Disillusioned, need help staying motivated for AP

[CDX-2]

Greetings,

this is my 1st post on SDN.

I'm currently an Australian AP registrar (resident), and am about to finish my 2nd year (out of a 5 year training program).

I did my first 2 years rurally, but I got matched to another rural lab for 3rd year, which is extremely unusual, despite me preferencing it very low because it has a reputation for cut-up / grossing for 5 days / week, for both registrars. There'll be very little time to practice reporting cases or preparing slides for multidisciplinary meetings.

The rationale for sending me to such a lab was apparently because my Histology knowledge was sub-par.
But that was because the current lab I'm at is understaffed, and I had to do scut work that is usually done by scientists / lab techs, most notoriously the accessioning and block-printing (up to TEN hours / week), which gets slowed down with shoddy IT infrastracture. I also had to deal with two co-registrars resigning, which meant I had to do more cut-up / grossing whilst the new co-registrar is learning cut-up.

I fell behind in my reporting count, and was really hoping to move to a lab where I can alternate reporting / cut-up days, but instead I got sent to a place where I'll be doing even more cut-up. It makes no sense to me.

I feel like this arrangement has been unfair, coz I feel like I'm penalized for the consequences of an understaffed (corporatized) lab. I did message the powers that be about what I've been through, but they didn't budge. Atm I feel like the College doesn't care about me.

I'm disillusioned and concerned about physical (RSI) and/or mental burnout.

I dunno if it's worth sacrificing these years studying for exams when the job market in Australia is already relatively saturated. Rural areas can only absorb so many new consultants / attendings. And I keep reading about how labs cut staff, or even shut down labs.

I think the material is intellectually stimulating, but I'm just sick of how the workplace is understaffed and corporatized, and the Pathologists seem to get treated like servants / waitresses by a lot (but not all) of the surgeons. I've also seen very senior Pathologists get fired, and not out of malpractice...

I can't see myself applying for Radiology or any other specialties as I'm nowhere near competitive, and my clinical medicine skills have atrophied since my general medical resident year. I feel like I've entered a trap / limbo.

The role of a "Pathologist's Assistant" doesn't officially exist in Australia, although there are a few public hospitals that have scientists doing cut-up of Bowel and Breast Cancers, but those positions are very limited.

Any advice would be much appreciated,
thank you in advance.

CDX-2

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[Spikebd]

Waiting for thrombus, mikesheree and LADoc00 like

 

[LADoc00]

The pay in Australia in general is garbage with a cost of living in places like Sydney roughly comparable to Los Angeles!

And the population is minuscule, sub 25 million, substantially less than just California.

Australia has "Medicare for all", literally that is name! Imagine a world where Bernie Sanders went full Crocodile Dundee and took over an entire empire in his image with Medicare for all and then implemented the largest gun confiscation since the 1956 Cambodian gun ban that lead indirectly to rise of the Khmer Rouge.

Your entire nation is literally a recipe for enslavement, so step 1 would be plot your escape from the Queen's prison island.

I would try to make my way to Canada, then to freedom south of border eventually. But even Canada is better and pathologists are actually in demand there from the last I heard.

Australia is a recipe for Pathology fail. A tiny group of enslaved government glass monkeys could easily man a consolidated mega lab or 2 and read the material for all 25 million. That is not even remotely far fetched for a place that socially engineered the only modern nationwide gun confiscation in a supposed full participatory democracy non-totalitarian state in HUNDREDS OF YEARS. With that tier of government mind control running, the sky is the limit!

Medicine in general is a garbage career path in a system like that. Pathology being surgery slaves is nothing new or even unique my friend. That is highly dependent on you the person/man.

Before I give you a specific attack plan:
1.) gender? this is very important not necessarily for plan objectives, but modes of operation.
2.) ethnicity? also very important, are you an Anglo Australian or non-Anglo?

overall the whole "Im burnt out, woe is me" is weak sauce. Ive worked 16 hour days for months on end with no day off AFTER training, so that is sort of self pity that has no ear with me.

Unless they are physically beating you when you show up to work, depriving you of any night rest in some Kafkaesque Abu Ghraib prison nightmare, you can take it. Trust me, your half starved ancestors killed tusked boars with sharpened sticks in the freezing cold to survive and evolve to you. Forget the "no one love me" B.S. and come up with a winning strategy to move on and make money.

Your entire op screams "Im having a very bad day and already decided the only path forward is full EMO." We have all been there at some point, take a deep breath, maybe have some drinks and smoke up?

 

[CDX-2]

The pay in Australia in general is garbage with a cost of living in places like Sydney roughly comparable to Los Angeles!

And the population is minuscule, sub 25 million, substantially less than just California.

Australia has "Medicare for all", literally that is name! Imagine a world where Bernie Sanders went full Crocodile Dundee and took over an entire empire in his image with Medicare for all and then implemented the largest gun confiscation since the 1956 Cambodian gun ban that lead indirectly to rise of the Khmer Rouge.

Your entire nation is literally a recipe for enslavement, so step 1 would be plot your escape from the Queen's prison island.

I would try to make my way to Canada, then to freedom south of border eventually. But even Canada is better and pathologists are actually in demand there from the last I heard.

Australia is a recipe for Pathology fail. A tiny group of enslaved government glass monkeys could easily man a consolidated mega lab or 2 and read the material for all 25 million. That is not even remotely far fetched for a place that socially engineered the only modern nationwide gun confiscation in a supposed full participatory democracy non-totalitarian state in HUNDREDS OF YEARS. With that tier of government mind control running, the sky is the limit!

Medicine in general is a garbage career path in a system like that. Pathology being surgery slaves is nothing new or even unique my friend. That is highly dependent on you the person/man.

Before I give you a specific attack plan:
1.) gender? this is very important not necessarily for plan objectives, but modes of operation.
2.) ethnicity? also very important, are you an Anglo Australian or non-Anglo?

overall the whole "Im burnt out, woe is me" is weak sauce. Ive worked 16 hour days for months on end with no day off AFTER training, so that is sort of self pity that has no ear with me.

Unless they are physically beating you when you show up to work, depriving you of any night rest in some Kafkaesque Abu Ghraib prison nightmare, you can take it. Trust me, your half starved ancestors killed tusked boars with sharpened sticks in the freezing cold to survive and evolve to you. Forget the "no one love me" B.S. and come up with a winning strategy to move on and make money.

Your entire op screams "Im having a very bad day and already decided the only path forward is full EMO." We have all been there at some point, take a deep breath, maybe have some drinks and smoke up?

Hello LADoc00,

thank you for your reply.

Firstly, I'm a single Asian male, but I'm legally an Australian citizen as I was born in Australia. English is my 1st language.

I'm 30 years old, and I have zero university debt ($AU 60K for entire med school tuition paid off) and no mortgage.

However, I'm helping my dad pay off a housing construction (on land that he already owns, which I'll eventually inherit), which I think will be $300K, so I suppose you could call that debt...

The wages in Australia are higher, but so is the cost of living.
Current minimum wage in Australia is ~$AU 18 / Hr.
I'm currently paying $1300 / month for rent in a RURAL area (Sydney's inner city rent would probably be $1800 - 2000 / month).

I think the only places in America comparable to Australia in terms of prices would be ?Hawaii and ?San Francisco.

Australia's Medicare is basically like America's "Medicaid" but it applies to all Australian citizens and permanent residents.
There's also a large private health sector, which people use for elective surgeries if they have private health insurance.
The Medicare reimbursement / rebate values for Histology are ~40-50% undervalued compared to the mid-1990s.

