Doctor of Clinical Laboratory Science (DCLS) filling Medical Director roles

[anonymousu]

Mass General Brigham on LinkedIn: We welcome Ryan Mize, DCLS, MHA and Daniel Dees, DCLS, CC(NRCC), MLS(ASCP)… | 39 comments

I guess DCLS (Doctor of Clinical Laboratory Science) graduates are now able to work as pathology medical directors. Not laboratory supervisors, but MEDICAL DIRECTORS...! For those who don't know, DCLS programs are online programs designed for medical lab scientists/medical technologists. These programs aren't really comparable to traditional Ph.D. programs as they lack lab-based scientific research and training. From what we know, the CAP is strongly against this degree as of yet. Where does Clinical Pathology go from here? This is a big blow to CP graduates who already have limited opportunities at big academic hospitals. It's not even comparable to other mid-levels as none of them can really work as a "Medical Director". Medical directors provide consultation regarding lab tests which is a scope of practicing medicine. Pretty shocking that it happened at Mass Gen which should have more than enough pathologists and PhD microbiologist or chemist applicants for these positions. These hospitals might think they can completely replace CPs with DCLS graduates who are willing to accept 2/3 of the CP wages.

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[hurrycane]

We have already given away micro and chemistry, we’ve given away dermpath. Heck, we even have few non-MD department chairs. Of course we can give away medical directorship too 👍

 

[wholeheartedly]

I’m kinda mixed on this. I have a clinical lab science background and would still likely choose a traditional PhD or MD route over DCLS at this point due to the regulatory situation. But I really like the extensive broad content coverage the DCLS has.

I worked closely with both pathology residents/fellows and PhD fellows at a large place with a very strong clinical path program. Most of the path residents seemed totally checked out and uninterested in a good chunk of CP. They still struggled a bit more on understanding the deeper workings of the assays and limitations than the PhD folks. The PhD folks seemed very invested. Having a solid research background and that deeper understanding of the assay methods and troubleshooting is great but two years is a short amount of time to cram in all the relevant pathophysiology with everything else they’re doing. The DCLS person won’t have the same extensive research training but they do get research training (an MD path isn’t going to have PhD level research training either). They have in person practicums. The didactics that a DCLS gets though are pretty extensive and broad for pathophysiology and diagnostic methodology and training in quality and regulatory issues compared to a PhD. The PhD gets that during fellowship but not to the same degree. I’m not sure they’re somehow less well prepared than a PhD would be? Especially since the lines between fields like clin chem and clin micro and clin genomics etc are blurring a bit and the DCLS will cover all of that, not just one area.


As for taking over pathologist positions, the best setup I’ve seen is when places large enough have both an MD and a PhD for oversight. It gives you the best of both worlds. It gives you the extensive pathophys background of the MD with the more mechanistic analytical science background of the PhD. I’m not sure DCLS couldn’t be subbed for PhD in that context. I don’t see a DCLS person out in a rural shop running the show by themselves.

Given the current regulatory framework I would think they’d have to be partnered with someone.

 

[MetroPath]

Most pathology residents and fellows don’t care for CP. They study for it just to pass the boards and get a job. There are of course some that do CP only and truly enjoy it. CP is just a break from the busy AP rotations.

CP training at most places sadly is terrible. At lower tier places it’s non existent and you just rely on self study.

I propose closing down programs that don’t train pathologists well in CP. There are many of them. Why the hell you training for clinical pathology and you aren’t learning anything.

This will help decrease the number of graduates each year, improve the quality of graduates (more well rounded pathologists who are actually strong in CP) and make more jobs available. Focus on training programs with strong a CP laboratory curriculum. ARUP/Utah for example.

There’s a lot of WASTE in pathology training and cutting programs that have poor CP training is a good start in improving our field. Smaller programs with 2 residency spots is a good start.

My proposal (follow what the leaders in dermatology do, essentially make pathology HIGHLY COMPETITIVE to get in and thus make the job market great and improve the image of our field):

-Cut the number of residency programs-start with programs that are weak in CP training (non-existent CP training where residents sit around doing nothing).

