Demand for pathology services in the future?

[jargon124]

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Hello all. Before I ask my question let me introduce myself since this is my first post on this board (though I've been lurking for a while now)...I'm a 3rd year med student at the University of Arizona. I'm seriously considering applying for path residency and am excited that I've come across a specialty that I can actually see myself in. I've been having a miserable time during most of my clinical rotations so far, as I suspect many of you have, and I can't wait for fourth year...anyhow, to get to the point...

I know that these things are difficult/impossible to predict, but I'm just trying to generate some discussion here so don't flame me. I'm wondering how the demand for pathologists and their services will change in the coming years as the population ages. I mean it makes sense to me that as people get older they will have more medical issues, i.e. more masses that need biopsy, and that this would benefit us as future pathologists. But is this too simplistic a view? What other factors will play a role in shaping demand for services? Any bold supply/demand predictions for the future of path?

 

[yaah]

It's a tough question. Most people who are experts or claim to be experts suggest that the need for pathologists isn't going to go away anytime soon. Molecular tests are becoming more important, but they are not yet at the stage (nor will they be anytime soon, likely) where they will replace biopsies and getting actual tissue.

Molecular tests are becoming important in many ways for treatment issues - determining the exact genetic makeup of certain tumors or diseases to see what treatments they might be susceptible to or what the prognosis is. Molecular tests, however, don't often allow you to MAKE a diagnosis, they only supplement it. It may change though. Cervical testing is changing - molecular studies looking for HPV subtypes are becoming quite important, although they are still a supplement to the pap smear.

Some suggest that as technology improves, the need for biopsies will decrease. Well, it hasn't really happened so far. All the high tech radiology and ancillary tests still only suggest diagnoses or conditions. A small cell lung carcinoma might be suggested on radiology, but that constellation of findings could be caused by a metastatic tumor or a non small cell lung primary.

If I had to guess, the way things are going suggests that screening and profiling are going to be more important. People suffering from hypertension may be able to have tests to see which drugs they are most susceptible to. People at risk for cancers can have them caught earlier and earlier. And research being done does not seem at all to be decreasing diagnostic tests. Older tests are merely replaced by something more complicated, or supplemented with further tests. Occasionally a new test arises that replaces something inefficient and complicated though.

I'm rambling. It's hard to predict the future. Important changes often happen slowly though. Tradition is important to people.

 

[LADoc00]

New tests almost never replace they just add. Microarrays? Laser Capture Microdissection? Laser Catapults? All that biophotonics stuff I used to think would dominate pathology in 10 years will not replace one single thing, at least for decades.

BY FAR, the biggest threat to pathology is the commericial labs: Dianon Systems, AmeriPath, Quest Diagnostics and ARUP. They buy out pathologists, put others out of business and take a nice chunk of the reimbursements and hand em to admin types. They are in short the work of the devil. To most MBA types we are replaceable as cytotechs, actually its harder to find a histotech than a new pathologist (!) and they know that. Ameripath probably asks for "Prima Nocte" rights to your wife too when you sign on.

 

[RyMcQ]

BY FAR, the biggest threat to pathology is the commericial labs: Dianon Systems, AmeriPath, Quest Diagnostics and ARUP.

I completely agree that the biggest threat to pathology is corporatization.

AmeriPath is bad because it is trying to plug pathologists into a system as wage slaves. That is, you get hired, and then they squeeze you as hired labor to get more productivity out of you (by longer hours and more pressure to reduce time spent per case). Eventually, company revenue (a number that is easy to manipulate) will drop some, giving the company the excuse they need to freeze annual salary increases (if you ever got increases above inflation in the first place) or reduce benefits. They might even go "bankrupt", but through it all, the CEO that is going for short term gains and quarterly stock price increases will still make his 10 million per year.

I half expect that you were trying to bait me by including ARUP with AmeriPath. But I'll bite. ARUP is wholly owned by the University of Utah Department of Pathology. They are not snapping up small labs. They have no goal to expand from their current site in SLC. They have a niche in esoteric tests, and pose little threat to small labs. (They certainly compete with other reference labs, but that's different.)

ARUP is a growing operation that more or less has to reduce its profitability by treating its employees like royalty (free on-site medical clinic is just one perk), investing heavily in the future (R&D), and generously funding some of the perks of the pathology residency program. If ARUP makes too much money, the notoriously stingy Utah legislature will no doubt find a way to get that money to offset cuts they want to make to the University of Utah Health Sciences Center. It's quite the balancing act.

I don't expect everyone to love ARUP. I know people who have worked in labs that have lost market share to ARUP. But they definitely aren't trying to be the next WalMart of laboratories.

 

[LADoc00]

I completely agree that the biggest threat to pathology is corporatization.

AmeriPath is bad because it is trying to plug pathologists into a system as wage slaves. That is, you get hired, and then they squeeze you as hired labor to get more productivity out of you (by longer hours and more pressure to reduce time spent per case). Eventually, company revenue (a number that is easy to manipulate) will drop some, giving the company the excuse they need to freeze annual salary increases (if you ever got increases above inflation in the first place) or reduce benefits. They might even go "bankrupt", but through it all, the CEO that is going for short term gains and quarterly stock price increases will still make his 10 million per year.

I half expect that you were trying to bait me by including ARUP with AmeriPath. But I'll bite. ARUP is wholly owned by the University of Utah Department of Pathology. They are not snapping up small labs. They have no goal to expand from their current site in SLC. They have a niche in esoteric tests, and pose little threat to small labs. (They certainly compete with other reference labs, but that's different.)

ARUP is a growing operation that more or less has to reduce its profitability by treating its employees like royalty (free on-site medical clinic is just one perk), investing heavily in the future (R&D), and generously funding some of the perks of the pathology residency program. If ARUP makes too much money, the notoriously stingy Utah legislature will no doubt find a way to get that money to offset cuts they want to make to the University of Utah Health Sciences Center. It's quite the balancing act.

I don't expect everyone to love ARUP. I know people who have worked in labs that have lost market share to ARUP. But they definitely aren't trying to be the next WalMart of laboratories.

Dont try and sugar coat it! I know you guys are sitting around in Salt Lake plotting to take over the world...muhahahahaha
Isnt Dr. Evil the head of ARUP? Or is he the diet coke of evil? Just one calorie of evil?

 

[yaah]

Ha! The head of ARUP is quite far from Dr Evil. He is a very pleasant Norwegian (I think Norwegian) who is quitting as chair of Utah's path department but remaining as CEO of ARUP. His office is actually quite humble, open to the main thoroughfare, and smaller than the chairman's office at Hopkins, among others.

ARUP is one of those "top x places in the country to work" and it seems like it to just walk through.

Of course, all of this means it will probably be bought out by some sleazy private corporation like Wallmart or Pfizer and that will be the end of that.

Yup, that's right. I called Walmart sleazy. They are not patriotic at all. In fact, they are tantamount to being unamerican. At least, the ideal of America.

 

[b&ierstiefel]

Yup, that's right. I called Walmart sleazy. They are not patriotic at all. In fact, they are tantamount to being unamerican. At least, the ideal of America.

According to South Park, this is true.