Dare I ask about $?

[emergentmd]

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No kidding. I started to moonlight in the middle of my 2nd year and made more than my residency. Good thing about ED is you usually do 18-20 shifts a month. Then you have about 4-6 days you can moonlight.

I was making $1000 a shift 12 years ago. Now you can easily find moonlighting gigs at $100/hr.

If I could run an ED by myself after 1.5 yrs of residency, there is no reason pathologists can't run a lab after 4 years. You may not be very experienced but you gotta work to gain it.

 

[MOHS_01]

What is up with this forum. So much negativity. Anyway, I have my $300k job for next year and this will rise to $500k the year after that. Don't you worry about me buddy.

Lmao - you're kidding yourself if you think I give two pints of monkey piss about you. 😉

I just don't want to see your overtrained cannibalistic specialty erode my earning potential any further.

 

[MOHS_01]

You actually used the word "preeminent" to described your training...you did it, you went full ******. Never go full ******. Never.

Now Im curious...there is a very short list of completely self absorbed narcissistic-type DP professors who would actually refer to themselves as "preeminent" ..given the crew at MGH would never do that as they are quite humble from my experience...you must have trained with a certain gentlemen with French surname in San Francisco...

dunno, maybe that Cockrell guy in TX walks around referring to himself as preeminent, Ive never met him.

I also want to point out that Dermpath is the most narrow and easy of a field as you can possibly get in all Path...so dont pat yourself on the back too hard.

I have heard rumors of the RUC committee planning to utterly nuke Derm and GI biopsies into the dirt at some point in the next 5 years (perhaps less on the PC side but more on the TC where many DP groups make a tidy bundle of cash, 88305 TC for 14.99 anyone?). Hence why I would never recommend new trainees to sole focus on niche markets atm.

Good luck preeminent one.

Didn't they just do that? Like this year?

 

[icpshootyz]

If I could run an ED by myself after 1.5 yrs of residency, there is no reason pathologists can't run a lab after 4 years. You may not be very experienced but you gotta work to gain it.

No one is going to let them. No residency lets residents even sign out official biopsy reports (well, some allow "junior attending" months at the very end). I did autopsy moonlighting as a resident - still needed an attending to sign off on those reports even though I did the work. It's simply not allowed in pathology. Do you really want your biopsy and resection reports coming from a resident? Other fields often allow it because they can't find attending staff to fill those shifts. That's not even remotely a problem in pathology, as these boards can tell you. When your fields have an over abundance of attendings looking for work, come back and talk to us. There is no comparison, you're talking apples to oranges.

 

[gbwillner]

No one is going to let them. No residency lets residents even sign out official biopsy reports (well, some allow "junior attending" months at the very end). I did autopsy moonlighting as a resident - still needed an attending to sign off on those reports even though I did the work. It's simply not allowed in pathology. Do you really want your biopsy and resection reports coming from a resident? Other fields often allow it because they can't find attending staff to fill those shifts. That's not even remotely a problem in pathology, as these boards can tell you. When your fields have an over abundance of attendings looking for work, come back and talk to us. There is no comparison, you're talking apples to oranges.

That's hardly the reason residents don't sign out in pathology. Pathology is a specialty that reimburses for procedures (or in our case, per case), not our time. Not an exam. Once we write the report it is in stone and cannot be edited, only amended or corrected. If the attending does not write the report the hospital cannot bill for it, and basically ALL our revenue comes from that. At my institution I could sign out all the autopsies I wanted by myself. Why? Because we don't bill for it. that is 99% of the answer right there. I could also sign out frozens, but only if there is no attending available (like late at night when they are asleep). You cannot compare our system to medicine, EM (probably), peds, or psych. You CAN compare it to surgery, rads, maybe ENT. How many surgery residents do their own surgeries without an attending? From what I recall zero.

