Crap jobs in Pathology

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Trust fund.

People like Bill Gates’ daughter go to medical school. Obviously an extreme example but plenty of people at my med school have parents with 15-20 million in the bank
15 to 20 million isn't real impressive either. Hell I have farms worth that much.

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Trust fund.

People like Bill Gates’ daughter go to medical school. Obviously an extreme example but plenty of people at my med school have parents with 15-20 million in the bank
No trust fund kid is going into Pathology lmao. No trust fund kid going to be working for 230K slaving away in NYC.

The people who take these jobs are people that need to stay in NYC and have no other options for jobs.
 
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15 to 20 million isn't real impressive either. Hell I have farms worth that much.
I don’t know it generates anywhere between 750k and 1 million per year without doing anything. It’s definitely enough to never worry about money again for most people
 
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No trust fund kid is going into Pathology lmao. No trust fund kid going to be working for 230K slaving away in NYC.

The people who take these jobs are people that need to stay in NYC and have no other options for jobs.
What do they go into? She’s doing pediatrics
 
Pathologists in private practice who are junior to the partners also typically have 4 weeks or less vacation, and sick days taken out of vacation days (including maternity leaves).
The same partners who show zero compassion or flexibility regarding sick leave and maternity time (all must be completed in the gifted 4 weeks of paid leave) will not think twice about taking the day off to bring their dog to a vet appointment or to handle gardening emergencies on their home front.
I've seen it, and tipped my hat in silent deference to the unabashed audacity of it.
 
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The same partners who show zero compassion or flexibility regarding sick leave and maternity time (all must be completed in the gifted 4 weeks of paid leave) will not think twice about taking the day off to bring their dog to a vet appointment or to handle gardening emergencies on their home front.
I've seen it, and tipped my hat in silent deference to the unabashed audacity of it.
Please don’t take these jobs people.

These jobs are only able to able to exist because someone is willing to take it. Lack of options regionally forces people to take these crap jobs.

You worked hard to get to where you are at. Don’t let some greedy employer lowball you on salary or vacation.
 
Please don’t take these jobs people.

These jobs are only able to able to exist because someone is willing to take it. Lack of options regionally forces people to take these crap jobs.

You worked hard to get to where you are at. Don’t let some greedy employer lowball you on salary or vacation.
By the time this is apparent to you, your spouse is already settled in his or her job, your kids are settled in their schools, and you have a mortgage to pay and don't want to take a loss on the property.
Plus, the same thing is probably going to happen in the next job anyhow. Due diligence only rarely seems to help. Grin and bear.
 
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One of many reasons why Pathology has fallen out of favor with American grads. Crap pay jobs for high cost of living areas. Too many trainees leads to depressed salaries in major cities. It’s unfortunate but this is the ugly truth of our field. Director of Anatomic Path with a salary of 260K!?! Really?View attachment 384866

So entry level low 200s and experienced mid 200s. That not too different from going rate in my local market with COLA lower than NYC but still high. A lot of folks in the entry market can only get hired in academia around me (many private groups won’t even consider a new grad unless their top shelf from big 3 programs in Boston). Many assistant prof and all instructors start off in the 100s.
 
So entry level low 200s and experienced mid 200s. That not too different from going rate in my local market with COLA lower than NYC but still high. A lot of folks in the entry market can only get hired in academia around me (many private groups won’t even consider a new grad unless their top shelf from big 3 programs in Boston). Many assistant prof and all instructors start off in the 100s.
How does mgma stay so high
 
So entry level low 200s and experienced mid 200s. That not too different from going rate in my local market with COLA lower than NYC but still high. A lot of folks in the entry market can only get hired in academia around me (many private groups won’t even consider a new grad unless their top shelf from big 3 programs in Boston). Many assistant prof and all instructors start off in the 100s.
Exactly what Ive been hearing. My buddy at Northwell in Long Island getting around 250K starting. This is in a "good job market". Imagine if the job market was how it was before. Prob 180-200 or even less. I told him to get experience and get out of there. Not sure what he can get though since the New England area is saturated with trainees.

You wonder why we can't recruit American grads into this field. Garbage salaries and after taking into account the HCOL you are effectively at 100-150K a year. LOL.
 
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How does mgma stay so high
There are other pathologists doing well financially. It depends on the group you are in and location. Try moving to the Midwest if you want higher salaries. Ive heard of groups in SE as well as in West coast. Really all over the country. Groups in larger cities generally dont advertise and hire by word of mouth. Some groups that are in less desirable locations do advertise.

They know there are a lot of pathologists out there looking for jobs so they can be selective. Larger cities expect to get lowballed because its so saturated. There are probably groups here and there in large cities that pay well but they dont advertise, like I said.

Higher paying jobs can be had 2-3 hours from bigger cities from my experience. Other fields like rads and anesthesiology salaries are still great even if you want to live in a bigger city and the job market is booming.
 
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So entry level low 200s and experienced mid 200s. That not too different from going rate in my local market with COLA lower than NYC but still high. A lot of folks in the entry market can only get hired in academia around me (many private groups won’t even consider a new grad unless their top shelf from big 3 programs in Boston). Many assistant prof and all instructors start off in the 100s.
I just find this both sad and stunning.
 
