Dermpath practice settings

[mario2010]

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My question is to current fellows and practicing dermatopathologists. What kind of practice setting you are looking into/ currently working:

a) 100% dermpath

b) Dermpath with general surgical pathology

c) Dermpath + surg path + CP responsibilities

Any input on salaries at the entry level in different settings would be very helpful.

Thanks,

 

[Gunneria]

bump

 

[caffeinegirl]

I work in a private practice group doing surg path/cyto+dermpath+little CP. I serve as one of the subspecialists in the group that act as a consultant for skin biopsies that the others may receive, and also as one of the dermpath people who reads the dermatologist-performed skin biopsies.

Entry level salaries depend on many factors including
private vs. academic
partnership vs. nonpartnership
geographic location

When I was looking for jobs about a year ago, the starting salary for commercial lab and private lab dermpath only nonpartnership was about mid 300's. Academic dermpath +/- surgpath was around 180-low 200's, and partnership track in private practice was low 200's. As for geography, sometimes it was a difference of 10-50K in "desirable" coastal cities vs. other.

 

[LADoc00]

Any notice dermpath opportunities are becoming more and more pure Pod-lab focused?

Page after page of newsletters with DP-Pod lab jobs with no opportunity for advancement is making me think dermpath is really dying.

Im sure they are more than enough interested (debt-burdened) newly minted fellows to keep the pods alive too.

 

[caffeinegirl]

Any notice dermpath opportunities are becoming more and more pure Pod-lab focused?

Page after page of newsletters with DP-Pod lab jobs with no opportunity for advancement is making me think dermpath is really dying.

Im sure they are more than enough interested (debt-burdened) newly minted fellows to keep the pods alive too.

It also doesn't help the field that many of the large commercial labs now have their own fellowship programs..(ie. Ameripath and Caris). The future of dermpath as a field in which research/academics is a focus is on the decline. More and more fellows go straight to the commercial/pod labs... Not that I blame them, given the debt they incur and the fact that many academic dermpath positions are purely money-makers for the department, without research time or funds. I think being a path/dermpath in a pod lab can be a really depressing job (akin to being a path in a urologist practice)...however, a derm/dermpath who can do clinical derm and read slides allows for more leverage when it comes to negotiating partnership status.

 

[2121115]

Any notice dermpath opportunities are becoming more and more pure Pod-lab focused?

Page after page of newsletters with DP-Pod lab jobs with no opportunity for advancement is making me think dermpath is really dying.

Im sure they are more than enough interested (debt-burdened) newly minted fellows to keep the pods alive too.

So few general private practices even get skin biopsies these days that they don't really need a dermpath person. Not to say they wouldn't hire them, but it isn't the huge job market advantage that it used to be. Of the jobs I interviewed for (all traditional private private practice) derm was one thing they said they weren't necessarily looking for.

All of the skin biopsies have been taken up by large derm-path only practices (pod jobs and whatnot). There has been so much consolidation of specimens to just a few derm-only practices that the demand for dermpath (at least outside of the pod job scenario) is not as high these days as it once was. In my experience, lately the job market is favoring heme and GI big time.

 

[Thaitanium]

So few general private practices even get skin biopsies these days that they don't really need a dermpath person. Not to say they wouldn't hire them, but it isn't the huge job market advantage that it used to be. Of the jobs I interviewed for (all traditional private private practice) derm was one thing they said they weren't necessarily looking for.

All of the skin biopsies have been taken up by large derm-path only practices (pod jobs and whatnot). There has been so much consolidation of specimens to just a few derm-only practices that the demand for dermpath (at least outside of the pod job scenario) is not as high these days as it once was. In my experience, lately the job market is favoring heme and GI big time.

I dont know why these in house labs aren't illegal? There is a financial incentive to take more biopsies so that clinicians can profit from the PC and TC component. Can someone clear this up for me?

Thanks.

 

[2121115]

I dont know why these in house labs aren't illegal? There is a financial incentive to take more biopsies so that clinicians can profit from the PC and TC component. Can someone clear this up for me?

Thanks.

Historically, dermpath is a little bit of a different animal than traditional pod labs. Dermatologists have always been trained to read biopsies during residency and many dermpath fellowships train (and may even prefer) dermatology graduates to pathology graduates. This is historical tradition and it has traditionally not been affected by self referral laws. Dermatologists can sign out their own biopsies (and they often do sign out the easy ones). The rise of "true" pod labs is different, so forgive me for in the post above I was referring to the vernacular "pod lab" rather than a true podlab.

