consolidation

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Arctic Char said:
If you didn't smell it coming yet, here is a taste of what we can reasonably expect in the next decade . . . http://www.nytimes.com/2012/12/01/b...hpw&adxnnlx=1354370664-izkdYWD2xFxkq2zQ3iVuxA

thoughts?
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Reminds me of a story from this summer. My cousin in-law is a pediatrician in Boise employed by one of those two hospital chains. We were passing though town and my kid got sick or hurt or something and we called him up. He had to sneak us in his office through the back of the building to examine my kid as he said his office manager would have reported him to the hospital administration for seeing a family member for free. Can you believe it? How times have changed.

But for sure the insurance companies and hospitals chains have way more clout than physicians in the market place.
 
Good question. My guess is they may start cutting down on size, and focusing on more esoteric testing. Regardless, I agree that we are all likely to be practicing in institutionalized systems, as employees. If we are treated well, ala Kaiser for example, then things may not be so bad. However, it would probably frustrate pre-existing small practices, and those with an entrepreneurial spirit. But there are perks to having others take care of the overhead . . . and, yes, there are sacrifices of autonomy as well.

we'll see . . .
 
Arctic Char said:
Good question. My guess is they may start cutting down on size, and focusing on more esoteric testing. Regardless, I agree that we are all likely to be practicing in institutionalized systems, as employees. If we are treated well, ala Kaiser for example, then things may not be so bad. However, it would probably frustrate pre-existing small practices, and those with an entrepreneurial spirit. But there are perks to having others take care of the overhead . . . and, yes, there are sacrifices of autonomy as well.

we'll see . . .
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Somehow I get the feeling that your definition of "well" varies from mine.

So let's see.... loss of income? Check. Loss of autonomy? Check. What is there possibly not to like?
 
OooO I know people who got hit in this particular article.

This is real and it is the future.

Prepare.Go read Oswald Spengler, Ayn Rand and the Special Forces Survival Guide.
 
Agree with the above.

One thing I am concerned about is that as the hospitals become more powerful and consolidated that they will approach us and say "you guys have been independent long enough. We (ACO or corporate or some entity) think a hard working pathologist should make about 200k a year. If you are not interested, let us know.
 
pathstudent said:
Agree with the above.

One thing I am concerned about is that as the hospitals become more powerful and consolidated that they will approach us and say "you guys have been independent long enough. We (ACO or corporate or some entity) think a hard working pathologist should make about 200k a year. If you are not interested, let us know.
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Would 200k be unreasonable? It's less than a million, but the possibility of only earning 200k in pathology still sounds pretty nice to me - and I'd bet most students.
 
Enkidu said:
Would 200k be unreasonable? It's less than a million, but the possibility of only earning 200k in pathology still sounds pretty nice to me - and I'd bet most students.
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But currently a hard working (i.e. working 2000 hours a year) hospital based community pathologist earning PC alone makes twice that (assuming no one is taking a cut off her salary), as do most senior faculty members, especially when you factor in benefits (retirement, health, slush fund for work related travel).

So yes it does sound unreasonable.

As Eames said to Arthur, "You mustn't be afraid to dream a little bigger, Darling."
 
pathstudent said:
But currently a hard working (i.e. working 2000 hours a year) hospital based community pathologist earning PC alone makes twice that (assuming no one is taking a cut off her salary), as do most senior faculty members, especially when you factor in benefits (retirement, health, slush fund for work related travel).

So yes it does sound unreasonable.

As Eames said to Arthur, "You mustn't be afraid to dream a little bigger, Darling."
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2000 hours per year is still less than 40 hours per week.

But whether a wage is "reasonable" is a little nebulous. I think it would be reasonable for corporate CEOs to make 1 million dollars or less per year. That would still be a huge pay cut for them.

I doubt that quality students would avoid pathology based on that salary, just as I doubt that business types would not work as executives for a million dollars.
 
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200K wouldnt be bad if I was living in the rural Midwest, was 65+ years old and worked 1 day a week.

I would take that probably.

What will probably happen in a "future dystopian state" is experienced guys like myself will be paid by an ACO to manage a slave ship of younger folks. In such a system, I will probably hold up in an office somewhere sipping martinis toasting the Halcyon Days of Pathology and coming out to occasionally crack a whip on the slave ship Amistad.

I will do no real work with no value added other than to write personnel reviews, make snide comments on the quality of work that now passes for pathology and slip out of office 1/2 the time on "business trips."

Ive actually seen the model above, it exists now in many "bubba gubberment" positions, but it will be everywhere in 10 years.

"That is the land of Socialism and universal bliss for you!" Enemy at the Gates.
 
Enkidu said:
2000 hours per year is still less than 40 hours per week.

But whether a wage is "reasonable" is a little nebulous. I think it would be reasonable for corporate CEOs to make 1 million dollars or less per year. That would still be a huge pay cut for them.

I doubt that quality students would avoid pathology based on that salary, just as I doubt that business types would not work as executives for a million dollars.
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Sure they would. Primary care has been having issues based on comparatively low salaries around 200k and they can't get anyone to join up. Why settle for 200k when 400k is out there? Why do a 4 year path residency to make 200k when you can do a 3 year FM residency to make the same? Not to mention pathology has the worst job market in medicine. Why would a student do path over anything else, besides having an unhealthy obsession to do pathology or being an FMG who wants into the system and path is the only way?
 
