Dermpath Salary In PP and Academia?

[Path or bust]

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It could be the worst. Hard to say.

HA!

You guys are being more ambiguous than an MCAT verbal passage (those things always garbled my mind).

 

[Unty]

It could be the worst. Hard to say.

If you can read more slides per hour that in any other surgical path subspec. and biopsies are abundant, you would want to be in that field when those 88305s decline. How can dermpath be the worst field to go into if reimbursements decline?

 

[djmd]

If you can read more slides per hour that in any other surgical path subspec. and biopsies are abundant, you would want to be in that field when those 88305s decline. How can dermpath be the worst field to go into if reimbursements decline?

Well what if they change the rules regarding the billing coding of skins. What if all non-neoplastic skin is coded at 88303 or 88302?

 

[docbiohazard]

If you can read more slides per hour that in any other surgical path subspec. and biopsies are abundant, you would want to be in that field when those 88305s decline. How can dermpath be the worst field to go into if reimbursements decline?

Perhaps many other path residents have the same thought, perhaps many derm residents complete a DP fellowship so they can read their own slides, perhaps all of this happens and there is a glut of DPs in 10-20 years... maybe the germans build a laser scanner device that makes the bulk of skin biopsies obsolete...

It could be the best, it could be the worst...

BH

 

[Arctic Char]

daaa . . . those pesky germans!

 

[yaah]

What if reimbursement changes so that you get paid for how much you actually work, and not how many cases you actually see? What if salaries normalize between subspecialties due to reimbursement changes? What if people doing the hiring decide they need fewer dermpaths because 75% of dermpath (if not more) can be done by people who have done 1-2 months of training in it?

The people best positioned will likely be those who chose their career path because it is something they enjoy doing, and that they are stimulated to do. Because if you have more of a passion for something you are likely to be more successful at it. If you're just in it to make money, well, people like that are a dime a dozen.

 

[DarksideAllstar]

daaa . . . those pesky germans!

Cartman : Mom, have you ever been in a german schiza (sic) movie?
Cartman's mom: No, dear.

 

[KeratinPearls]

What if reimbursement changes so that you get paid for how much you actually work, and not how many cases you actually see? What if salaries normalize between subspecialties due to reimbursement changes? What if people doing the hiring decide they need fewer dermpaths because 75% of dermpath (if not more) can be done by people who have done 1-2 months of training in it?

The people best positioned will likely be those who chose their career path because it is something they enjoy doing, and that they are stimulated to do. Because if you have more of a passion for something you are likely to be more successful at it. If you're just in it to make money, well, people like that are a dime a dozen.

I always wondered how does Medicare decide which fields will receive reimbursement cuts? When they do cut reimbursement, who makes the decision how much will be axed?

If someone could educate me, that would be great.

Thanks a lot.

 

[djmd]

I always wondered how does Medicare decide which fields will receive reimbursement cuts? When they do cut reimbursement, who makes the decision how much will be axed?

If someone could educate me, that would be great.

Thanks a lot.

Even better if someone could educated the people who make those decisions, that would be great.

Thanks.

 

[Arctic Char]

I always wondered how does Medicare decide which fields will receive reimbursement cuts? When they do cut reimbursement, who makes the decision how much will be axed?

Well first, these guys have to figure out what exactly it is . . . ya do here

 

[djmd]

Well first, these guys have to figure out what exactly it is . . . ya do here

Well that's Dr. Cox... and I don't know the guy on the right..

 

[Matte Kudesai]

Well that's Dr. Cox... and I don't know the guy on the right..

I thought with your cool blue hair, goatee, mug of beer and second generation ipod stylings.... you would know about Bob and Bob from OFFICE SPACE.

Watch the movie and learn about it.... Because in a few years most pathologists will be in cubicles passing glasssssssss for a factory.😉

Pathology is the one field in medicine that seems to best fit Office Space model IMHO.

 

[levels x3]

If we end up following the cubicle model a la Office Space, someone better be Milton...

"...set the building on fire."

...I mean that figuratively of course.

 

[djmd]

I thought with your cool blue hair, goatee, mug of beer and second generation ipod stylings.... you would know about Bob and Bob from OFFICE SPACE.

Watch the movie and learn about it.... Because in a few years most pathologists will be in cubicles passing glasssssssss for a factory.😉

Pathology is the one field in medicine that seems to best fit Office Space model IMHO.

