Date documenting projected shortage of pathologists

[LADoc00]

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LADoc you say a lot of good stuff on here but you're kind of grasping at straws to make this survey seem terribly relevant. Did you actually read it? The numbers they are using are pretty low and they are not representative. It's like taking a survey of hospital employees, limiting your analysis to two departments, and then generalizing it to everyone.

I get it now
~When HRSA and AAMC compiles completely bogus government data to support the "We Needz Mor Docs" Socialist mantra, that is real relevant data you all listen carefully to.

~When the ASCP produces vastly more specific real time surveying of the current workforce, that data is now somehow not representative?


I just want to be clear there has NEVER been a shortage of Pathologists in the US since WW2. Never. It has never happened. It will never happen. Let's be 100% crystal clear on that.

Moving forward, there is no possible way one could argue that there isnt a huge section of current trainees who will struggle to find full time employment, especially on the Coasts.

Im not saying the ASCP survey is gospel truth but I am pointing out the initial surveys by the HRSA and AAMC quoted in the thread have absolutely no bearing on the reality of the current workforce needs for our field.

I would no sooner believe the HRSA than I would Stalin or Goebbels as they have a clear political agenda that this is guiding everything they do.

Let's be clear: there IS a vast conspiracy, it's a conspiracy of the dream of Socialism and Socialist Medicine here on U.S. soil. It's a dream held dear by liberals since the 1960s, when they proclaimed "Better Red than Dead" or "Better to Live on your Knees than Die on your Feet." The American Communist Party believes now as they did then, Americans would never freely accept the tenets of Communism and Marxism but under the cover of Socialism they would drink every drop.

Socialized Medicine is impossible to impose if Physicians have power. If there is a community with only a limited number of Pathologists, the government cannot so easily force its will upon them. But give every community a hundred hungry and starving doctors, families with bills to pay and they walk willingly into the arms of Socialized Medicine.

The HRSA and others like it will continue to push to flood our cities with these hungry well educated Proletarians. The Left will continue to attack fee-for-service because as independent business people, we have power and clout. But as employees in ACOs, we WILL be made to follow the orders of politicians and their Socialist intellectuals. Socialists who hide away among the Ivory Towers and plot new ways to encumber Harrison Bergeron and create their ideals of Social Justice where they rule without peer.

THAT is the last step into a Thousand Years of Darkness.

 

[Thrombus]

I get it now
~When HRSA and AAMC compiles completely bogus government data to support the "We Needz Mor Docs" Socialist mantra, that is real relevant data you all listen carefully to.

~When the ASCP produces vastly more specific real time surveying of the current workforce, that data is now somehow not representative?


I just want to be clear there has NEVER been a shortage of Pathologists in the US since WW2. Never. It has never happened. It will never happen. Let's be 100% crystal clear on that.

Moving forward, there is no possible way one could argue that there isnt a huge section of current trainees who will struggle to find full time employment, especially on the Coasts.

Im not saying the ASCP survey is gospel truth but I am pointing out the initial surveys by the HRSA and AAMC quoted in the thread have absolutely no bearing on the reality of the current workforce needs for our field.

I would no sooner believe the HRSA than I would Stalin or Goebbels as they have a clear political agenda that this is guiding everything they do.

Let's be clear: there IS a vast conspiracy, it's a conspiracy of the dream of Socialism and Socialist Medicine here on U.S. soil. It's a dream held dear by liberals since the 1960s, when they proclaimed "Better Red than Dead" or "Better to Live on your Knees than Die on your Feet." The American Communist Party believes now as they did then, Americans would never freely accept the tenets of Communism and Marxism but under the cover of Socialism they would drink every drop.

Socialized Medicine is impossible to impose if Physicians have power. If there is a community with only a limited number of Pathologists, the government cannot so easily force its will upon them. But give every community a hundred hungry and starving doctors, families with bills to pay and they walk willingly into the arms of Socialized Medicine.

