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LADoc00

LADoc00

Gen X, the last great generation
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I think we are now under an hour before the deadline for the submission of the 2015 CMS reimbursement schedule. So far the changes in ancillary testing appears huge:

Elimination of G0461-2 IHC bullcrap, return to 88342 for 1st ab with +88341 for each additional single stain and +88344 for each additional multiplex stain ab. Hopefully the 1st 88342 will much much higher than G0461 was set at.

88360/1 appear unchanged although you cannot get multiple units of service per specimen with a multiplex procedure for this code now (ie you cant do a semi-quant triple stain and get paid for 3x88360s)

88367 still there with each following probe being 88373 or 88374 (multiplex)...this could HURT alot. I am afraid.

If anyone sees a link to the actual dollar numbers, please post.
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Noooooooooooooooo, we get hosed YET again. What was supposed to be a 3-4% increase turned out be net zero to negative. That is the final straw that broke the camel's back for me in listening to the midyear CAP PFS analysis, they were completely off.

According to the CMS, the impact of 2015 Medicare fee schedule changes resulted in a 0% change from total reimbursements rates set for 2014. The CMS said pathology services will see a 1% decrease to the work relative value units used to calculate the professional component of pathology services as well as global payment. However, the impact on changes to the practice expense used to calculate the technical component as well as global payment resulted in a 1% increase in pathology payment. The combined impact results in a 0% change.

Immunohistochemistry Medicare Payment

In response to CAP advocacy throughout 2014, the CMS accepted new and revised American Medical Association Current Procedural Terminology (AMA CPT) codes for immunohistochemistry services. The CMS had created G-codes to bill IHC in 2014 after it was targeted as a misvalued service.

The CAP advocated for an alternative to the G-codes and proposed changes to CPT codes. The revised codes aim to eliminate use of G-codes, which led to confusion between Medicare and non-Medicare payers. For 2015, the CMS is deleting the IHC G-codes.

In accepting the revised 2015 CPT codes, the CMS lowered the value recommended by the AMA Relative Value Scale Update Committee (RUC) for IHC add-on services; however, this represented an increase over the 2014 IHC G-code values.



In Situ Hybridization Services

The CMS accepted new and revised CPT codes for in situ hybridization services (FISH). However, the CMS lowered the value recommended by the RUC for in situ hybridization add-on services. It accepted values for the majority of the new multiplex FISH codes.

FISH services had been under review through the misvalued code initiative since 2011. The CAP had used its position on the RUC to mitigate payment reductions to services targeted as overvalued. The CAP further advocated that revaluations of pathology services accurately account for the cost of delivering the services provided. The CMS does not always agree with or take the RUC’s recommendations.

I will say that this blast information ALONE is worth giving money to CAP. Although CAP can be down right worthless, everyone should still be a member to at least get this info and attend the webinar next week.
 
Looks like significant hit to FISH reimbursement. Once again, those who abuse the system and profit off of it have caused everyone else to get hit. I think CMS should just station operatives in in-office labs full time to see where the abuse and outliers are, then they will know specifically what to target before it becomes a rampant problem.
 
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yaah said:
Once again, those who abuse the system and profit off of it have caused everyone else to get hit.
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This bespeaks of lack of a strong Leadership. A strong Leader(s) would have fought abuses (of all types), along side those inside and outside of our Field. Pathologists seem mostly meek, shy, unable and unwilling to organize to defend what is right for the Specialty long term.
 
If someone sees the numbers please post. Im expecting a bloodbath.
 
Yes, basically now I do not think it possible to make any sort of profit from a free standing lab servicing a hospital. In fact, if you are unlikely enough to own one, you will likely be operating at a loss very soon.
 
yaah said:
I think CMS should just station operatives in in-office labs full time to see where the abuse and outliers are, then they will know specifically what to target before it becomes a rampant problem.
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This is great in theory but would never happen because the expense would be far too great for CMS to implement and they're trying to prevent further losses in federal revenue. Instead of plucking the few bad weeds individually who are let's just say less than scrupulous, it's easier to mow the whole field down with a weed wacker.

