Daily workload slide number

[pathslides]

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For those in practice, roughly how many slides does your daily surg path workload average? Not counting IHC, CYTO cases, or number of cases, just total H&E slides your lab routinely cuts for cases/parts . Our practice divides the daily surg path workload by number of slides (i.e, if you get two massive cases with multiple parts/trays, those will be your only "cases" for the day.). Just curious how other practices work and what their workload is like.

 

[coroner]

Our practice covers multiple hospitals. There's only one person doing all reading of surgicals at each place for that day; therefore, we don't divide them. It can be as low as averaging 20 slides/day at our smallest hospital up to 160.

 

[jupiterianvibe]

100.

 

[icpshootyz]

I'd guess around 100-120.

 

[pathslides]

Seems pretty similar. Same for me, around 120. Anyone who works at the big labs for GI or derm care to comment? Curious to what slide volume is like, also heard you can get daily bonus pay if you look at more slides.

 

[Cellpathology]

There really is no way to meaningfully answer the question without also mentioning how many people are expected to deal with the number of slides.

 

[pathslides]

There really is no way to meaningfully answer the question without also mentioning how many people are expected to deal with the number of slides.

I don't agree. Most people are answering what their individual daily surg path slide load is. That takes the 'number of people' variable out.

 

[Cellpathology]

well then you do agree.........they are giving you the number of people (1), and that is the variable......the variable isn't removed, it is provided

 

[icpshootyz]

well then you do agree.........they are giving you the number of people (1), and that is the variable......the variable isn't removed, it is provided

What? I'm fairly certain everyone here was responding what their individual daily slide workload is. I know I was. Why would you think otherwise?

 

[pathslides]

well then you do agree.........they are giving you the number of people (1), and that is the variable......the variable isn't removed, it is provided

No, I don't agree with your statement saying there is no meaningful way to answer the original question. Most people gave their individual slide load, and that is meaningful to me. And like icpshootyz said, not sure why you would think otherwise.

 

[Cellpathology]

LOL I said you cant give a meaningful answer without saying how many people are there to deal with X number of slides cut by the lab.........since they gave their personal slide load it made the information meaningful.....

 

[pathstudent]

When signing out the surgicals from the ORs, I typically have 200-250 blocks. My personal record is 450. My record for biopsies is 120 blocks.

 

[Euchromatin]

110-120 slides is an average daily surg path case load for me (range: 40 to 214 slides, depending on both volume and # of pathologists covering general surgicals that day). This does not include any cyto, bone marrows, GI biopsies or much derm (we have enough volume to separately assign those cases to a specific pathologist with fellowship training/extensive experience in each of those areas each day)

 

[NuclearDust]

110-120 slides is an average daily surg path case load for me (range: 40 to 214 slides, depending on both volume and # of pathologists covering general surgicals that day). This does not include any cyto, bone marrows, GI biopsies or much derm (we have enough volume to separately assign those cases to a specific pathologist with fellowship training/extensive experience in each of those areas each day)

Just out of curiosity, how much time do you spend per day on average dealing with CP/lab management stuff on top of this slide volume (I understand that this is likely variable)?

 

[Euchromatin]

Just out of curiosity, how much time do you spend per day on average dealing with CP/lab management stuff on top of this slide volume (I understand that this is likely variable)?

With rare exceptions of AP-related things like reviewing immunos for validation studies or modifying/writing new entries for the grossing manual for the PAs, essentially none. I haven't been assigned any medical directorships by my group yet, so I only deal with CP stuff while I'm on call. I do also cover frozens periodically without any adjustment to my regular case load (our group schedules frozen coverage for a half day at a time so it doesn't typically get overly burdensome on any one particular day).

The pathologists in our group with medical director duties get specific days (or sometimes half days) off service when they are scheduled to travel to their lab(s) for meetings, etc. and I believe they try to do as much CP/admin/management work as is feasible on those days. There are also 2 pathologists covering CP daily (bone marrows, peripheral bloods, flow, SPEPs, etc.) and I think general day-to-day CP/lab management-related questions get routed to one of them.