 

[2121115]

That's hardly the reason residents don't sign out in pathology. Pathology is a specialty that reimburses for procedures (or in our case, per case), not our time. Not an exam. Once we write the report it is in stone and cannot be edited, only amended or corrected. If the attending does not write the report the hospital cannot bill for it, and basically ALL our revenue comes from that. At my institution I could sign out all the autopsies I wanted by myself. Why? Because we don't bill for it. that is 99% of the answer right there. I could also sign out frozens, but only if there is no attending available (like late at night when they are asleep). You cannot compare our system to medicine, EM (probably), peds, or psych. You CAN compare it to surgery, rads, maybe ENT. How many surgery residents do their own surgeries without an attending? From what I recall zero.

You are right. It is 100% related to billing. Academic pathology departments operate on AP revenue generated minus what they pay the attendings who sign it out. Which is why they pay so little even though they have sweet 3rd party payor contracts, and then they load up the low level attendings with work for pennies on the dollar. That is how they are able to pay everything from department chairs' high salaries, to researchers who generate no revenue, to department secretaries. If they let the work go unbilled, the house of cards falls down.

 

[jp123ok]

Lmao - you're kidding yourself if you think I give two pints of monkey piss about you. 😉

Clearly sarcasm is lost on you.

 

[MOHS_01]

Clearly sarcasm is lost on you.

Well... maybe if you were a little better at sarcasm... 🙄

 

[jp123ok]

I just don't want to see your overtrained cannibalistic specialty erode my earning potential any further.

Well... maybe if you were a little better at sarcasm... 🙄

You clearly are a delightful individual. I wouldn't normal offer free business advice but for someone special like you I will make an exception. If you work in private practice then the business of pathology, is in effect a customer service industry. As such, behaving like an @ss h0le will lose you more business faster than just about anything else you will do.

The attendings (or people claiming to be attendings) on this forum have displayed a complete lack of understanding of what quality of service means, or should mean, in the area of pathology. Interestingly these same supposed attendings can be consistently found b!tching about how bad the business of pathology is becoming for them perhaps there is a connection!

 

[jp123ok]

You actually used the word "preeminent" to described your training...you did it, you went full ******. Never go full ******. Never.

LOL. My use of the word preeminent reflects my opinion of the people with whom I will be training. Even in the world of academic pathology you'd be hard pressed to find someone who'd use a word like "preeminent" when describing themselves.

I also want to point out that Dermpath is the most narrow and easy of a field as you can possibly get in all Path...so dont pat yourself on the back too hard.

I've never heard dermpath described as easy before. Yeah, maybe if you are looking at BCCs or nevi all day, but if you throw in some inflammatory derm and melanoma it is not all that easy.

I have heard rumors of the RUC committee planning to utterly nuke Derm and GI biopsies into the dirt at some point in the next 5 years (perhaps less on the PC side but more on the TC where many DP groups make a tidy bundle of cash, 88305 TC for 14.99 anyone?).

Didn't they just do that? Like this year?

TC was cut recently and PC was increased slightly so I think the politicians will keep their hands out of the pockets of dermpaths for the foreseeable future.

Hence why I would never recommend new trainees to sole focus on niche markets atm

I'm not worried about specializing so early in my career. It is not like I would have trouble getting a surg path fellowship somewhere if I need to refresh my skills in a few years time.

Good luck preeminent one.

Thanks LADoc. Good luck to you. I always enjoy reading your witty comments even though I frequently disagree with your political views

 

[cmz]

dunno, maybe that Cockrell guy in TX walks around referring to himself as preeminent, Ive never met him.

He's a boss... however, I am pretty sure he had to let a few folks know that they won't be coming to Dallas for fellowship since he sold his practice again.

 

[MOHS_01]

. Dbl. post gremlin

 

[MOHS_01]

You clearly are a delightful individual. I wouldn't normal offer free business advice but for someone special like you I will make an exception. If you work in private practice then the business of pathology, is in effect a customer service industry. As such, behaving like an @ss h0le will lose you more business faster than just about anything else you will do.

