CA prostate biopsies

[Path_Anon]

I heard some devastating news today...(CAP: ARE YOU LISTENING???) While others out there might already be aware of this, but that greasy bastard Oppenheimer of OUR lab is moving to CA (I've heard northern Cali, unconfirmed actual location though), and bringing his POD-lab pushing mojo's with him. ONE HALF of my groups' prostate biopsies will be phased out completely by the end of the year.

Again, CAP: are you listening? When are you gonna do something about this??

I've chatted with some of the younger urologists in my hospital that'll be moving out their prostate business , and have confirmed that kick-backs are the real reason -- NOT diagnostic issues or turn around time (I think most knowledgeable folks know that OUR-lab and other uroPOD labs are staffed by mostly by weakass FMGs...and VERY few by solid GU pathologists).

just an FYI to other cali pathologists (you know OUR lab is gonna hit the whole damn state) who should be aware of potential future loss of revenue...until someone (CAP, you listening??) stands up and does something about it.

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[lipomas]

Straight up kickbacks are illegal. What do you mean? Is it an in-office arrangement where they send someone to read the slides in the office or something?

The fascinating thing is that Oppenheimer used to have a blog called, get this, "Ethical pathology." http://ethicalpathology.blogspot.com/ Hasn't been updated in awhile, maybe his ethics have changed!

I agree about the OURlab quality - not great. I have seen cases (in residency) that were signed out there that were flat out wrong. Not at the level of flat out wrong that I saw from some of the pod labs (especially Florida ones), but still wrong. But they had pretty pictures so I guess it's ok.

Have you called CAP yourself? Chances are they don't monitor this forum.

 

[Path_Anon]

Straight up kickbacks are illegal. What do you mean? Is it an in-office arrangement where they send someone to read the slides in the office or something?

The fascinating thing is that Oppenheimer used to have a blog called, get this, "Ethical pathology." http://ethicalpathology.blogspot.com/ Hasn't been updated in awhile, maybe his ethics have changed!

I agree about the OURlab quality - not great. I have seen cases (in residency) that were signed out there that were flat out wrong. Not at the level of flat out wrong that I saw from some of the pod labs (especially Florida ones), but still wrong. But they had pretty pictures so I guess it's ok.

Have you called CAP yourself? Chances are they don't monitor this forum.

found out more info on this scheme. depends on how you define "kickback". But the urologists are basically buying out a lab, which seems like will be run and staffed by OUR lab slums, including pathologists reading out cases [NOTE: this will include (at least) prostate AND bladder biopsies]. Urologists will likely take majority of TC/PC $ off the top, pathologists will be billed salary (by OUR lab contract). This has greasiness written ALL over it. I am going to call CAP, but I urge others including residents, fellows, and practicing pathologists reading this in the bay area, ALL over California, and frankly ANYWHERE in the country to call in and voice your concern, as I hear that Oppenheimer already has plans underway to expand all up and down CA. And he IS relocating his TN lab to CA, 100%ly confirmed.


FOLKS TO CALL in CA: Please, at least voice your concern. I'm gonna hit up the main CAP # as well.
http://www.cap.org/apps/cap.portal?...tails&statePathologists_1stateName=California

 

[lipomas]

Ah, ok. That sounds more like it. Caris labs is doing that too I believe. What I think is more accurate is that the lab itself BUYS the urology practice. But I'm sure it happens both ways. I cannot believe it is legal for these big labs to buy out urology or GI practices for the purposes of taking their biopsies, but there probably are ways around it.

Urologists don't have to buy out a lab - they can send their business to whoever they want. There would be no point in buying a lab in order to receive their own specimens which they are free to send to whoever they want. They can, however, allow themselves to be bought (at least in part) by a reference lab who will in turn provide the pathology service. Again, I don't know how this is legal but I'm sure it's due to sleazeball congressmen tacking on amendments and exceptions for their friends.

I would like to see CAP take a stand against these practices but I worry that there is very little that they will be able to do and little that they will want to do.

That's ethical pathology for you!

 

[LADoc00]

Im well aware of this....
these are indeed kickbacks and are questionable imo. Depends on how you personally want to roll: Down-n-dirty with "Dark Magic" or Clean-n-poor.

 

[Gyric]

A few other ideas.

Try CSP, they will have access to CA public officials/hospital leadership who can raise questions about this group. Write to the CA medical board, request a review of all pathologists in his group based on your experiences in another state. Write to your own medical board about his unethical practices.

 

[SLUsagar]

A few other ideas.