I know the movie, I was being facetious...
After all I am a straight shooter with upper management written all over me..

Just don't ask be about my flair, I don't like to talk about my flair..

 

[Matte Kudesai]

I know the movie, I was being facetious...
.

What does facetious mean?😉

 

[docbiohazard]

This is what I turned up in a search for "german scanners":

 

[CameronFrye]

Well what if they change the rules regarding the billing coding of skins. What if all non-neoplastic skin is coded at 88303 or 88302?

Exactly. Anyone trying to predict the future of medicine is probably going to be wrong (unless you say everything is going to decline!).

 

[yaah]

I always wondered how does Medicare decide which fields will receive reimbursement cuts? When they do cut reimbursement, who makes the decision how much will be axed?

If someone could educate me, that would be great.

Thanks a lot.

The way I assume the process goes is that they get a bunch of people in a room who are given the task to cut spending and improve the political impression of health care. These people come into the room with biases from years of experience with the system, maybe even there are a couple of doctors. Then they tell their flunky interns to write it all up, it gets to be about a billion pages. Then a process of immense whining from all sides starts, and small little niche things get inserted here and there (like how we need to institute a 50% increase on reimbursements for barium enemas because someone on the panel has a brother that runs the company with the exclusive contract for barium or whatever). Other things get cut probably based on lack of whining (they don't care, so ditch it). Then they finally present the bill to congress whereupon they attach 8 billion dollars of pet projects and the language gets further changed because of corruption and bias that is rampant in the system (along with incompetence).

And that's probably why MRIs get reimbursed at such a better rate than reading breast core biopsies. In the next round, they will try to cut funding to radiology, I'm sure. Depending on how much whining goes on and who is doing the whining, they probably will to some extent.

 

[docbiohazard]

I have heard stories similar to this, like some congressman (or congressional family member) wound up with kidney disease and needed dialysis... and the kidney disease foundations got together and made this case about how kidney disease robbed people of productivity during their young productive years, and this was a national tragedy, so boom, dialysis suddenly got very favorable reimbursement terms under medicare/medicaid, and that led to the boom in dialysis centers... I also know that the OB/Gyn department at my medical school was perhaps the only profitable department, thanks to the 100% coverage of pregnant women by medicaid (or medicare, I can never keep the two straight)...

BH

 

[Nilf]

The way I assume the process goes is that they get a bunch of people in a room who are given the task to cut spending and improve the political impression of health care. These people come into the room with biases from years of experience with the system, maybe even there are a couple of doctors. Then they tell their flunky interns to write it all up, it gets to be about a billion pages. Then a process of immense whining from all sides starts, and small little niche things get inserted here and there (like how we need to institute a 50% increase on reimbursements for barium enemas because someone on the panel has a brother that runs the company with the exclusive contract for barium or whatever). Other things get cut probably based on lack of whining (they don't care, so ditch it). Then they finally present the bill to congress whereupon they attach 8 billion dollars of pet projects and the language gets further changed because of corruption and bias that is rampant in the system (along with incompetence).

And that's probably why MRIs get reimbursed at such a better rate than reading breast core biopsies. In the next round, they will try to cut funding to radiology, I'm sure. Depending on how much whining goes on and who is doing the whining, they probably will to some extent.

Scary. Where do you get your assumptions from? Do you know any insiders involved in the process?

Seriously, this is communism under a thin veil. Once medicare goes bellyup, Congress will have a choice of (1) raise taxes, and further push the county toward the Scandinavian model, or (2) ditch medicare allthogether and let the free market dictate who should get the priority.

 

[Matte Kudesai]

And that's probably why MRIs get reimbursed at such a better rate than reading breast core biopsies.

This is what is inane about the system. Anything with whizzz bang technology will get reimbursement at a higher rate.

Why do inexpensive, definitive, Gold Standard tests get such crappy reimbursement?

Is there some sort of conspiracy with ties to R&D and the military industrial complex?

 

[yaah]

This is what is inane about the system. Anything with whizzz bang technology will get reimbursement at a higher rate.

Why do inexpensive, definitive, Gold Standard tests get such crappy reimbursement?

Is there some sort of conspiracy with ties to R&D and the military industrial complex?