Substance said:
Sure they would. Primary care has been having issues based on comparatively low salaries around 200k and they can't get anyone to join up. Why settle for 200k when 400k is out there? Why do a 4 year path residency to make 200k when you can do a 3 year FM residency to make the same? Not to mention pathology has the worst job market in medicine. Why would a student do path over anything else, besides having an unhealthy obsession to do pathology or being an FMG who wants into the system and path is the only way?
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This is not how normal people make career choices. I doubt there is a student equivocating between path and FM. I'd say that most people choose their careers based on their interests - provided that it pays 'enough'. If people made decisions the way you're suggesting we wouldn't have any pediatricians or teachers or any number of other 'low-pay' professions.

As for unhealthy obsessions with practicing pathology - how is that different from preferring pathology because its simply more interesting or satisfying? Would you suggest that secondary teachers all suffer from unhealthy obsessions, or could they just be passionate about their work?

What is your specialty, by the way? If its not the most highly compensated field in medicine, then what obsession and poor decision making led you to it?
 
Enkidu said:
2000 hours per year is still less than 40 hours per week.

But whether a wage is "reasonable" is a little nebulous. I think it would be reasonable for corporate CEOs to make 1 million dollars or less per year. That would still be a huge pay cut for them.

I doubt that quality students would avoid pathology based on that salary, just as I doubt that business types would not work as executives for a million dollars.
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Yes it is less than 40 hours per week if you take 0 weeks of vacation a year.

It is reasonable to get paid for your work. And wages aren't nebulous at all in medicine. They are based on CPT codes and RVUs. So if you have a published medicare fee schedule and a knowledge of your contracts with the private insurers you can estimate pretty closely what you generated each day.

Don't go on about CEO earnings. Yes it seems obscent but it was the market dictates and the difference between a great company leader and a mediocre one is immense. Yes Lebron James would be lucky to get to play in the NBA for 1 million a year. Yes Katy Perry would be lucky to be a singer/performer for 1 million a year, but they are uniquely talented human beings who millions will pay to see live or on TV, and they get paid what they deserve.

But I am glad there are people like you, because when you are done, I would be happy to hire you or someone like you and pay you 50% of what you generate. Don't worry about where the rest is going.
 
pathstudent said:
Yes it is less than 40 hours per week if you take 0 weeks of vacation a year.

It is reasonable to get paid for your work. And wages aren't nebulous at all in medicine. They are based on CPT codes and RVUs. So if you have a published medicare fee schedule and a knowledge of your contracts with the private insurers you can estimate pretty closely what you generated each day.

Don't go on about CEO earnings. Yes it seems obscent but it was the market dictates and the difference between a great company leader and a mediocre one is immense. Yes Lebron James would be lucky to get to play in the NBA for 1 million a year. Yes Katy Perry would be lucky to be a singer/performer for 1 million a year, but they are uniquely talented human beings who millions will pay to see live or on TV, and they get paid what they deserve.

But I am glad there are people like you, because when you are done, I would be happy to hire you or someone like you and pay you 50% of what you generate. Don't worry about where the rest is going.
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Well - CEO earnings are fair relative to the market, sure. In fact - average salaries are always a function of the market, so that's true for every profession. What you were describing was a change in the market (ACOs and consolidation) and speculating how it would affect salaries. Obviously they will go down - maybe to 200k. But is this a reasonable salary? Of course it's 'reasonable' relative to the market - it has to be. But is it reasonable given the education requirements and stress of pathology practice? I dunno, but it seems so to me.

Of course, I'm not suggesting that I would want less than a fair market salary, whatever that is, but thanks for the offer.
 
pathstudent said:
Yes it is less than 40 hours per week if you take 0 weeks of vacation a year.

It is reasonable to get paid for your work. And wages aren't nebulous at all in medicine. They are based on CPT codes and RVUs. So if you have a published medicare fee schedule and a knowledge of your contracts with the private insurers you can estimate pretty closely what you generated each day.

Don't go on about CEO earnings. Yes it seems obscent but it was the market dictates and the difference between a great company leader and a mediocre one is immense. Yes Lebron James would be lucky to get to play in the NBA for 1 million a year. Yes Katy Perry would be lucky to be a singer/performer for 1 million a year, but they are uniquely talented human beings who millions will pay to see live or on TV, and they get paid what they deserve.

But I am glad there are people like you, because when you are done, I would be happy to hire you or someone like you and pay you 50% of what you generate. Don't worry about where the rest is going.
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Katy Perry is uniquely talented?
I will agree with Lebron James. He is a freak of nature but I could go down the local community college and find someone that could do what she does.
 
WEBB PINKERTON said:
Katy Perry is uniquely talented?
I will agree with Lebron James. He is a freak of nature but I could go down the local community college and find someone that could do what she does.
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Let me know the name of that person and so I can sign her.

The droves of community college kids trying out for American Idol are proof that Katy Perry is 1% of 1% of 1% of 1%. Yes she is gifted just like King James.
 
LADoc00 said:
..snip..

Prepare.Go read Oswald Spengler, Ayn Rand and the Special Forces Survival Guide.
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The Wilderness Survival Guide (US Army Edition, abridged(?), freely downloadable) recommends against drinking urine. Damn you, Bear Grylls.
 
pathstudent said:
Let me know the name of that person and so I can sign her.

The droves of community college kids trying out for American Idol are proof that Katy Perry is 1% of 1% of 1% of 1%. Yes she is gifted just like King James.
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She sings silly songs written by other people. Her voice is nothing special. If it wasnt for her body, we probably would have never heard of her. So basically all you have to do is find a hot girl to dress skanky and can sing a little. That is pretty easy to do.

I do like that tight Obama dress she wore before the election though.
 
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