Less than one year after the G0461/462 I'm not surprised they're doing away with this as it seems like a routine. So everybody get your billing office prepared for the new codes, lest ye miss out once they become official. And if you're lagging by even one day, you ain't gettin' paid...it's like hitting a moving target. I think they do this purposely so we have to constantly play catch up :thinking:
 
LADoc00 said:
Yes, basically now I do not think it possible to make any sort of profit from a free standing lab servicing a hospital. In fact, if you are unlikely enough to own one, you will likely be operating at a loss very soon.
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If you are doing TC for a hospital life sucks even more. Surgery centers are now bundled too.

If your group is hospital based PC only, expect hugh pressures to cut costs at the department level.

The hospitals will end many private practices and make everyone employees. This will happen if they can sipon off fees from the PC side. Lab and path are now in line with pharmacy and house keeping.

If your in a big city wait for LabCorp and Quest to make an offer your hospital to outsource histology to their central lab.

Oh, by the way they would like to have your pathology contact for professional services.

Are you ready to work for the big the lab?
 
The more I think about this the more Im coming to believe this is the end of the road for many private pathology groups that havent sold their TC shops. Even moreso, those companies that have spent large amounts of money for TC operations to gain market share are now undone.

The ancillary services bundling though likely spells the end in general of private Pathology when they finally make the push to bundle PC fees into them as well, which is the only next logical step now.

I heard them batting this around last year but never believed it would actually happen. CAP is not only asleep at the wheel but grossly incompetent at this point.

I think at this point unless the PC numbers are spectacular which we obviously know they wont be, the field of Path is officially dead.
 
They won't bundle PC charges for a while. This would imply all physician charges at the hospital could be bundled.
ie, radiology, ER, anesthesa Hospitalist etc. There would greater push back. No cared about pathology bundling except the hospitals and few odd labs.
 
But we're "the lab". We aren't physicians, and are thus not included in with radiology, ER, hospitalists or anesthesia. We'll be PC bundled soon enough. That's the day I stop practicing.
 
Just attended the CAP webinar, and this is the gist (similar to what has already been posted)

Prostate biopsy code is one G code for any number of specimens, which is for Medicare patients only (equivalent for about 88305*8). So if most of your prostate biopsies are not from MC patients, then no change (you can bill 88305)

IHC codes are back to 88342 (first stain) and 88341 (each additional stain) and new code 88344 for multiplex stains (cocktails) rather than G codes, which means that we code the same way for Medicare and other payers (no more G codes). So although the reimbursement rate hasn't changed from the G code in 2014, now since it's a CPT code it applies to all payers. Sucks somewhat, in that we are judicious about IHC, but hopefully will cut out those labs that do IHC for everything (see http://pathologyblawg.com/pathology...ves-college-american-pathologists-lcd-wanted/)

As for bundling of pathology services, they mentioned that the pathologist professional work is not part of the bundle and only mentions to technical component, for costs that are $100 or less (see http://www.discoveriesinhealthpolicy.com/2014/11/cms-rulemaking-for-cy2015-released.html). The CAP people on the call did not even realize that means all level I and level II surgical pathology codes(including 88305!!). That means no more global billing for hospital outpatient, ASCs (including endoscopy centers). Split billing, with the TC bundled into the procedure. Sucks big time. I don't think that the PC will ever be touched, because that affects too many specialties (anesthesia, surgery) and they have bigger lobbies than we do. If they touch our PC, it'll affect everybody's PC as well.

Sad sad day.... now it's off to number crunching to figure out the impact analysis of these big changes...
 
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Actually in terms of IHC, all it does is validate the folks doing multiplex prostate triple stains on EVERY biopsy block...
 
caffeinegirl said:
Just attended the CAP webinar, and this is the gist (similar to what has already been posted)

IHC codes are back to 88342 (first stain) and 88341 (each additional stain) and new code 88344 for multiplex stains (cocktails) rather than G codes, which means that we code the same way for Medicare and other payers (no more G codes). So although the reimbursement rate hasn't changed from the G code in 2014, now since it's a CPT code it applies to all payers. Sucks somewhat, in that we are judicious about IHC, but hopefully will cut out those labs that do IHC for everything (see http://pathologyblawg.com/pathology...ves-college-american-pathologists-lcd-wanted/)

Sad sad day.... now it's off to number crunching to figure out the impact analysis of these big changes...
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Maybe I misread this, but was the PC reimbursement for the new 88342 more than the PC reimbursement for this year's G0461?
 
upload_2014-11-5_13-44-40.png

From the CAP webinar
 
Better but still blows. FISH was the only thing holding the ship together. The ancillary bundling though will be the Death Blow to lots of labs.