Australian pathology is becoming increasingly privatized, with a few companies owning major share of the private market:

Sonic Healthcare (also owns labs in America, Switzerland and Germany?!)
Primary Health (largest shareholder is actually some Chinese healthcare company)
Australian Clinical Labs (owned by a private equity firm called Crescent Capital)

Despite the decreasing rebate values in real terms, I have a suspicion that the Australian Medicare system is financially unsustainable,
especially with an ageing population and increasing unemployment / underemployment. The mining boom in Western Australia is over.

~~~

I was considering Canada, but I read their forums that AP is also saturated, and also their healthcare system is even more public than Australia.
My impression was that the Canadian private sector was restricted to plastics / cosmetic medicine, and that Canadian pathologists are all salaried.

Also I thought I'd have to learn French (even if not applying for a position in Quebec) just to be competitive against the local Canadian graduates.

 

[Centropyge]

Hi CDX2. I'm an Australasian AP trainee also. Whilst I've heard of situations similar to the one you've described (being overwhelmed by grossing and other mundane tasks etc), your situation sounds particularly excessive. Are you geographically flexible? If so, sounds like you need to move elsewhere! Where I'm training, I'm never in the cut up room more than two days per week, often just once a week. PM me if you want more details.

 

[CDX-2]

Hi CDX2. I'm an Australasian AP trainee also. Whilst I've heard of situations similar to the one you've described (being overwhelmed by grossing and other mundane tasks etc), your situation sounds particularly excessive. Are you geographically flexible? If so, sounds like you need to move elsewhere! Where I'm training, I'm never in the cut up room more than two days per week, often just once a week. PM me if you want more details.

Hi Centropyge,

I can't seem to pm you. But it sounds like you're training in New Zealand if you only have to do grossing once or twice a week. Am I right...?

Addit: If you're training in New Zealand, I've already asked about it and all the AP spots are full for 2019. I got told that there were a few female AP registrars that got pregnant and then took maternity leave, but couldn't get back into the New Zealand system coz the labs hired new trainees instead!!!

 

[Centropyge]

Yes I'm an NZ trainee. Regarding the pregnant registrars not getting their job back, that is not possible due to NZ maternity leave laws.

 

[CDX-2]

Yes I'm an NZ trainee. Regarding the pregnant registrars not getting their job back, that is not possible due to NZ maternity leave laws.

Oh ok, I might've misheard about the pregnant NZ registrars.

But yes I was exceedingly envious when I heard that NZ registrars only have to do grossing once or twice / week.

In Australia this would be very unusual unless you were at a large tertiary/metropolitan lab with 3 or more registrars, and then it'd be grossing twice / week at best, with the registrars not on grossing duties being on-call for autopsies / frozen sections / FNAs / reporting.

I wouldn't be surprised if NZ registrars had a much higher exam pass rate than Australian registrars!

The NZ registrar pay looks like ~2/3 to 3/4 of Australian registrars' pay, but I would've been happy to consider applying given the increased opportunities to study and report histology.

 

[Centropyge]

In NZ, AP trainees are amongst the lowest paid amongst all the different specialties. This is because AP trainees work fewer hours per week than medical/surgical/paediatric/(pretty much any other) trainees, and all trainees in NZ are paid strictly according to number of hours worked and seniority. However, in the public health system, fully qualified anatomical pathologists are amongst the highest paid of all specialties (but that's an entirely different topic).

Anyway, we need to find a way to PM so I can feel comfortable giving more specific advice. AP in NZ represents such a small group of people it's hard to be anonymous.

 

[CDX-2]

In NZ, AP trainees are amongst the lowest paid amongst all the different specialties. This is because AP trainees work fewer hours per week than medical/surgical/paediatric/(pretty much any other) trainees, and all trainees in NZ are paid strictly according to number of hours worked and seniority. However, in the public health system, fully qualified anatomical pathologists are amongst the highest paid of all specialties (but that's an entirely different topic).

Anyway, we need to find a way to PM so I can feel comfortable giving more specific advice. AP in NZ represents such a small group of people it's hard to be anonymous.

I can't PM you coz it says that you restrict which people can view your profile.

In Australia, I'm officially rostered and paid for 43 hours / week, but because of all the scut work at my current lab, I end up physically being in the lab for ~50 hours / week.

Unlike surgical registrars (who can do overnight admissions or extra theatre scrubbing), I'm not allowed to claim unrostered overtime however.

Addit: You have to click on your profile and edit your "Privacy" settings to enable others to have conversations with you.

 

[LADoc00]

CDX glad you connected with someone on here, step 1: you are not alone.

Im not sure I understand the entire "helping your dad with his house" thing. Are you co-deeded on the property? I love my parents too, but until I had my financial situation on lockdown, I never helped anyone. Financially, this is akin to putting on your oxygen mask on a plane before you put your kids' masks on. As a parent, it can seem counter intuitive but if you dont you may all die right?

Also you are falling into a "eventually I will inherit everything" trap which is often easily foiled by a late in life mistress/girlfriend, so caveat emptor.

You dont sound like anywhere close to a position to help out right now, I would re-focus on yourself exclusively. Being single helps.

Also stop focusing on "all I do is grossing all week." Its whining and unworthy of you. Everyone everywhere thinks the same thing at one point or another. The grass is NOT greener anywhere else. Are you grossing 24 solid hours of day with barely enough time to eat, sleep and use the bathrooms? No? Then you have plenty of time to read up on your cases.

1.) End all self pity immediately. You should wake up and be happy you arent in a trench somewhere with crazed ISIS radicals shooting at you. Also be happy you arent being physically or sexually abused at work.
2.) Carve your time meticulously during the day. When I was resident, I could work 14 hours, hit the gym for an hour and still have time to hook up with a girl from the local community college. Plan your day, your week and month even with stern resolve. Time management skills make an average resident a great resident, make a good doctor a legendary one.
3.) Be selfish. Take time every single day to exercise. Everyday. You arent old enough you need to dial it back yet. I dont know what you look like, but I would guess and likely be right you could use 20 lbs of lean muscle on your frame and a drop of baby fat. This is absolutely vital for more things than you can imagine. from physical health to the influence of higher testosterone levels on brain function and social perceptions. You literally be stronger, smarter and garner more respect from colleagues at work. Payoff will be very slow in the making so be prepared.
4.) I would plot slowly an escape to Canada, the pay is far higher and your standard of living much better. Australia is in a particularly weak geopolitical position should China ever decide to exert force with a 1st world blue water navy.


Be lucky you arent in New Zealand as that sounds insane, the lowest paid of all medical specialties? Really? Okay that NZ guy for sure needs to leave.

I would also look very very carefully at possibly going to Singapore. That is almost the promised land, my highest job offer for an employed position EVER was from Singapore and it was insane even with the high cost of living there I would have been a made man for life.

Gluck

 

[Centropyge]

[QUOTE="LADoc00, post: 20544672, member: 5tweak

Be lucky you arent in New Zealand as that sounds insane, the lowest paid of all medical specialties? Really? Okay that NZ guy for sure needs to leave.

I would also look very very carefully at possibly going to Singapore. That is almost the promised land, my highest job offer for an employed position EVER was from Singapore and it was insane even with the high cost of living there I would have been a made man for life.

[/QUOTE]

Pathology trainees are paid poorly only because essentially all trainees in every medical specialty are on the same contract, and that contract pays according to number of hours worked per week. Pathology trainees work relatively fewer hours than almost any other specialty, hence the low pay.

However the story is completely different for fully qualified anatomical pathologists as they are, on average, amongst the most well paid doctors in NZ public hospitals.

 

[deleted314957]

I have never given it any thought but I can now get a sense of just why
an AP residency is 5 years there as opposed to 3 in the US for straight AP
(2 in combined AP/CP). Looks like there is a huge scut load/ cheap labor
routine. But, after 5 years it seems to all come out in the wash. The
Commonwealth trained folks who get boarded seem to be every bit as good or better than their US counterparts. I think you are just going to have to suck it up
for a few. You already have a significant hit against you in that your knowledge