No, I think it's more of technology outpacing legislation. When legislation catches up with radiology, reimbursement will surely plummet there just like in every other field. MRIs used to be more rare and esoteric, so they were expensive. Same with CTs even. Most of what pathologists do has been around for decades. When flow came out the billing practices were excessive and reimbursement was astounding. But no longer. I am a little surprised that molecular testing hasn't led to higher reimbursements, but it's probably because the manufacturers of the tests and test kits control so much and they make all the profits, there isn't really any left to squeeze out.

When something becomes routine and mainstream the profit per test will go down. MRIs aren't far off, I would bet.

Scary. Where do you get your assumptions from? Do you know any insiders involved in the process?

I am just a pessimist when it comes to government and their actual desire to do well on behalf of who they represent. And also, I just assume that is how it works based on the few politicians I know and how sleazeball and hypocritical they tend to be. Witness the disgusting pandering about an 18 cent gas tax "holiday" they are currently falling all over themselves to put forward. Politicians suck ***.

 

[CameronFrye]

I was interested in radiology at one time and still receive emails from AuntMinnie. In today's email, they noted that radiologist salaries actually dropped this year in their newest survey. Although possibly just a temporary blip, it goes to show that no specialties are going to be immune from price pressures.

 

[Arctic Char]

so are dermpath incomes typical large simply due to volume, or are the biopsies of skin billed at a higher rate per specimen?

 

[djmd]

so are dermpath incomes typical large simply due to volume, or are the biopsies of skin billed at a higher rate per specimen?

It is a number of factors, due mostly to a favorable ratio of time spent per/ bx and the relative strength in CPT coding...
But their BX aren't code any higher than most other BX...

 

[deltamed]

Is it easier to get a dermpath fellowship coming from derm or path?

Is it easier to setup a lucrative practice as a derm->dermpath because you "know" all the dermatologists in the community and get referals and consults easier?

Who makes the better dermpath in general? I would think pathologists have broader experience reading slides and therefore might be better at it; altough dermatologists have more clinical correlation experience.

 

[Patrick O]

Is it easier to get a dermpath fellowship coming from derm or path?

Is it easier to setup a lucrative practice as a derm->dermpath because you "know" all the dermatologists in the community and get referals and consults easier?

Who makes the better dermpath in general? I would think pathologists have broader experience reading slides and therefore might be better at it; altough dermatologists have more clinical correlation experience.

Ah! The age old question. I hesitate even trying to answer. I will only reply to the first and last questions you pose. My feeling is that it is up to the individual, no matter what background, which ultimately determines how good he/she is in dermpath. Whether you are MD, DO, foreign grad, dermatologist or pathologist.

I am a pathology resident, and personally I feel that my training has been excellent in all areas of pathology especially soft tissue and hematologic. From my personal experience (which is obviously somewhat limited) I have seen a few dermatology trained residents struggle when approaching cutaneous lymphomas and soft tissue neoplasms because these require a breath of knowledge that a pathology trained individual has been exposed to over the course of 4 years of training. Personally, I will have 5 months of heme training after I've competed residency this year, not to mention many months of surgpath, cytology, and other AP electives. I will say that path trained dermpaths have to play catch-up a bit when it comes to ddx of inflammatory conditions. Dermatology trained dermpath fellows are initially much better at classifying inflammatory lesions in the beginning of their dermpath training.
To reiterate, I believe both training backgrounds bring a unique perspective to signout at the microscope, but in the end they are each just as good.

 

[LADoc00]

Is it easier to get a dermpath fellowship coming from derm or path?

Is it easier to setup a lucrative practice as a derm->dermpath because you "know" all the dermatologists in the community and get referals and consults easier?
for an outpatient histology lab, being able to employ histotechs, transcription etc and actually having the volume to be able support your cash flow needs.
Who makes the better dermpath in general? I would think pathologists have broader experience reading slides and therefore might be better at it; altough dermatologists have more clinical correlation experience.

it would be easier to set up a lucrative practice as a derm IF you knew how to do such. That would imply knowledge of licensure

So in theory yes it is easier for a dermy to slide into a new dermpath practice of their own, but it is not very practical in reality and rarely happens nowadays, in fact almost never in my experience.

The dermpath experience dermies get although great for common dermpath lesions falls far short of what you would need to nail very rare lesions such as metastatic renal cell to skin, metastatic soft parts sarcoma to skin and cutaneous lymphomas etc. Because path is sort of unique in terms of willingness to get 2nd opinions from academia, a solo dermy IMO is very prone to flailing in the community setting.