The attendings (or people claiming to be attendings) on this forum have displayed a complete lack of understanding of what quality of service means, or should mean, in the area of pathology. Interestingly these same supposed attendings can be consistently found b!tching about how bad the business of pathology is becoming for them perhaps there is a connection!

That's so sweet! And so insightful to boot. Thank you!!! And you're quite the little observer, too - catching right away that I'm a pretty big deal the way you did....


that's how you do sarcasm, kid



Seriously, though - it simply is not as simple as you lay it out to be here. Some of the nicest guys around, plenty capable and qualified, are sucking for air while some of the biggest douchebags drawing breath are raking in millions.

Just an observation, so take it for what it is worth. Being good at what you do - and being personable about it - simply is not enough to earn at your potential all too often these days.

 

[jp123ok]

Seriously, though - it simply is not as simple as you lay it out to be here. Some of the nicest guys around, plenty capable and qualified, are sucking for air while some of the biggest douchebags drawing breath are raking in millions.

Just an observation, so take it for what it is worth. Being good at what you do - and being personable about it - simply is not enough to earn at your potential all too often these days.

I agree, it is not enough to be a good diagnostician as a private practice pathologist and have a rapport with your contributors (although both of these are important). There are marketing strategies required too. Sadly pathologists as a group are not trained at all for the business side of our industry during residency or fellowship. Then, we complain about being exploited by people with more business acumen...

 

[MOHS_01]

I agree, it is not enough to be a good diagnostician as a private practice pathologist and have a rapport with your contributors (although both of these are important). There are marketing strategies required too. Sadly pathologists as a group are not trained at all for the business side of our industry during residency or fellowship. Then, we complain about being exploited by people with more business acumen...

I'm beginning to get the feeling that you do not have (yet) an appropriate understanding or appreciation for how compromised your position is. One of the most common errors in the world is the underestimation of those around you, be they enemies or colleagues. Arrogance is one bitch of an Achilles heel - and unrecognized arrogance even more so. The pathologists who have gone before you and now find themselves in this precarious position surely have been guilty of their share of missteps and mistakes (for this is true for everyone, everywhere), but to assume that is the product of ignorance or stupidity is just plain wrong. As a whole, they are not stupid. You know what they are, though? Stuck in a weak negotiating position that is totally beyond their control. Wholly reliant upon referral streams - referral streams that are increasingly consolidated and with strings attached. Markets that are contractually locked up, controlled by a few players with zero interest in "sharing the wealth" with young whippersnappers just because they are really good guys with training well beyond that of their own.

Put in simpler terms, for many graduating pathology residents, they have exactly jack **** to offer -- other than cheap labor... that allows those holding the reigns to skim off the top... and look at that second (or third) vacation home in Maui... or Aspen... or Boca... or Costa, depending upon where they are at in the cycle.

It's a structural problem for your specialty, not a cyclical one as that **** article implies (or a personal problem as some would suggest).

 

[LADoc00]

Didn't they just do that? Like this year?

Only partially. Will drop another 50% in the next 3-5 years.

At that price point all small podlabs will not be viable and likely abandoned. Whoever picks those up might possible clean house if they find some way to mass produce glass for 7-8 bucks a pop...

My thoughts are there will be a massive price shift from 88305 to 88307/9. Massive. Which is why see alot of OP players dumping their business ASAP. When big Path whales sell off outpatient labs all at once, this NOT a coincidence. Once that happens, DP, GU and GI will cycle under as incomes drop 40-50%. I think your average hospital based glass monkey will see a completely cost neutral situation (or minor decrease if they have alot of outpatient bx material) which is how they sold the recent 88305 TC slash to the Path seat on the RUC.

People might scoff but I remember not so long ago many hemepath said they would NEVER touch the flow PC...and oh they did! Flow cytometry was like roadkill after they got done with it.

My prediction about 3 years ago was a net 75% income reduction to those doing solely outpatient biopsy/88305 work. Which why I did it for the easy $, but never rested my future on it. It looks like that day will come, likely a few years earlier than my initial time table unfortunately.