is considered “ sub par”. That is NOT GOOD and you must do whatever it takes to turn that impression around.

 

[Centropyge]

As far as I know, few pathologists here do fellowships, and the ones who do fellowships are encouraged to work as a "general" AP for at least a few years before embarking further training to establish a solid general foundation. So I guess a 5 year training program does make some sense, as most pathologists here are still generalists with sub-specialty interest rather than actual sub-specialists.

FWIW, I think the OP just had really bad luck with his lab allocations. I've rotated through four labs during my training, and I've never spent more than 16 hours/week in the cut up room in any of those labs, usually 8-12 hours/week.

 

[LADoc00]

Pathology trainees are paid poorly only because essentially all trainees in every medical specialty are on the same contract, and that contract pays according to number of hours worked per week. Pathology trainees work relatively fewer hours than almost any other specialty, hence the low pay.

However the story is completely different for fully qualified anatomical pathologists as they are, on average, amongst the most well paid doctors in NZ public hospitals.

Okay that makes more sense. Who cares what you make in residency...Gluck.

 

[CDX-2]

CDX glad you connected with someone on here, step 1: you are not alone.

Im not sure I understand the entire "helping your dad with his house" thing. Are you co-deeded on the property? I love my parents too, but until I had my financial situation on lockdown, I never helped anyone. Financially, this is akin to putting on your oxygen mask on a plane before you put your kids' masks on. As a parent, it can seem counter intuitive but if you dont you may all die right?

Also you are falling into a "eventually I will inherit everything" trap which is often easily foiled by a late in life mistress/girlfriend, so caveat emptor.

You dont sound like anywhere close to a position to help out right now, I would re-focus on yourself exclusively. Being single helps.

Also stop focusing on "all I do is grossing all week." Its whining and unworthy of you. Everyone everywhere thinks the same thing at one point or another. The grass is NOT greener anywhere else. Are you grossing 24 solid hours of day with barely enough time to eat, sleep and use the bathrooms? No? Then you have plenty of time to read up on your cases.

1.) End all self pity immediately. You should wake up and be happy you arent in a trench somewhere with crazed ISIS radicals shooting at you. Also be happy you arent being physically or sexually abused at work.
2.) Carve your time meticulously during the day. When I was resident, I could work 14 hours, hit the gym for an hour and still have time to hook up with a girl from the local community college. Plan your day, your week and month even with stern resolve. Time management skills make an average resident a great resident, make a good doctor a legendary one.
3.) Be selfish. Take time every single day to exercise. Everyday. You arent old enough you need to dial it back yet. I dont know what you look like, but I would guess and likely be right you could use 20 lbs of lean muscle on your frame and a drop of baby fat. This is absolutely vital for more things than you can imagine. from physical health to the influence of higher testosterone levels on brain function and social perceptions. You literally be stronger, smarter and garner more respect from colleagues at work. Payoff will be very slow in the making so be prepared.
4.) I would plot slowly an escape to Canada, the pay is far higher and your standard of living much better. Australia is in a particularly weak geopolitical position should China ever decide to exert force with a 1st world blue water navy.


Be lucky you arent in New Zealand as that sounds insane, the lowest paid of all medical specialties? Really? Okay that NZ guy for sure needs to leave.

I would also look very very carefully at possibly going to Singapore. That is almost the promised land, my highest job offer for an employed position EVER was from Singapore and it was insane even with the high cost of living there I would have been a made man for life.

Gluck

I think I'm co-deeded on the property, will need to double-check when I see them again. I haven't passed them any money yet. I was thinking of maybe putting half of my post-tax earnings into paying off the house and putting the rest in personal savings (for a rainy Day). If I'm legally co-deeded the house + the land that it's on, that means I theoretically won't have to buy property anymore for the rest of my life. $300K to me is a lot of money, but I've been told that for a house and land in inner Sydney or Melbourne these days this is considered very cheap... : S This financial year, I started chipping in a bit of money into my superannuation (Australian equivalent of a 401K) more for the tax benefits, reaching age 65 is quite a while away though...

It's difficult in east Asian cultures to maintain a balance between being independent and engaging in "filial piety"... : (

If the grass isn't greener anywhere else, then how come you recommend Canada?
Or were you just referring to other training labs whilst being a registrar / resident?

Yes I could theoretically consider Singapore too, I actually have some family there but I'm not a Singaporean citizen (hence I didn't have to do National Service). I can't stand the hot weather though, and the environment feels much more conservative and stifling than Australia (even though it's much safer thanks to their no-nonsense government). Singapore job openings seem to be very scant though, plus they also have their own trainees. But it sounds like their consultant jobs pay lots of $$$, which works out to be even more given their low tax rates...

Yes you're right, I'm thin. I've never weighed more than ~150 pounds. I'm currently on a ketogenic / low-carb paleo diet (for ~2 years now) not to lose weight, but to help with my daytime fatigue issues (carbs make me crash, especially in the afternoon), plus I'm on ADHD meds as well. It's really hard for me to have enough appetite to take in the calories to bulk up during the working week. I carb up on Friday nights and the weekends, but I get dopey and bloated. I could take protein powder, but too much will kick me out of ketosis. Apparently a few bodybuilders go on a ketogenic diet, but I think that might just be in the shredding phase, not when they're trying to bulk up.

I haven't been to a gym in years but I've just restarted bodyweight exercises. I don't wanna exert myself too hard coz my hands / shoulders / back already start to get sore from grossing (especially uteri, hunting for lymph nodes in tumour bowels, or doing piles of biopsy transfers), and I don't wanna get RSI.

Are there any exercises that you recommend?

 

[CDX-2]

I have never given it any thought but I can now get a sense of just why
an AP residency is 5 years there as opposed to 3 in the US for straight AP
(2 in combined AP/CP). Looks like there is a huge scut load/ cheap labor
routine. But, after 5 years it seems to all come out in the wash. The
Commonwealth trained folks who get boarded seem to be every bit as good or better than their US counterparts. I think you are just going to have to suck it up
for a few. You already have a significant hit against you in that your knowledge
is considered “ sub par”. That is NOT GOOD and you must do whatever it takes to turn that impression around.

In Australia and New Zealand, straight AP is a 5 year training program.

AP Part 1 exam (written paper and slide exam) is usually sat in 3rd year.

The Cytology, Small Biopsy, and Autopsy Exams (latter has now been removed) are usually sat in 4th year.
- The autopsy exam has been abolished, but you can choose do do it separately and gain a "Diploma in Autopsy".

AP Part 2 exam (another written paper and silde exam + oral Viva) is usually done in 5th year.

Really, they should call it AP Part 1, Part 2 and Part 3. (AP Part 1, Part 1.5, and Part 2 doesn't sound as cool)...

For family reasons, I got to sit my Part 1 exam in 4th year, so even if I pass every single exam on first attempt (assuming I don't burn out or drop out), my training program will be 6 years, twice as long as a US AP residency!!!!!!

Straight General Pathology (aka combined AP / CP) in Australia is also 5 years.
It's 2 years AP + 1 year Microbiology + 1 year Haem Path + 1 year Biochemistry.

There's lots and lots of exams. Yet in Australian labs (in contrast to New Zealand) there's lots and lots of grossing (depending on the lab) as we don't officially have "Pathologist Assistants" like in North America, and the Medicare reimbursements have been decreasing in real terms since the 1990's, so a lot of labs are understaffed (due to budgeting issues and/or wanting to make a profit)...

New South Wales this year had 10 vacancies after round 1 applications, including in metropolitan Sydney! A few of those labs are super busy for grossing though. I heard the average day is like 10 tumour bowels / breasts. There were a few rural labs in New South Wales that aren't as super busy cut-up / grossing-wise, but I had already signed my contract with the lab for 2019, and I didn't want to burn bridges.

 

[HeyDalaron]

I would try to make my way to Canada, then to freedom south of border eventually. But even Canada is better and pathologists are actually in demand there from the last I heard.

Sure there is demand, but there is no money to meet the demand.

The number of Canadian pathology positions are decided by the government. Because of the boneheaded remuneration scheme that pays pathologists through hospital budgets, which are entirely a government funding matter, don't expect new pathologist positions to open up anytime soon. Ontario, the country's most populous province, has not seen funding open up for a new position since 2012. The only way to get a job there is if someone else retires.