Anyone with extremely solid biz skills can become wealthy in almost any field of medicine, although some are going to be far more of a challenge than others. There are pediatricians who yank down 7 figs, ODs who pull down 2 mil a year and dermpaths who muck around with a measely 150K a year to show for their training so IMO do what you love and be smart about it.

Conclusion: Dermpath fellowship will NOT compensate for your total lack of biz skills, in fact it will only amplify 'The Total Fail' of your professional endeavor.

 

[NPR]

I'll be honest with you, I love his music, I do, I'm a Michael Bolton fan. For my money, I don't know if it gets any better than when he sings "When a Man Loves a Woman".

 

[Arctic Char]

I'll be honest with you, I love his music, I do, I'm a Michael Bolton fan. For my money, I don't know if it gets any better than when he sings "When a Man Loves a Woman".

i celebrate his entire collection.

 

[Long Dong]

It is a number of factors, due mostly to a favorable ratio of time spent per/ bx and the relative strength in CPT coding...
But their BX aren't code any higher than most other BX...

So how much do you get paid per slide? I've heard it was ~$75, but now more like ~$35, so what is the current rate?

 

[2121115]

So how much do you get paid per slide? I've heard it was ~$75, but now more like ~$35, so what is the current rate?

No one gets paid per slide. We get paid per specimen, which includes gross and microscopic evaluation. Some specimens may have 10 slides and some may have 1 or 2. Different types of specimens get reimbursed different amounts.

 

[cheesebrie]

at the current economy, ANYTHING can change. For DP, I don't think going down to <$35/specimen for the routine cases is entirely unreasonable. After that... $25... after that $10....then....outsourcing?! Doesn't sound completely impossible either. This economy can get anyone pessimistic....

 

[ih8biochem]

Outsourcing to who? Non US board certified international docs? Send entire specimens overseas?

 

[2121115]

Since some here don't really seem to understand how pathologists bill for their services and get paid, here is a question. Does your program educate you on these things? I think they should. My program makes residents code (both CPT and ICD-9, etc) for each case when we dictate the case; maybe that is not the case everywhere. I would think that most every resident in my program knows exactly what the codes mean and has a decent idea what each code reimburses. I imagine most of the posters here who don't get it are probably med students though.


As a side note, FWIW, reimbursement for all physicians is dropping because the total lump sum amount that gets allotted by the government for medicare's CPT reimbursement (which is how every specialty bills) decreases every year; it doesn't even keep up with inflation, it actually goes down. In other words, the total pot out of which every code gets paid shrinks. Think about it. I'm no math guy, but if inflation is 3% per year (which it is much higher lately) and your income stays the same over 12 years, that is a 36% drop in real purchasing power. What about over a 25 year career? And that is if your income stays the same. How much purchasing power do you lose if your income actually goes down? Much more than that unfortunately. I wish they would at least index to inflation, but its not going to happen.

 

[scurred]

to answer the original question simply without everyone getting into a hussy...

the average "salaried" dermpath makes more than the average "salaried" (?)path

 

[malchik]

Great, but that wasn't the original question (April 2008) nor the more recent question posed by LongDong. . .

 

[scurred]

the answer to longdongs question is the following

slide reimbursement actually depends a lot on where you are located...for example the cost of reading a slide in new york is more expensive and reimbursed more than reading a slide in jackson, miss

dermpath slides don't really get reimbursed more, just think about it the same way that dermatologists don't get reimbursed more, its just that the majority of their cases are non-emergency and out of pocket expense...so are the dermpath cases...

Great, but that wasn't the original question (April 2008) nor the more recent question posed by LongDong. . .

 

[KeratinPearls]

the answer to longdongs question is the following

slide reimbursement actually depends a lot on where you are located...for example the cost of reading a slide in new york is more expensive and reimbursed more than reading a slide in jackson, miss

dermpath slides don't really get reimbursed more, just think about it the same way that dermatologists don't get reimbursed more, its just that the majority of their cases are non-emergency and out of pocket expense...so are the dermpath cases...

longdong is asking a basic question. How much does an 88305 currently pay?

dermpath cases are out of pocket (cash)? I think you got it all wrong. Botox is out of pocket. Patients don't come to you with a wad of benjamins for all the biopsies you read.