Try CSP, they will have access to CA public officials/hospital leadership who can raise questions about this group. Write to the CA medical board, request a review of all pathologists in his group based on your experiences in another state. Write to your own medical board about his unethical practices.

yeah i'll do all that. but you, and others reading this, gotta do the same to make this point legit.

1 phone call or letter.....eh, 1 bitchy complaint. gets dumped in the garbage.

20+ such calls/letters --> okay, maybe this is indeed a prob.

 

[pathstudent]

I heard some devastating news today...(CAP: ARE YOU LISTENING???) While others out there might already be aware of this, but that greasy bastard Oppenheimer of OUR lab is moving to CA (I've heard northern Cali, unconfirmed actual location though), and bringing his POD-lab pushing mojo's with him. ONE HALF of my groups' prostate biopsies will be phased out completely by the end of the year.

Again, CAP: are you listening? When are you gonna do something about this??

I've chatted with some of the younger urologists in my hospital that'll be moving out their prostate business , and have confirmed that kick-backs are the real reason -- NOT diagnostic issues or turn around time (I think most knowledgeable folks know that OUR-lab and other uroPOD labs are staffed by mostly by weakass FMGs...and VERY few by solid GU pathologists).

just an FYI to other cali pathologists (you know OUR lab is gonna hit the whole damn state) who should be aware of potential future loss of revenue...until someone (CAP, you listening??) stands up and does something about it.

You know I used to get worked up over these issues too, but the truth is is that this is capitalism and it is legal and no one is going to come in and save you, not CAP not California not CMS.

This is just like how doctors started building their own out-patient surgery centers to cherry pick high reimbursing patients. It has been going on in all aspects of medicine for the last ten-fifteen years.

Yes the urologists would probably rather have you do their cases and you would probably give better service and quality, but if the urologist can make an extra 50K a year, then any normal person would take the money and tell you sorry. We aren't talking about chump change. GI and prostate bx are incredibly lucrative and they have the tissue and they don't have to give it to you.

 

[SLUsagar]

You know I used to get worked up over these issues too, but the truth is is that this is capitalism and it is legal and no one is going to come in and save you, not CAP not California not CMS.

This is just like how doctors started building their own out-patient surgery centers to cherry pick high reimbursing patients. It has been going on in all aspects of medicine for the last ten-fifteen years.

Yes the urologists would probably rather have you do their cases and you would probably give better service and quality, but if the urologist can make an extra 50K a year, then any normal person would take the money and tell you sorry. We aren't talking about chump change. GI and prostate bx are incredibly lucrative and they have the tissue and they don't have to give it to you.

just b/c they have the tissue doesn't mean their businesses practices are correct. Fair, no. Legal, well as of now, maybe. Ethical, obviously not. Perhaps of all the wrong things that Obama wants to do to MDs in terms of taking away $, his plan will prevent such conflict of interest greasy PODlabs like OUR lab from existing.

 

[pathstudent]

just b/c they have the tissue doesn't mean their businesses practices are correct. Fair, no. Legal, well as of now, maybe. Ethical, obviously not. Perhaps of all the wrong things that Obama wants to do to MDs in terms of taking away $, his plan will prevent such conflict of interest greasy PODlabs like OUR lab from existing.

First there is no such things as Fair so let's not even talk about that.

The urologists are just being entrepreneurial. They are opening a lab and hiring a pathologist to sign out the cases while they bill for physician's work. How is that inherently unethical.

If I am a pathologist with an outpatient lab that has a flow cytometer and immunostainer, I have the opportunity to be unethical and order flow on every single surg path case or order 20 immunos on every cancer biopsy, but I wouldn't necessarily do that. Is a pathologist owning an outpatient lab where he profits by "working up" cases more any less of a conflict of interest then urologists billing for pathology? I am not sure it is.

And this Oppenheimer is not being a "greedy bastard" as the OP stated. He is simply trying to do the best he can for him and his family with the system in place. He is trying to be Starbucks and a lot of the mom and pop corner store pathology cafes are going to go out of business or learn to adapt.

The problem again goes back to there being too many pathologists. Had the ABP been run like ENT, Optho and the like where they strictly limit the number of professionals to protect the profession, none of this would have ever happened. But pathology went through a real low point where there were only 100-150 AMGs applying a year for 400 spots. This was an advantage back in the 90s for those AMGs as they got great jobs with high partner salaries and owned their own labs and got all the prostate and GI bx and the like. But reference labs figured out that there was a ton of money in this and as the reference labs went and marketed to the GIs and GUs the Gis and GUs figured out that they don't need the reference labs. And now there are thousands of formerly marginalized pathologists who can take these jobs and do pretty good. Plus now that path has switched from a 5 year to 4 year pathology program there are an extra 25% of pathologists finishing every year. Lastly the ABP is run by academics and academics would like as many residents as possible because more residents means more fellows means more junior faculty to work their outreach services.