The HRSA and others like it will continue to push to flood our cities with these hungry well educated Proletarians. The Left will continue to attack fee-for-service because as independent business people, we have power and clout. But as employees in ACOs, we WILL be made to follow the orders of politicians and their Socialist intellectuals. Socialists who hide away among the Ivory Towers and plot new ways to encumber Harrison Bergeron and create their ideals of Social Justice where they rule without peer.

THAT is the last step into a Thousand Years of Darkness.

Freedom ---->

 

[yaah]

Stop. Just stop. Go back and reread the document starting on page 23. The ASCP has the data for trainees WITH COMPLETED FELLOWSHIPS. With fellowship training, the job success rate isn't much different. 40%+ failure to get at least 1 offer for some fields. It's a crazy 31% for hemepath!

You typed all the that which I guarantee took 10x longer than just reading the whole .pdf file.

"Your experience" is also quite limited given you went to 1 training program for everything and have I assume the same job you got after that.

None of your 3 categories is even close to correct.
1.) Researchers dont wake up one day and apply to work in a community hospital doing surgical pathology.
2.) there are boatloads of people with 2+ fellowships and bottom of the barrel communication skills.
3.) all the physicians who come a military training background usually have NO fellowships, even though they literally have a decade+ more sign out experience than almost anyone in the job market.

So your no fellowships=crap candidate insinuation is completely and utterly bunk.


I just want to clear before people on this forum begin again the throwing of stones from their glass internet houses...

Look man, I respect you and what you post but I don't think you really read my post nor did you really look at that survey. If you don't want to read my response below fine, but at least have the decency to not respond like you have and that my opinons are something they are not. I have looked at that survey a lot, every year it gets posted and referenced here, I look at it carefully because it's an interesting topic. Every year I am disappointed in both the numbers of responses they get as well as the conclusions they draw. These surveys have to date been quite flawed.

If you look at the survey, the "fellowships" it is studying are really not at all representative. I mean really, how many people a year truly do peds path, TM, neuropath fellowships? Forensics data is interesting but it's only really applicable to people who do forensics fellowships because that field is so different from general practicing pathologists. So they do NOT have the data for people completing fellowships. They have SOME data, mostly for people completing a small selected subset of fellowships. The hemepath data is good I suppose, although I don't know how much to really trust it. There are so many hemepath fellowships these days and I would love to know if that data is stratified by career path, other fellowships completed, what kind of job they are doing, training background.

You can trivialize my experience all you want but that isn't really relevant, particularly when this forum seems to thrive on uninformed experience and anecdote. I have enough experience to know a lot. I have a lot of contacts, friends, etc.

I also don't think you understood at all my point about the 3 categories. I am, again, referring to people who do ZERO fellowships and then look for jobs. As I said, these are usually academics who are doing research, people with family/personal connections to the job they get, or people who are not really stellar candidates. I am NOT referring to military people, I am NOT referring to academics who did zero fellowships who then go try to get another job. I am referring to residents looking for their first job. The ASCP continues to shove out data regarding residents who do zero fellowships and in my opinion that is not helpful data for the average current resident. Do you disagree with that?

Obviously there are people doing multiple fellowships who have poor communication skills and no one wants to hire. This is part of the reason why many of them do multiple fellowships!

And I will say this again, I have no idea why people keep interpreting these comments as somehow advocating that the job market is good or there is a shortage or whatever you think I'm saying. I post this stuff and argue with you all because I am trying to get people to think and consider reality, not just assumption.

And again, saying that the ASCP survey is flawed doesn't mean the government data is superior. They are both data. I have posted multiple times why I have questions about the government data (mostly because of assumptions made or lack of assumptions made). But yet you all continue to buttonhole my opinions into something they are not, because it is fitting your world view that everyone who questions things about "the bad job market" is trying to prove that it is awesome or something.

You all need to ask more questions and open your minds more. Not just keep jumping to conclusions. Anecdotes are important, they inform our world view, but they are not evidence. Nor is poorly collected data.