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By the time this is apparent to you, your spouse is already settled in his or her job, your kids are settled in their schools, and you have a mortgage to pay and don't want to take a loss on the property.
Plus, the same thing is probably going to happen in the next job anyhow. Due diligence only rarely seems to help. Grin and bear.
You know before signing the contract what your salary will be or how much vacation you will get but I get you, there arent many options when it comes to jobs if you are geographically restricted, so you got to take what you can get. Hope everything works out for you.
 
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I just find this both sad and stunning.
Sad and stunning but you cant blame anyone except for yourself (and the pathology field for overtraining) for taking these jobs. Im assuming these 100K jobs are at MGH or the elite Boston institutions and you are only taking these jobs because of prestige and you are academically oriented.

On the other hand, not even being able to get a private job out of training is purely our fields fault for overtraining as they are pumping out way too many grads for the number of jobs available.
 
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You know before signing the contract what your salary will be or how much vacation you will get but I get you, there arent many options when it comes to jobs if you are geographically restricted, so you got to take what you can get. Hope everything works out for you.
You know your starting salary and vacation time from your contract. Basically, this is the information that takes you through your "honeymoon" phase. Everything after that is a gamble, and due diligence doesn't help. People lie or are evasive because of a real or perceived fear of repercussions for saying something negative (or even just neutral). Also, the job seeker tries to stay optimist and unconsciously has selective hearing and eyesight.
 
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Sad and stunning but you cant blame anyone except for yourself (and the pathology field for overtraining) for taking these jobs. Im assuming these 100K jobs are at MGH or the elite Boston institutions and you are only taking these jobs because of prestige and you are academically oriented.

On the other hand, not even being able to get a private job out of training is purely our fields fault for overtraining as they are pumping out way too many grads for the number of jobs available.
What do you mean “you”? I started practice in 1988 after 10 1/2 years in the Navy. I was continuously in community hospital practice until I retired in 2013. I was never an academic. The military’s large teaching hospitals are most decidedly NOT academia.
You can count the number of people who have a major interest in publishing or allowed the nonsense of “single specialty “ sign-out on the little finger of one hand.
 
What do you mean “you”? I started practice in 1988 after 10 1/2 years in the Navy. I was continuously in community hospital practice until I retired in 2013. I was never an academic. The military’s large teaching hospitals are most decidedly NOT academia.
You can count the number of people who have a major interest in publishing or allowed the nonsense of “single specialty “ sign-out on the little finger of one hand.
You meaning anyone who takes an academic job for 100-200K.
 
I don’t trust the mgma data..that’s why I started the salary thread a while back
I totally agree. My personal experience, and that of friends in other medical fields, in practices across the country, runs contrary to what is published by the MGMA. There are plenty of lucky folk who will say otherwise, but IMO if you're a regular medical grunt the MGMA is more of career aspiration than an average. What they call the median is what I'd refer to as around the 80th percentile.
 
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I totally agree. My personal experience, and that of friends in other medical fields, in practices across the country, runs contrary to what is published by the MGMA. There are plenty of lucky folk who will say otherwise, but IMO if you're a regular medical grunt the MGMA is more of career aspiration than an average. What they call the median is what I'd refer to as around the 80th percentile.
Got a job and my hospital used MGMA data to base my salary on. I guess I should consider myself lucky then but then again I will be working in the middle of nowhere.

I talked to a friend today who got a job in a large city. She told me she got THREE WEEKS of vacation.

This field is full of have and have nots.
 
I think the larger takeaway from the MGMA is the extreme variability of income potential, even if the mean, median and mode are wrong. Yes, most orthos and derms generally make bank, and academics make quite little, but private practice anything can lead to considerable income "disparity" in most specialties, and what probably matters most is your region & payer mix & whether one is PP vs employed and having significant income siphoned of the top. The only docs of any sort I know making <250 are hospital employed primary care; the 250-500 crowd are hospital employed specialists or more competitive-ish fields (ER, some specialists) or PP primary care; 500-750 are a few PP primary care and the rads/path/anesthesia/CC/gen surg fields; 750+ are some more of the rads/path/anesthesia/CC/gen surg folks, and all oncologists, surgical specialists, derms, orthos, and some IM specialists (cards and gastro), and most in this group are closer to if not over the 7 figure mark (especially the ortho folks). But this is Midwest small to medium metro--not the East coast or the West coast, which may have docs making extreme multiple 7 figure incomes, but that's more of the exception than the rule.
 
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pumping out way too many grads for the number of jobs available.
While I totally agree with this, I still can’t get one thing straight. How pumping out too many mediocre grads helps these institutions to find a good/competent pathologist?
In my training and few years of practice I’ve seen over a hundred of early career pathologists (residents, fellows and attendings in the first 3 years). With matching standards being so low, especially near the lower end of the barrel, there must be hundreds of really crappy pathologists out there. If I can’t trust a tubular adenoma slide to about a quarter of residents from a higher tier program, I can’t even imagine what is happening in those 10k-cases/y programs in the middle of nowhere. How these places manage to get competent pathologists with experience? Or do they not care? If you are in a good private practice on one of the coasts you will surely get 50 CVs in a day. But I wouldn’t be surprised if 49 of them will either be crap, or fresh grads w/o any s/o experience.
 