There is also a great deal of downward pressure on payment, and upward demand on volume, as large hospital conglomerates rely on "insourcing" compliant pathologist labor from India, Pakistan, Russia and the like.

 

[LADoc00]

So now Canada is a bust...Dont know what to tell you guys then. I feel for all the people with no control they were born under Hammer&Sickle Socialism. I can only imagine it was completely suck while the masses of peons march around proclaiming how awesome it to have doctors paid like crap and all the guns taken away. Australia sounds the place where fun and freedom goes to die...

Luckily the world is a very large place.

For workout stuff, bodyweight/prison style (or military style) works well if you are already a guy like me who is big, but for you at 150, I would bulk a bit. Maybe slowly walk up to 160 and see if you can check your bodyfat %.

Do a 4 day week 50-60min free weight routine broken by body part to give maximal rest: legs day 1, chest day 2, arms day 3, shoulders and back day 4. Put a day between #2/3 and #3/4. Get hydrolyzed whey protein whatever it is branded down there and take 60 grams of that per day, 5g of creatinine. You will be in pain initially so try to find a cryotherapy business near you.

Then grab Arimidex aka anastrozole (breast cancer med, blocks aromatase action). Take a 2mg tab on day #1 and day 4 per week.

Then try to next level it with HCG. 300 IU/per day on training days, 1200 IU per week. It comes lypholized and its reconstituted in bacteriostatic water, 5cc in 5000IU vials. HCG is incredible on many levels but the most important thing is unlike anabolic steroids, HCG promotes your own testicular production of testosterone. There is pretty much zero downside risk with HCG(few rare things like those folks with elevated PSAs etc but this is very well studied).

Gotta block conversion to estradiol with arimidex though or you are just pissing in the wind.
At your age, any direct testosterone stuff is not needed. But you will put on 25lbs in literally no time and feel like a million bucks. No idea how it works in Australia but here you go to a clinic and tell them you have "decreased libido" which you are guaranteed to honestly have because you are working like a slave, and you can get HCG fairly cheaply. And of course while you are at it, take 2000mg a day of Metformin. 1g in the am, 1g at night. Take CBD, melatonin and rhodiola at night.

Consult your doctor first though..

Also dont full crazymode, stop at about here:

 

[Dro133]

So now Canada is a bust...Dont know what to tell you guys then. I feel for all the people with no control they were born under Hammer&Sickle Socialism. I can only imagine it was completely suck while the masses of peons march around proclaiming how awesome it to have doctors paid like crap and all the guns taken away. Australia sounds the place where fun and freedom goes to die...

Luckily the world is a very large place.

For workout stuff, bodyweight/prison style (or military style) works well if you are already a guy like me who is big, but for you at 150, I would bulk a bit. Maybe slowly walk up to 160 and see if you can check your bodyfat %.

Do a 4 day week 50-60min free weight routine broken by body part to give maximal rest: legs day 1, chest day 2, arms day 3, shoulders and back day 4. Put a day between #2/3 and #3/4. Get hydrolyzed whey protein whatever it is branded down there and take 60 grams of that per day, 5g of creatinine. You will be in pain initially so try to find a cryotherapy business near you.

Then grab Arimidex aka anastrozole (breast cancer med, blocks aromatase action). Take a 2mg tab on day #1 and day 4 per week.

Then try to next level it with HCG. 300 IU/per day on training days, 1200 IU per week. It comes lypholized and its reconstituted in bacteriostatic water, 5cc in 5000IU vials. HCG is incredible on many levels but the most important thing is unlike anabolic steroids, HCG promotes your own testicular production of testosterone. There is pretty much zero downside risk with HCG(few rare things like those folks with elevated PSAs etc but this is very well studied).

Gotta block conversion to estradiol with arimidex though or you are just pissing in the wind.
At your age, any direct testosterone stuff is not needed. But you will put on 25lbs in literally no time and feel like a million bucks. No idea how it works in Australia but here you go to a clinic and tell them you have "decreased libido" which you are guaranteed to honestly have because you are working like a slave, and you can get HCG fairly cheaply. And of course while you are at it, take 2000mg a day of Metformin. 1g in the am, 1g at night. Take CBD, melatonin and rhodiola at night.

Trust me on this.

What's the point of taking anastrozole unless you're doing anabolic steroids concurrently? From what I understand it's an aromatase inhibitor that is used to block estrogen production in people taking exogenous testosterone.

 

[LADoc00]

What's the point of taking anastrozole unless you're doing anabolic steroids concurrently? From what I understand it's an aromatase inhibitor that is used to block estrogen production in people taking exogenous testosterone.

Blocking AI action will increase natural T-level independent of alternative modes of enhancing T. Made a big mistake, thought arimidex was 2mg tabs, its 1mg, so 2mg per week TOTAL not 2mg twice a week.

refs:
J Clin Endocrinol Metab. 2005 Oct;90(10):5717-22. Epub 2005 Jul 26.
Comparative assessment in young and elderly men of the gonadotropin response to aromatase inhibition.
also here: Off label therapies for testosterone replacement

"Estrogen excess has been associated with premature closure of the epiphyses and gynecomastia as well as low gonadotropin and testosterone levels (19). Estrogen effects on the gonadotropins and testosterone have led to the evaluation of estrogen as a potential target for treating hypogonadism.

Estradiol is the most potent form of estrogen and its synthesis is a result of the enzymatic activity of aromatase. Aromatase activity has been found in the gonads, placenta, brain, fat, hair, bone, muscle and vascular tissue (19). The conversion of testosterone to estradiol in the gonads has been predicted to be the cause of an increased testosterone/estradiol (T/E) ratio. This ratio has been implicated as one of the causes of infertility. Decreased seminal T/E levels have been shown to be a good indicator for identifying the absence of sperm"

Disclaimer: this is absolutely NOT medical advice, everyone should closely consult with a male health specialist before doing anything. Not all docs are progressive enough however to think in this manner so you may need to shop a bit. This is just my personal plan.

 

[CDX-2]

So now Canada is a bust...Dont know what to tell you guys then. I feel for all the people with no control they were born under Hammer&Sickle Socialism. I can only imagine it was completely suck while the masses of peons march around proclaiming how awesome it to have doctors paid like crap and all the guns taken away. Australia sounds the place where fun and freedom goes to die...

Luckily the world is a very large place.

Atm the welfare / safety net in Australia is much bigger than both US and Canada, but I don't think it'll be sustainable in its current state within the next 10-20 years coz of the ageing population, rising under/un-employment (not enough jobs and public infrastructure relative to the current levels of immigration), ongoing abuse of the system by some (not all) groups of people, and seemingly inefficient use of taxpayers' money by the governments.

Public hospital treatment is currently "free" for Australians, with no co-payments / gap fees for medical emergencies or medical / surgical admissions. Currently a lot of Australians expect healthcare to be "free", and expect to be able to see a GP (family physician) for "free" (via bulkbilling, getting paid a set rebate from the government in lieu of patient directly paying) but it was never free to begin with. They also seem to forget that doctors also have running expenses, and that if the Medicare rebates are insufficient to cover this, then they'll need to charge a gap fee. Anyhow the Medicare rebates are all paid for (directly or indirectly) via taxpayer's money.

It'll probably look absolutely pathetic to you, but there are actually a lot of Australians who complain or think it is immoral / unethical for a GP to charge a $20 gap fee ("co-payment") because it impairs one's "right" to "free" healthcare. But somehow they don't mind paying $20+ for a dentist (Medicare doesn't cover dentistry) / hairdresser / plumber / restaurant meal etc etc.

I feel that something's got to give at the end...

The 1st year public consultant / attending pay in my state is ~$AU 180K, but given our high tax brackets, a lot of the money can get eaten up as tax (to fund the welfare system etc etc), plus the cost of living is high. And public pathology positions are now very competitive.

The private consultant positions are relatively easier to get, and the starting pay would be similar, but it seems that the pathologist consultants / attendings get seriously busy. The company I work for seems to work them very hard.

And they have to meet arbitrary billing targets which I find completely illogical, because with the way Medicare funds the histology cases, 6 x GI biopsies reporting a "Tubular Adenoma" (6 blocks total) would bill more than a bilateral tumour mastectomy with sentinel lymph nodes (40+ blocks)!!!