In addition to traditional private practice and academic settings, dermatopathologists can practice in dermpath only practices which are composed of dermatopathologists who read slides full time and are not clinician owned.

Also, dermpaths can be part of a group of dermatopathologists. This is where things can get dicey. In one scenario, the dermpath is a full partner physician with the other docs in the practice and is treated equally. This is less common.

Another scenario is where the dermpath is an employee of the dermatology docs and gets paid a salary by them to their read biopsies. In this case the dermatologists make serious $$$ off of the dermpath by paying them a fraction of the total revenue generated by their pathology services. Obviously, in this type of setting the dermpath needs to be a "type B" personality and enjoy working for someone else who is more "type A" and wants to be in charge. Nothing wrong with that if that is what they want. Unlike similar set-ups with GI, GU, etc (which will likely in the future be phased out by removing AP from the in office ancillary services exception) derm-based set-ups like this will likely not go away because of tradition and other factors (which are too much to get into here).

 

[Thaitanium]

Historically, dermpath is a little bit of a different animal than traditional pod labs. Dermatologists have always been trained to read biopsies during residency and many dermpath fellowships train (and may even prefer) dermatology graduates to pathology graduates. This is historical tradition and it has traditionally not been affected by self referral laws. Dermatologists can sign out their own biopsies (and they often do sign out the easy ones). The rise of "true" pod labs is different, so forgive me for in the post above I was referring to the vernacular "pod lab" rather than a true podlab.

In addition to traditional private practice and academic settings, dermatopathologists can practice in dermpath only practices which are composed of dermatopathologists who read slides full time and are not clinician owned.

Also, dermpaths can be part of a group of dermatopathologists. This is where things can get dicey. In one scenario, the dermpath is a full partner physician with the other docs in the practice and is treated equally. This is less common.

Another scenario is where the dermpath is an employee of the dermatology docs and gets paid a salary by them to their read biopsies. In this case the dermatologists make serious $$$ off of the dermpath by paying them a fraction of the total revenue generated by their pathology services. Obviously, in this type of setting the dermpath needs to be a "type B" personality and enjoy working for someone else who is more "type A" and wants to be in charge. Nothing wrong with that if that is what they want. Unlike similar set-ups with GI, GU, etc (which will likely in the future be phased out by removing AP from the in office ancillary services exception) derm-based set-ups like this will likely not go away because of tradition and other factors (which are too much to get into here).

Thank you for the explanation. I understand the dermpath scenario. I was referring to the gastros and uros that are hiring pathologists to come into their office and read their biopsies. I don't know how rampant this is, but wouldn't these clinicians just biopsy EVERYTHING to run up the bill and profit from this (in addition to all the unnecessary immunostains)? So, you're saying this will become illegal in the near future? Hopefully so.

 

[2121115]

... but wouldn't these clinicians just biopsy EVERYTHING to run up the bill and profit from this (in addition to all the unnecessary immunostains)?

Yes. Absolutely.

So, you're saying this will become illegal in the near future? Hopefully so.

I hope so. Nothing is for certain. There is a big push to get anatomic pathology taken out of the in office ancillary services exception to the Stark Law. However, as you obviously have gathered, there is much opposition to this. Pathologists want it taken out; gastros and uros don't. There is much political maneuvering to be done, but people are working on it. I recommend reading the STATline publication that CAP sends out periodically. There is good information there, particularly if you can read between the lines.

 

[Gunneria]

that blows...if a dermpath starts at 200k at partnership-track, where could he end up as partner?

 

[Unty]

that blows...if a dermpath starts at 200k at partnership-track, where could he end up as partner?

Dude your obsession with money is unbelievable. From wanting to do radiology, radiation oncology to consulting. Ive seen several of your posts...if you want big bucks go into business. Successful business types trump docs any day of the week.

 

[zao275]

Yes. Absolutely.



I hope so. Nothing is for certain. There is a big push to get anatomic pathology taken out of the in office ancillary services exception to the Stark Law. However, as you obviously have gathered, there is much opposition to this. Pathologists want it taken out; gastros and uros don't. There is much political maneuvering to be done, but people are working on it. I recommend reading the STATline publication that CAP sends out periodically. There is good information there, particularly if you can read between the lines.

Great points. I would also recommend becoming a member of the CAP Advocacy Network (PathNET). Attend CAP Advocacy training school in DC. Donate to PathPAC. If we want things to be different, then we need to get involved and do something about it. NO ONE ELSE will do this for us. If pathologists don't defend our patients and our specialty from inappropriate activities and abuses, then no one will.