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While I totally agree with this, I still can’t get one thing straight. How pumping out too many mediocre grads helps these institutions to find a good/competent pathologist?
In my training and few years of practice I’ve seen over a hundred of early career pathologists (residents, fellows and attendings in the first 3 years). With matching standards being so low, especially near the lower end of the barrel, there must be hundreds of really crappy pathologists out there. If I can’t trust a tubular adenoma slide to about a quarter of residents from a higher tier program, I can’t even imagine what is happening in those 10k-cases/y programs in the middle of nowhere. How these places manage to get competent pathologists with experience? Or do they not care? If you are in a good private practice on one of the coasts you will surely get 50 CVs in a day. But I wouldn’t be surprised if 49 of them will either be crap, or fresh grads w/o any s/o experience.
Being competent at a job isn't like being a pro athlete. Nothing in medicine or most any other career is that difficult. Even with the worst candidates going to pathology these people aren't crackheads. The bottom of the barrel can (mostly) pass the boards and do the job. I doubt pathologists actually perform at a noticeably lower level than most surgeons, dermatologists, etc, who were closer to the top of their classes.
 
While I totally agree with this, I still can’t get one thing straight. How pumping out too many mediocre grads helps these institutions to find a good/competent pathologist?
In my training and few years of practice I’ve seen over a hundred of early career pathologists (residents, fellows and attendings in the first 3 years). With matching standards being so low, especially near the lower end of the barrel, there must be hundreds of really crappy pathologists out there. If I can’t trust a tubular adenoma slide to about a quarter of residents from a higher tier program, I can’t even imagine what is happening in those 10k-cases/y programs in the middle of nowhere. How these places manage to get competent pathologists with experience? Or do they not care? If you are in a good private practice on one of the coasts you will surely get 50 CVs in a day. But I wouldn’t be surprised if 49 of them will either be crap, or fresh grads w/o any s/o experience.
They show up in your office every day with trays of junk asking you to review everything. Outside of the first few weeks of actual practice or unless there is something unusual about the specimen, people shouldn’t be needing you to review 10 benign gallbladders and trays of hyperplastic polyps.

The most egregious in my opinion are the 80+ year olds. They make a lot of ridiculous mistakes and are usually too arrogant to retire. The lights are on but no one’s home.
 
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Most people I worked with or trained with "seemed" to be competent. Not sure how all performed in practice but in training they seemed competent. Some people just gravitated towards one specialty in training and I wonder how they would perform in a general surgical path practice. At one place I trained the attendings wouldnt even recommend (via a letter of recommendation) their own resident for a fellowship. Other stories:

1. I trained with a guy who couldnt recognize cancer on a frozen at the fellowship level.

2. I was told by a pathologist that one of their new hires (from a reputable institution brought all their cases to the attending to signout, even basic cases). Its not just low tier folks who can suck. People from higher tier programs also have issues.

3. I was told by a chair of a busy hospital that some of the trainees that passed through their program just "didnt have an eye for pathology".

4. I was told by a pathologist at a job interview some of their applicants completely bombed a 10-20 slide test assessing if the candidate would be able to recognize the pathology shown on a slide or if they knew how to work up a case.

5. I was told by the president of a small group that they had to let go of one of their pathologist because he/she came to them with ALL of their cases for help.

6. I was told one person was let go from a group due to being confrontational/not willing to work with others in the group.

7. I know of a guy who jumps from job to job due to mental health issues.

8. I know of a residency program where an attending writes on their residents evaluation that "(Insert first year residents name) should not be in pathology".

You wonder why groups/programs are selective when they hire. Just as long as you don't have diagnostic issues or a difficult/crazy personality you should be fine in this field.
 
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Most people I worked with or trained with "seemed" to be competent. Not sure how all performed in practice but in training they seemed competent. Some people just gravitated towards one specialty in training and I wonder how they would perform in a general surgical path practice. At one place I trained the attendings wouldnt even recommend (via a letter of recommendation) their own resident for a fellowship. Other stories Ive been told:

1. I trained with a guy who couldnt recognize cancer on a frozen at the fellowship level.

2. I was told by a pathologist that one of their new hires (from a reputable institution brought all their cases to the attending to signout, even basic cases). Its not just low tier folks who can suck. People from higher tier programs also have issues.

3. I was told by a chair of a busy hospital that some of the trainees that passed through their program just "didnt have an eye for pathology".

4. I was told by a pathologist at a job interview some of their applicants completely bombed a 10-20 slide test assessing if the candidate would be able to recognize the pathology shown on a slide or if they knew how to work up a case.

5. I was told by the president of a small group that they had to let go of one of their pathologist because he/she came to them with ALL of their cases for help.

6. I was told one person was let go from a group due to being confrontational/not willing to work with others in the group.

7. I know of a guy who jumps from job to job due to mental health issues.

8. I know of a residency program where an attending writes on their residents evaluation that "(Insert first year residents name) should not be in pathology".