Each of the consultants seem to have ~150 - 200 slides / day to look through, and this is before they start ordering IHC and/or extra levels.

Is it like this in America, or only in the glass mills like "Ameripath" or "Quest Diagnostics"?

Or is this actually even busier than "Ameripath" / "Quest Diagnostics"?

 

[CDX-2]

For workout stuff, bodyweight/prison style (or military style) works well if you are already a guy like me who is big, but for you at 150, I would bulk a bit. Maybe slowly walk up to 160 and see if you can check your bodyfat %.

Do a 4 day week 50-60min free weight routine broken by body part to give maximal rest: legs day 1, chest day 2, arms day 3, shoulders and back day 4. Put a day between #2/3 and #3/4. Get hydrolyzed whey protein whatever it is branded down there and take 60 grams of that per day, 5g of creatinine. You will be in pain initially so try to find a cryotherapy business near you.

Then grab Arimidex aka anastrozole (breast cancer med, blocks aromatase action). Take a 2mg tab on day #1 and day 4 per week.

Then try to next level it with HCG. 300 IU/per day on training days, 1200 IU per week. It comes lypholized and its reconstituted in bacteriostatic water, 5cc in 5000IU vials. HCG is incredible on many levels but the most important thing is unlike anabolic steroids, HCG promotes your own testicular production of testosterone. There is pretty much zero downside risk with HCG(few rare things like those folks with elevated PSAs etc but this is very well studied).

Gotta block conversion to estradiol with arimidex though or you are just pissing in the wind.
At your age, any direct testosterone stuff is not needed. But you will put on 25lbs in literally no time and feel like a million bucks. No idea how it works in Australia but here you go to a clinic and tell them you have "decreased libido" which you are guaranteed to honestly have because you are working like a slave, and you can get HCG fairly cheaply. And of course while you are at it, take 2000mg a day of Metformin. 1g in the am, 1g at night. Take CBD, melatonin and rhodiola at night.

Consult your doctor first though..

Also dont full crazymode, stop at about here:

By 4-day gym week, do you mean like Saturday (#1 legs) / Sunday (#2 chest) / Tuesday (#3 arms) / Thursday (#4 back / shoulders)?

I know my GP definitely won't prescribe testosterone coz since ~2012 (IIRC), the Australian government has been suspending doctors who prescribe testosterone outside of the formal indications (hypogonadism +/- ?Klinefelter's Syndrome, or for transgendered people who want to transition from female-to-male).

I don't think he'll believe my "low libido" story coz I'm still single and a virgin. I actually did have my testosterone levels (+ thyroid function, iron studies, vitamin D, vitamin B12 levels) tested as a medical student for chronic fatigue / daytime sleepiness, but I think it turned out to be within the normal range.

I can ask him about anastrozole, but he might still be uncomfortable coz the goal would be to (indirectly) increase endogenous testosterone production, of which the potential testosterone side effects are known. Anyway, all I can do is ask.

I didn't know you could use HCG for muscle growth, I'll need to see if it isn't already on the Australian TGA's (Therapeutics Good Association) list of banned / restricted substances. Even stuff that would be OTC in the US is on that list. Basically either the substance is illegal to import (eg CBD extract, DHEA), or I can only import it in small quantities at a time with a script (Melatonin, I love American melatonin).

I could possibly, indirectly get CBD via hemp seeds, of which the food consumption in Australia has recently been legalized, but the prices are completely unaffordable for daily consumption (cheapest brand seems to be ~$35 / kg).

How would the Metformin help me if I don't have diabetes and I'm already on Keto / low-carb Paleo?

 

[LADoc00]

By 4-day gym week, do you mean like Saturday (#1 legs) / Sunday (#2 chest) / Tuesday (#3 arms) / Thursday (#4 back / shoulders)?

I know my GP definitely won't prescribe testosterone coz since ~2012 (IIRC), the Australian government has been suspending doctors who prescribe testosterone outside of the formal indications (hypogonadism +/- ?Klinefelter's Syndrome, or for transgendered people who want to transition from female-to-male).

I don't think he'll believe my "low libido" story coz I'm still single and a virgin. I actually did have my testosterone levels (+ thyroid function, iron studies, vitamin D, vitamin B12 levels) tested as a medical student for chronic fatigue / daytime sleepiness, but I think it turned out to be within the normal range.

I can ask him about anastrozole, but he might still be uncomfortable coz the goal would be to (indirectly) increase endogenous testosterone production, of which the potential testosterone side effects are known. Anyway, all I can do is ask.

I didn't know you could use HCG for muscle growth, I'll need to see if it isn't already on the Australian TGA's (Therapeutics Good Association) list of banned / restricted substances. Even stuff that would be OTC in the US is on that list. Basically either the substance is illegal to import (eg CBD extract, DHEA), or I can only import it in small quantities at a time with a script (Melatonin, I love American melatonin).

I could possibly, indirectly get CBD via hemp seeds, of which the food consumption in Australia has recently been legalized, but the prices are completely unaffordable for daily consumption (cheapest brand seems to be ~$35 / kg).

How would the Metformin help me if I don't have diabetes and I'm already on Keto / low-carb Paleo?

1.) of course the Australian government banned anything that raises T levels, but Im sure they give whopping doses of ethinyl estradiol to 14 year girls. Great statistic: 40 girls died just in the trials of Nuvaring, 700+ class action lawsuits pending and the product is still on the market. 99.9%+ of oral birth control does not treat any known disease yet somehow Australia deems it necessary to prohibit medicine that is treating epidemic low T in men in industrialized countries:
"During the past two decades, testosterone levels in American men have rapidly declined.
This information comes from a long-term prospective study that evaluated changes in serum testosterone on a population-wide basis." -Endocrine Today.
Interestingly T levels of a 25 year old male in urban U.S. cities are now lower than the average 84 year old man in 1934, the first year such longitudinal data was taken. Then we wonder why we have an explosion of transgender men, ever increasing suicide rates and declining longevity. Think about that.
In industrialized countries, T levels are falling by an astonishing 1% PER YEAR. Since T level directly parallels spermatogenesis, we are mere decades from the average man being infertile.
Go read about the herbivore men of Japan, that stuff is beyond frightening.

2.) Your government sounds like a dystopian hell. Aside from the whole "being eaten by dogs" thing, I dont see much of a difference between that and North Korea. Scratch that, North Korea is relatively clean with no crime...

3.) I would refocus and put maximal effort into you. You are actually scaring me. Pathology residency should be about as low on your priority list as your next run for groceries. The top 10 things on the list should be you.

Not sure what advice I can give to you aside from going full Che Guevera and overthrowing the tyranny that seems to be oppressing your land. I would grab a company of Che's 1961 Guerrilla Warfare book and study that.

~Youtube 'metformin and longevity' or see the other SDN thread we have on this.

Well just when I think America is sucking, I hear a tale like this. Yikes.

 

[CDX-2]

1.) of course the Australian government banned anything that raises T levels, but Im sure they give whopping doses of ethinyl estradiol to 14 year girls. Great statistic: 40 girls died just in the trials of Nuvaring, 700+ class action lawsuits pending and the product is still on the market. 99.9%+ of oral birth control does not treat any known disease yet somehow Australia deems it necessary to prohibit medicine that is treating epidemic low T in men in industrialized countries:
"During the past two decades, testosterone levels in American men have rapidly declined.
This information comes from a long-term prospective study that evaluated changes in serum testosterone on a population-wide basis." -Endocrine Today.
Interestingly T levels of a 25 year old male in urban U.S. cities are now lower than the average 84 year old man in 1934, the first year such longitudinal data was taken. Then we wonder why we have an explosion of transgender men, ever increasing suicide rates and declining longevity. Think about that.
In industrialized countries, T levels are falling by an astonishing 1% PER YEAR. Since T level directly parallels spermatogenesis, we are mere decades from the average man being infertile.
Go read about the herbivore men of Japan, that stuff is beyond frightening.

Nuvaring is available in Australia for contraception, but anecdotally is much less commonly used than Implanon (etonogestrel) or Mirena (progestogen IUD).

What's the cause of testosterone levels declining over these decades?!?!

Atm in Australia, in theory it seems easier for a transgender person (female-to-male) to obtain testosterone than it is for a male that doesn't have full-on hypogonadism, even if in both scenarios it'd be a private script with no federal PBS (Pharmaceutical Benefits Scheme) subsidy. The GP has a lesser fear of being deregistered / penalized by the medical board for the former scenario.

