a year) then we get paid 5000 times x instead of 3000 times x.
If we get deincentivized to work hard and do more, then we will do what is necessary. If the regulators say, a pathologist is worth 300,000 to sign out 3000 cases a year and we salaried as such, then we will sign out 3000 cases a year and not say "oh year sure I'll do that extra 2000 for nothing". Just like DMV workers don't come in and work overtime for nothing.
If pathologists are deincentivized to work hard, then there could be a shortage.
Currently you are incentivized to work harder because if you do more you make more. Which seems appropriate for pathology because it is not like we are sending patients for procedures and making money off it. We don't effect the volume of care a patient gets, but if we are willing to do a bigger volume of cases (i.e. sign out 5,000 cases instead of 3,000 a year) then we get paid 5000 times x instead of 3000 times x.
If we get deincentivized to work hard and do more, then we will do what is necessary. If the regulators say, a pathologist is worth 300,000 to sign out 3000 cases a year and we salaried as such, then we will sign out 3000 cases a year and not say "oh year sure I'll do that extra 2000 for nothing". Just like DMV workers don't come in and work overtime for nothing.
If pathologists are deincentivized to work hard, then there could be a shortage.
ummm....well who is going to pay that? What you are suggesting isn't abandoning the current reimbursement system but rather just massively increasing it and converting pathologists to salaried positions. The employers for these salaried positions are going to pay a salary that is related to what the pathologist is bringing in, and the only way an employer could pay a salaried pathologist that sort of money is if the reimbursement for specimens went up dramatically.
You could easily apply the same logic to any field.....I'd like for someone to pay me 275k a year to see 10 med mgt patients a day. Maybe they should change the reimbursement in my field to allow that to happen.
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It's really not that bizarre. Instead of being paid on a volume metric you could be paid on a quality metric. Then your 15 minute med checks might be expanded to include some therapy and social work type stuff and collaboration with families and support systems - that may lead to better outcomes.
You would also have the quality of a government employee. Those with brains and any sort of ambition would never do this.
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I thought the ACA was gonna change reimbursement from rewarding Quantity to Quality.
http://www.kaiserhealthnews.org/Stories/2012/April/15/medicare-doctor-pay.aspx
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This seems like it might reduce ancillary testing to save costs - and put an end to that 12 separate container business going on in urology, but I don't see how surgical pathology can be held to a quality standard. Maybe it would relate to writing better reports and providing more specific guidance to clinicians? Accurate diagnosis is already assumed, so I'm not sure what else can be done...
Clinical pathology seems better from a quality perspective. Clinical pathologists can simply refuse tests that aren't necessary, or perhaps implement informatics and reflex testing and things like that to improve care.
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A kinder gentler way of saying "lowering reimbursement".
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Agree.
It would make sense to say we will pay you x dollars if your breast biopsy report includes this essential information "......." and if does not include it then we will pay you less.
However, if I read out 20 breast biopsies in a day, it makes sense that I earn more than someone who reads out 10. HOw can it not. If I don't earn more, then screw it, I'll do the minimum I need to do and then go do something else with my time.
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