You wonder why groups/programs are selective when they hire. Just as long as you don't have diagnostic issues or a difficult/crazy personality you should be fine in this field.
We keep talking about crap jobs in pathology but we also forget about the crap pathologists that are abound. And having been on the hiring side of things now for a while, its these kinds of pathologists that are the first to complain about doing too much work for too little money.

We've had pathologists that couldn't get through 30 cases in a day, half of them being gallbladders, appendices, and lipomas. Some of them couldn't turn around a simple hysterectomy in a week. And my favorites are the ones who call 80% of their cases "atypical _" which often generates endless phone calls for me trying to explain to an irritated clinician on why so and so can't ever make a diagnosis - even on an excisional biopsies.

And to add to the pile of goodness are the pathologists who don't even bill enough to cover their salary and benefits to the practice but somehow think they're entitled to partner level compensation because we should only be so fortunate to have them in our group.
 
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From my observation there seems to be 3 categories of problems as noted above:
1 - people who lack "skill", or are not visual pattern recognizers. These people might be great clinicians in other areas, but they lack the "eye". Or maybe they have a medical condition that prevents them from having the eye required. I think these people should be made aware what their strength and weakness are and it should be the residency's responsibility to screen them out and send them to another residency.

2 - people who lack work management and workflow skills. These people can do the work, but they are slow, or disorganized, or lack attention to detail, etc. So the result of their work is shoddy. I think these people may benefit from coaching from an HR professional, or have some more secretarial assistance to help them improve their workflow

3 - people who have personality deficiencies that prevents them from performing optimally. Maybe they can discuss things in theory, but becomes indecisive in real life, or lack confidence to make a call. Or some might have personality defects that make them impossible to work in a collaborative environment. I think this category is the hardest to deal with because personality deficiencies are usually entrenched and difficult to change. These people will likely require long term psychological counselling outside of work. Or perhaps they would benefit from a work arrangement that lessens the impact of their personality deficiency (eg. someone who cannot get along with others may be better off doing short term locum coverage where their interaction with others are more limited). Some of these people may be better off with a career change.
 
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We keep talking about crap jobs in pathology but we also forget about the crap pathologists that are abound. And having been on the hiring side of things now for a while, its these kinds of pathologists that are the first to complain about doing too much work for too little money.

We've had pathologists that couldn't get through 30 cases in a day, half of them being gallbladders, appendices, and lipomas. Some of them couldn't turn around a simple hysterectomy in a week. And my favorites are the ones who call 80% of their cases "atypical _" which often generates endless phone calls for me trying to explain to an irritated clinician on why so and so can't ever make a diagnosis - even on an excisional biopsies.

And to add to the pile of goodness are the pathologists who don't even bill enough to cover their salary and benefits to the practice but somehow think they're entitled to partner level compensation because we should only be so fortunate to have them in our group.
Im curious, before you hired them, weren't you able to vet their surgpath skills and efficiency? Did these people come from busy well known reputable surgpath programs? Any fellowships or were these people straight out of residency? Were they recommended from a friend at a nearby institution that you trusted and you got burned?

Did you talk to these hires during an evaluation process? What were their reasons for being so slow?

Just like candidates have the right to turn down a crap job offer, employers have the ability to decline a candidate they deem not competent for their group. Did you not properly vet a candidate? Did you not let them know or communicate to them what is required to be considered for partner level compensation prior to hiring so that you both (partner and non-partner) are on the same page?

That could prevent a lot of headaches.
 
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Im curious, before you hired them, weren't you able to vet their surgpath skills and efficiency? Did these people come from busy well known reputable surgpath programs? Any fellowships or were these people straight out of residency? Were they recommended from a friend at a nearby institution that you trusted and you got burned?

Did you talk to these hires during an evaluation process? What were their reasons for being so slow?

Just like candidates have the right to turn down a crap job offer, employers have the ability to decline a candidate they deem not competent for their group. Did you not properly vet a candidate? Did you not let them know or communicate to them what is required to be considered for partner level compensation prior to hiring so that you both (partner and non-partner) are on the same page?

That could prevent a lot of headaches.
We used to do a slide exam for all the prospective hires and I certainly went through one before I was brought on back in the day. Now no one in my area, which is already hard to recruit to, makes prospective applicants go through one. Interestingly enough, of the pathologists in my group we did slide exams with, they all did very well. We were told that slide exams aren't viewed favorably by the current crop of pathologists and as soon as they catch wind of one they pretty much either bolt or give you the thanks but no thanks spiel after the interview.

And yes, we do talk to and meet all the applicants in person. They all seem to come from reputable programs, some from very name brand programs of either general AP/CP or fellowship training. We also vet them with their programs or previous work place. Doesn't seem to make a difference.

As far as the partnership thing - everyone of the applicants basically asks "are you going to make me a partner?" during the interview. No joke. They literally want to know if there's a guaranteed path to partnership in the group even before they start working. Our experience is such that even if the answer is "possibly", they say thanks for the offer but I'll go elsewhere.

Depressingly, all my clinical colleagues I talk to are also having these problems. One of them told me that their program director, who they still keep in contact with, said that their class "was the last one to be worth anything" - and that was just 5 years ago.
 