 

[turtle1966]

I'm beginning to get the feeling that you do not have (yet) an appropriate understanding or appreciation for how compromised your position is. One of the most common errors in the world is the underestimation of those around you, be they enemies or colleagues. Arrogance is one bitch of an Achilles heel - and unrecognized arrogance even more so. The pathologists who have gone before you and now find themselves in this precarious position surely have been guilty of their share of missteps and mistakes (for this is true for everyone, everywhere), but to assume that is the product of ignorance or stupidity is just plain wrong. As a whole, they are not stupid. You know what they are, though? Stuck in a weak negotiating position that is totally beyond their control. Wholly reliant upon referral streams - referral streams that are increasingly consolidated and with strings attached. Markets that are contractually locked up, controlled by a few players with zero interest in "sharing the wealth" with young whippersnappers just because they are really good guys with training well beyond that of their own.

Put in simpler terms, for many graduating pathology residents, they have exactly jack **** to offer -- other than cheap labor... that allows those holding the reigns to skim off the top... and look at that second (or third) vacation home in Maui... or Aspen... or Boca... or Costa, depending upon where they are at in the cycle.

It's a structural problem for your specialty, not a cyclical one as that **** article implies (or a personal problem as some would suggest).

Simply remember that " Jp123ok" is just a young fellow giddy on finding 300k first and 500k second year job, so let him enjoy it!

Jp123ok, simply remember that there is something called, initial income, speed of income ascent, plateau income and duration of the plateau. I wish all four go well for you.

It is good to have eagle's eye view of things. Till last year, 10K of 88305 equated to 1 million and any decent DP could read annually at least 20K of 88305; that is 10% payout.

So making 300K or 500K is not big of a deal as you may think. Unfortunately, the pathology residents were slowly cooked to perfection to accept an average "cut" as a golden egg. It is really very very very hard for an old timer like me not to see a big irony in all this.

FYI, I happen to currently know of three DPs, all former professors of very prestigious academic centers looking for "more hours" and "more stable" positions.

Plagues upon the dogs of Academia that brought our field down to mud!!!

 

[turtle1966]

Only partially. Will drop another 50% in the next 3-5 years.

At that price point all small podlabs will not be viable and likely abandoned. Whoever picks those up might possible clean house if they find some way to mass produce glass for 7-8 bucks a pop...

My thoughts are there will be a massive price shift from 88305 to 88307/9. Massive. Which is why see alot of OP players dumping their business ASAP. When big Path whales sell off outpatient labs all at once, this NOT a coincidence. Once that happens, DP, GU and GI will cycle under as incomes drop 40-50%. I think your average hospital based glass monkey will see a completely cost neutral situation (or minor decrease if they have alot of outpatient bx material) which is how they sold the recent 88305 TC slash to the Path seat on the RUC.

People might scoff but I remember not so long ago many hemepath said they would NEVER touch the flow PC...and oh they did! Flow cytometry was like roadkill after they got done with it.

My prediction about 3 years ago was a net 75% income reduction to those doing solely outpatient biopsy/88305 work. Which why I did it for the easy $, but never rested my future on it. It looks like that day will come, likely a few years earlier than my initial time table unfortunately.

I agree with you. Nothing is sacred or untouchable!! We all have to be humble and be prepared for the worst.

 

[2121115]

I think your average hospital based glass monkey will see a completely cost neutral situation (or minor decrease if they have alot of outpatient bx material) which is how they sold the recent 88305 TC slash to the Path seat on the RUC.

100% correct.

The safest place to be right now is in a stable generalist hospital based group. That is who will suffer the least in the coming years.

If you are relying on outpatient biopsies for your income, better start making a plan B.

 

[Substance]

100% correct.

The safest place to be right now is in a stable generalist hospital based group. That is who will suffer the least in the coming years.

If you are relying on outpatient biopsies for your income, better start making a plan B.

Seems like the powers that be are trying to centralize your field.

 

[MOHS_01]

100% correct.