If you are a CAP member and got the registration link but missed this, you can go back to that link, enter your email and review it as a multimedia file (need microsoft player or something similar to run the recording).

Summary: for most, the Heme FISH took a bonkers -71% reduction with the new multiplex code effectively killing it. Reminiscent of how they killed -26 payment for Flow (and why many even boarded hemepath people dont bother reading their own cases).

Residency training in Path has officially become a joke.
 
Agreed..the ancillary bundling is a nightmare. And there's only a few months before it takes into effect! The commentary on pathologyblawg's article is spot on. It's a race to the bottom for the TC. And, due to bundling, now your colonoscopy 88305 TC is just part of a larger pie, with pathology/lab getting the smallest piece regardless of number of specimens.
But how will this be enforced? And how is it even realistic to enter into contracts with ASCs in such a short amount of time?
 
It's not realistic. What they hope will happen is that Pathology labs continue as normal for several months and lose their bleeping shirt as the TC AND Global bounce back.

This is BY INTENTION. We are dealing with people who do not play fair.
 
So if a hospital system owns the GI suite or outpatient procedure area the TC is still bundled? This is no different than if the procedure was done at a physician owned complex and read at the infamous in-office lab?
 
So it that really true that if a woman has a breast biopsy as an outpatient that Medicare claims that the TC for the 88305, 88361x3 and 88368 x2 is included in the payment to the facility? That's hard to believe. I need more clarification.
 
How will this effect specimens from an in office lab (outpatient derm or GI) not coming from a surgicenter?

I can't believe these changes could really be coming in less than 2 months. That seems absurdly inadequate for how it is likely to shake things up.
 
LNsquasher said:
How will this effect specimens from an in office lab (outpatient derm or GI) not coming from a surgicenter?
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I am asking myself the same question. Does this affect derm, GI, and GYN from outpatient offices?
What does it mean 'hospital outpatient'? Someone clarify this please.
 
Sucks when you battle hard for direct billing and then **** like this happens.
 
Does anybody know if other non-MC payers are bundling the clinical lab fee schedule into ASC visits? CP/lab tests other than molecular were bundled under CMS last year. Just wondering if it trickled down to other payers as well...
 
pathstudent said:
So it that really true that if a woman has a breast biopsy as an outpatient that Medicare claims that the TC for the 88305, 88361x3 and 88368 x2 is included in the payment to the facility? That's hard to believe. I need more clarification.
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I was thinking this same thing too... does it matter that the combined TC for this patient is greater than $100?
 
i hope cms gives us guideance about how much money they are putting in the payment for the TC. Otherwise how can we strike a deal with the surgery centers?

It will be a nightmare,like getting pccl from hospitals on Medicare patients.
 
Tissue issue said:
Oh wow. So this rewards in-office labs.
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Good luck getting any agreement for payment from the surgery centers for endoscopic biopsies. If the facility fee is capped by the diagnosis code for ASCs, won't the gastros be paid a flat fee regardless of how many biopsies they do? I think we'll see a sharp decline in the number of GI biopsies to get more patients through the endoscopy mill. For now, they'll probably shunt all their Medicare patients to the hospital and keep the private insurance in the ASCs. This will work until private insurers follow suit and use a flat fee. Any reason to think they won't?

I don't think this change will reward in-office labs - they will suffer, too. Aren't many in-office labs associated with endoscopy centers? These endoscopy centers are ASCs, since they're not where the physician has his/her office. If the gastros opened a condo lab to reap profits off the pathology TC from their own biopsies, that will now be gone since it's bundled into the facility fee. The gastros can have 2 responses to the pathologists who are servicing these labs - either close the in-office lab (the pathologists can take it all back, of and by the way we won't pay you for the TC since we don't get paid) or try to collect the PC component of what the pathologist does and pay him/her a fixed flat fee (if they're not already doing that). If you think #1 is unlikely, I'm not sure - right now this only affects Medicare, but if private insurers will almost certainly follow suit and begin bundling, too.