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As far as the partnership thing - everyone of the applicants basically asks "are you going to make me a partner?" during the interview. No joke. They literally want to know if there's a guaranteed path to partnership in the group even before they start working. Our experience is such that even if the answer is "possibly", they say thanks for the offer but I'll go elsewhere.
Aren't there lots of stories of abuse and dismissal of non-partners in our field? I remember some of my colleagues working for years and then being told they weren't going to be partners, even though they signed out more than their share of cases. Some emeritus partners were collecting their partner's share for doing almost nothing (except getting their name on the contract). Don't most specialties in medicine offer partnership tracks in writing when hiring? Or make people partners after a year? Are pathology practices still asking applicants to pay for tail coverage and sign non-compete contracts? All in all, the market has allowed pathology private practices to leverage their position when hiring for the past 20 years, at least, right? I think new grads may be able to find non-pathology work that pays as much as academic path or non-partner private practice. Like in pharma or biotech. Without the prospect of partnership, other career paths may be more attractive. Until the field is oversupplied again in a year or two, private practices may need to reduce partner vacation time from 14 weeks to 8 weeks, and require the emeritus partners to sign out.
 
2 - people who lack work management and workflow skills. These people can do the work, but they are slow, or disorganized, or lack attention to detail, etc. So the result of their work is shoddy. I think these people may benefit from coaching from an HR professional, or have some more secretarial assistance to help them improve their workflow
or they have TOO much attention to detail and get lost in esoteric academic details that have no bearing on the practical implications, which doesn't result in shoddy work, just less work in general.
 
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Depressingly, all my clinical colleagues I talk to are also having these problems. One of them told me that their program director, who they still keep in contact with, said that their class "was the last one to be worth anything" - and that was just 5 years ago.
I think the desire for partnership and newer generations having different expectations is as old as the hills. My grandfather dealt with it before selling his IM practice, my uncle dealt with it in cardiology in the 90s and early 2000s...'seniority' is an idea of the past, but it unfortunately goes hand-in-hand with senior partners 'abusing' their seniority.
 
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As far as the partnership thing - everyone of the applicants basically asks "are you going to make me a partner?" during the interview. No joke. They literally want to know if there's a guaranteed path to partnership in the group even before they start working. Our experience is such that even if the answer is "possibly", they say thanks for the offer but I'll go elsewhere.
Well I don’t blame applicants for asking this.

I probably would not ask it that way however.

I would probably ask “is there a path to partnership?” and if so, then “what criteria do you look for before someone makes partner.”

I would also ask “have previous pathologists in your group NOT become partner and why not?”

If I were to interview for a group and I was told I was just going to get 250-350 a year and I knew partners were probably making a lot more skimming off money from my work, I would not be working for your group and would be looking elsewhere.

That’s just me.

There’s a lot of predatory groups out there and I don’t want to be making any greedy pathologists extra income if I can help it.

I agree with Granular. When the job market is good, pathologists have more options and they can decline a job if there’s no partnership track. If the market sucks, you may have to take a non partnership track job because you have no other options.
 
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And to add to the pile of goodness are the pathologists who don't even bill enough to cover their salary and benefits to the practice but somehow think they're entitled to partner level compensation because we should only be so fortunate to have them in our group.
This is the crap pathologist who creates at least 2-3 crap pathology jobs within that same group. The other pathologists in the group have to subsidize them.
 
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Well I don’t blame applicants for asking this.

I probably would not ask it that way however.

I would probably ask “is there a path to partnership?” and if so, then “what criteria do you look for before someone makes partner.”

I would also ask “have previous pathologists in your group NOT become partner and why not?”

If I were to interview for a group and I was told I was just going to get 250-350 a year and I knew partners were probably making a lot more skimming off money from my work, I would not be working for your group and would be looking elsewhere.

That’s just me.

There’s a lot of predatory groups out there and I don’t want to be making any greedy pathologists extra income if I can help it.

I agree with Granular. When the job market is good, pathologists have more options and they can decline a job if there’s no partnership track. If the market sucks, you may have to take a non partnership track job because you have no other options.
I also don't blame them for asking either. Its just how they ask it that tells us everything about how they see themselves and how they are envisioning their role in the practice even before they've started their first job.

As for making $350,000 - which by the way is a pretty good salary out of the gate today: In 2024 you would have to sign out about 7,340 RVUs which is the equivalent of 9,970 biopsy specimens (88305-26s, reimbursed at $35.75) to cover your base expense to the practice. Of course adding benefits and the retirement package will add significantly to that, so that's just the absolute minimum you would have to work to justify your salary. Assuming 44 weeks of work a year (220 days), that's 45 cases or total specimens per day that you would have to see that aren't of the 88300-88304 series, which we all know exist as part of our routine surgical pathology mix. Obviously, that number of cases won't be exact because of either bigger resections (88307-88309s) or special stains, IHC, ISH, etc. that will change the mix of CPT codes billed. But it doesn't detract from the amount of overall work (RVUs) needed to justify your existence.