This brings me back to why you should consider academics if you truly love pathology. It is because you don't really have to worry about this. The GU people will send you your tissue in the university as will the GI. YOu don't have to grovel for business because you have a captive audience.

BUt no matter, all of this will be coming to an end. The greed in medicine has ruptured the field and with the current administration and political climate all of this will go away.

I remember reading an article in the WSJ back when I was considering applying to medical school. It was titled "Mama don't let your babies grow up to be doctors" (a play on an old country song about not letting your babies grow up to be cowboys) And the article predicted all that has happened in medicine. We are in the final spasms of for profit medicine.

 

[yaah]

This brings me back to why you should consider academics if you truly love pathology. It is because you don't really have to worry about this. The GU people will send you your tissue in the university as will the GI.

No they won't. Many academic programs have lost biopsy business. I've talked to many path residents who don't see any prostate cores unless they are patients transferring their care. And many residents don't see any derm either unless it's a big resection.

 

[rockit]

No they won't. Many academic programs have lost biopsy business. I've talked to many path residents who don't see any prostate cores unless they are patients transferring their care. And many residents don't see any derm either unless it's a big resection.

QFT. Most of our GYN goes to Quest and most of our derm is taken care of by their department.

 

[pathstudent]

No they won't. Many academic programs have lost biopsy business. I've talked to many path residents who don't see any prostate cores unless they are patients transferring their care. And many residents don't see any derm either unless it's a big resection.

Well people at real programs like Cleveland Clinic, MGH, Stanford, Mayo, University of Chicago will see everything.

But like I said this OUR labs and in sourcing of pathology is the agonal gasps of for profit medicine.

 

[pathstudent]

QFT. Most of our GYN goes to Quest and most of our derm is taken care of by their department.

Well your path program must be spineless. Why would the gyn stuff go to quest over you?

 

[yaah]

Well people at real programs like Cleveland Clinic, MGH, Stanford, Mayo, University of Chicago will see everything.

But like I said this OUR labs and in sourcing of pathology is the agonal gasps of for profit medicine.

Yes but even those programs may see less of the outpatient specimens. Large academic programs used to have fairly large outreach programs for outpatient specimens from private groups, but those disappeared. The "captive audience" academic clinicians obviously continue to send their specimens, and for many places this is a large load.

Personally I think the agonal gasps of for profit medicine started with the "doctors' hospitals" taking all of the low-risk outpatient surgery and opening their own clinics with ORs.

 

[exPCM]

As stated above this is all traces back to the pathologist oversupply.

I know of one pathology group in the 1990s that built their own endoscopy center and hired 2 GI docs to work there. All the GI biopsies from the center were read by the path group. However, within 2 years both of the GI docs had left for greener pastures and the endoscopy center closed. A basic problem is that they had a hard time getting in demand GI docs who were willing to be employees of pathologists.

However GI and urology docs have no problem with getting desperate pathologists to work for them due to the pathologist oversupply.

I do not blame Dr. Oppenheimer for this as he is not the cause. I think the academic pathology community is at fault for doing nothing to curb the production of residents which as stated above has increased 25% since going down to the four year AP/CP. However the vast majority of residents now end up training for at least five years anyway because the vast majority are now doing fellowships.

I personally hope the Dr. Oppenheimers of the world take away a lot of business from academic medical centers as hitting them in the pocketbooks I hope may hurt enough to finally get them to address the oversupply issue.

 

[SLUsagar]

I personally hope the Dr. Oppenheimers of the world take away a lot of business from academic medical centers as hitting them in the pocketbooks I hope may hurt enough to finally get them to address the oversupply issue.

i understand the point, but i'm sad to inform that bay area academic centers really don't seem to care about "Doctor" O's greasy, pudgy hands digging into local community pathologists' pockets b/c as mentioned above, the urologists at these centers are gonna go about their merry way and keep sending bx's in-house (within their academic center). The academic centers could care less (most aren't even aware of these sorts of issues) and, to my knowledge, have NO plans of reducing the # of residency spots (which i COMPLETELY agree with you, really ought to seriously considering doing to protect the longterm survival of our specialty).

