Dermpath face-off

[LADoc00]

Who is your favorite academic superstar of dermpath?

Crap: that should be Martin or Marty Mihm, not Mary...sheeesh

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[torero]

Got to say Bernie. He has the best stats. The guy never bunts. He goes for the home-run each and every time, and has countless to his credit (too many to mention), while rarely striking-out (e.g. dysplastic nevus).

 

[LADoc00]

Got to say Bernie. He has the best stats. The guy never bunts. He goes for the home-run each and every time, and has countless to his credit (too many to mention), while rarely striking-out (e.g. dysplastic nevus).

The sultan of slam, the king of crash, the colossus of clout, the great BAMBINO.

 

[dermpathlover]

I gotta go with ackerman, but I admire that Leboit making 1.5 million a year. Now that is bank!

 

[PathOne]

While Bernie is certainly hugely controversial, he essentially founded modern dermatopathology, and has trained far more people than anybody else, including LeBoit and Cockerell.

BTW: Who in the world is Mary Mihm? S'pose you're referring to Martin Mihm!?

 

[LADoc00]

While Bernie is certainly hugely controversial, he essentially founded modern dermatopathology, and has trained far more people than anybody else, including LeBoit and Cockerell.

BTW: Who in the world is Mary Mihm? S'pose you're referring to Martin Mihm!?

yeah you cant edit the poll once you post it, yeah as I said Marty not Mary!

 

[pathdawg]

Most people will probably say A.B. He has a brilliant mind (and he'll be the first to tell you that). But to those that have ever rotated or trained under him, he can be pretty intolerable. I know he has his deciples, but I never quite got the whole cult of personality thing with him.

His initials after M.D. should be O.O.C. (Out Of Control).

 

[yaah]

That guy at Arkansas. I am blanking on his name...Bruce Smoller?

The guys you list (I don't know how old LeBoit is though, but I don't think he is that old) are a bit old. Smoller is younger, and one of the major faces in the game.

 

[LADoc00]

That guy at Arkansas. I am blanking on his name...Bruce Smoller?

The guys you list (I don't know how old LeBoit is though, but I don't think he is that old) are a bit old. Smoller is younger, and one of the major faces in the game.

Bruce Smoller is the total dark horse. Formally he was the most published pathologist at Stanford. Now at Arkansas, which accepts what one person every OTHER year. Has to be nice with him backing you up on your job search. Definitely a backdoor ticket to very nice bankola.

 

[gungho]

The sultan of slam, the king of crash, the colossus of clout, the great BAMBINO.

Sultan of Swat, I believe, but who's checking?

 

[DermpathDO]

Got to say Bernie. He has the best stats. The guy never bunts. He goes for the home-run each and every time, and has countless to his credit (too many to mention), while rarely striking-out (e.g. dysplastic nevus).

Bernie did NOT strike out on Dysplastic nevus....the world is still out of touch..you tell me...HOW do you grade dysplasia?? I have yet to see a coherent article that accurately grades dysplaisa in nevus. Until you can accurately quantitate something it is NOT real

 

[LADoc00]

Bernie did NOT strike out on Dysplastic nevus....the world is still out of touch..you tell me...HOW do you grade dysplasia?? I have yet to see a coherent article that accurately grades dysplaisa in nevus. Until you can accurately quantitate something it is NOT real

How do you grade dysplasia?? Umm dunno, I only do it EVERY DAY! How bout VIN I-III, VAIN I-III, CIN I-III, ADH-DCIS, how about the difference between an actinic keratosis and SCC in situ?

 

[DarksideAllstar]

After having several didactic sessions with LeBoit, I can honestly say the guy is bad ass. Not to mention he's got a pretty good sense of humor. Anyway, not sure about any of the others (of course I have heard of Ackerman), so WTF do I know.

 

[pathdawg]

Bernie did NOT strike out on Dysplastic nevus....the world is still out of touch..you tell me...HOW do you grade dysplasia?? I have yet to see a coherent article that accurately grades dysplaisa in nevus. Until you can accurately quantitate something it is NOT real

I think by saying "striking out" (and the "home run" analogy), the poster meant that Bernie doesn't tend to hedge on whether a nevus is dysplastic or atypical, but rather he is more likely to make a definitive call (i.e. call it out-and-out benign or malignant). I didn't take that as saying he was completely off-base (yet another baseball analogy, folks!) with his theory on the subject of dysplastic nevi.
That was my take, anyway.

 

[yaah]

How do you grade dysplasia?? Umm dunno, I only do it EVERY DAY! How bout VIN I-III, VAIN I-III, CIN I-III, ADH-DCIS, how about the difference between an actinic keratosis and SCC in situ?

Ackerman now will slug you. ACTINIC KERATOSIS IS SQUAMOUS CELL CARCINOMA!!!!!!!!