And in regards to making money for people. If it's anyone's concern that you're going to be making money for the practice owners (being "skimmed"), may I suggest moving to a communist country. There is no scenario in a market based economy under any circumstance in any job, including those outside of medicine, where an employee won't be generating a profit for the corporation. We've had applicants turn us down for employee positions with large hospital owned groups for more money. What they don't understand is that the hospital isn't hiring them for some altruistic reason. That organization is going to make bank off them and probably take anywhere from 50-66% of their billing for themselves. Yes, the pathologists make comparatively more there, but they are also billing more because the hospital contracts are far more favorable in reimbursement. This also holds true in the clinical specialties by the way.
 
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I also don't blame them for asking either. Its just how they ask it that tells us everything about how they see themselves and how they are envisioning their role in the practice even before they've started their first job.

As for making $350,000 - which by the way is a pretty good salary out of the gate today: In 2024 you would have to sign out about 7,340 RVUs which is the equivalent of 9,970 biopsy specimens (88305-26s, reimbursed at $35.75) to cover your base expense to the practice. Of course adding benefits and the retirement package will add significantly to that, so that's just the absolute minimum you would have to work to justify your salary. Assuming 44 weeks of work a year (220 days), that's 45 cases or total specimens per day that you would have to see that aren't of the 88300-88304 series, which we all know exist as part of our routine surgical pathology mix. Obviously, that number of cases won't be exact because of either bigger resections (88307-88309s) or special stains, IHC, ISH, etc. that will change the mix of CPT codes billed. But it doesn't detract from the amount of overall work (RVUs) needed to justify your existence.

And in regards to making money for people. If it's anyone's concern that you're going to be making money for the practice owners (being "skimmed"), may I suggest moving to a communist country. There is no scenario in a market based economy under any circumstance in any job, including those outside of medicine, where an employee won't be generating a profit for the corporation. We've had applicants turn us down for employee positions with large hospital owned groups for more money. What they don't understand is that the hospital isn't hiring them for some altruistic reason. That organization is going to make bank off them and probably take anywhere from 50-66% of their billing for themselves. Yes, the pathologists make comparatively more there, but they are also billing more because the hospital contracts are far more favorable in reimbursement. This also holds true in the clinical specialties by the way.
If I am offered a job at two separate practices, with an equal amount of work, and assuming other factors are equal, I’m taking the higher paying job.

Yes you will always be making money for someone in our capitalistic society. I’m fine with that.

I was offered an academic job for mid 200s by a privately owned group. The academic center does not own the group. So therefore you are essentially making money for the senior pathologists in the group who manage the group. (I’m assuming they are making bank off of each of the younger pathologists work). High surgical volume.

On the other hand, I was offered 450 at a private job in an undesirable location. Hospital based practice.

Both seemed to be busy practices. I took the latter job of course just because of the higher pay (double the money) and I didn’t want to take a job where I knew I would be making the older senior pathologists in the first group (academic) money, some of who do little work compared to the rest of the group.

Yes I’m going to be making the hospital money in the second job like all of us are but at least I’m getting paid well for my services/time.

I guess what I’m trying to say is that we all are making money for someone. Just make sure you don’t take it up the a$$ making other people rich slaving away. At least make sure you get paid well while slaving away.
 
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If I were to interview for a group and I was told I was just going to get 250-350 a year and I knew partners were probably making a lot more skimming off money from my work, I would not be working for your group and would be looking elsewhere.
Agree with the questions you'd ask, though would add there's nothing wrong with private groups offering a lower salary to new employees, especially if they're right out of the gate. The scenario is almost always different for people transferring in with years of experience under their belt.

There is absolutely nothing inherent to a medical degree that obligates practicing members of a group to pay new hires the same as themselves, and this practice is generally accepted across the board in other medical specialties as well as other professions. Hell, even in academics, one may be an associate professor for years and years and years until one proves (via the usual route of research dollars and brown nosing) that one is "Professor" material . Said new employee hasn't been vetted...they haven't proven to the group that they're worth the hire...and I would certainly want it spelled out ( like after you reach a certain level of proficiency or after a certain amount of time has passed) that partnership is attainable, and I wouldn't take a job with very loose open-ended possibilities, but a "buy in" period is completely reasonable. Hell, there should even be annual requirements for partners that if not met one relinquishes partnership status.

There are SOOOOO many pathologists that don't deserve to be partners because they aren't interested in putting in the time and effort requisite of conventional assumptions of a "partner". If someone joins a practice and after 2-3 yrs has not shown the ability to function at a partner level, both in terms of volume and personal skills, there's no obligation to make that person a partner. Yes there are predatory groups, but there are considerably more pathologists with expectations of high income who lack a corresponding skill set.
 
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Agree with the questions you'd ask, though would add there's nothing wrong with private groups offering a lower salary to new employees, especially if they're right out of the gate. The scenario is almost always different for people transferring in with years of experience under their belt.

There is absolutely nothing inherent to a medical degree that obligates practicing members of a group to pay new hires the same as themselves, and this practice is generally accepted across the board in other medical specialties as well as other professions. Hell, even in academics, one may be an associate professor for years and years and years until one proves (via the usual route of research dollars and brown nosing) that one is "Professor" material . Said new employee hasn't been vetted...they haven't proven to the group that they're worth the hire...and I would certainly want it spelled out ( like after you reach a certain level of proficiency or after a certain amount of time has passed) that partnership is attainable, and I wouldn't take a job with very loose open-ended possibilities, but a "buy in" period is completely reasonable. Hell, there should even be annual requirements for partners that if not met one relinquishes partnership status.