 

[yaah]

o find full time employment, especially on the Coasts.

Im not saying the ASCP survey is gospel truth but I am pointing out the initial surveys by the HRSA and AAMC quoted in the thread have absolutely no bearing on the reality of the current workforce needs for our field.

I don't think anyone is saying the government surveys posted have any bearing at all on the reality of the current workforce needs. You are totally missing the point - the data posted are trying to get at FUTURE needs, not current ones. Future data is always much harder to gather. Since we have a next to impossible time even assessing adequate data for the current situation, what makes you think the future data is going to be that helpful either? They are projections. Demographically, they may well be accurate. What it means for pathologists is really hard to gather though.

p.s. you made a nazi reference so you lose 😛

 

[LADoc00]

Yaah,
yes ASCP like the less than brilliant people they are, choose to pick Peds, Neuro and Forensics to look at job offers.

Yes that is the 3 Musketeers of Booby Fellowships.

I wish they had chosen Surgical Path.

so I agree with you there.

and I wasn't dismissing your work experience I'm dismissing the manner you selectively rely on anecdotes in cases that fit your narrative.

But points taken, I apologize.

 

[yaah]

Hmm, I try not to rely on anecdotes. Anecdotes can be helpful but they are not really evidence. They are most helpful when they are used to counter other anecdotes because it shows that all it is is one person's experience. Anecdotes can help younger trainees to see the different paths that people take. I was pretty sure that I was typically the one telling people not to rely on anecdotes - it's the "SKY IS FALLING" people that tend to produce the most anecdotes and ask people to draw conclusions. In return I and others often post anecdotes that counter that narrative - doesn't mean we are selectively picking anecdotes to believe, it means we are encouraging people to NOT do that.

I would be interested to know why ASCP picked those fellowships to analyze - I know why they picked hemepath (I think), it's because they have an inservice exam so they have a captive audience. But they don't for those other specialties. And if they are only going with boarded fellowships why not include cyto which includes lots of "typical" residents? The other problem is that the surveys are taken before the end of the year, and people are at all various stages of job search - it's like comparing apples to handbaskets and lawnmowers. I mean seriously, I know a handful of people who have done TM fellowships in the past few years. A couple of them were pure bloodbankers who wanted to do that as their career. The majority were seriously just filling time while waiting for the fellowship they really wanted or because they couldn't find the job they wanted.

It's hard to do anything with surg path in a survey fashion because it isn't an "official" fellowship, and sometimes people who do those are actually considered staff pathologists or junior attendings. So how do they answer questions? How do you find them? Like I said, the best study would be to take everyone 3-5 years after completion of all their fellowships and then ask all these questions.

 

[MetroPath]

Hmm, I try not to rely on anecdotes. Anecdotes can be helpful but they are not really evidence. They are most helpful when they are used to counter other anecdotes because it shows that all it is is one person's experience. Anecdotes can help younger trainees to see the different paths that people take. I was pretty sure that I was typically the one telling people not to rely on anecdotes - it's the "SKY IS FALLING" people that tend to produce the most anecdotes and ask people to draw conclusions. In return I and others often post anecdotes that counter that narrative - doesn't mean we are selectively picking anecdotes to believe, it means we are encouraging people to NOT do that.

I would be interested to know why ASCP picked those fellowships to analyze - I know why they picked hemepath (I think), it's because they have an inservice exam so they have a captive audience. But they don't for those other specialties. And if they are only going with boarded fellowships why not include cyto which includes lots of "typical" residents? The other problem is that the surveys are taken before the end of the year, and people are at all various stages of job search - it's like comparing apples to handbaskets and lawnmowers. I mean seriously, I know a handful of people who have done TM fellowships in the past few years. A couple of them were pure bloodbankers who wanted to do that as their career. The majority were seriously just filling time while waiting for the fellowship they really wanted or because they couldn't find the job they wanted.