I'm not sure it is convincing anyone, but he certainly keeps talking about it.

 

[dermpathlover]

After having several didactic sessions with LeBoit, I can honestly say the guy is bad ass. Not to mention he's got a pretty good sense of humor. Anyway, not sure about any of the others (of course I have heard of Ackerman), so WTF do I know.

Does Ursell, Olsen, Farrell and Chuck Z. ever gripe that he makes 5-8 times what they make?

 

[DarksideAllstar]

Does Ursell, Olsen, Farrell and Chuck Z. ever gripe that he makes 5-8 times what they make?

There have been a few comments, mostly humorous, made re: the salary issue by some faculty. I dont think anyone harbors any animosity (at least outwardly) because they enjoy what they do. Plus, the dermpath service is one busy mo-fo, so the higher salary is probably at least expected by others.

 

[LADoc00]

There have been a few comments, mostly humorous, made re: the salary issue by some faculty. I dont think anyone harbors any animosity (at least outwardly) because they enjoy what they do. Plus, the dermpath service is one busy mo-fo, so the higher salary is probably at least expected by others.

Leboit does not warrant that salary. Period. That is a total travesty and a huge hit to the local Bay area private prac crowd who he sucks his biz from. If he were out in private prac with no University affliation he would getting 8-10K/cases a year, still make a solid living but not at the expense of everyone else. Listen to me now and believe me later: The medical playing field is NOT level, a small pop. within academia have used the massive publicly funded system to better their own finances not unlike the California railroads barons.

 

[dermpathlover]

Leboit does not warrant that salary. Period. That is a total travesty and a huge hit to the local Bay area private prac crowd who he sucks his biz from. If he were out in private prac with no University affliation he would getting 8-10K/cases a year, still make a solid living but not at the expense of everyone else. Listen to me now and believe me later: The medical playing field is NOT level, a small pop. within academia have used the massive publicly funded system to better their own finances not unlike the California railroads barons.

I was thinking about that. It would be almost impossible for me to go to SF and try to build my own private mini-dermpath empire because he probably already has all of Northern CA locked up. Still he can only sign-out so many cases a day. There would have to be something left over for me, unless he has a few bitches underneath him who work for him...hmmmmm.... Oh well, at least the rest of the west coast is still unclaimed territory. I can go fight it out and try to carve out my little empire in SD, LA, Central Coast, Portland, or Seattle.

It sounds like Alabama and Bostson are off limits too. That's OKAY. NYC is still open. There are just too many people there for one man to control all.

 

[LADoc00]

I was thinking about that. It would be almost impossible for me to go to SF and try to build my own private mini-dermpath empire because he probably already has all of Northern CA locked up. Still he can only sign-out so many cases a day. There would have to be something left over for me, unless he has a few bitches underneath him who work for him...hmmmmm.... Oh well, at least the rest of the west coast is still unclaimed territory. I can go fight it out and try to carve out my little empire in SD, LA, Central Coast, Portland, or Seattle.

It sounds like Alabama and Bostson are off limits too. That's OKAY. NYC is still open. There are just too many people there for one man to control all.

LA is controlled by the ever growing UCLA service, almost as bad as Leboit/UCSF. The UC med centers have really taken notice of Leboit's Robberbaron ways are trying to duplicate it, had UCI held, their empire would have been vast indeed. The Central Coast of Cali from Santa Barbara to South Monterey county is locked up by one group, do an internet search for them. San Diego is fairly open as is the Cali central valley. Portland has Oregon Health Sci but otherwise is wide. Seattle is fairly locked. Booming places like Eastern Oregon, Reno, Suburbian WA state might be more cherry targets.

 

[DarksideAllstar]

Leboit does not warrant that salary. Period. That is a total travesty and a huge hit to the local Bay area private prac crowd who he sucks his biz from. If he were out in private prac with no University affliation he would getting 8-10K/cases a year, still make a solid living but not at the expense of everyone else. Listen to me now and believe me later: The medical playing field is NOT level, a small pop. within academia have used the massive publicly funded system to better their own finances not unlike the California railroads barons.

Whether or not he has managed to "steal" business from NorCal private practice is not what I am addressing. I was addressing whether there is any outright animosity within the dept re: his salary, business practices aside. I'm not in a position to comment re: how much of his income comes from consults (both locally and out-of state), but I am sure it is fairly significant. The question I pose is, why cant the private practice dermpaths sign these cases out without having to send to UC for a friggin consult (assuming that there is a dermpath in the group, and exceptions being esoteric ****, of course)?