The safest place to be right now is in a stable generalist hospital based group. That is who will suffer the least in the coming years.

If you are relying on outpatient biopsies for your income, better start making a plan B.

Seems like the powers that be are trying to centralize your field.

Substance beat me to it...

Why do you think that is? "Vertical integration" ring a bell? LADoc's sig line is most apropos...

 

[WEBB PINKERTON]

100% correct.

The safest place to be right now is in a stable generalist hospital based group. That is who will suffer the least in the coming years.

If you are relying on outpatient biopsies for your income, better start making a plan B.

Most hospital based groups rely on outpatient work too.

 

[LADoc00]

Now mind you, I do NOT think the coming 88305 bloodbath is a good thing because in government's mad swinging of the scimitar to cut the throats of podlabs, Derm only practices and GI bx sweatshops they will nick the hospital based generalist. Some groups will be hurt bad, especially smaller private hospitals that have outsized volumes of GI cases.

But make no mistake, the large academic and tert referral centers will see a cost neutral situation. This is intended...

I think we can all see what our supposed "voice" on the RUC is gearing his support towards..

Youth is easily deceived because it is quick to hope.

 

[Substance]

Now mind you, I do NOT think the coming 88305 bloodbath is a good thing because in government's mad swinging of the scimitar to cut the throats of podlabs, Derm only practices and GI bx sweatshops they will nick the hospital based generalist. Some groups will be hurt bad, especially smaller private hospitals that have outsized volumes of GI cases.

But make no mistake, the large academic and tert referral centers will see a cost neutral situation. This is intended...

I think we can all see what our supposed "voice" on the RUC is gearing his support towards..

Youth is easily deceived because it is quick to hope.

So your RUC rep is trying to make academics the only safe haven in path? Isn't that why path is sucking so hard?

 

[LADoc00]

So your RUC rep is trying to make academics the only safe haven in path? Isn't that why path is sucking so hard?

The Grand Conspiracy will come full circle within the decade. Its been clear for the better part of last few decades that academia has been pushing full tilt for the all-employee "Swedish Model" for Physicians as part of their Socialist Utopia.

There is a new NYT propaganda peice published I think today that is a rehash of the old SPA/CPUSA (Socialist Party of America etc.) language from the 1960s and 70s.

Dont worry, academics will be at the top of the new pyramid. When your job and salary are assured, you can afford to play the Long Game to win total domination.

At the risk of offending some of you, Im sure many non-Socialist academics (they are rare, perhaps only in Utah and other realms of the Golden West) will be unwilling Sonderkommandoes in the grim dark future, but that will be cold comfort for the rest of us.

There isnt much I can say else aside from: Resist.

 

[WEBB PINKERTON]

The RUC rep

http://www.ama-assn.org/resources/doc/rbrvs/ruc-members-current.pdf

http://pathresidents.com/usapathology/Tucker_Allan.html

 

[LADoc00]

lo and behold he is the Chair at Bama. Not suspicious at all. Not at all...

Go Tide?

 

[jp123ok]

Here is the article that LADoc seems to be referring to:
http://www.nytimes.com/2013/06/16/business/what-sweden-can-tell-us-about-obamacare.html?ref=health&_r=0

 

[WEBB PINKERTON]

lo and behold he is the Chair at Bama. Not suspicious at all. Not at all...

Go Tide?

South Alabama. Not sure what the chant is there. Looks like their mascot is a Jaguar.

At this point, I pretty much expect all physicians to be employees of Kaiser or whomever. I would also wager good money that all the forums on SDN will turn into what this one has become. Paths lost autonomy and entrepreneurship. Other specialties are/will follow.

 

[LADoc00]

South Alabama. Not sure what the chant is there. Looks like their mascot is a Jaguar.

At this point, I pretty much expect all physicians to be employees of Kaiser or whomever. I would also wager good money that all the forums on SDN will turn into what this one has become. Paths lost autonomy and entrepreneurship. Other specialties are/will follow.