Oh, and we're totally screwed on IHC. Previously, only Medicare used the hated G codes, since they're government codes - last year, insurers were still paying 88342 for all IHC. Now, private insurers, can follow suit and pay 88342 and the decreased 88341, since this will be in their code set.

Come on, Blonde Docteur - tell us again how civilized path residency is! How educational! How refined! Keep dancing and having a drink while the Titanic sinks beneath you...
 
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I am glad I am not the only one that understands the gravity of CMS move. It results in a massive underpayment for hospital pathology labs or those servicing them or an ASC.

Hospitals have got to cut pathology costs. Think of all of they ways they can. Cut techs, transcription, equipment.

How about cut the pathology contract ..... Part A or make the group employees. Bundling is scary but 100.00 per patients is a joke.
 
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Crossed Path said:
Good luck getting any agreement for payment from the surgery centers for endoscopic biopsies. If the facility fee is capped by the diagnosis code for ASCs, won't the gastros be paid a flat fee regardless of how many biopsies they do? I think we'll see a sharp decline in the number of GI biopsies to get more patients through the endoscopy mill. For now, they'll probably shunt all their Medicare patients to the hospital and keep the private insurance in the ASCs. This will work until private insurers follow suit and use a flat fee. Any reason to think they won't?

I don't think this change will reward in-office labs - they will suffer, too. Aren't many in-office labs associated with endoscopy centers? These endoscopy centers are ASCs, since they're not where the physician has his/her office. If the gastros opened a condo lab to reap profits off the pathology TC from their own biopsies, that will now be gone since it's bundled into the facility fee. The gastros can have 2 responses to the pathologists who are servicing these labs - either close the in-office lab (the pathologists can take it all back, of and by the way we won't pay you for the TC since we don't get paid) or try to collect the PC component of what the pathologist does and pay him/her a fixed flat fee (if they're not already doing that). If you think #1 is unlikely, I'm not sure - right now this only affects Medicare, but if private insurers will almost certainly follow suit and begin bundling, too.

Oh, and we're totally screwed on IHC. Previously, only Medicare used the hated G codes, since they're government codes - last year, insurers were still paying 88342 for all IHC. Now, private insurers, can follow suit and pay 88342 and the decreased 88341, since this will be in their code set.

Come on, Blonde Docteur - tell us again how civilized path residency is! How educational! How refined! Keep dancing and having a drink while the Titanic sinks beneath you...
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Hey, we were all naive until we got into the real world and saw how this business works.

Will bundling spread to physician offices as well? My guess is yes since we seem to put up such little reistance. The lack of fight is sad.
 
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My take on this:

1-This "bundling of TC" affects only "facilities", which presumably receive other indirect income stream from Government.
2-Therefore, at present, only select few of us (owners of or purveyors of TC to "facilities") will be affected. Overnight, they will become a "cost center."
3-Amongst few so affected, those who intermediate work of "others", will attempt to push down wage of "others."

4-The real long-term threat is potential extension of "bundling of TC" to other hospital work.
5-If #4 were to happen, laboratories will become a "cost center". More testing, more money to pathologists and less to hospitals and vice versa.
6-This will engender situation in which pathologists will be forced to cede their income to hospitals, either by lowering volume or by becoming salaried.
 
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caffeinegirl said:
Does anybody know if other non-MC payers are bundling the clinical lab fee schedule into ASC visits? CP/lab tests other than molecular were bundled under CMS last year. Just wondering if it trickled down to other payers as well...
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Yes Blue Shield and Blue Cross are doing it for some areas in California starting 3-4 months ago. When you had the Blues, Medicare and MediCal (our Medicaid), that would encompass 85% of payors in many areas.
 
jkdoctor said:
I wonder if yaah and blondedocteur will continue to post and recommend that medical students go into pathology.
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This is such an ignorant and idiotic comment. If you hate pathology so much, go and quit. Go find work in some other field where the challenges are even greater. Or if you want, continue comparing pathology to some idealized version of another profession (which only exists ephemerally). If med students want to go into pathology, they should go into pathology. Are you seriously suggesting that someone who loves pathology and wants to make a career out of it NOT go into it because reimbursement is down and because autonomy is declining in the current environment? So what, they should go into family practice and continue to make 50% of what the average pathologist makes while working longer hours? This argument is so old and tiresome and ignorant.