There are SOOOOO many pathologists that don't deserve to be partners because they aren't interested in putting in the time and effort requisite of conventional assumptions of a "partner". If someone joins a practice and after 2-3 yrs has not shown the ability to function at a partner level, both in terms of volume and personal skills, there's no obligation to make that person a partner. Yes there are predatory groups, but there are considerably more pathologists with expectations of high income who lack a corresponding skill set.
The last paragraph pretty much sums up what I've seen and heard, and confirms that many many crap jobs are in/have been in private pathology groups in recent years.

It's hard to fathom that there are soooo many pathologists out there who don't deserve to be partners, but this attitude seems to be pervasive. I do think we have an overtraining issue and there are a good amount of crap pathologists. However, almost every (pretty much every) crap job that I've heard of has been out of a small to medium sized private group with a partnership track. Hospital-based and academic (especially non-coastal) may be the way to go for a first job, especially if you don't want to be (totally) taken advantage of. Larger entities are willing to pay 400+ and you don't have to worry about the business end of things or making partner.
 
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Hospital-based and academic (especially non-coastal) may be the way to go for a first job, especially if you don't want to be (totally) taken advantage of. Larger entities are willing to pay 400+ and you don't have to worry about the business end of things or making partner.
Academics: A lot of work and low pay and dealing with residents. I hope you like research although some pathology “academic” centers don’t do much research anyways.

Probably good for experience but then again you are only signing out two subspecialties (and lose your skills in other areas) and you get to be on frozens and take 3 am organ transplant frozens. Yipeeee!!!!

Yes, academics is good for a first job solely for the experience and you get to work/learn under more senior/expert pathologists to get good experience.

I would bolt for private practice in 2-3 years however if you are truly not into academics and you would bring with you a strong academic background in two subspecialties which is a bonus for private groups.
 
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The (great) advice I received from one of the preceptor is to keep as many skills as you can after finishing residency, that way you are not stuck in 2 areas (or worse, become an expert for superior left parathyroid and nothing else). I think in retrospect it's a fantastic advice, and I followed his advice by entering practice straight after residency. But I realize this may not be possible in USA where everyone does 2 fellowships.
 
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Agree with the questions you'd ask, though would add there's nothing wrong with private groups offering a lower salary to new employees, especially if they're right out of the gate. The scenario is almost always different for people transferring in with years of experience under their belt.
Agree. Nothing wrong with starting someone with a lower salary especially with no experience. The same holds true with every other field in society.

What is considered a lower salary though depends on what the market considers “low”. 25th-50th percentile pay MGMA is what I’ve been told practices will start you out at with no experience. Academics are paying 10th-25th percentile MGMA near me (more towards the 10th percentile end).

If there is no road to a higher salary with time and experience assuming I’m pulling the same amount of weight as others and have developed the skillset, then that’s a red flag for me. I’ll be looking at other groups then.
There is absolutely nothing inherent to a medical degree that obligates practicing members of a group to pay new hires the same as themselves, and this practice is generally accepted across the board in other medical specialties as well as other professions. Hell, even in academics, one may be an associate professor for years and years and years until one proves (via the usual route of research dollars and brown nosing) that one is "Professor" material . Said new employee hasn't been vetted...they haven't proven to the group that they're worth the hire...and I would certainly want it spelled out ( like after you reach a certain level of proficiency or after a certain amount of time has passed) that partnership is attainable, and I wouldn't take a job with very loose open-ended possibilities, but a "buy in" period is completely reasonable. Hell, there should even be annual requirements for partners that if not met one relinquishes partnership status.
Agree. If there’s nothing spelled out in regards to a possible partnership with criteria that needs to be met to attain partnership then I’ll be looking at other options. But like I said some people have NO other options due to limited jobs. Everyone wants fairness but that’s not always the case in some groups.
There are SOOOOO many pathologists that don't deserve to be partners because they aren't interested in putting in the time and effort requisite of conventional assumptions of a "partner". If someone joins a practice and after 2-3 yrs has not shown the ability to function at a partner level, both in terms of volume and personal skills, there's no obligation to make that person a partner. Yes there are predatory groups, but there are considerably more pathologists with expectations of high income who lack a corresponding skill set.
Agree. As long as those criteria are made known to the junior pathologist then I think that’s fair. If you don’t meet criteria x, y and z then we will NOT consider you a partner.

Agree, some trainees I’ve met are just lazy. I think some people that want higher pay don’t realize they have to generate enough revenue to meet that higher pay which equates to being busy.

Some people I think want it easy and get paid a lot, but it doesn’t work that way.
 
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What if you worked your ass off for a private group on a low salary (200-250K) in hopes of making partner and you find out it was a revolving door job by 3-5 years? What do people do in these situations? Do they go to another group and start from zero or they end up taking some high paying hospital job?

We talk a lot about incompetent and inefficient new pathologists but I would like to add that there are many high performing young pathologists from good training programs who like to work hard and are flexible to sign out 3-4 subspecialties outside of their fellowship subspecialty. But they want to be compensated well. Sometimes they get caught in predatory roles. Yes, they will bounce back again because they are good at their jobs but it takes away a few of one's most productive years which sucks and makes one paranoid about all future jobs!
 