 

[NuclearDust]

With rare exceptions of AP-related things like reviewing immunos for validation studies or modifying/writing new entries for the grossing manual for the PAs, essentially none. I haven't been assigned any medical directorships by my group yet, so I only deal with CP stuff while I'm on call. I do also cover frozens periodically without any adjustment to my regular case load (our group schedules frozen coverage for a half day at a time so it doesn't typically get overly burdensome on any one particular day).

The pathologists in our group with medical director duties get specific days (or sometimes half days) off service when they are scheduled to travel to their lab(s) for meetings, etc. and I believe they try to do as much CP/admin/management work as is feasible on those days. There are also 2 pathologists covering CP daily (bone marrows, peripheral bloods, flow, SPEPs, etc.) and I think general day-to-day CP/lab management-related questions get routed to one of them.

That is very helpful. Thanks!

 

[pathstudent]

I have exactly 300 blocks today. Better get cranking.

 

[pathslides]

I have exactly 300 blocks today. Better get cranking.

Dang dude, that is 300 slides without even taking into account any upfront levels. How the heck do you get through that many in one day?

 

[Ishie]

Hmm. We usually do 20-40 *cases* a day per person, but those cases can have anywhere from one H&E to 40, and of course the hole-punch GI biopsies.

Time is dependent though. I can cruise through a large goiter that's multiple blocks and parts and then spend four times as long on skin punches before caving and sending them out.

 

[pathstudent]

Dang dude, that is 300 slides without even taking into account any upfront levels. How the heck do you get through that many in one day?

You get an early start, stay focused and kick ass. I started at 630am and was done with the bulk by 300pm.

 

[Tiki]

I just signed out a prophlyactic gastrectomy for CDH1 mutation that had more slides (221) than some people do all day. Plus add in a whipple or two, and esophagogastrectomy and about 10 full trays of biopsies. Granted, that is a very busy day (more than 500 slides) but on average, I'd say I sign out at least 200 slides per signout day (subspecialist GI at an academic center). We get a lot of 12 part cases for IBD, Barrett's, plus tons of whipples, stomachs, GEJs, colons on a regular basis.

Edited to add, all the biopsies are 3 slides each, so if others only get one slide, that would cut the biopsy slide number down by 2/3. Obviously not the bigs, though.

 

[Dave CX]

I do nothing but GI in their offices. Typically 120-150 accessions per day, x2 for slides.

 

[pathstudent]

I just signed out a prophlyactic gastrectomy for CDH1 mutation that had more slides (221) than some people do all day. Plus add in a whipple or two, and esophagogastrectomy and about 10 full trays of biopsies. Granted, that is a very busy day (more than 500 slides) but on average, I'd say I sign out at least 200 slides per signout day (subspecialist GI at an academic center). We get a lot of 12 part cases for IBD, Barrett's, plus tons of whipples, stomachs, GEJs, colons on a regular basis.

Edited to add, all the biopsies are 3 slides each, so if others only get one slide, that would cut the biopsy slide number down by 2/3. Obviously not the bigs, though.

Wow. If you are doing about 200 blocks a day and most are biopsies you are generating around 20,000 per day in global revenue for the hospital. If I was that productive in my practice with my overhead I would be earning well over a million a year and I take 3 months off.

 

[Tiki]

Wow. If you are doing about 200 blocks a day and most are biopsies you are generating around 20,000 per day in global revenue for the hospital. If I was that productive in my practice with my overhead I would be earning well over a million a year and I take 3 months off.

Nah, it's not 200 cases. Not sure how many tissue blocks but an average day is probably about 300-500 slides. About half are resections (whipples, ton of colons, GEJs, stomachs, livers). The rest are biopsies, which are 3 slides per block.

10 big cases can easily be 100 blocks.

