Does Pathology Need a complete top to bottom Leadership Change?

[LADoc00]

Im beginning to think a total leadership change at USCAP and ASCP is the only way forward.

The entire field seems to be careening into the gutter in terms of staffing, reimbursement and perceived value to prospective medical students.

The fact that Elizabeth Holmes actually formerly addressed the AACC in 2016 is final nail in the coffin of this entire circus.

Who is running this Venezuelan dumpster fire of a profession now?

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[Unty]

Stephen Myers
Chief Executive Officer of CAP

R. Bruce Williams, MD, FCAP
CAP President
Term 2017-2019

Patrick E. Godbey, MD, FCAP
CAP President-Elect
Term to 2017-2019

 

[pathslides]

CAP is such a garbage and corrupt organization. Why anyone would pay to be a member is beyond me.

 

[Spikebd]

LADoc for pres? Would he keep the average grunt in mind if he assumed power? Can a propaganda campaign reverse this trend? Pathologists don’t seem to be charismatic enough to lead such a campaign.

 

[y2k_free_radical]

Im beginning to think a total leadership change at USCAP and ASCP is the only way forward.

The entire field seems to be careening into the gutter in terms of staffing, reimbursement and perceived value to prospective medical students.

The fact that Elizabeth Holmes actually formerly addressed the AACC in 2016 is final nail in the coffin of this entire circus.

Who is running this Venezuelan dumpster fire of a profession now?

AGREE 100%

 

[jupiterianvibe]

Please read this. It is analogous to what we're experiencing:

https://www.google.com/url?sa=t&rct...Medicine.pdf&usg=AOvVaw301Im4XtLwsXe6iVrrkRtm

 

[Vicinal]

Im beginning to think a total leadership change at USCAP and ASCP is the only way forward.

The entire field seems to be careening into the gutter in terms of staffing, reimbursement and perceived value to prospective medical students.

The fact that Elizabeth Holmes actually formerly addressed the AACC in 2016 is final nail in the coffin of this entire circus.

Who is running this Venezuelan dumpster fire of a profession now?

Seems like some sort of independent audit is necessary. If most of the spots are supported by Medicare secured funding (tax payers) and hospitals/programs get an equivalent amount, why would they ever give up those spots unless they are forced to. As others have mentioned many resident jobs would be more efficiently performed by PAs and CLSs. Maybe there should be a a minimum of 10-15K accessions with a certain level of complexity per resident. Some programs have less than 30K accessions and 4-5 residents per year. How does this happen?

 

[path24]

Decades prove things won't change. Pathology can get no better. You fight for a job. You fight to keep your specimens, and contracts. Insurance companies ignore you. You bring no power to the negotiating table. It follows your ENTIRE career. In the end, all docs end up employed and we still are the least important doc in the room. I don't encourage anyone (AMG, FMG..etc.) to go into this field. Even if its the only thing you can get, try to jump ship during residency. You will put yourself in a better situation.

Those stuck, become FI as soon as possible. It is what I am working on. I have a slightly above average job and I am lucky to have it. I don't think I could repeat it and I don't take it for granted. Pathology is the worst career choice a medical student can make. You fold all of your cards once you join. Don't make it.

 

[Torsed]

You are absolutely correct about a career long struggle.

 

[StatistPriceControlsFail]

Price controls don't work.
Physician Fee Schedule - Centers for Medicare & Medicaid Services
http://www.jpands.org/vol20no3/miller.pdf
Price Controls: Price Floors and Ceilings, Illustrated

 

[Alteran]

...is this a trick question?

 

[gbwillner]

You are all free to try to change pathology leadership.

No one individual or group is at fault for the perceived weaknesses of the field.

Imho, the problems stem from:
1. A general consolidation environment in the healthcare space
2. Lack of direct patient access by pathologists
3. Changing technology and medical practices, and SOME pathologist resistance to that change
4. General trend for "type B" personalities in the field

 

[gbwillner]

You are all free to try to change pathology leadership.

No one individual or group is at fault for the perceived weaknesses of the field.

Imho, the problems stem from:
1. A general consolidation environment in the healthcare space
2. Lack of direct patient access by pathologists
3. Changing technology and medical practices, and SOME pathologist resistance to that change
4. General trend for "type B" personalities in the field

Forgot to add:
5. Ever increasing costs of laboratory services, much of it as a result of fraudulent activity that is difficult to snuff out without hurting everyone

 

[y2k_free_radical]

Forgot to add:
5. Ever increasing costs of laboratory services, much of it as a result of fraudulent activity that is difficult to snuff out without hurting everyone

The main problem remains of too many residents produced versus demand for same in the real world marketplace.