-Focus on programs with low AP volume. Close them down.

-Fewer programs will make pathology competitive to get in so that we aren’t a dumping ground for foreign grad applications, many of who are looking for a residency spot. No longer will we get applications from foreign grads who graduated 20 years ago and think they have a chance. Only the best of the best will apply. Do you see FMGs applying to Derm who graduated from medical school 10-20 years ago?

-No longer will programs get hundreds upon hundreds of applications. Pathology is no longer the field you go to because you think you can get A residency spot. Our field will no longer be considered a dumping ground for applications.

-Only the best of the best of candidates get a spot, which improves the image of the field in general because every physician knows how hard is it to get in PLUS clinicians start respecting you because you are a pathologist. The key here is IMPROVING THE IMAGE of our field. Let’s face it some clinicians think we are technicians.

-The job market will improve. No longer are jobs by word of mouth. Groups will openly advertise their positions (even in tight markets) because it’s hard to find someone and groups aren’t selective with who they interview because most grads will be the cream of the crop versus now, where some graduates are questionable because we are a dime a dozen.

-jobs in larger cities are plentiful just like every other specialty.

-Demand for a pathologist outstrips supply.

-Starting salaries go up because it’s hard to find A pathologist and almost every pathologist that graduates will be a well rounded AP/CP, high caliber pathologist because all the other crap in the field has been weeded out.

-Higher starting salaries? US grads start to become interested in the field and US grads start applying to pathology en masse because essentially we have turned pathology into dermatology where only the best applicants get considered with HIGH starting salaries. No longer will employers think a 200-277 K starting salary is OK. 300+ starting offers across the board because employers are paying for a legit well trained well rounded junior pathologist.

In summary, too many residency spots degrades the field in general. Why is it that derm is completely dominated by US grads while pathology is completely all FMGS? Is looking at skin all day that tough? Why is dermpath so difficult to get in and command high salaries? It’s because they restrict the number of people who are allowed to play. If you don’t have ultra high board scores or publications, you can’t play with us. They protect their money aka salaries.

It’s because the Derm profession has protected their field from degradation. We in pathology have not.

Derms: quality>>>>quantity; demand outstrips supply
Pathology: quantity>>> quality, supply outstrips demand.

The leaders that control derm are smart. There is nothing special about Derm and dermpath. They just control their numbers very well and at the end of the day they protect their MONEY. it’s all about the money. That’s why they have been able tocommand high salaries over many years. Not just derm but dermpath. Increase spots 5-10 fold, you’ll start seeing derms get paid 200k a year because there’s just too many of them.

If we as a profession can control our numbers just like Derm/dermpath, everything would improve for the pathologist. The only people that would be hurt are large labs and employers that have to pay a lot more to employ you. So less money for them, which I could care less.

Medicine is a business guys if you like it or not.

100 applications for one job 10 years ago? WTFFFFFF! That’s just incompetent leadership who do not have the pathologists interests at heart.

With changes in the field as mentioned by caffeinegirl (digital pathology, consolidation), this supply demand imbalance will get exposed, which will not favor the employee pathologist.

 

[mike-sheree]

Most pathology residents and fellows don’t care for CP. They study for it just to pass the boards and get a job. There are of course some that do CP only and truly enjoy it. CP is just a break from the busy AP rotations.

CP training at most places sadly is terrible. At lower tier places it’s non existent and you just rely on self study.

I propose closing down programs that don’t train pathologists well in CP. There are many of them. Why the hell you training for clinical pathology and you aren’t learning anything.

This will help decrease the number of graduates each year, improve the quality of graduates (more well rounded pathologists who are actually strong in CP) and make more jobs available. Focus on training programs with strong a CP laboratory curriculum. ARUP/Utah for example.

There’s a lot of WASTE in pathology training and cutting programs that have poor CP training is a good start in improving our field. Smaller programs with 2 residency spots is a good start.