 

[dermpathlover]

Whether or not he has managed to "steal" business from NorCal private practice is not what I am addressing. I was addressing whether there is any outright animosity within the dept re: his salary, business practices aside. I'm not in a position to comment re: how much of his income comes from consults (both locally and out-of state), but I am sure it is fairly significant. The question I pose is, why cant the private practice dermpaths sign these cases out without having to send to UC for a friggin consult (assuming that there is a dermpath in the group, and exceptions being esoteric ****, of course)?

He probably does more than just consults. He probably has dermies sending him all their routine cases directly in addition to consults.

**** Consults. I want a piece of the routine action. But if these guys in LA and SF are hoarding all the business then I don't see how a private practice guy can stand a chance, unless he has an all-star winning charismatic personality or offers free b-jobs from strippers to all new clients.

 

[LADoc00]

Watch carefully: Dermatologist Dr. Bob does 100 biopsies 88305s/month, he sends those to his local community hospital, St. Tim's in downtown BFE. The pathologists at good ol' St. Tims maintain their proficiency in skins because they had Dr. Bob's biz. Now Prof. X shows up, he sets up a fellowship where residents must sign a covenant agreement (thought by many to be illegal) that they will never practice with several hundred miles of him. Then Prof. X offers courses for free to local area dermatologists. At the conference he offers to review slides initially for free, wonderful deal! So the dermatologists take him up on it. See Prof. X is initially just a salaried employee of a big U, if he reviews cases for free his income doesnt change. St. Tims cant compete with that.

Then Prof. X re-reviews the work from St. Tim's. In doing so he disagrees with every minute detail of their reports and phones Dr. Bob to tell him his local pathologists are idiots. Dr. Bob is scared about malpractice because Prof. X also is a big expert witness for the local legal scene and begins sending biz to the University. Prof. X's case load is soaring so he renegotiates with the school for a sizable cut of the action, he brings in junior faculty to sign out the easy stuff and he goes about writing books and such.

St. Tims loses the outpatient derm, a year goes by and now theyve lost their edge in looking at skins. They ask for one more chance to get back Dr. Bobs biz so they dont have to fire their younger pathologists, but because they havent seen derm for a year are slow in their reports. Dr. Bob dumps them again, promising never to return. St. Tims downsizes their department, the few senior guys are making much less and decide to stay much longer after 60 than they intended. Residents coming out dont see any job offers locally and are stuck in HMOs with other docs who dont speak English.

All in all, the cycle repeats until the entire Pathology community begins to buckle. Everyone in the community is working too hard for too little pay to make meetings or conferences. Prof. X dominates the discussions, strengthening his position even more. For St. Tim's, mistakes start creeping in, making other departments angry, ruining the rep. of the field in general. Less AMGs enter pathology as a result.

Armageddon essentially.

 

[dermpathlover]

Watch carefully: Dermatologist Dr. Bob does 100 biopsies 88305s/month, he sends those to his local community hospital, St. Tim's in downtown BFE. The pathologists at good ol' St. Tims maintain their proficiency in skins because they had Dr. Bob's biz. Now Prof. X shows up, he sets up a fellowship where residents must sign a covenant agreement (thought by many to be illegal) that they will never practice with several hundred miles of him. Then Prof. X offers courses for free to local area dermatologists. At the conference he offers to review slides initially for free, wonderful deal! So the dermatologists take him up on it. See Prof. X is initially just a salaried employee of a big U, if he reviews cases for free his income doesnt change. St. Tims cant compete with that.

Then Prof. X re-reviews the work from St. Tim's. In doing so he disagrees with every minute detail of their reports and phones Dr. Bob to tell him his local pathologists are idiots. Dr. Bob is scared about malpractice because Prof. X also is a big expert witness for the local legal scene and begins sending biz to the University. Prof. X's case load is soaring so he renegotiates with the school for a sizable cut of the action, he brings in junior faculty to sign out the easy stuff and he goes about writing books and such.

St. Tims loses the outpatient derm, a year goes by and now theyve lost their edge in looking at skins. They ask for one more chance to get back Dr. Bobs biz so they dont have to fire their younger pathologists, but because they havent seen derm for a year are slow in their reports. Dr. Bob dumps them again, promising never to return. St. Tims downsizes their department, the few senior guys are making much less and decide to stay much longer after 60 than they intended. Residents coming out dont see any job offers locally and are stuck in HMOs with other docs who dont speak English.

All in all, the cycle repeats until the entire Pathology community begins to buckle. Everyone in the community is working too hard for too little pay to make meetings or conferences. Prof. X dominates the discussions, strengthening his position even more. For St. Tim's, mistakes start creeping in, making other departments angry, ruining the rep. of the field in general. Less AMGs enter pathology as a result.

Armageddon essentially.

That makes academics seem like a good way to go for subspecialites that are biopsy out-patient clinic based or surgery center heavy, such as GI and urology, hell you could probably get every needle core breast biopsy sent to you.