 

[rockit]

Well your path program must be spineless. Why would the gyn stuff go to quest over you?

Because Quest gives them money. Haven't you read this entire conversation?

 

[pathstudent]

Because Quest gives them money. Haven't you read this entire conversation?

There is something wrong with your administration then.

 

[exPCM]

i understand the point, but i'm sad to inform that bay area academic centers really don't seem to care about "Doctor" O's greasy, pudgy hands digging into local community pathologists' pockets b/c as mentioned above, the urologists at these centers are gonna go about their merry way and keep sending bx's in-house (within their academic center). The academic centers could care less (most aren't even aware of these sorts of issues) and, to my knowledge, have NO plans of reducing the # of residency spots (which i COMPLETELY agree with you, really ought to seriously considering doing to protect the longterm survival of our specialty).

I guess I have had a different experience than you have with urologists at academic centers. I have seen a good number of these urologists send their in office prostate biopsies to outside labs/POD labs if they can make money off it. I have seen many urologists who have no loyalty at all to the in house pathologists at their institutions. You seem to have had a different experience where you have trained.

I completely agree about the overtraining being a critical issue. I seem to recall seeing a study where the biopsy/surgical rate in the US is about 6 per 100 persons per year. So with 300 million people this calculates out to 18 million surgical/bxs per year. In my area most pathologists are doing 6000 cases per year which means that all the cases in the US could be done by 18,000,000/6000 = 3000 pathologists. Yet we are producing almost 600 new pathologists per year now which means every 5 years we train enough pathologists to do all the surg path in the nation - UNREAL.

 

[2121115]

All of this will go away eventually when one of several things happens.

1. CAP/ASCP lobbying groups are able to convince CMS that these arrangements violate the Stark law while academic centers do not. This is very hard to do, as every time you close one loophole another one opens up.

2. CMS is looking for ways to cut costs and they find out that TC for the 88305 is tremendously over-priced and they cut it.

3. Fee for service medicine gets scrapped altogether and there is a new reimbursement system.


I think that, one way or another, all of this will go away before long... for better or worse.

 

[pathstudent]

CMS should just come out and say we will only pay for two 88305s for a prostate biopsy case. Doing these 12 "quadrant biopsies" doesn't have an iota of impact on treatment or prognosis versus just taking 12 biopsies and putting them in two containers "left vs. right".

As much as we can gripe about outsiders exploting pathology there is plenty of evidence that pathologists "work the system" also.

 

[Gyric]

All of this will go away eventually when one of several things happens.

1. CAP/ASCP lobbying groups are able to convince CMS that these arrangements violate the Stark law while academic centers do not. This is very hard to do, as every time you close one loophole another one opens up.

2. CMS is looking for ways to cut costs and they find out that TC for the 88305 is tremendously over-priced and they cut it.

3. Fee for service medicine gets scrapped altogether and there is a new reimbursement system.


I think that, one way or another, all of this will go away before long... for better or worse.

#3 is unlikely and in that setting #2 will almost certainly happen. CMS is well aware of the money dermpath labs (as well as these few GI/prostate ventures) are bringing in and will further cut 88305 in the future (I think it might be the most used code in medicine?), which will of course hurt general pathologists most.

 

[SLUsagar]

All of this will go away eventually when one of several things happens.

1. CAP/ASCP lobbying groups are able to convince CMS that these arrangements violate the Stark law while academic centers do not. This is very hard to do, as every time you close one loophole another one opens up.

2. CMS is looking for ways to cut costs and they find out that TC for the 88305 is tremendously over-priced and they cut it.

3. Fee for service medicine gets scrapped altogether and there is a new reimbursement system.


I think that, one way or another, all of this will go away before long... for better or worse.

yeah it'd be nice, but the question is WHEN.
a few years is already too late, with these PODlabs (particularly the new ones) already becoming established, and gaining more firepower to defend themselves.

 

[2121115]

#3 is unlikely and in that setting #2 will almost certainly happen. CMS is well aware of the money dermpath labs (as well as these few GI/prostate ventures) are bringing in and will further cut 88305 in the future (I think it might be the most used code in medicine?), which will of course hurt general pathologists most.

#1 and #3 are the least likely, IMO. #2 will almost certainly happen regardless of healthcare reform- its only a matter of when. Until then, we just have to manage as best we can.

 

[APCPBBNP]

I heard some devastating news today...(CAP: ARE YOU LISTENING???) While others out there might already be aware of this, but that greasy bastard Oppenheimer of OUR lab is moving to CA (I've heard northern Cali, unconfirmed actual location though), and bringing his POD-lab pushing mojo's with him. ONE HALF of my groups' prostate biopsies will be phased out completely by the end of the year.