 

[AZpath]

Wow. If you are doing about 200 blocks a day and most are biopsies you are generating around 20,000 per day in global revenue for the hospital. If I was that productive in my practice with my overhead I would be earning well over a million a year and I take 3 months off.

Pathstudent , sounds like I would be making 800-900K on your volume. Better do a review on contracts and collections🙂

 

[AZpath]

Hmm. We usually do 20-40 *cases* a day per person, but those cases can have anywhere from one H&E to 40, and of course the hole-punch GI biopsies.

Time is dependent though. I can cruise through a large goiter that's multiple blocks and parts and then spend four times as long on skin punches before caving and sending them out.

Your experience is more typical. My last group we had very good case mix and did about 65-75 cases on the surgical day. We grossed it ourselves then did slides the next day. It was followed by a cytology day and then a clinical-clean up day. I always signed out 95% of surgical on day 1. Some of the big cases ones with a lot of IHC were signed the next morning. We actually had a lot cytology and plenty of clinical work. We were very involved with the lab and were compensated well.

Nevertheless, this indicates our surgical volume was averaging 20 cases.
I thought we were overstaffed. I still had extra time on the cytology day and clinical day. We were not killing ourselves and had eight weeks off. The members of group preferred time off verses salary.
Also we should have recruited a PA. Grossing all your own cases costs too much time. This is what happens when a group is too old school.

 

[pathstudent]

Nah, it's not 200 cases. Not sure how many tissue blocks but an average day is probably about 300-500 slides. About half are resections (whipples, ton of colons, GEJs, stomachs, livers). The rest are biopsies, which are 3 slides per block.

10 big cases can easily be 100 blocks.

Pathstudent , sounds like I would be making 800-900K on your volume. Better do a review on contracts and collections🙂

Will do.

 

[yaah]

I average about 120 slides or "slide equivalents." We get credit for covering heme and flow. Credit in the form of slide totals. Cytology and bone marrows are also a fixed credit which doesn't vary based on number of slides. Everything else is one credit per slide. Offsite duties don't count but take up time every day.

Today I had I think 45 non-slide equivalent slide credits and 90 slides which were a mix of big cases and small cases. My highest here has been 300 I think. In residency I counted my busiest day as 1100 slides reviewed which included morning signout, afternoon preview, outside consultation cases.

 

[Ishie]

Your experience is more typical. My last group we had very good case mix and did about 65-75 cases on the surgical day. We grossed it ourselves then did slides the next day. It was followed by a cytology day and then a clinical-clean up day. I always signed out 95% of surgical on day 1. Some of the big cases ones with a lot of IHC were signed the next morning. We actually had a lot cytology and plenty of clinical work. We were very involved with the lab and were compensated well.

Nevertheless, this indicates our surgical volume was averaging 20 cases.
I thought we were overstaffed. I still had extra time on the cytology day and clinical day. We were not killing ourselves and had eight weeks off. The members of group preferred time off verses salary.
Also we should have recruited a PA. Grossing all your own cases costs too much time. This is what happens when a group is too old school.

I'm happy and feel good about my whole work/life balance thing. We do have two really awesome PAs so I gross when both of them happen to be out (rare), am doing a frozen (I prefer to do my own rather than pull a PA from grossing) or show what I want for difficult or extensive cases.

Eight weeks of PTO would be awesome though. I love my job, but I also love traveling and finally get a chance to do it and *not* have it be for fellowship and job interviews is super.

Really have no complaints though. Some days have run me late, but more often than not, I get off at a reasonable hour. My colleagues are awesome. They never seem to resent the baby member asking for second opinions. Even most of the surgeons are pleasant. Hard to believe that well less than a year ago, I was thinking of switching to family med because I'd never find a job.

 

[coroner]

After reassessing this some more, I realized that total slides can be somewhat nonspecific. I think a better indicator is blocks per pathologist. I was counting levels before which makes a big difference. Case mix should be a factor as well: 20 slides of colon polyps vs 20 slides of a prostate bx will have a significant difference in time.