My proposal (follow what the leaders in dermatology do, essentially make pathology HIGHLY COMPETITIVE to get in and thus make the job market great and improve the image of our field):

-Cut the number of residency programs-start with programs that are weak in CP training (non-existent CP training where residents sit around doing nothing).

-Focus on programs with low AP volume. Close them down.

-Fewer programs will make pathology competitive to get in so that we aren’t a dumping ground for foreign grad applications, many of who are looking for a residency spot. No longer will we get applications from foreign grads who graduated 20 years ago and think they have a chance. Only the best of the best will apply. Do you see FMGs applying to Derm who graduated from medical school 10-20 years ago?

-No longer will programs get hundreds upon hundreds of applications. Pathology is no longer the field you go to because you think you can get A residency spot. Our field will no longer be considered a dumping ground for applications.

-Only the best of the best of candidates get a spot, which improves the image of the field in general because every physician knows how hard is it to get in PLUS clinicians start respecting you because you are a pathologist. The key here is IMPROVING THE IMAGE of our field.

-The job market will improve. No longer are jobs by word of mouth. Groups will openly advertise their positions (even in tight markets) because it’s hard to find someone and groups aren’t selective with who they interview because most grads will be the cream of the crop versus now, where some graduates are questionable because we are a dime a dozen.

-jobs in larger cities are plentiful just like every other specialty.

-Demand for a pathologist outstrips supply.

-Starting salaries go up because it’s hard to find A pathologist and almost every pathologist that graduates will be a well rounded AP/CP, high caliber pathologist because all the other crap in the field has been weeded out.

-Higher starting salaries? US grads start to become interested in the field and US grads start applying to pathology en masse because essentially we have turned pathology into dermatology where only the best applicants get considered with HIGH starting salaries. No longer will employers think a 200-277 K starting salary is OK. 300+ starting offers across the board because employers are paying for a legit well trained well rounded junior pathologist.

In summary, too many residency spots degrades the field in general. Why is it that derm is completely dominated by US grads while pathology is completely all FMGS? Is looking at skin all day that tough? Why is dermpath so difficult to get in and command high salaries? It’s because they restrict the number of people who are allowed to play. If you don’t have ultra high board scores or publications, you can’t play with us.

It’s because the Derm profession has protected their field from degradation. We in pathology have not.

Derms: quality>>>>quantity; demand outstrips supply
Pathology: quantity>>> quality, supply outstrips demand.

The leaders that control derm are smart. There is nothing special about Derm and dermpath. They just control their numbers very well and at the end of the day they protect their MONEY. it’s all about the money. That’s why they have been able tocommand high salaries over many years. Not just derm but dermpath.

If we as a profession can control our numbers just like Derm/dermpath, everything would improve for the pathologist. The only people that would be hurt are large labs and employers that have to pay a lot more to employ you. So less money for them, which I could care less.

Medicine is a business guys if you like it or not.

With changes in the field as mentioned by caffeinegirl (digital pathology, consolidation), this supply demand imbalance will just get worse, which will not favor the employee pathologist.

AND, add a clinical internship if you want to get rid of lots of the dead wood. Your ideas AND the extra clinical year would go a long way to making pathologists a far scarcer commodity. 95% of the problems in this field are supply and demand. Imagine if you threaten to walk and there WERE NOT 5 others salivating to step into your shoes. Imagine if there were NOBODY readily available to step into your shoes.
Just as a thought problem: how does a tertiary non-major academic affiliated hospital get needed in-patient dermatology coverage/consultation(think bullous skin diseases). The answer involves appreciable amounts of money. Further, how much do you think major trauma centers pay to have a neurosurgeon on one hour(or less) call.

And they pay lots of y’all’s part “A” in magic beans!

 

[MetroPath]

AND, add a clinical internship if you want to get rid of lots of the dead wood. Your ideas AND the extra clinical year would go a long way to making pathologists a far scarcer commodity. 95% of the problems in this field are supply and demand. Imagine if you threaten to walk and there WERE NOT 5 others salivating to step into your shoes. Imagine if there were NOBODY readily available to step into your shoes.
Just as a thought problem: how does a tertiary non-major academic affiliated hospital get needed in-patient dermatology coverage/consultation(think bullous skin diseases). The answer involves appreciable amounts of money. Further, how much do you think major trauma centers pay to have a neurosurgeon on one hour(or less) call.