Again, CAP: are you listening? When are you gonna do something about this??

I've chatted with some of the younger urologists in my hospital that'll be moving out their prostate business , and have confirmed that kick-backs are the real reason -- NOT diagnostic issues or turn around time (I think most knowledgeable folks know that OUR-lab and other uroPOD labs are staffed by mostly by weakass FMGs...and VERY few by solid GU pathologists).

just an FYI to other cali pathologists (you know OUR lab is gonna hit the whole damn state) who should be aware of potential future loss of revenue...until someone (CAP, you listening??) stands up and does something about it.

As far as I know, majority of pathologists that sign-out Bx in pod and similar labs are actually very experienced ones (not some frustrated, otherwise un-employable pathologist), often with full time positions at Universities, pod/commercial labs are just additional source of income for them; for examples visit www.mypathlabs.com (Pathology Solutions lab from NJ) and look up medical staff profiles; almost all have appointments at close-by universities like Tempe University or UMDNG; some are semi-retired; no wonder fresh-out of training fellows can’t find jobs

 

[yaah]

As far as I know, majority of pathologists that sign-out Bx in pod and similar labs are actually very experienced ones (not some frustrated, otherwise un-employable pathologist), often with full time positions at Universities, pod/commercial labs are just additional source of income for them; for examples visit www.mypathlabs.com (Pathology Solutions lab from NJ) and look up medical staff profiles; almost all have appointments at close-by universities like Tempe University or UMDNG; some are semi-retired; no wonder fresh-out of training fellows can’t find jobs

That is generally true, but not always. And a lot of the "experience" comes from being a fellow at reference labs. The bigger reference labs have enticed academics to leave their jobs by contracting with academic institutions to have a teaching appointment there. It works well for the faculty because they have a greatly increased source of biopsy material for research. I suppose it would be good for teaching residents too but I doubt this happens very much since teaching is rarely such a priority these days.

The semi-retired and part-time people who fill a lot of these positions is another one of the "unforeseen" consequences of these jobs, as they do not create any additional jobs and may in fact lead to a reduction in pathologist jobs.

 

[2121115]

for examples visit www.mypathlabs.com (Pathology Solutions lab from NJ)

Wow. That is depressing. Hard to not have a doom-and-gloom outlook after seeing this....

Triage
We will triage your specimens so you don't pay a pathologist if you don't get paid.


WTF? Is this not the definition of kick-back?


Billing & Support
Our billing department, including managers with over 24 years experience, will teach you what you need to know to bill properly and get paid for your pathologist's services.


"your pathologist"? OMG. Pathologists who agree to this must have no professional pride - the lowest of the low.



Credentialing
As a value added service, we will link your employee pathologist to the plans you work with.




It is hard for me to see how this isn't explicitly related to oversupply. The writing is on the wall here folks.

 

[pathstudent]

As far as I know, majority of pathologists that sign-out Bx in pod and similar labs are actually very experienced ones (not some frustrated, otherwise un-employable pathologist), often with full time positions at Universities, pod/commercial labs are just additional source of income for them; for examples visit www.mypathlabs.com (Pathology Solutions lab from NJ) and look up medical staff profiles; almost all have appointments at close-by universities like Tempe University or UMDNG; some are semi-retired; no wonder fresh-out of training fellows can't find jobs

Notice how they drop the word "subspecialized" over and over again. This is what patients and surgeons and physicians want. This is the power of academia. As we went subspecialized and promoted it, so have the reference labs. Now we are at the point where a first year out of gyn path fellowship is more trusted by other physicians than general community pathologists who have been looking at ovarian tumors for 30 years. It is true and kinda sad but not that sad. General community pathology is a dying field.

 

[path24]

Wow. That is depressing. Hard to not have a doom-and-gloom outlook after seeing this....

Triage
We will triage your specimens so you don't pay a pathologist if you don't get paid.


WTF? Is this not the definition of kick-back?


Billing & Support
Our billing department, including managers with over 24 years experience, will teach you what you need to know to bill properly and get paid for your pathologist's services.


"your pathologist"? OMG. Pathologists who agree to this must have no professional pride - the lowest of the low.



Credentialing
As a value added service, we will link your employee pathologist to the plans you work with.




It is hard for me to see how this isn't explicitly related to oversupply. The writing is on the wall here folks.

Just more proof that people can ignore.