It's hard to do anything with surg path in a survey fashion because it isn't an "official" fellowship, and sometimes people who do those are actually considered staff pathologists or junior attendings. So how do they answer questions? How do you find them? Like I said, the best study would be to take everyone 3-5 years after completion of all their fellowships and then ask all these questions.

There is a Peds in service exam now. Started earlier this year I believe called the PISE.

 

[TMZ2007]

They picked those fellowships to study because the jobs survey is only administered to fellows taking the ASCP fellowship-specific in-service exam.

The heme path numbers are surprisingly pretty blah; I always had the feeling that hemepath was more desirable.

 

[lipomas]

I get it now
~When HRSA and AAMC compiles completely bogus government data to support the "We Needz Mor Docs" Socialist mantra, that is real relevant data you all listen carefully to.

~When the ASCP produces vastly more specific real time surveying of the current workforce, that data is now somehow not representative?


I just want to be clear there has NEVER been a shortage of Pathologists in the US since WW2. Never. It has never happened. It will never happen. Let's be 100% crystal clear on that.

Moving forward, there is no possible way one could argue that there isnt a huge section of current trainees who will struggle to find full time employment, especially on the Coasts.

Im not saying the ASCP survey is gospel truth but I am pointing out the initial surveys by the HRSA and AAMC quoted in the thread have absolutely no bearing on the reality of the current workforce needs for our field.

I would no sooner believe the HRSA than I would Stalin or Goebbels as they have a clear political agenda that this is guiding everything they do.

Let's be clear: there IS a vast conspiracy, it's a conspiracy of the dream of Socialism and Socialist Medicine here on U.S. soil. It's a dream held dear by liberals since the 1960s, when they proclaimed "Better Red than Dead" or "Better to Live on your Knees than Die on your Feet." The American Communist Party believes now as they did then, Americans would never freely accept the tenets of Communism and Marxism but under the cover of Socialism they would drink every drop.

Socialized Medicine is impossible to impose if Physicians have power. If there is a community with only a limited number of Pathologists, the government cannot so easily force its will upon them. But give every community a hundred hungry and starving doctors, families with bills to pay and they walk willingly into the arms of Socialized Medicine.

The HRSA and others like it will continue to push to flood our cities with these hungry well educated Proletarians. The Left will continue to attack fee-for-service because as independent business people, we have power and clout. But as employees in ACOs, we WILL be made to follow the orders of politicians and their Socialist intellectuals. Socialists who hide away among the Ivory Towers and plot new ways to encumber Harrison Bergeron and create their ideals of Social Justice where they rule without peer.

THAT is the last step into a Thousand Years of Darkness.

Well, as to the first part of your post, they aren't really that related. The government stuff is trying to predict the future and the ASCP thing is trying to assess the present. Neither is likely to be doing a very good job. The ASCP limitations have been described above. The government limitations are that well it's the government, who makes predictions based on flawed and flimsy stuff all the time, and these predictions have a track record that is up there with the track record of the Cleveland Browns. You keep saying the government data is stupid because it has no bearing on current reality. Isn't that obvious though? It isn't supposed to reflect current reality. Is anyone really arguing that? They are answering two different questions.

As to the rest, medicine is totally socialized and will be forever except on the fringes. That is how people want it. There are exceptions. Cosmetic surgery isn't socialized, but that's considered a luxury by everyone except hollywood starlets. Some people are trying to do concierge stuff but that's borderline. All the rest is mostly socialized with some non-socialized elements. It has to be, given that almost everyone in the country has a stake in it. Even if the government is not involved at all it would be in a sense socialized. I don't really see a way out of that.

Even non-government health insurance has extensive socialized elements now. Tax deductions, govt regulations, group purchasing power, all that stuff. You can pay cash but why?