Do yourself a favor and go and read the posts in any other forum and see how much they think the future bodes well for their specialty. They are all pessimistic except maybe those working on the margins, those dealing with a significant private pay component, or those who don't care one bit about financial rewards. Even dermatologists are pessimistic. If you want me to say I hate my job and I wish I did something else I am not going to do it, because it isn't true. I interact with other clinicians who are facing equal or greater challenges and I do not regret my career path at all. If you do, that's your problem, it is not my fault nor is it the fault of anyone who is just starting their career. It is starting to BECOME my problem because it effects the field as a whole when it is filled with do-nothing complainers and whiners who want someone else to fix all their problems while they cash out or skate by.

Again, if you hate pathology so much, quit. The field will probably be better off. If you love it but hate the problems that are in the field right now, then figure out how you're going to handle it. You have a few options:
1) Get out
2) Deal with it and adjust your practice
3) Advocate for change, get political, etc
4) Complain online anonymously and discourage people so that at least the competition for your job will decrease.

#4 sucks and doesn't help anyone, even you. So just quit it and move on. Here's my recommendation for you: Leave the field. Go to law school, go to business school, see how successful you are. Change fields of medicine. Do something you hate where you can't wait to retire. When you succeed and your life and financial rewards are significantly better than they are now, come back and educate us.

The challenges now are substantial. Medicine has reached the age of the bean counter and, god help us all, accountability. No one likes accountability, most particularly those who have skated by through the years without having to deal with it. But it is a reality. Reimbursement is declining, respect for every profession is declining, responsibility is increasing. Now, faced with these challenges you can throw a tantrum or you can choose to adjust and deal with it (or fight it) as best you can. I think we all can figure out the tactic that many who post on these forums have chosen.

There are lots of people on these forums who are complaining about changes and problems justifiably. They are trying to understand them and how to adjust and how to fight them. I have no problem with this. This thread has been largely a good and productive discussion. I respect most of the people on here, some of which I disagree with on some perspectives. What I don't respect are pathetic cheap shots and slams from up there on some pedestal. It solves nothing.

Medicine is a challenging field. NO ONE should go into it these days without appreciating the challenges, risks, and potential for huge debts and time sink and impact on your life that it causes. Medicine will take over your life. It can destroy your family life if you have a bad situation. I don't recommend medicine, or pathology, for anyone who isn't prepared for the lifestyle, the personal challenges, and such. Anyone who decides on a field without seriously considering these things typically becomes jaded, pissed off, and becomes the kind of person who goes on the internet anonymously to blame others for their problems and is dissatisfied with the direction of their career. Many well-meaning people also get this way.

But ok, yeah, it's just about reimbursement declining. Bailout now, you're going to get paid less.

end rant.
 
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A lot of these changes hurt most for people who do tons of them, that's always the issue. If you do tons of multiplex immunos or multiplex FISH then the changes are going to be more significant. But if you already are judicious and/or are not highly specialized the changes are less significant.

The problem I have with a lot of these changes is that once again it encourages cherry-picking by reference labs or in office labs. They still have a way to siphon out the most profitable cases for themselves and leave everyone else with the bag on the complicated cases.
 
I appreciate your perspective yaah, and I thought I would add a few thoughts as well.

I have been a part of SDN since I was a premed..many years ago, and have continued to post/lurk through medical school, residency, fellowship and now as a pathologist. If I could go back in time, I would have told myself to learn more about the field of pathology from a practice perspective, and not just a clinical perspective. Know more about what PC and TC mean, payer mixes, cash flow, practice management and how basic Econ-101 applies to the field. Also, I wish I could have told my past self that my position will not be stable or "guaranteed." I made plenty of personal sacrifices to be a pathologist, and now with all of these changes coming, I wonder if I made the right choices in the long run.

I love pathology..the diagnosis of disease, the clinical context of my diagnoses and being an integral part of patient care. However, in the "real world" this isn't what I spend most of my time on anymore....

For those future pathologists or those who are going into the field, love what you do, but be smart about your decisions. Understand whether your position or practice is stable, keep up to date with the practice changes in pathology (ie. such as this major paradigm shift in ambulatory reimbursement) and realize that if you want stability it will come with being a part of a large HMO/laboratory/conglomerate or academia (with a stable but lower income). If you want to stay on your toes, adapt to every change coming (and this is the first of much more to come) and spend more time on the business of medicine rather than the practice of medicine, then private practice is what that has become.
 