Low serum testosterone in Australia is currently defined as < 8 nmol/L (< 230 ng/dL),
but in order to get government-subsidized testosterone, the levels need to be < 6 nmol/L (< 173 ng/dL) on two separate occasions,
and the patient also needs to have been seen by an endocrinologist.

In 2015, the government tightened the hypogonadism criteria from < 8 nmol/L to < 6 nmol/L in order to rein in the federal spending on testosterone.

This was preceded by punishing GPs who were prescribing testosterone, which meant that a lot of GPs are now terrified of prescribing testosterone (even on private script) to cisgender males, unless they fits this strict criteria of < 6 nmol/L.

There might be a few GPs who are still willing to do private testosterone scripts for those with level between 6 - 8 nmol/L, but I think they're now considered "brave" / "cowboys".

Do you feel that the current testosterone reference range is too low?

The testosterone issue also reminds me of vitamin D.

Australia considers >75 nmol/L (>30 ng/mL) to be sufficient, but there's growing research that one should aim even higher to reduce the risk of colorectal and breast cancer. Perhaps the current recommendations are solely in the context of bone health (preventing rickets). However unlike testosterone, we can still buy vitamin D over the counter (but only in 1000 IU / 25mcg tablet size).

And I thought the Japanese herbivore men phenomenon was due to economic reasons (slow recovery since their bubble economy burst in the early 1990's). Or has radiation affected their testosterone production?!

 

[CDX-2]

2.) Your government sounds like a dystopian hell. Aside from the whole "being eaten by dogs" thing, I dont see much of a difference between that and North Korea. Scratch that, North Korea is relatively clean with no crime...

3.) I would refocus and put maximal effort into you. You are actually scaring me. Pathology residency should be about as low on your priority list as your next run for groceries. The top 10 things on the list should be you.

Not sure what advice I can give to you aside from going full Che Guevera and overthrowing the tyranny that seems to be oppressing your land. I would grab a company of Che's 1961 Guerrilla Warfare book and study that.

~Youtube 'metformin and longevity' or see the other SDN thread we have on this.

Well just when I think America is sucking, I hear a tale like this. Yikes.

How did I scare you?

Apart from exercising and spending a bit of time on hobbies after work, I dunno what else I can do to put maximal effort into myself (outside of studying for exams).

I did take a gap year after med school coz I got burnt out (7 years of university was just too much), which was refreshing, but it means I'm behind the competition by 1 year. I can't afford to take another gap year coz I need to continue saving money.

I was considering job-sharing in pathology training to get a better work-life balance, but our College (and many lab supervisors) apparently frown upon it unless you're pregnant or just came off maternity leave. And additionally this would further lengthen my AP training (it's already 6 years full-time providing I don't drop out / get kicked out)!!!

In a very twisted way, I sometimes feel like Australia is a "pseudo-democratic" and wealthier version of North Korea. We have compulsory voting, but it always ends up being one of the two major parties (Labor / Liberal), who seem to end up appealing to the lobbyists who provide the most "donations" / "benefits", at the expense of the middle class. We don't actually elect individual candidates at the federal level. And unlike Switzerland, we can't initiate referendums if the government decides to do things that we don't agree with, it just seems that we have to suck it up.

Despite our welfare state and safety net, it really scares me how much crime there is in Melbourne and Sydney these days. People are now getting stabbed, carjacked and robbed (including in the daylight). At first I thought providing more welfare / jobs will stop the crime, but then Singapore has much less welfare than Australia yet has much less crime. I've also done charity work in a developing country where whole families live on < $10 / day, yet they seemed better behaved as a whole.

I'm not a right-wing person, but I feel our government is too strict with things that can be relaxed, and too relaxed with things that should be strict...

I found it funny that you mentioned Che Guevara, coz Australian society is now already quite socialist / left-wing without his help!

 

[WEBB PINKERTON]

Low T is the equivalent of low Vitamin D. BS.

We just have to diagnose EVERYONE with something in the US. More treatments, more waste, keep the machine running . We probably don't need a third of the physicians and medical professionals we have in this country.

 

[LADoc00]

Low T is the equivalent of low Vitamin D. BS.

We just have to diagnose EVERYONE with something in the US. More treatments, more waste, keep the machine running . We probably don't need a third of the physicians and medical professionals we have in this country.

I will say I WAS 100% with you until I did my own research on it. The entire thing stunk of a bogus medical money making scheme from the era of medical charlatans riding around in pop out wagons selling concoctions in the wild west.

After around a year of reading the research articles and going to talks, there is something incredibly damaging to male (and female) endocrine function that no one has a definitive handle on. In my mind, this is the single greatest threat to the human race, far far beyond climate change as it has the real ability to morph into Calhoun's Mouse Utopia experiment with same exact final result: total human extinction.

 

[k_sheep]

The 1st year public consultant / attending pay in my state is ~$AU 180K, but given our high tax brackets, a lot of the money can get eaten up as tax (to fund the welfare system etc etc), plus the cost of living is high. And public pathology positions are now very competitive.

The private consultant positions are relatively easier to get, and the starting pay would be similar, but it seems that the pathologist consultants / attendings get seriously busy. The company I work for seems to work them very hard.

And they have to meet arbitrary billing targets which I find completely illogical, because with the way Medicare funds the histology cases, 6 x GI biopsies reporting a "Tubular Adenoma" (6 blocks total) would bill more than a bilateral tumour mastectomy with sentinel lymph nodes (40+ blocks)!!!

I assure you, there is no starting public consultant in Australia that pays that low. The lowest is about 280k. The 'bracket' it falls into might be 180, but you get car allowances, right to private practice allowances etc etc which bump it up. Private is often a little less at the start but ramps up quicker than in public.

A hisl45 is not worth more than a hisl6. Unless you are talking about 5 separate patients - but that also costs more in data entry, and you claim more in PEIs.

I'm unsure about why you are worried about consultant positions. I'm getting cold called weekly about positions including locums and I am certainly nothing special. The college website lists over a dozen openings, and these are all positions that haven't been able to be filled by said cold callers.

Finally, AP registrars need to remember that it is a service provision position. You are paid 100+k/pa to WORK. Imagine if a med reg said, no I'm not going to admit or round on patients for more than 20 hours per week, I need to study for the other 20. You'd be laughed out of the hospital. What if a surg reg just followed their boss around all day, providing no meaningful benefit, in fact actively slowing him/her down by 30-50%? Please look around at your clinical colleagues before saying you do too much 'scut work'. Same as them, you do your shift, then you do your study and learning after the work is done - and if you've worked hard and efficiently in hours, your bosses will only be too happy to do some teaching at a mutually agreeable time.

 

[AZpath]

"And they have to meet arbitrary billing targets which I find completely illogical, because with the way Medicare funds the histology cases, 6 x GI biopsies reporting a "Tubular Adenoma" (6 blocks total) would bill more than a bilateral tumour mastectomy with sentinel lymph nodes (40+ blocks)!!!

That's way our payment system works too. Little cases often pay more than big cases

Each of the consultants seem to have ~150 - 200 slides / day to look through, and this is before they start ordering IHC and/or extra levels."

Typical volumes for US too!

 

[CDX-2]

I assure you, there is no starting public consultant in Australia that pays that low. The lowest is about 280k. The 'bracket' it falls into might be 180, but you get car allowances, right to private practice allowances etc etc which bump it up. Private is often a little less at the start but ramps up quicker than in public.

I'm unsure about why you are worried about consultant positions. I'm getting cold called weekly about positions including locums and I am certainly nothing special. The college website lists over a dozen openings, and these are all positions that haven't been able to be filled by said cold callers.

Finally, AP registrars need to remember that it is a service provision position. You are paid 100+k/pa to WORK. Imagine if a med reg said, no I'm not going to admit or round on patients for more than 20 hours per week, I need to study for the other 20. You'd be laughed out of the hospital. What if a surg reg just followed their boss around all day, providing no meaningful benefit, in fact actively slowing him/her down by 30-50%? Please look around at your clinical colleagues before saying you do too much 'scut work'. Same as them, you do your shift, then you do your study and learning after the work is done - and if you've worked hard and efficiently in hours, your bosses will only be too happy to do some teaching at a mutually agreeable time.