Factoring that, I think if you're in a hospital based practice with a mix of small and big cases ≥100 blocks/day is a robust amount for a pathologist. Again, in one day this could amount to 25 cases or 50. Any more [blocks] than that, hopefully the majority are bxs. or you have a PA.

 

[Dave CX]

256 GI 88305's for me today. Whipped my butt. 5.5 hrs non stop slide pushing.

 

[WEBB PINKERTON]

5.5 hours non-stop is NOT HEALTHY. Take it from someone who has nearly died from emboli-take breaks, get a stand up desk, start taking warfarin daily. Seen many pathologist die or toss clots over the years. It aint worth it.

 

[LADoc00]

People are soloing 300+ block counts in a day? That is gnarly. If even a good chunk of that is not GI or easy Derm, I hope you are pulling out of the hospital lot in a Porsche GT3 to arrive home to a naked Argentinian swimsuit model wife at your lake house abode on 10 acres....

261 workdays x 300 block days x $40.31 Medicare per 88305 in 2018 fee schedule x estimated 250 CPT codes per 300 "blocks" - 8% billing fee -2% additional overhead = $2,367,204.75 per year.

That is near the identical salary of #3 David West on the Golden State Warriors...you would literally be a "baller shotcaller":

 

[coroner]

5.5 hours non-stop is NOT HEALTHY.

I would bet most pathologists are sedentary for at least 6 hrs/day if not longer. Taking breaks, standing up, walking around etc, would be beneficial during the work day. I would say more importantly, have an active lifestyle outside of pathology (in Dave's case swingin') that incorporates some type of mild - moderate activity a couple of times a week.

261 workdays x 300 block days x $40.31 Medicare per 88305 in 2018 fee schedule x estimated 250 CPT codes per 300 "blocks" - 8% billing fee -2% additional overhead = $2,367,204.75 per year.

Yes, that would be correct with ZERO VACATION and working every day of the year while getting 250 billable cases every single day for the entire year which no one is doing alone. But if you had a partner to split that, certainly doable, still hustling, but doable...

I think some people here are giving their extremes, rather than an average day. But for sure, it would seem like everyone on here should be making at least 7 figures which I doubt. The reason is likely because most of us aren't billing 250 specimens/day. Even Dave's example of 256 specimens is double his mean which he stated earlier was normally around 120 - 150/day.

Given the fact that most people on here (and most pathologists in general) are hospital based, we are looking at a mix of smalls and bigs = fewer blocks per day = fewer billable CPT codes = fewer "baller shotcallers" No hate though, if someone's doing it on the reg, more power to you.

 

[Dave CX]

"261 workdays x 300 block days x $40.31 Medicare per 88305 in 2018 fee schedule x estimated 250 CPT codes per 300 "blocks" - 8% billing fee -2% additional overhead = $2,367,204.75 per year"

There is not a pathologist on the planet seeing that many 88305's who is keeping all the money. The only way to get that volume is to work for the source, and they take more than half.

But you are right about one thing LA, I do have a sexy woman and a house on the water!!!!

And Coroner is right, my average is 150 per day, maybe a bit more. So my annual earnings are a bit less than 1/3 of LA's estimate. Also, I do work every day and I haven't taken a vacation in 2 yrs (although I either fish or hunt most every weekend and I never have call or a beeper).

Webb, I do worry about blood clots. I take a bunch of fish oil and a baby aspirin every day. Hopefully I have it covered.

 

[octopusprime]

Depends on the day and the service...based on numbers the avg is 50 blocks/partner/day if fully staffed, 70-80 if several gone on vaca...but that's average...some days all i might see is 3 or 4 cases if I'm on call or at meetings, some days well over 200...and 'block counting' doesn't count 40 slide staging EBUS cases w/BAL, endo biopsies, etc.