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Absolutely. No one should go into things without eyes wide open.

I did not say what I said to minimize anyone's struggles or difficulties, I know it is has been a difficult few years for graduating residents and fellows. There are lots of reasons for this.

It behooves everyone to sincerely attempt to educate themselves on two things prior to embarking on a career in medicine
1) The business aspects of medicine. What does billing mean, how does insurance work, all of this stuff. You can't possibly learn it all but you can learn a lot about how the business works, why certain fields are more profitable, why hospitals are focusing more on "quality" and process now in addition to simple volume. THink about what is the difference between working for a private group (as a partner) vs working as an employee. Learn about what it means to have people working for you. As a physician you may be the highest paid in your office/clinic/etc but if you are in a private group you are also the last one to get paid. Everyone else's salary is guaranteed except yours if you are a partner. What are contracts? etc.
2) Financial literacy. What does it mean when you have a large student loan debt? How will that impact your life? What does it mean to have a mortgage, how far does your potential salary actually go, how will you handle daily expenses, do you want a family and how will that impact things? So much there to learn and unfortunately many many med students just have no clue. They think once they finish med school it will be fine because they will be making a 6 figure salary and who can have trouble living on that, after all. Learn about retirement plans, investment options, debt burdens, cost of living, inflation, reimbursement.

Medicine is a HUGE undertaking. AFTER college it is a minimum of 7 years before you are getting paid decently for your efforts, and by that point you may have accumulated significant debt and living expenses that have become essentially non-modifiable. If you finish residency you are typically at a minimum 30 years old (often older) and think about what it would be like to be essentially starting your career halfway through it.

Important to think about and discuss with anyone with expertise!
 
jkdoctor said:
Sorry. I strongly disagree with your message telling med students to go into pathology if they want to go into pathology.
If a student had a passion for repairing Smith Corona typewriters would you advise them to follow this passion and open a typewriter repair shop?
Several specialties were either eliminated or radically changed by the antibiotic revolution that began in the mid 1940s. Syphilology disappeared, as did thoracic medicine.
Would you have advised a medical student in 1941 to specialize in syphilology?
Ignoring the practical and economic aspects of a field due to PASSION does a great disservice and is harmful in my opinion.
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Well gee, no ****. It's not an all or none phenomenon though. No one is going into syphilology now but very few people these days would have an overpowering interest in spending their career only on syphilis. This is a total strawman argument, same with the typewriter thing. But you know what? If someone DOES truly have a massive interest in syphilis or spirochetes they probably could extend that into a career. If that's your passion. You would be amazed at some of the stuff people can form research careers around even these days. Obviously if you hear someone is going into a field that has minimal chance of employment (like Screenwriter, for example) you make sure they understand what the problems in the field are and the challenges.

While the unemployment rate in pathology is real it is still FAR lower than most professions in the world. Just because it is higher (it may or may not be, I actually don't know the specific #s) than other fields of medicine doesn't mean it is significantly higher enough to warrant avoiding it as a career.

Pathology is not a smith corona typewriter, nor is it syphilis.

A little perspective would do you well.
 
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In general, telling someone to "do what you love" is not good advice. In the end, almost all jobs become routine. I usually tell people to do something you can see yourself doing for many years: something that you like (or at least can tolerate), that seems fairly stable, and that will allow a quality of life that you'll be content with (balance of income and personal time is unique to everyone).

I have serious reservations about encouraging my own children to go into the field of medicine at all due to the years of training required, lost income, liability, and stress. In the past, it ma have been worth it, but now you're more likely become a drone in your field working for a large "non-profit" organization. Most people who decide to become physicians don't understand this when they're relatively young.

I definitely would not encourage anyone to become a pathologist. It's not the same as becoming a typewriter repairman, but I could only advise it for someone who really can't see him/herself doing anything else and enters it with eyes open. The problem is that most medical students aren't given the chance to see the practical side of medicine and particularly pathology, or they're too naive. My response is to say "I really wouldn't suggest you do that," whereas Yaah's response seems to be more along the lines of "make an informed decision and live with the consequences." I think both are correct.
 
yaah said:
Absolutely. No one should go into things without eyes wide open.
..............
It behooves everyone to sincerely attempt to educate themselves on two things prior to embarking on a career in medicine.............