Haha my bad slamming Alabama when S. Alabama is the source of this...

But yes Webb you are spot on.

The End is nigh.

 

[jp123ok]

South Alabama. Not sure what the chant is there. Looks like their mascot is a Jaguar.

At this point, I pretty much expect all physicians to be employees of Kaiser or whomever. I would also wager good money that all the forums on SDN will turn into what this one has become. Paths lost autonomy and entrepreneurship. Other specialties are/will follow.

You bring up a good point. Why do you think that pathologists have lost entrepreneurship or to put it another way, why aren't more pathologists interested in being entrepreneurs?

 

[MOHS_01]

You bring up a good point. Why do you think that pathologists have lost entrepreneurship or to put it another way, why aren't more pathologists interested in being entrepreneurs?

Because most of them can't be. It's not like a general pathologist can go out, talk to a few surgeons, derms, urologists, etc and set up their own lab. I mean, yeah, they technically can do it... much in the way that fusion is possible. These referral streams are locked up. They are consolidated. You have layers upon layers of hurdles to jump through -- obtaining competitive insurance contracts -- hell, even being accepted onto insurance panels. High entry costs. The list goes on and on...

Path is different from most other specialties; they are wholly dependent upon referrals. When I started my practice I could see general derm -- there was a demand -- until my referral base could build. It's not like you can go out and start doing prostate biopsies, performing colonoscopies, or even run a skin lesion clinic to drive a need for yourself... and even if you could you may find yourself in some treacherous waters from outside referring providers.

Again, compromised. That's the nature of the pathology, radiology, and anesthesiology beasts. Once you are on the wrong end of the supply curve, prepare to be ****ed -- for all it serves to do is drive down prices, further consolidation, and generally screw your future prospects -- entrepreneurial spirits be damned.

I'm not happy about it, but pathology is serving as the canary in the coal mine for consolidated medicine. A test tube / pilot project, if you will.

 

[jp123ok]

Because most of them can't be. It's not like a general pathologist can go out, talk to a few surgeons, derms, urologists, etc and set up their own lab. I mean, yeah, they technically can do it... much in the way that fusion is possible. These referral streams are locked up.

Locked up how?

 

[vistaril]

Locked up how?

other entities(corporate labs, their own podlabs so themselves, other groups) already have the contracts.

 

[jp123ok]

Is it common practice for these contracts to last for more than a couple of years at a time?

 

[WEBB PINKERTON]

I can't think of a single new pathology lab that has popped up in my area other than a few in-office labs. Many labs have closed up shop including one I worked at back in the 90s till the old timers sold it. It finally bit the dust recently after being run into the ground by the new "owners." They interviewed the pathologist that started the place 50 years ago. Of course he is in his 80s and still working despite pocketing many millions of dollars from the deal. Last time I saw the guy in 2009, he stood up, lost his balance and fell back in his chair. LOL.

 

[turtle1966]

Locked up how?

Doors are not shut tight, however, it is not easy for a newbie to open it.

In order to feel it yourself, imagine that you are planning to open a new lab. Write down steps that you would have to follow, i.e., legal papers, insurances, staff to recruit, lab space to rent, equipment to purchase, financing to secure, etc.

After you have written down the Plan, try to execute it. You will soon realize that you will have to breath, live and dream your business, 24/7, 365 days a year. It is no wonder that independent lab owners do not feel it is fair to simply share on the ownership of their labs with new young associates just for a "song".

 

[LADoc00]

I can't think of a single new pathology lab that has popped up in my area other than a few in-office labs. Many labs have closed up shop including one I worked at back in the 90s till the old timers sold it. It finally bit the dust recently after being run into the ground by the new "owners." They interviewed the pathologist that started the place 50 years ago. Of course he is in his 80s and still working despite pocketing many millions of dollars from the deal. Last time I saw the guy in 2009, he stood up, lost his balance and fell back in his chair. LOL.

Can you explain further HOW the new owners ran it into the ground? These stories are always helpful.

And what part of the country is this??