Lowest as $280K? That sounds more like Queensland or Western Australia.

If someone is already working full-time in the public system to get $180K, how practical is it to work privately on the side to claim the right to private practice allowances? Public system also provides salary packaging ($9K pre-tax deduction), meals & entertainment (?$2.5K), car allowances, and conference reimbursements, but all that would be an extra $25K at best.

From what I was told, none of the AP graduates from 2018 in Victoria were able to get a Victorian public consultant position. They either got a job rurally, or will be applying interstate for those positions listed on the college website (atm only 2 are listed as being in Victoria, with 1 being for a senior pathologist). They'd also be competing against graduates from other states, and to my knowledge there are >40 AP graduates/year for Australia alone. I imagine a General Pathologist would have a lot more flexibility with job offers.

Re: alternating cut-up / reporting days, in Victoria, this is a common arrangement held in labs where there are only 2 anatomical pathology registrars. It's the intended and ideal arrangement as per the lab consultants, so both registrars can take turns doing specimen cut-up and learning/reporting histopathology. If there are more registrars in a lab, then the cut-up load becomes more spread out, and the registrars not on cut-up can learn/report histopathology, or be on-call for autopsies and attend FNAs etc.

You're also expected to study after work, but you're ALSO expected to practice reporting cases as part of your job. If it wasn't part of the job, the college wouldn't have issued guidelines about recommended weekly time limits for service provision (in the form of cut-up and biopsy transfers, 20 hours/week). If we were only expected to do specimen cut-up at work, then we might as well be full-time cut-up assistants/scientists.

By scut work, I was referring to tasks that literally isn't your job to begin with, but you do it because the place is understaffed. One or two things here and there every now and then is ok as a courtesy, but if it's up to 10 hours / week, it's not unreasonable to question that aspect.

Do you think it is acceptable for an accredited anatomical pathology registrar to do accessioning and cassette-printing for up to 10 hours/week as part of service provision, when that time would be better spent draft reporting cases, preparing meetings, or even doing more cut-up (the latter tasks being relevant as a consultant)?

Hypothetically, would it be acceptable for an accredited medical registrar to be expected to spend 10 hours/week mopping the floors in various parts of the hospital, and wash hospital cutlery as part of service provision,

with this being ***on top of*** admitting / reviewing patients, managing MET-Calls / Code Blues, doing outpatient clinic, supervising interns/residents, being on-call, charting meds, cooperating with nursing and allied health, communicating with patients and their families, and doing ward paperwork???

 

[CDX-2]

A hisl45 is not worth more than a hisl6. Unless you are talking about 5 separate patients - but that also costs more in data entry, and you claim more in PEIs.

I should've been clearer, for histopathology alone,

6 different patients, each providing one GI biopsy ($97.15 x 6 = $582.90) bills more than a bilateral tumour mastectomy with sentinel lymph nodes ($417.2 + $74.5 for ER/PR/HER2 = $491.7).

Even 6 gallbladders ($86.35 x 6 = $518.1) bills more from Medicare than the above breast case!!!

Do data entry costs and PEIs get factored in when it comes to billing targets in the private sector?

It would be interesting to see if somebody was able to analyze and report a bilateral tumour mastectomy (with sentinel lymph nodes) quicker than reporting 6 GI biopsies or 6 gallbladders......

 

[CDX-2]

"And they have to meet arbitrary billing targets which I find completely illogical, because with the way Medicare funds the histology cases, 6 x GI biopsies reporting a "Tubular Adenoma" (6 blocks total) would bill more than a bilateral tumour mastectomy with sentinel lymph nodes (40+ blocks)!!!

That's way our payment system works too. Little cases often pay more than big cases

Each of the consultants seem to have ~150 - 200 slides / day to look through, and this is before they start ordering IHC and/or extra levels."

Typical volumes for US too!

Thank you for the clarification.

 

[CDX-2]

Update:

It's been ~3 months into my placement at the different lab. Me and my co-registrar are both doing grossing / cut-up 5 days a week (200+ blocks / day), I'm getting a workout with my triceps coz of all the cutting lol.

We're also getting some daily teaching on the side (albeit not reporting time), but I suppose this is a step up from my previous lab. The consultants here all seem nice and are supportive. One of our senior consultants / attendings got fired with no notice as part of lab budget cuts which was very unfortunate...

Otherwise I'm extremely relieved that I don't have to spend 10 hours / week on accessioning and cassette-printing. And I don't have to do vet cut-up, manual defat (with alcohol / xylene buckets) or specimen throwout!!!

I can't believe it, but I might actually contemplate staying here for 4th year if I can't get back to a city lab?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!??!?!?!?

 

[CDX-2]

Update:

I've decided to stay in my current lab for 2020. I now have a satisfactory mid-year assessment. I'm grossing every day but the staff are nice to work with atm. I feel like I'm making progress for now.

I found out that the lab I previously wanted to transfer to (but didn't get) is down-sizing to just ONE consultant (attending) for a Histo Count of ~#20,000/Year. I have no idea how that'd be feasible in terms of reporting and supervision...

I feel like I've dodged a bullet, by being sent to a lab with 3 Consultants...

Also I found out that the registrar / resident who replaced me in my previous lab resigned after 3 months, which makes it 5 registrars resigning in a row. Hmm I wonder why...

 

[Centropyge]

Also I found out that the registrar / resident who replaced me in my previous lab resigned after 3 months, which makes it 5 registrars resigning in a row. Hmm I wonder why...

In some ways, it’s not a bad thing some trainees resign. It may eventually force improvements in working conditions of trainees. Better yet, fewer consultants are created, increasing the bargaining power of current consultants

 

[CDX-2]

In some ways, it’s not a bad thing some trainees resign. It may eventually force improvements in working conditions of trainees. Better yet, fewer consultants are created, increasing the bargaining power of current consultants

Lol the previous rural lab I was in is apparently just going to hire a senior reg for 2020 (who is supposedly less likely to resign), unlike the 5 x 1st Year Regs who have resigned in the past 4 years...

If they really wanted to cut down on registrars, perhaps they could formalize the "Pathologist's Assistant" position like in North America...

But then the labs would have to pay for the PA positions out-of-pocket instead of relying on government-funded registrars...

 

[CDX-2]

Update:

The lab that I previously wanted (but didn't get) will be shutting down next year as all the consultants (attendings) will have retired / resigned, with nobody wanting to fill in the vacancies!!!

I've also heard rumours that the lab I previously worked in might also shut down next year...
If this happens, I'm not sure what happens to the 2 registrars (residents) who are matched there for 2020...

Both of those labs are from the same company.

I've TRULY dodged a bullet...

 

[CDX-2]

Update:

I sat my AP Part 1 board exams this year.

I passed the Written / Theory Exam, but I failed the Slide Exam.

I believe for the Slide Exam, I got 15/20 correct. You need 16+/20 to pass.

I was really close, and I feel frustrated......

I honestly found the Slide Exam less mentally draining than the Written / Theory Exam, because it had up to 8 "spotter" entities (eg oncocytoma, traumatic neuroma, granular cell tumour), where you only needed to write a 2 sentence answer.

I think what let me down was the exam technique for the more complex cases.

I only have to resit the Slide Exam in 2021.

Overall, my current supervisors and I are very happy with the progress that I've made in my current rural private lab, and I've received positive references.

I've obtained an AP registrar (resident) position in an interstate lab for 2021.

I'm very excited to move but also very sad to leave, because I'll really miss my current supervisors, they were really good to work with and were supportive...

 

[jp123ok]

The pay in Australia in general is garbage with a cost of living in places like Sydney roughly comparable to Los Angeles!

And the population is minuscule, sub 25 million, substantially less than just California.

Australia has "Medicare for all", literally that is name! Imagine a world where Bernie Sanders went full Crocodile Dundee and took over an entire empire in his image with Medicare for all and then implemented the largest gun confiscation since the 1956 Cambodian gun ban that lead indirectly to rise of the Khmer Rouge.

Your entire nation is literally a recipe for enslavement, so step 1 would be plot your escape from the Queen's prison island.