 

[Med Director New England]

The main problem remains of too many residents produced versus demand for same in the real world marketplace.

This is the only problem IMO
Fix this and everything else fixes itself

 

[gbwillner]

This is the only problem IMO
Fix this and everything else fixes itself

How? Pathologists relying on other clinicians for 100% of their business is way bigger of an issue. It will only get worse as we move more to bundled payments. Lab services costs and things like PAMA that reduce those costs cannot be impacted by reducing residency spots. I am not arguing that it is not an issue, but really it is not clear it is even a top consideration.

 

[Guest8]

How? Pathologists relying on other clinicians for 100% of their business is way bigger of an issue. It will only get worse as we move more to bundled payments. Lab services costs and things like PAMA that reduce those costs cannot be impacted by reducing residency spots. I am not arguing that it is not an issue, but really it is not clear it is even a top consideration.

But that is inherent to what pathology is - a service provided to other physicians. We don't create the biopsies or resections, so we'll always be at the mercy of fellow clinicians. But if there's far too many of us fighting for the same specimens, it's even easier to pit us against each other to fight for scraps. If there were fewer of us, we'd have more control over what clinicians can offer us for things like in-office work, etc.

 

[y2k_free_radical]

How? Pathologists relying on other clinicians for 100% of their business is way bigger of an issue. It will only get worse as we move more to bundled payments. Lab services costs and things like PAMA that reduce those costs cannot be impacted by reducing residency spots. I am not arguing that it is not an issue, but really it is not clear it is even a top consideration.

I respectfully strongly disagree with your assessment of cause and affect.If we weren't in such great supply,we wouldn't be so easy to control.

 

[HeyDalaron]

You are all free to try to change pathology leadership.

No one individual or group is at fault for the perceived weaknesses of the field.

Imho, the problems stem from:
1. A general consolidation environment in the healthcare space
2. Lack of direct patient access by pathologists
3. Changing technology and medical practices, and SOME pathologist resistance to that change
4. General trend for "type B" personalities in the field
5. Ever increasing costs of laboratory services, much of it as a result of fraudulent activity that is difficult to snuff out without hurting everyone

I would agree with the other posters that an overabundance of pathologist labor may be responsible for all or some of these negative downward pressures on the profession. Consolidation reduces employment options, so if there is a pathologist abundance, individual pathologist bargaining power is reduced.

For your second point about direct patient access, changing this would require a shift in how pathologists are trained. Currently, the rules for opening residency programs are outdated and too lax. Were residency programs required to provide adequate types of case exposures rather than just autopsies, the few programs remaining could push the training envelope further, by including clinical interventions for instance.

An overabundance of affordable pathologist labor reduces the pressure on employers and groups to invest in technology. Why move forward with slide scanning or in vivo when you can get someone to push glass for pennies?

The unprestigious nature of pathology unfortunately attracts the desperate or the unmotivated. Neither of these categories exhibit leadership potential. This will not change until getting into pathology, and not just at the big programs, is seen as an accomplishment.

And your fifth point is also the result of an overabundance of pathologists. Desperate individuals are easier to exploit for unethical profit, and will more likely take part in unethical behavior themselves.

How? Pathologists relying on other clinicians for 100% of their business is way bigger of an issue. It will only get worse as we move more to bundled payments. Lab services costs and things like PAMA that reduce those costs cannot be impacted by reducing residency spots. I am not arguing that it is not an issue, but really it is not clear it is even a top consideration.

On the contrary, I believe that the widespread availability of substandard pathology training programs producing substandard physicians is the top issue that must be corrected. For every MGH there are ten Hollywood-upstairs Medical Colleges. If one is at or has trained in a top institution, the outlook probably appears more rosy and is skewed positively, as these programs have the resources to do what needs to be done to prepare their grads for the future. Most programs do not have this potential. From the sky, it is impossible to see the dirt on the ground.

The field of radiation oncology has experienced its worst match year in decades. There is discussion at the top levels of their professional society regarding submitting a proposal to the ACGME for modernizing the training requirements of its programs, which would also effectively close down a large percentage of them. It would be wise for the field of pathology to adopt a similar approach.