BTW, this is a common scenario.

 

[WEBB PINKERTON]

Can you explain further HOW the new owners ran it into the ground? These stories are always helpful.

And what part of the country is this??

BTW, this is a common scenario.

The midwest. Immediately after the sale, a lot of staff was fired. Service and quality went down, many accounts left as the culture of the corporate lab took over. It amazed me how apathetic the old greedy bastards were when all hell was breaking lose. Suprised I never saw them playing the fiddle. They could have cared less, especially since they got a pile of cash. The place continued on as a shell of its former self, eventually shut down and the remaining accessions were sent to another lab the large corporation owns. Basically, the new "owners" just wanted to kill off another competitor and salvage as many accessions as they could. I've seen it play out again and again.

 

[Thrombus]

They interviewed the pathologist that started the place 50 years ago. Of course he is in his 80s and still working despite pocketing many millions of dollars from the deal. Last time I saw the guy in 2009, he stood up, lost his balance and fell back in his chair. LOL.

The CAP's academics declared 25 years ago this guy's retirement was "imminent".

 

[Silent Cool]

Hey I'm curious,

If Path blows this much these days, why don't some of you go back and re-train in something like IM or ER? I know that Path tends to attract a certain type, but if you didn't mind either of those fields, wouldn't they be reasonable options to much more $$$?

 

[Tissue issue]

Any updates from the OP? How does what you've heard from other sources compare to the feedback you've received here?

 

[LADoc00]

Hey I'm curious,

If Path blows this much these days, why don't some of you go back and re-train in something like IM or ER? I know that Path tends to attract a certain type, but if you didn't mind either of those fields, wouldn't they be reasonable options to much more $$$?

Im not sure that would help. IM is already on the ropes worse than Path. In my town EVERY single new IM practice has folded for the last 5 years. Every one. Not a single exception. Many of them left in such a hurry they literally disgorged their office furniture into their parking lot and let people take it for free. Real low rent stuff. I havent crawled into their finances but from what I can gather, their houses if they were stupid enough to buy one went into foreclosure and their employees went unpaid before they vanished. And this isnt 1-2 people, this is like half a dozen!

EM I have no clue about. EM docs have never struck me as having any sort of financial savvy. They tend to be wannabe cool guys who spend lots of time golfing and driving around in cheesey cars like Porsche Boxsters.. I have never seen one in my experience in any geographic area that was even close to the real deal as the Spine Surgeons, Neuro, Cardio, Plastics folks etc. I think income wise they typically end floating well below Radiology and if I had to guess below Path folks who own contracts...

The actual income data is so skewed in Path by all the vampires feeding on the weak, its basically worthless. When you have one guy in New York pulling down 10m/yr doing Path and another pulling down 90K what can you possibly discern with a delta that extreme??

 

[Silent Cool]

Im not sure that would help. IM is already on the ropes worse than Path. In my town EVERY single new IM practice has folded for the last 5 years. Every one. Not a single exception. Many of them left in such a hurry they literally disgorged their office furniture into their parking lot and let people take it for free. Real low rent stuff. I havent crawled into their finances but from what I can gather, their houses if they were stupid enough to buy one went into foreclosure and their employees went unpaid before they vanished. And this isnt 1-2 people, this is like half a dozen!

EM I have no clue about. EM docs have never struck me as having any sort of financial savvy. They tend to be wannabe cool guys who spend lots of time golfing and driving around in cheesey cars like Porsche Boxsters.. I have never seen one in my experience in any geographic area that was even close to the real deal as the Spine Surgeons, Neuro, Cardio, Plastics folks etc. I think income wise they typically end floating well below Radiology and if I had to guess below Path folks who own contracts...

The actual income data is so skewed in Path by all the vampires feeding on the weak, its basically worthless. When you have one guy in New York pulling down 10m/yr doing Path and another pulling down 90K what can you possibly discern with a delta that extreme??