Tell you what though, not sure how you think it's going to change. Med students these days are increasingly left-leaning politically as well as decreasingly concerned about economics and business issues. They all want to be employed, not partners, with 10 weeks of vacation and the option to go part time. Have you met any of them? They like money but they don't really understand where it comes from. That's someone else's job, someone who they think should get paid less than them because they (the student) went to Honduras for 3 days in med school.

p.s. LA Doc what are your thoughts on UN Agenda 21? 😉

 

[rollwithit]

They picked those fellowships to study because the jobs survey is only administered to fellows taking the ASCP fellowship-specific in-service exam.

The heme path numbers are surprisingly pretty blah; I always had the feeling that hemepath was more desirable.

That's why I said the fellowship section was crap. Take Heme, for example. It shows that 39% of Heme fellows did not formally apply for a job and 31% did not receive a job offer. What does "formally apply" mean? Did these people have a job already lined up informally through connections over the years? To be consistent, did they also check the box that said "no job offer" because they also said they never formally applied? If so, now you have 8% with no offers for Heme fellows that formally applied for a job. Are the people with no job offers the *****s that too scared to practice until they've completed 4 fellowships as they feel the need to be an "expert" in everything before weaning themselves off the subsidized training teat? How many are going back to their home country?

This is in no way me stating I think the job market is poor or great. I just think the survey is crap because I can't answer the question of "how many of X fellows wanted a job, seriously looked for one, but received no offer". Before we even get to picking apart whether or not people are getting the jobs they prefer, you have to be able to at least quantify "wanted job / couldn't get one" first.

 

[lipomas]

I always had the feeling that hemepath was more desirable.

Depends what you mean by desirable. Hemepath used to be more limited, fewer fellowships. Now everyone with at least 100 marrows a year is starting a hemepath fellowship. And there are now tons of IMGs doing hemepath, it's starting to rival cytopath. But looks to me like they are training more hemepaths than they need. Lots of private groups need people to do hemepath but they often want them to do something else too. FREIDA lists like 85 hemepath fellowships, a lot of them probably have more than 1 fellow per year. That's a lot. This is the stuff we need data on - how many hemepath fellows finish and go back to another country? How many want to do just hemepath?

If you figure 1.5 fellows per hemepath fellowship program that's like 120+ fellowship graduates every year. That sounds kind of insane to me but I don't really know if it is.

 

[pathstudent]

Looks like the Mayans were wrong. I thought today was supposed to be the end of all pathologists. Now I am just at work and uber-hung over.

 

[Pathwrath]

All this heated discussion about getting reliable employment data before changing residency numbers, as if the current number is based--or has ever been based, or ever will be based--on anything but the aggregate staffing whims of individual programs and quality restrictions placed on them by the ACGME!

Have any of you ever been present when a major path program decided to up its resident numbers? I have. Real world supply-and-demand was never considered, even as an aside. I doubt very much my experience was unique.

As for that ideal study that will once and for all clarify the issue, keep on dreaming. Why go to the trouble of implementing research with potentially undesirable results, when you can cobble together a crappy study with far less effort that gives you what you want?

 

[Path or bust]

cobble together a crappy study with far less effort that gives you what you want?

very true.

 

[scienceguy19]

I heard that the hemepath market has been very tough recently.

Depends what you mean by desirable. Hemepath used to be more limited, fewer fellowships. Now everyone with at least 100 marrows a year is starting a hemepath fellowship. And there are now tons of IMGs doing hemepath, it's starting to rival cytopath. But looks to me like they are training more hemepaths than they need. Lots of private groups need people to do hemepath but they often want them to do something else too. FREIDA lists like 85 hemepath fellowships, a lot of them probably have more than 1 fellow per year. That's a lot. This is the stuff we need data on - how many hemepath fellows finish and go back to another country? How many want to do just hemepath?

If you figure 1.5 fellows per hemepath fellowship program that's like 120+ fellowship graduates every year. That sounds kind of insane to me but I don't really know if it is.

 

[Enkidu]

As for that ideal study that will once and for all clarify the issue, keep on dreaming. Why go to the trouble of implementing research with potentially undesirable results, when you can cobble together a crappy study with far less effort that gives you what you want?