 

[LADoc00]

I think if I became head of CAP, I would need to embark on almost Stalin style purges of the entire profession. I would weaponize the entire CAP survey system as the method for bringing rogue pathologists into line and would close around 80% of the training programs. Keep the main 12 or so programs going: Brigham, Duke, Hopkins, Emory, UT, Columbia for 1 program in NYC but all of them really suck atm, Stanford, WashU, Penn, UC (1 program only, likely in LA), Chicago, Minn, UW maybe a few others like Mayo and Utah.Everything else shutters for 8-10 years.

Perhaps create a loyal group of around 40 or so mid career pathologists who can act as local area enforcers, like commissar type surveyors, showing up unannounced at academic or commercial labs and striking the fear of CAP into them. Telling their employees to confidentially report any potential rebellions against CAP leadership.

Then I would hire the most crack lobbyists in DC, people who normally sell Patriot missiles to the middle east or something, to lobby CMS directly. I would actually engage multiple teams of lobbyists even. Hit the entire problem from several tiers: reimbursement on pro fees, pathologist autonomy, combat bundled payment plans etc.

I would then lobby directly to congressional and senate staff appealing to patient safety and anti-fraud/abuse of CMS to both Republicans and Democrats with a non-stop platform of reforms to get whatever I can passed. I would create Maoist like meeting groups in every region across the country where pathologists are forced to interact in a small group and share stories of being abused or fraud or whatever so I can back up my political war with real events and details.

Heck I might even hire Russian troll farms to attack large commercial labs, put private detectives on their executives hoping to catch one with a pile of cocaine and dead hookers, entice their employees to become whistleblowers. Real Carl Von Clausewitz sh-t.

dunno, maybe I should delete this post...

 

[Med Director New England]

How? Pathologists relying on other clinicians for 100% of their business is way bigger of an issue. It will only get worse as we move more to bundled payments. Lab services costs and things like PAMA that reduce those costs cannot be impacted by reducing residency spots. I am not arguing that it is not an issue, but really it is not clear it is even a top consideration.

There is plenty of revenue in pathology..even with pressures like PAMA any busy pathologist bills plenty to support a nice salary.

Problem is we are already > 90% employed and trending up. Employers of pathologists are making money off our backs and the oversupply makes this easier to accomplish.

I still maintain if you Fix this literally everything anyone ever complains about goes away and quickly.

 

[y2k_free_radical]

There is plenty of revenue in pathology..even with pressures like PAMA any busy pathologist bills plenty to support a nice salary.

Problem is we are already > 90% employed and trending up. Employers of pathologists are making money off our backs and the oversupply makes this easier to accomplish.

I still maintain if you Fix this literally everything anyone ever complains about goes away and quickly.

Surely more than 10 % of pathologists are self employed

 

[Torsed]

LaDoc00:

My hospital lab is JC accredited, the CAP theory of the purge falls apart. I can tell you the one JC inspector that comes totally stinks compared to the 10 or so that would show up with CAP inspections. The lab is able to hide a lot of problems during inspection because of this. :-/

 

[WEBB PINKERTON]

CAP inspections aren't exactly real thorough. Few hours inspecting, hour eating and socializing, few hours getting ready for summation.

 

[dukeresident]

This is the only problem IMO
Fix this and everything else fixes itself

Supply and demand does typically work.

 

[dukeresident]

I think if I became head of CAP, I would need to embark on almost Stalin style purges of the entire profession. I would weaponize the entire CAP survey system as the method for bringing rogue pathologists into line and would close around 80% of the training programs. Keep the main 12 or so programs going: Brigham, Duke, Hopkins, Emory, UT, Columbia for 1 program in NYC but all of them really suck atm, Stanford, WashU, Penn, UC (1 program only, likely in LA), Chicago, Minn, UW maybe a few others like Mayo and Utah.Everything else shutters for 8-10 years.

Perhaps create a loyal group of around 40 or so mid career pathologists who can act as local area enforcers, like commissar type surveyors, showing up unannounced at academic or commercial labs and striking the fear of CAP into them. Telling their employees to confidentially report any potential rebellions against CAP leadership.

Then I would hire the most crack lobbyists in DC, people who normally sell Patriot missiles to the middle east or something, to lobby CMS directly. I would actually engage multiple teams of lobbyists even. Hit the entire problem from several tiers: reimbursement on pro fees, pathologist autonomy, combat bundled payment plans etc.

I would then lobby directly to congressional and senate staff appealing to patient safety and anti-fraud/abuse of CMS to both Republicans and Democrats with a non-stop platform of reforms to get whatever I can passed. I would create Maoist like meeting groups in every region across the country where pathologists are forced to interact in a small group and share stories of being abused or fraud or whatever so I can back up my political war with real events and details.