Well, I was thinking that for the Path docs having trouble breaking above 200K, then ER would be a good deal. Only a few years of training and a great job market. There's not any real entrepreneurial opportunities (except for owning an urgent care), but the money sounds pretty sweet.

 

[Tissue issue]

OP- Still here?

 

[2121115]

I agree, it is not enough to be a good diagnostician as a private practice pathologist and have a rapport with your contributors (although both of these are important). There are marketing strategies required too. Sadly pathologists as a group are not trained at all for the business side of our industry during residency or fellowship. Then, we complain about being exploited by people with more business acumen...

Its not like residents in other fields get tons of business training. The reason things are the way they are isn't because pathologists know less business or are less skilled negotiators than other docs. It is because the system is set up to give us no leverage. You can't negotiate when you don't have anything the other guy wants. New pathology grads essentially offer nothing to a group other than being willing to work hard, make less $$ than they generate, and have a good attitude about it. Experienced pathologists compete with each other for the GI docs/GU docs/hospitals specimens, and their services are all valued the same (commodity) so they negotiate on price to the benefit of other docs - but they are all still in a far better position than a new grad. That is essentially why a new grad doesn't go out and start a new lab - not because they don't teach business in residency.

So your RUC rep is trying to make academics the only safe haven in path? Isn't that why path is sucking so hard?

Not academics per se, but large well connected hospital based groups (private and academic) will be the future. Traditional private practices will remain, and they will still make their money, but the landscape will change. The days of making mad $$$ doing only easy outpatient cases are numbered, for corporations (Caris GI, etc), pod labs, and the pathologists working there (think the market is tough for new grads now? wait until Caris has to cut their path salaries in half in order to maintain profit margin as the 88305 drops and the market floods with experienced pathologists). Then those outpatient specimens will come back to the hospital, as is the intended plan. Like LADoc said, pretty much revenue neutral for them.

 

[jp123ok]

You can't negotiate when you don't have anything the other guy wants.

There are legal ways that pathologists can gain the upper hand in terms of their bargaining position with clinicians without resorting to giving up any of their TC or PC...

wait until Caris has to cut their path salaries in half in order to maintain profit margin as the 88305 drops and the market floods with experienced pathologists

Caris is no more. The company is now called Miraca. I don't know about GI, but in dermpath Miraca is expanding. They recently advertised that they had an opening for a dermatopathologist in Texas.

 

[icpshootyz]

I don't know about GI, but in dermpath Miraca is expanding. They recently advertised that they had an opening for a dermatopathologist in Texas.

For now. But as incentive to keep patient money within ACO's grows, that may turn in the opposite direction. Miraca has physicians who have been listed on staff at some of the local hospitals near me, but they are not having their appointments renewed as the push to keep money in the ACO builds. I don't see their business model succeeding long-term.

 

[2121115]

More TC cuts now in the works - 80% for ISH and flow, and 50% for special stains.

On the bright side, PC will increase 4%.

The shift mentioned above is in full force.

http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=statline%2Fspecial_report_2014_pfs.html&_state=maximized&_pageLabel=cntvwr

 

[Silent Cool]

Wow, reading these threads makes me wonder why anyone would go into pathology. Working for 600/dy, can't find job after residency/fellowships, having to go get another fellowship b/c you can't find a job, being happy getting a job making 180k/yr, not being trained well enough to work after residency.

how ridiculous.

I don't know about other fields but EM looks like paradise compared to Path. you guys really need to do something about this and do it now.

I know EM docs would never settle for 600/day. My partners are getting moonlighting shifts and offered base $3600/12hr shift. On desperate days, they are getting $400/hr.
No ED Doc needs a fellowship to work in any ED and our training is 3 years. Getting a job is quite easy. I still get emails and calls weekly asking me if there are docs available.

What is wrong w/ you guys. Why are pathologist settling for this type of work environment.

Supply vs. Demand.

Why did Radiologists in the early 2000s make 500K with insta-partnership? Because supply had not yet met demand. The same will be true of ED in 5-ish years. Make hay while the sun shines.