So what do they want? To make the job market look worse, or better?

 

[Pathwrath]

This thread began with a study purporting to show a looming shortage of pathologists. Have you ever seen a study concluding there's an oversupply? Will you ever see one?

 

[Enkidu]

This thread began with a study purporting to show a looming shortage of pathologists. Have you ever seen a study concluding there's an oversupply? Will you ever see one?

I dunno - there's that ASCP data that's also in this thread. I'd say it reflects a present oversupply. I've never seen a study predicting a future oversupply, though, if that's what you mean.

 

[Pathwrath]

The ASCP study that concludes "The job situation for pathology fellows is still mixed"? That one? What is the intention of that conclusion, except to keep things exactly as they are?

 

[Enkidu]

The ASCP study that concludes "The job situation for pathology fellows is still mixed"? That one? What is the intention of that conclusion, except to keep things exactly as they are?

heh, yeah. I guess I wasn't reading their conclusion. But my conclusion based on their figures was that the job market sucks.

 

[Pathwrath]

heh, yeah. I guess I wasn't reading their conclusion. But my conclusion based on their figures was that the job market sucks.

The reality is irrelevant. What counts is the interpretation of that reality. This is politics. My point is that no ASCP/CAP or federal study is ever going to conclude we are training too many pathologists. If the data is grim, the conclusion will be "mixed". And that's worse case. If they can spin something better, you'll get conclusions like the HRSA study that inspired this thread.

 

[pathstudent]

The reality is irrelevant. What counts is the interpretation of that reality. This is politics. My point is that no ASCP/CAP or federal study is ever going to conclude we are training too many pathologists. If the data is grim, the conclusion will be "mixed". And that's worse case. If they can spin something better, you'll get conclusions like the HRSA study that inspired this thread.

It is time to move on. Continuing to complain about an oversupply is not helpful and not going to change anything.

On the bright side, there will be no increase in CMS funded residency spots for the foreseeable future. In this political-economic climate it would be like asking for even greater tax cuts for the rich. The current move is towards primary care and away from specialists who are percieved as making too much money and increasing the cost of medicine with little to show for it.

CAP, ASCP, "academia" are just trying to keep what they have. If they warn of an impending severe shortage, they hope they will be passed on when the chopping block comes out.

 

[Path or bust]

CAP, ASCP

These are two organizations that will never see a penny out of my checkbook.

 

[Pathwrath]

It is time to move on. Continuing to complain about an oversupply is not helpful and not going to change anything.

On the bright side, there will be no increase in CMS funded residency spots for the foreseeable future. In this political-economic climate it would be like asking for even greater tax cuts for the rich. The current move is towards primary care and away from specialists who are percieved as making too much money and increasing the cost of medicine with little to show for it.

CAP, ASCP, "academia" are just trying to keep what they have. If they warn of an impending severe shortage, they hope they will be passed on when the chopping block comes out.

For the record, I'm late to this thread and only piped in to rebut the nonsense about waiting for the proper data before acting, as if any program has ever done that before churning out more residents. I don't think anything in pathology is going to change, regardless. At least not for the better.

As for the rest of your post, you make sense, but I am still not sure. The "current move" towards primary care has been going on for more than two decades by my count, but you'd never know it by the number of specialists cranked out in that time. LADoc makes some interesting points above regarding flooding the system with docs to reduce their collective clout.

 

[Ruination]

I heard that the hemepath market has been very tough recently.

I haven't had much of a problem this year. Then again, I want to sign out surg path in addition to hemepath, something not every hemepath wants or is inclined to do.

 

[lipomas]

The ASCP study that concludes "The job situation for pathology fellows is still mixed"? That one? What is the intention of that conclusion, except to keep things exactly as they are?

The intention I think is to say don't take this survey too seriously and don't rely on it for individual circumstances. Because the job market is better for really good candidates and terrible for poor candidates. Thus, "mixed!"