All the while the "leaders" of pathology speak about a shortage.

 

[2121115]

Now we are at the point where a first year out of gyn path fellowship is more trusted by other physicians than general community pathologists who have been looking at ovarian tumors for 30 years.

I'm not sure that they are trusted more. I think it is the fact that with these kick backs clinicans can make a lot of money and the fact that a "gyn-trained" person is reading the slides gives them a justification for their conscience. They rationalize that this scenario makes money for them and is also good for the patient.

It is true and kinda sad but not that sad. General community pathology is a dying field.

I think general community pathologists are certainly going to have to adapt, but not the way they think. For example, right now community practices are aggressively recruiting GI pathologists because clinicians are telling them they are switching to the reference lab/pod lab/whatever because of expertise. The problem is that expertise is only the excuse they use to do this (see my comment above). It is really about money. A community practice could be loaded with GI pathologists but if the GI docs are going to make $$$ by setting up a pod lab or sending their tissue to mypathlabs.com or whatever then it doesn't matter if your practice hires Odze to sign out the cases. It is about $$ not expertise - expertise is only the superficial justification.

For community pathology to survive something is going to have to happen. One thing could be a legislative fix to the in-office ancillary services AP exception. While CAP is supporting this sort of change (read STATline), it will be a tooth-and-nail fight. Even if it happens business savvy types will find another loophole. That is just what they do.

One way or another, community pathologists will need to adapt and alter their business model, although I'm not sure how (if I knew how to do this I'd be a rich man obviously). Restricting the supply of pathologists at the training level is certainly a good start, but that is really really unlikely to happen and even if it did it won't fix the issue in the short term.

 

[SLUsagar]

A community practice could be loaded with GI pathologists but if the GI docs are going to make $$$ by setting up a pod lab or sending their tissue to mypathlabs.com or whatever then it doesn't matter if your practice hires Odze to sign out the cases. It is about $$ not expertise - expertise is only the superficial justification.

One way or another, community pathologists will need to adapt and alter their business model, although I'm not sure how (if I knew how to do this I'd be a rich man obviously). Restricting the supply of pathologists at the training level is certainly a good start, but that is really really unlikely to happen and even if it did it won't fix the issue in the short term.

Your assessment is 100% accurate. Most urologists could care less if they could be reassured that the private practice group has hired Epstein himself to sign out their prostate biopsies...they still wouldn't be able to peel off the technical component (read: 12 sometimes 14 biopsies, each 88305, per pt...read:IPOX on a BUNCH of 'em...read:$$$).

But to me, it seems like a lot of community pathologists are too weak, too scared, or simply too content with just billing out the 88309 for the prostatectomies while some podlab rips off the biopsies. Until we, as a community, grow a pair and take a stand on this issue, it'll continue to happen in my opinion.

 

[yaah]

Those labs are quite hit or miss. Some of them do a fine job. Others do a horrible job. I tend to wonder if the urologists know which one is which (obviously the smart ones do). I saw a report from one of them once that had every core signed out as "Gleason 2+4=6" or "Gleason 4+2=6" when all of them were 4+5 or 4+3. As with everything though, there are gradations of the truth. There are lots of urologists who care only about how much money they can gouge out of pathology. Others care mostly about quality and honestly see it as a way to get more quality control over the path results. But the $$$ is the ultimate arbiter in many situations (but not all). Same with GI. Derm has been relatively more protected because dermatologists have a much better general knowledge of pathology than other fields do, but even there the quality is hit or miss.

I agree that a legislative fix is the only way to really improve things, but it's hard to write a law that legitimately fixes things without creating loopholes. This is part of the problem with medicine as a business - if we fix the problem and remove loopholes income likely goes down because there is more government control. It's hard to have it both ways, as many people seem to want.

 

[adenosis]

I see the point everyone made about community path docs, large commercial labs and small office based labs. The bottom line is that everyone's motives (including community path docs) are driven by greed. Many folks used to make $$$$ and now make $$ (each $ = 200-300K) and blame others for stealing their work. Whether pathologists, hospitals, clinicians or corporations own the labs, the vast majority of pathologists will never be on the top of the food chain sucking money out of the junior path docs. Same goes to the all holy academic centers, dept/hospital suck all the money and pay the attendings a small fraction of the revenues they regenerate for the big fish. Most people blame the clinicians who are in the same boat with decreased reimbursements and try to milk the path docs too.
As far as I know many labs operate in CA and other states taking business away from community path docs. Let's compete with one another!!!

 

[lipomas]

I blame Obama.