I would try to make my way to Canada, then to freedom south of border eventually. But even Canada is better and pathologists are actually in demand there from the last I heard.

Australia is a recipe for Pathology fail. A tiny group of enslaved government glass monkeys could easily man a consolidated mega lab or 2 and read the material for all 25 million. That is not even remotely far fetched for a place that socially engineered the only modern nationwide gun confiscation in a supposed full participatory democracy non-totalitarian state in HUNDREDS OF YEARS. With that tier of government mind control running, the sky is the limit!

LADoc, you clearly do not know much about Australia. It is a terrific country to live and work and the pay for pathologists and most other specialists is decent. Cost of living in Sydney and Melbourne is high but the lifestyle and work life balance is much better then the US. Medicare is fantastic. The pharmaceutical benefits scheme is fantastic (subsidized drugs). The society is not as polarized along political or ethnic lines. The way that Australia has been able to control Covid should be a lesson to countries all over the world. I feel sorry for people living in the USA at the moment.

 

[jp123ok]

Update:

I sat my AP Part 1 board exams this year.

I passed the Written / Theory Exam, but I failed the Slide Exam.

I believe for the Slide Exam, I got 15/20 correct. You need 16+/20 to pass.

I was really close, and I feel frustrated......

Congratulations on passing some of the part 1 exams CDX2. The College exams are difficult as you would know. I have taken both the US Boards and the RCPA exams and I thought the RCPA exams were much harder and required significantly more preparation. It can be incredibly frustrating to come so close to passing but you just have to keep on preparing and you will get through.

In regard to pay for pathologists in Australia, I can tell you that in private practice in Victoria salaries are significantly higher that $180K.

 

[deleted314957]

LADoc, you clearly do not know much about Australia. It is a terrific country to live and work and the pay for pathologists and most other specialists is decent. Cost of living in Sydney and Melbourne is high but the lifestyle and work life balance is much better then the US. Medicare is fantastic. The pharmaceutical benefits scheme is fantastic (subsidized drugs). The society is not as polarized along political or ethnic lines. The way that Australia has been able to control Covid should be a lesson to countries all over the world. I feel sorry for people living in the USA at the moment.

Spare us your pity and go play with your didgeridoo.

 

[deleted314957]

Congratulations on passing some of the part 1 exams CDX2. The College exams are difficult as you would know. I have taken both the US Boards and the RCPA exams and I thought the RCPA exams were much harder and required significantly more preparation. It can be incredibly frustrating to come so close to passing but you just have to keep on preparing and you will get through.

In regard to pay for pathologists in Australia, I can tell you that in private practice in Victoria salaries are significantly higher that $180K.

180K “+” is not good pay, fair, or adequate for the services of an ap/cp path. I’m f****** retired and make more than that. In a high cost metro area you are making what a shift foreman at the LIRR makes, or less.

 

[KeratinPearls]

180K “+” is not good pay, fair, or adequate for the services of an ap/cp path. I’m f****** retired and make more than that. In a high cost metro area you are making what a shift foreman at the LIRR makes, or less.

They are in Austrailia sir.

 

[LADoc00]

LADoc, you clearly do not know much about Australia. It is a terrific country to live and work and the pay for pathologists and most other specialists is decent. Cost of living in Sydney and Melbourne is high but the lifestyle and work life balance is much better then the US. Medicare is fantastic. The pharmaceutical benefits scheme is fantastic (subsidized drugs). The society is not as polarized along political or ethnic lines. The way that Australia has been able to control Covid should be a lesson to countries all over the world. I feel sorry for people living in the USA at the moment.

This the "bread lines are actually really great! You are missing out man, seriously" response. I guess in Australia its more "shrimp lines for the barbie."

Not only is the pay garbage tier in Australia, the Australian dollar is so devalued your real purchasing power is total crap. And yes the cost of goods on islands are typically sky high, Australia being no exception.

Definitely dont feel sorry for us here, working from home, making 3x, living on actual acreage, cost of goods at like 50-75% and drinking bloody mary's in the hot tub by 3pm everyday...it's real struggle, but someone has to do it.

I would guess most Australians get home too tired to really practice with their home defense boomerang or whatever weapon the government decides to allow this week. I would honestly go home defense combat kangaroo. I think they offer more versatility than pet snakes from the Outback.

Im not implying its not livable, of course it is, but I would question your points of reference in making any comparison with the US.

I mean North Korea is controlling COVID, Cuba check....If that is bar measurement for "quality of life" I guess you could look at Pyongyang and Havana?

Also turn off your propaganda spewing TV, I live around people of all ethnic groups here in the US, far more than you can find in Australia and we are a one big harmonious group: white people, east Indians, Africans, Asians, Hispanics, native tribes, Europeans, Middle Easterners etc all sharing one common trait: we have money. Good times are had by all.

 

[LADoc00]

They are in Austrailia sir.

Yes they are, a country that struggles with monetary policy and exports so much that 180K AUS = 135K US with the COLA that at least 10%+ making that 135K actually like making 121.5K here.

Good luck on being a lifelong renter or having to ration all the shrimp you put on the barbie.

As crazy as it sounds, you are actually far better off in Canada OR the middle of England. And this before you consider how thin the atmospheric ozone layer is in that part of the world and you wonder why white people are still there to begin with...

 

[jp123ok]

Senior Pathologists in private practice in Australia earn far more than $180K. $400K is what many senior consultants earn and some earn more . LADOC you don't need to worry about me. I don't rent and I haven't had any trouble accumulating a nice stash of cash. That's despite traveling the world and enjoying the good life.

I have lived and worked in both Australia and America for many years and I have a good understanding of life in both countries. Despite America's wealth, there is horrendous poverty. The US Federal government is useless. The society has deep divisions along political lines (Republican vs Democrat) and along socioeconomic lines. American cities contain ghettos where you aren't safe to go during the day let alone at night. Gun violence is out of control and your gun laws are insane. Health care costs for Americans are outrageous. And now, to top it all off, America has the worlds most out of control Covid19 outbreak being fueled by a president who is a compulsive liar and has chosen to downplay the seriousness of the virus and politicize mask wearing. I think it is reasonable for me to feel some sympathy towards people living in America right now.

By comparison, Australia is a rich country with free healthcare, competent government and sensible gun laws. Our weather is nicer than Canada or England or much of the USA. Our cities are far safer than American cities. For those of you living in the USA, if you are happy where you are good luck to you. I know which country I'd rather live in.

 

[LADoc00]

JP it’s folks like you that keep thousands of people each year from coming to America. Definitely take them in Australia please and from the US, we thank for your service!

Yes Australia is a paradise, everyone go there!

I love you guys. Make my mornings fun.
Also I need to teach you some basic economics at some point, when you spend your life training in a field and a government offers your services for free to the shivering masses, that isn’t a job, it’s actually called slavery bud. Look it up, I’m not messing with you.

 

[CDX-2]

UPDATE:

I did the RCPA AP Part 1 slide exam in 2021 (2nd attempt, GLASS) and narrowly failed, got 15.5 / 20.

This year (2022), I did the AP Part 1 slide exam (3rd attempt, but DIGITAL for the first time) and had to repeat the written paper (as my 12 month exemption had expired).

I PASSED AP PART 1 (DIGITAL slide exam + Written Paper) FINALLY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

This year's RCPA AP Part 1 slide exam (DIGITAL) had a ~61% pass rate (37/61 candidates passed),
which is probably the lowest pass rate in the past 10 years.

I now have up to 5 years to complete my remaining AP Part 2 exams (Cytology, Small Biopsy, Part 2 Slide Exam, Viva Voce).

I'm so glad I moved interstate for my remaining AP training.



Also the original regional private lab that I got abused and exploited at for 1st and 2nd year AP (back in 2017 and 2018),
has down-sized to just ONE consultant.

As a result, RCPA has cut down the AP registrars (residents) for that lab from 2 --> 1,
as there's insufficient registrar (resident) supervision.

That solo AP registrar (resident) in that regional private lab is now apparently doing accessioning, cassette-printing, specimen throwout, along with cut-up 5 days / week......

 

[mike-sheree]

Our AP/CP exam should be ~60% pass. Now, it is practically a gimme.