 

[DarksideAllstar]

Watch carefully: Dermatologist Dr. Bob does 100 biopsies 88305s/month, he sends those to his local community hospital, St. Tim's in downtown BFE. The pathologists at good ol' St. Tims maintain their proficiency in skins because they had Dr. Bob's biz. Now Prof. X shows up, he sets up a fellowship where residents must sign a covenant agreement (thought by many to be illegal) that they will never practice with several hundred miles of him. Then Prof. X offers courses for free to local area dermatologists. At the conference he offers to review slides initially for free, wonderful deal! So the dermatologists take him up on it. See Prof. X is initially just a salaried employee of a big U, if he reviews cases for free his income doesnt change. St. Tims cant compete with that.

Then Prof. X re-reviews the work from St. Tim's. In doing so he disagrees with every minute detail of their reports and phones Dr. Bob to tell him his local pathologists are idiots. Dr. Bob is scared about malpractice because Prof. X also is a big expert witness for the local legal scene and begins sending biz to the University. Prof. X's case load is soaring so he renegotiates with the school for a sizable cut of the action, he brings in junior faculty to sign out the easy stuff and he goes about writing books and such.

St. Tims loses the outpatient derm, a year goes by and now theyve lost their edge in looking at skins. They ask for one more chance to get back Dr. Bobs biz so they dont have to fire their younger pathologists, but because they havent seen derm for a year are slow in their reports. Dr. Bob dumps them again, promising never to return. St. Tims downsizes their department, the few senior guys are making much less and decide to stay much longer after 60 than they intended. Residents coming out dont see any job offers locally and are stuck in HMOs with other docs who dont speak English.

All in all, the cycle repeats until the entire Pathology community begins to buckle. Everyone in the community is working too hard for too little pay to make meetings or conferences. Prof. X dominates the discussions, strengthening his position even more. For St. Tim's, mistakes start creeping in, making other departments angry, ruining the rep. of the field in general. Less AMGs enter pathology as a result.

Armageddon essentially.

1) Excellent work. I applaud your ability to convey the impact of such a scenario, and I am currently brushing up on my FMG vocab skills, such as speaking both louder and slower.

2) So based, on what we had talked about I took a quick peek at the number of cases that come through the UCSF Demrpath service (here ). amd these numbers split, say between 4-5 dermpaths affiliated with UCSF would imply that each is seeing roughly 12K, which is fairly close to the 10K in volume that you are suggesting is reasonable. I do know that LeBoit and McCalmont see more than the others in the group, explaining the disparity between the other dermpath salaries. Any additional thoughts? BTW, the service gets roughly 60K specimens (10K in consults)
for those that were too lazy to follow the link.

I just want to mention that I don't condone shady business practices. I am merely enjoying my half days off by trying to entertain LADoc and improving my inadequate understanding of private practice.

 

[LADoc00]

1) Excellent work. I applaud your ability to convey the impact of such a scenario, and I am currently brushing up on my FMG vocab skills, such as speaking both louder and slower.

2) So based, on what we had talked about I took a quick peek at the number of cases that come through the UCSF Demrpath service (here ). amd these numbers split, say between 4-5 dermpaths affiliated with UCSF would imply that each is seeing roughly 12K, which is fairly close to the 10K in volume that you are suggesting is reasonable. I do know that LeBoit and McCalmont see more than the others in the group, explaining the disparity between the other dermpath salaries. Any additional thoughts? BTW, the service gets roughly 60K specimens (10K in consults)
for those that were too lazy to follow the link.

I just want to mention that I don't condone shady business practices. I am merely enjoying my half days off by trying to entertain LADoc and improving my inadequate understanding of private practice.

There is nothing shady in business or war. The key is not to sit around with your pile of Harvhaad-level diplomas and look like a lost puppy while the world around you ass rapes you into oblivion. Think like a guerilla fighter, read the Book of Five Rings, Che's On Guerilla Warfare, Sun Tzu, Machiavelli....

"You must know there are two ways of contesting, the one by the law, the other by force; the first method is proper to men, the second to beasts; but because the first is frequently not sufficient, it is necessary to have recourse to the second. Therefore it is necessary for a prince to understand how to avail himself of the beast and the man. "

 

[DarksideAllstar]

There is nothing shady in business or war. The key is not to sit around with your pile of Harvhaad-level diplomas and look like a lost puppy while the world around you ass rapes you into oblivion. Think like a guerilla fighter, read the Book of Five Rings, Che's On Guerilla Warfare, Sun Tzu, Machiavelli....

"You must know there are two ways of contesting, the one by the law, the other by force; the first method is proper to men, the second to beasts; but because the first is frequently not sufficient, it is necessary to have recourse to the second. Therefore it is necessary for a prince to understand how to avail himself of the beast and the man. "

I feel like Daniel to your Miyagi.