 

[pathstudent]

longdong is asking a basic question. How much does an 88305 currently pay?

dermpath cases are out of pocket (cash)? I think you got it all wrong. Botox is out of pocket. Patients don't come to you with a wad of benjamins for all the biopsies you read.

It varies from market to market but I think it is about $40 in most places for the PC.

 

[Long Dong]

Since some here don't really seem to understand how pathologists bill for their services and get paid, here is a question. Does your program educate you on these things? I think they should. My program makes residents code (both CPT and ICD-9, etc) for each case when we dictate the case; maybe that is not the case everywhere. I would think that most every resident in my program knows exactly what the codes mean and has a decent idea what each code reimburses. I imagine most of the posters here who don't get it are probably med students though.

Yes I don't understand how pathologist bill for their services. My program does educate me on these things but I haven't done my dermpath rotation yet so billing for dermpath is still a ? for me. I've only billed for patients I've seen in clinic. I do look at dermpath everyday though mostly with the fellow or attending. I look at everything I cut out and trust me I cut out a ton of stuff everyday. And no i'm not a med student.

longdong is asking a basic question. How much does an 88305 currently pay?

Yes thank you.

It varies from market to market but I think it is about $40 in most places for the PC.

Thanks

 

[gavilan]

What is the salary of a dermpath in PP vs. academia? What is the future of dermpath?

Academic dermpath pwns PP, and is the future of dermpath:
http://www.nytimes.com/imagepages/2009/02/23/us/23pay_graph.html

 

[KeratinPearls]

Academic dermpath pwns PP, and is the future of dermpath:
http://www.nytimes.com/imagepages/2009/02/23/us/23pay_graph.html

Dude, those dermpaths are experts just like Leboit. It takes years and lots of publications, presentations to get to that level. These ppl have put in lots of effort, committment, sacrifice to get to where they are. In addition, I'm sure these ppl are super bright.

Not all academic dermpaths make nearly that much. Starting salary for academic dermpaths are most likely very good as compared to general surgical pathologists in academia. The same can be said of in private practice.

Experts in most fields (not just medicine) can make boatloads of money.

 

[djmd]

longdong is asking a basic question. How much does an 88305 currently pay?

dermpath cases are out of pocket (cash)? I think you got it all wrong. Botox is out of pocket. Patients don't come to you with a wad of benjamins for all the biopsies you read.

As funny as that image, it was immediately followed by an even funnier image, patients try to slip you a little something extra to read their slides...
"Would Mr. Jackson change your mind?"

 

[2121115]

Yes I don't understand how pathologist bill for their services. My program does educate me on these things but I haven't done my dermpath rotation yet so billing for dermpath is still a ? for me. I've only billed for patients I've seen in clinic. I do look at dermpath everyday though mostly with the fellow or attending. I look at everything I cut out and trust me I cut out a ton of stuff everyday. And no i'm not a med student

Sorry, I didn't realize you were a dermatology resident. Yeah, an 88305 pays about $35-36 per case for the professional component (not per slide as was mentioned earlier). Dermpath can potentially pay more than general path because derm cases are, generally, faster and easier than other pathology cases (certainly not all of them are easier, but the common sk's, ak's, squams, basal's, etc). Therefore, a dermpath can sign out more cases per unit time than a general path who is looking at other types of biopsies that reimburse the same but take longer or require more work up.

Again I didn't realize that you weren't a path resident. Path residents are usually pretty familiar with the 88305. Also, contrary to what was posted earlier, my understanding is that an 88305 reimburses the same professional component in New York or Georgia or Wyoming or California.

 

[PathDr]

Here is my understanding of payment for 88305 according to the most recent edition of CAP Today.
{(Work RVU x Work GPCI) + (Transitioned PE RVU + PE GPCI) + (MP RVU x MP GPCI)} x Conversion Factor (CF) = Physician Fee Pay Amount
Where (for 88305):
Work RVU = 0.75
Transitioned PE RVU = 2.06
MP RVU = 0.07
2009 Conversion Factor = 36.0666
The GPCI components are geographically variable. I found a website where you can enter your CPT code and location within the country and it will tell you what the physician fee pay is as well as the professional component.
http://www.cms.hhs.gov/PFSlookup/02_PFSSearch.asp#TopOfPage
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