Important to think about and discuss with anyone with expertise!
Click to expand...

In life, there are trends beyond one's control. Going against it usually brings grief and regret.

Pathology has been the worst Specialty, by a wide margin, over last 4 decades, in managing supply of its trainees, owing to incompetence of its Leadership. Academics have been minting unneeded trainees based on their Academic glory than in Reality. The worst of it, They refuse to take their "blinders" off.

My advice to medical students with "options": AVOID PATHOLOGY IF YOU CAN.

If you are an IMG, without options, then best of lucks to you and take solace that future has not yet been written in stone.
 
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Reduce residency spots, go interventional...... Something has to be done about the distance pathologists have from patients. It is getting worse unfortunantly.
 
If I told most of my adult friends to drop what they are doing and follow their interests and passion they would spend equal parts of time trying to get into young women's pants, playing Call of Duty and getting completely smashed on booze...Sadly I do have a few friends pushing 30 now that are indeed "following their passion". Though Im not sure what this says about me.

Anyway, we need to not tear each other apart or fall for the ridiculous Marxist propaganda that we should all be in Medicine because we love it and if necessary accept bread and water as payment to follow our passion. This is the same bizarre logic the government shoved down my throat in the military, an almost surreal audacity that somehow I should be paying the taxpayer for the right to kill our nation's enemies!

I now feel though that even stopping the mad overtraining at this point wont help us. We are too far gone and will be subject to death by a thousand cuts over the next decade.

That said, I relish the challenge.

In a fight, the man who wins is the one with 1 more round in his magazine!
~Generalfeldmarschall Erwin Rommel
 
I think I may have been misquoted..I said to love what you do, not do what you love..those are two very different things.

If I did what I loved, I would binge watch TV and be the head of the Joss Whedon fan club.

But if you spend all this time in training, then you better love what you do on a daily basis and have some job satisfaction, or the sacrifice won't be worth it in the long run. I agree with the prior comments in that this includes being happy with your daily grind as well.

Just be aware that in the field of pathology, job stability isn't guaranteed in the private sector anymore (ie. small community private practices).
 
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caffeinegirl said:
Know more about what PC and TC mean, payer mixes, cash flow, practice management and how basic Econ-101 applies to the field.
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That would have been nice. My fellow residents and I even asked our program to have something like this in our curriculum, if only a single hour-long introduction to the basics. We were essentially told by the head of AP: "You don't need to worry about that yet. You'll pick it up as needed once you get into real practice."

Needless to say, many eyes were rolling during that meeting...
 
yaah said:
So what, they should go into family practice and continue to make 50% of what the average pathologist makes while working longer hours?
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In which parallel universe?
 
Johnny Sunshine said:
That would have been nice. My fellow residents and I even asked our program to have something like this in our curriculum, if only a single hour-long introduction to the basics. We were essentially told by the head of AP: "You don't need to worry about that yet. You'll pick it up as needed once you get into real practice."

Needless to say, many eyes were rolling during that meeting...
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Very likely your head of AP had no clue regarding billing and business matters.
 
turtle1966 said:
Very likely your head of AP had no clue regarding billing and business matters.
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No, she was part of the department and hospital administrative body. She prided herself on being a business manager. She - and the other attendings - often held meetings relating to billing codes and reimbursement issues. She was in charge of purchasing new equipment, deciding what tests we would or would not offer, and running the numbers to determine whether such moves were financially viable.

Of course, it all could have been smoke and mirrors.
 
Johnny Sunshine said:
No, she was part of the department and hospital administrative body. She prided herself on being a business manager. She - and the other attendings - often held meetings relating to billing codes and reimbursement issues. She was in charge of purchasing new equipment, deciding what tests we would or would not offer, and running the numbers to determine whether such moves were financially viable.

Of course, it all could have been smoke and mirrors.
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I would strongly recommend that you push harder for an introduction/orientation to practice management. Do not expect any such orientation or education once you are in practice. If you don't have the background to begin with, or the insight to get the knowledge yourself, nobody will help you when you are out in the real world. I cannot stress how important this is for your future career...especially if you are in private practice. Do not rest on your laurels nor expect such mentorship when you are out of training.
 
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