And they pay lots of y’all’s part “A” in magic beans!

Yes it’s all about supply and demand.

Higher supply of pathologists:
Winner: Employers: Large corporate labs, senior partners in private groups, academia because of cost savings due to lower salary paid to pathologist.
Loser: Pathologist.

Lower supply of pathologist:
Reverse is true where the employee pathologist wins.

Not hard to understand.

We’ve been talking about this for the past 15 years

 

[mike-sheree]

Yes it’s all about supply and demand.

Higher supply of pathologists:
Winner: Employers: Large corporate labs, senior partners in private groups, academia because of cost savings due to lower salary paid to pathologist.
Loser: Pathologist.

Lower supply of pathologist:
Reverse is true where the employee pathologist wins.

Not hard to understand.

We’ve been talking about this for the past 15 years

But when a measure is suggested that makes it more rigorous, onerous and time consuming to become a pathologist, people bitch and moan. If it’s so darn easy to become one, to the point that it is almost a “default” residency, it won’t change.

 

[HeyDalaron]

But when a measure is suggested that makes it more rigorous, onerous and time consuming to become a pathologist, people bitch and moan. If it’s so darn easy to become one, to the point that it is almost a “default” residency, it won’t change.

Internship is essential to cull bad FMGs.

Didn't the CAP admit to undercounting the pathology workforce, thereby rendering their shortage numbers wildly inaccurate.

Have there been any formal retractions of these inaccurate studies?

 

[KeratinPearls]

CAP-Led Research Shows a 40% Pathology Workforce Undercount in Published Reports​

Recently the CAP highlighted the undercount of US pathologists in an article published by the Journal of the American Medical Association (JAMA) Network Open and further called for previous works citing the data to be corrected. The JAMA Network Open article highlights new CAP-led research that shows a 40% pathology workforce undercount in the US physicians database.
The JAMA Network Open article “Re-evaluation of the US Pathologist Workforce Strength” by Stanley J. Robboy, MD, FCAP, et al., explored unintended flaws in the methods used by various entities, and why most recent workforce counts have understated by about 40% the number of actively practicing pathologists in the US.
The CAP-led study followed up on a JAMA Network Open 2019 article with workforce data that concluded that the number of active pathologists dropped from 15,568 to 12,839 between 2007 and 2017. These data were based on information published by the American Association of Medical Colleges (AAMC), which drew from the American Medical Association (AMA) Physician Masterfile.
The authors recommend that AAMC change how it reports pathology workforce numbers to include all physicians, the AMA Masterfile, who are actively practicing pathologists. Currently, the AAMC database does not include those pathologists who are also trained any of the various pathology subspecialties, such as cytopathologists, dermatopathologists, hematopathologists, forensic pathologists and eight others.
The authors also recommend that all previously published reports, presentations, and other uses of the data from the AAMC be reexamined. Statements based on the AAMC data that report a pathology workforce shortage or decline must be reconsidered.
Recent surveys on the pathologist workforce have shown the job market for pathologists to be healthy. For example, according to a study published in the Archives of Pathology and Laboratory Medicineearlier in 2020, 45.5% of leaders of pathology practices responding to a CAP survey had sought to hire at least one pathologist in 2017

 

[Med Director New England]

An experienced MT who went thru this program would prolly be better at running a lab than most newly minted AP/CP grads…just sayin.

 

[anonymousu]

An experienced MT who went thru this program would prolly be better at running a lab than most newly minted AP/CP grads…just sayin.

So are you acknowledging that Medical Director positions are bs on the CP side? Why not just get rid of CP then?

 

[Med Director New England]

So are you acknowledging that Medical Director positions are bs on the CP side? Why not just get rid of CP then?