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there are many high performing young pathologists from good training programs who like to work hard and are flexible to sign out 3-4 subspecialties outside of their fellowship subspecialty. But they want to be compensated well. Sometimes they get caught in predatory roles.
Sure, but the private groups hiring them don't know them from Adam, and 'willingness' to sign out stuff doesn't always translate into 'ability'. Hence a period of 1.5 - 3 yrs (usually 2 ish) that serve as a 'buy in' / probation period to not only assess technical ability but group dynamics. But that's generally negotiable for people with 3-5+ yrs experience and that 'time to partner' for any good group worth joining is negotiated down. If it's a better paying job, maybe a 6 - 18 mos period is still worth a lower salary, particularly if you come in and can sign out partner volume cases, or bring something to the group they didn't have, like derm path.

Everyone wants to be well compensated. Not everyone can, not everyone will. There are wildly varying incomes in medicine, pathology included. It is certainly grating to earn $250k as an employee when you know the partners are making 3x that. And if you find yourself in a situation where there is little or no likelihood of circumstances changing, it's time to bolt. Ideally you've vetted a potential employer before you get to that point.
 
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And if you find yourself in a situation where there is little or no likelihood of circumstances changing, it's time to bolt. Ideally you've vetted a potential employer before you get to that point.
Every young pathologist should make sure they are treated fairly and with respect.

I’ve been lied to and one senior pathologist raised his voice at me during a dinner following an interview.

Make sure you work for good and honest people. If not, look elsewhere if you can.
 
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What if you worked your ass off for a private group on a low salary (200-250K) in hopes of making partner and you find out it was a revolving door job by 3-5 years? What do people do in these situations? Do they go to another group and start from zero or they end up taking some high paying hospital job?

We talk a lot about incompetent and inefficient new pathologists but I would like to add that there are many high performing young pathologists from good training programs who like to work hard and are flexible to sign out 3-4 subspecialties outside of their fellowship subspecialty. But they want to be compensated well. Sometimes they get caught in predatory roles. Yes, they will bounce back again because they are good at their jobs but it takes away a few of one's most productive years which sucks and makes one paranoid about all future jobs!
I think (despite the talks about there being an oversupply of pathologists) that there are very good opportunities to find a good, solid job. You may have to go through a recruiter to find what you're looking for because the jobs posted online may not tell you the whole story. The recruiter will want to do their best to get you the highest compensation because they are, in turn, compensated based on a percentage of your base salary (the employer would pay for this, not the hired pathologist). With that said, if you want to earn the big bucks, then you better be prepared to pump out the RVUs. There's a base pay that most employers are willing to give based on a certain volume. You can easily negotiate additional work for bonus pay. Is this system fair? I guess it depends on a lot of secret factors like knowing the group's payor mix and contractual compensation with insurance carriers. You won't easily find that information. There's always overhead in every business, so it's up to you to decide what you feel comfortable with giving up. There are no free lunches (including for the pathology group owners).

I do not understand the revolving door strategy some groups use. It's much harder to find and replace a pathologist, especially a good one. Once you're in the system and performing your job adequately, I would think that a group would do their best to keep that person happy. I guess it depends on how quickly that hole can get filled. You have to know when to use your leverage.
 
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Has anybody else noticed that the jobs graph on path outlines is slowly trending down? Doesn’t look like there is a ‘shortage’ really :D
If this trend continues we will get to pre-pandemic levels in 5-10 years roughly. Not making predictions here, just an observation.
 
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Well, yesterday, the CAP requested EMERGENCY funding from CMS for more residency slots! As I have said over years, if you are not signing out baseline 8-10k surgical/yr you are not breaking your ass. If all you do is medical kidneys with all that entails, AND you have medical director responsibilities, i’d lower that number to 5k.Today, folks waltz out of residency/fellowship and ONLY want to sign out sarcomas or primary CNS neoplasms and can’t/won’t pick up the slack with even bbx’s, px bx’s, fna’s, “basic” marrows, etc. ;all the things that are bread-and-butter pathology.
If the above is “offensive “ or unrealistic, then do not complain if you do not make in excess of $450k/yr.
I will be the first to admit that “superior “ effort such as limned above 30 years ago garnered far more justifiable generous remuneration.
 
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Has anybody else noticed that the jobs graph on path outlines is slowly trending down? Doesn’t look like there is a ‘shortage’ really :D
If this trend continues we will get to pre-pandemic levels in 5-10 years roughly. Not making predictions here, just an observation.
Equilibrium has been reached as the retirement cliff from covid19 has ended. Less people doing more work for less pay than ever before and no end in sight for mergers, consolidation, disruptive technology and managed decline.

Why does this seem so familiar?

All of you CAP shills are part of the problem!
 

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Equilibrium has been reached as the retirement cliff from covid19 has ended. Less people doing more work for less pay than ever before and no end in sight for mergers, consolidation, disruptive technology and managed decline.

Why does this seem so familiar?

All of you CAP shills are part of the problem!
Pathology outlines going to pulll that graph from their website once job market goes back to pre pandemic levels LOL
 
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