Heck I might even hire Russian troll farms to attack large commercial labs, put private detectives on their executives hoping to catch one with a pile of cocaine and dead hookers, entice their employees to become whistleblowers. Real Carl Von Clausewitz sh-t.

dunno, maybe I should delete this post...

Not so sure about Duke...my impression is it could be shuttered.

 

[gbwillner]

One thing behind my earlier post I did not discuss in detail is that path revenues are good because of the fee-for-service model. However, we have seen that the future is one of bundled payments. My major concern for the field is this shift, because as we currently practice, we will not have direct access to revenue and further rely on other physicians' good will to see any. While I don't disagree than an over-abundance of poorly trained pathologists is bad for the field, will that even matter if fee-for-service dies? We may see questioning of the utility of even the most standard pathology practices, as other docs feel the costs of our services directly.

 

[WEBB PINKERTON]

Bundling will lead to a pretty large exempt list I would think. Don't give the pathologist anymore work than they have to.

 

[y2k_free_radical]

In the eyes of administrators and our non pathologist colleagues we are definitely lowest on the scrotum pole

 

[chooks]

Bundling will lead to a pretty large exempt list I would think. Don't give the pathologist anymore work than they have to.

Absolutely. Yes. The arguments about the rare metastatic carcinoma or acute leukemia in hernia sacs will give way to the overall economics. Probably lots of 88304s will be gone in favor of 88300-ing them or on the exempt list.

 

[Med Director New England]

Surely more than 10 % of pathologists are self employed

Definitely not in my area.

 

[FourCandles]

Im beginning to think a total leadership change at USCAP and ASCP is the only way forward.

The entire field seems to be careening into the gutter in terms of staffing, reimbursement and perceived value to prospective medical students.

The fact that Elizabeth Holmes actually formerly addressed the AACC in 2016 is final nail in the coffin of this entire circus.

Who is running this Venezuelan dumpster fire of a profession now?

Physicians in general and pathologists in particular, are headless chickens. Let's face the reality: we are doomed. Even if we bring in great leadership, we will probably eventually vote them out because of self-interest, much like this nation state.

 

[dukeresident]

Physicians in general and pathologists in particular, are headless chickens. Let's face the reality: we are doomed. Even if we bring in great leadership, we will probably eventually vote them out because of self-interest, much like this nation state.

Total no brainer. Of course it does.

 

[MetroPath]

People have been saying pathology needs a leadership change since I came on this site years ago lol. LADoc is one of the few OGs of this forum.

 

[yaah]

Everyone wants a leadership change so that we don't make too many changes and so we go back to the way things were 20 years ago? Leadership changes probably have to happen on a national health care level. You can reduce number of residency spots all you want, it isn't going to increase the number of quality people who finish pathology training programs. If they're all hard up for work why is it every good candidate we look at seems to have 3 job offers? That's the kind of thing that SOUNDS like a good solution, but almost certainly isn't going to have significant effect for years and years by which time H&E is an obsolete procedure.

If increasing money continues to flow to drug companies, medical device companies, administrators, and physician extenders (scribes, medical assistants, surgical assistants, technical assistants) where is all this extra $ for labs supposed to come from? Fight for your piece of the pie, yes, but do it with actual competence and expertise, not with complaining and rent-seeking behavior.


That being said,

Im beginning to think a total leadership change at USCAP and ASCP is the only way forward.

The entire field seems to be careening into the gutter in terms of staffing, reimbursement and perceived value to prospective medical students.

Pathology leadership change would be a good thing - the model of "paying your dues in societies for decades, serving on ever increasing committees, before finally getting ceremonial positions" needs to change. I really don't know how though. Elections are fine, but elections are also a good way to elect the wrong people. Does anyone have a good proposal for getting actual leadership change in pathology elections? It is extremely hard to be anything but incremental with even minor reforms - the vast majority of the pathology population, as these forums prove, doesn't actually want change. They want things to stay the way they are without actual change. Anti-change.

 

[LADoc00]

I feel an apt analogy is Muammar Gaddafi and Libya, a pathology leadership that will cling to power to the very end for nothing else than to save themselves from the mobs. When the dust settles, pathology will be doomed to decades of a Mad Max'ian dystopian profession dominated by geographically placed marauding warlords vying for national level influence. With millions of dollars at stake in an ever shrinking Socialist healthcare landscape, these warlords will be ruthless to the extreme and SDN path forums will revert to calling the last 20 years "a time of gentle peace and freedom where a staff pathologist might dream of home ownership and a family one day"...