No not at all.
The director of the lab who has their name on a clia and takes responsibility for the output of that lab has a critical role. The role isn’t as simple as providing clinical consultation when other MDs have questions related to the lab. Your responsible for really everything in the lab and can ruin your career if you don’t know what your doing. Google the many examples of sloppy pathologists being barred from being on clia’s after their labs screwed up.

If a non pathologist wants to take on the responsibility and risk of lab directorship (and are capable of doing it) - I have no objection. For this specific situation (MT + DCLS running a lab) it makes more sense for this to be a bigger lab with CP trained pathologists in the mix.

 

[KeratinPearls]

Most residents (hell even some pathologists) I know wouldn’t be competent to be a medical director of a lab. They pass their CP but have no clue what to do if put into the role (managing, etc)

 

[anonymousu]

No not at all.
The director of the lab who has their name on a clia and takes responsibility for the output of that lab has a critical role. The role isn’t as simple as providing clinical consultation when other MDs have questions related to the lab. Your responsible for really everything in the lab and can ruin your career if you don’t know what your doing. Google the many examples of sloppy pathologists being barred from being on clia’s after their labs screwed up.

If a non pathologist wants to take on the responsibility and risk of lab directorship (and are capable of doing it) - I have no objection. For this specific situation (MT + DCLS running a lab) it makes more sense for this to be a bigger lab with CP trained pathologists in the mix.

I completely get your logic. What you are suggesting though seems like CP only positions can be completely replaced by non pathologists. In some countries, it is common to just specialize in lab medicine (CP). They don't have an option to pursue AP because they are considered completely different fields. The idea of letting a non physician be in charge of a clinical lab wouldn't be welcomed at all. I wonder what percentage of pathologists think in such a way in the US. I don't think CAP is supportive of it though.

 

[anonymousu]

Most residents (hell even some pathologists) I know wouldn’t be competent to be a medical director of a lab. They pass their CP but have no clue what to do if put into the role (managing, etc)

Many aren't because they genuinely have no interest.

 

[octopusprime]

I wonder how that would affect the part A services covered by CMS to the hospital DRGs...most groups that work in hospitals receive medical directorship compensation for 24/7 lab coverage (since the hospital is receiving those monies from CMS)...obviously it includes tumor board and call and perhaps autopsies, but CP lab oversight is included. I imagine if a degree like that takes hold we'd see a significant decrease in lab directorship compensation.

Many modern residents / young pathologists have no interest in CP but a moderately competent group and a handful of quality seasoned techs & lab managers are more than sufficient for most labs other than large / reference labs or academic centers, who probably already have CP dedicated pathologists and/or PhDs on site. So not sure why this is needed.

 

[RoachUSMLE]

No not at all.
The director of the lab who has their name on a clia and takes responsibility for the output of that lab has a critical role. The role isn’t as simple as providing clinical consultation when other MDs have questions related to the lab. Your responsible for really everything in the lab and can ruin your career if you don’t know what your doing. Google the many examples of sloppy pathologists being barred from being on clia’s after their labs screwed up.

If a non pathologist wants to take on the responsibility and risk of lab directorship (and are capable of doing it) - I have no objection. For this specific situation (MT + DCLS running a lab) it makes more sense for this to be a bigger lab with CP trained pathologists in the mix.

How about incorporating major curriculum for DCLS into AP/CP training?

 

[Med Director New England]

I completely get your logic. What you are suggesting though seems like CP only positions can be completely replaced by non pathologists. In some countries, it is common to just specialize in lab medicine (CP). They don't have an option to pursue AP because they are considered completely different fields. The idea of letting a non physician be in charge of a clinical lab wouldn't be welcomed at all. I wonder what percentage of pathologists think in such a way in the US. I don't think CAP is supportive of it though.

I think the question is - is a traditional PhD any more equipped to run a lab (or a part of a lab) than this newer degree. I know many awesome MTs who have left the lab completely (going the MBA route). At least this degree keeps them involved in actual lab work.

In my experience working with MTs over the years the really excellent ones are quite capable of taking on directorship / leadership roles. As I said above ideally in a larger lab admixed with MDs (CP trained pathologists).