Flee Pathology Now!!!

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SOME of us were making money off of TC. Not me. Haven't worked for a lab where path profit from TC in a LONG time. The firesale started early in my area with many throwing in the towel in the mid to late 2000s.

"We Are Young" was another big song in 2012. I liked the band fun.
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Ok, you meant in general. Yup, that time period was right around when many pathologist-owned labs started selling off to Quest, Ameripath, etc. Who would've ever thought calling 2012 the "glory days"...lol. Wonder if we end up saying the same thing about 2014 five years down the road... :nailbiting:
 
I just can't believe how many long standing labs sold out in the last decade. Wouldn't surprise me at all if a national duopoly happens with a few specialty and in-office labs sprinked in. We are practically there now. Bundling is coming to your local physician office next. The number of specimens is going plummet and I worry many will be getting diagnoses of "Poorly differentiated Carcinoma." Be plotting your escape.
 
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Ah, the "glory days", such as back in 2008 when my professors convinced me going into pathology would be a wise career move...
 
"We now have almost 80 applicants for our position. I must say that we got our money's worth!" Mr. P, Florida, 3 November 2014

Just weeks from the start of the massive shortage. Yep, the job market is still crap.

Always a good decision to flee pathology!!!
 
**** scary!!! It will be interesting to start a new thread and 'register' your unemployment in real time.
About me, I am doing my fellowship and am looking for a job to start in July 2015. Applied to 45 ads so far mostly from pathoutlines. Not a single interview. So I am registering myself as 'unemployed' now.
 
Just to throw in my experience . . . I'm also doing a fellowship now and applying for jobs with a July 2015 start date. I've applied to a total of about 10 places (all but one of them has been posted on pathoutlines . . . . two were word of mouth, but one of those ultimately got posted). From that I've gotten 4 interviews so far. At this point it's becoming less likely that I will go on any other interviews until I see how the current prospects pan out. I am not applying to any more positions at this point (but certainly will if everything falls through that's currently cooking).
 
path24 said:
"We now have almost 80 applicants for our position. I must say that we got our money's worth!" Mr. P, Florida, 3 November 2014

Just weeks from the start of the massive shortage. Yep, the job market is still crap.

Always a good decision to flee pathology!!!
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I have a relative who works for a large hospital in Florida and she says its a mess down there. Many "for profit" corporations are buying up hospitals, closing a large number of AP/micro departments. The paths that are surviving the consolidation are being forced to be employees so the corporation can get the PC money. Next time they slash TC, dont celebrate or think it doesnt affect me. They will be taking your PC to make up the cuts.
 
BoardShivers said:
**** scary!!! It will be interesting to start a new thread and 'register' your unemployment in real time.
About me, I am doing my fellowship and am looking for a job to start in July 2015. Applied to 45 ads so far mostly from pathoutlines. Not a single interview. So I am registering myself as 'unemployed' now.
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You're not unemployed by any definition. You don't have a job lined up for July 2015, but that in no way makes you unemployed. Most people don't have their first job lined up by Thanksgiving the year prior. You need to network. You need to use everyone you know to see if they know of any potential openings. Blindly applying on pathoutlines postings is not the best way at all to find a job these days. Call headhunters, call anyone. But you're not unemployed.
 
BoardShivers said:
**** scary!!! It will be interesting to start a new thread and 'register' your unemployment in real time.
About me, I am doing my fellowship and am looking for a job to start in July 2015. Applied to 45 ads so far mostly from pathoutlines. Not a single interview. So I am registering myself as 'unemployed' now.
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I hope you have another fellowship lined up. I wouldn't take the chance. I would not expect or assume I would have a job july 1.

Completely agree that our future pc will go to admin or other docs. Huge oversupply/no leverage.
 
I received an unsolicited call from Comp Health this week where the caller used the words "Impossible to place candidates into jobs in Pathology" which I immediately asked why and the caller responded there were literally zero opportunities opening for the past several months.

I have never heard that level of panic before. It was unusual and the call was quite awkward because after a long pause while sitting in my home office sipping a whiskey on ice I told "Yah, there is nothing I can do..." and the call ended.

Something that burst in the last few years has made a bad situation much much worse and I would predict it is the prostate code creation that destroyed that income stream combined with IHC income destruction and 88305 TC super cuts finally grinding down bigger groups that had been mills for 3rd/4th tier applicants for decades.
 
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Too bad they didn't point out that "Less is More" will be the mantra going forward. Much of what we do is being rightly questioned, so the number of specimens could drop big time.

The more pathologists we have out there floating around, the more waste we have. It's simple physics. :prof:
 
I don't understand.. is the truth somewhere in the middle? Can anyone explain the gap between the brochure and that "real world" experience?

Is this just non-(fill in profession description here; i.e., medical, legal, financial) HR personnel screwing things up again?
 
You know the market's bad when a position in a town that is basically a flyover-state truck stop is offering the same paltry rate as a NYC position.

Only in pathology, where your competition is not only your peers but the entire world, and your work is determined by its cost alone.
 
Everyone thinks rural is a way to make more money. It is just as saturated.

There has not been a rural premium in the last 20 years in our specialty.

If a rural practice did well it was only because insurance or MC paid better in that location. That GAP is closing rapidly. Hospitals are not paying more to retain pathologists. We are a dime a dozen.

One the best indicators of supply is locum tenens payments to pathologist by agencies. They don't pay for travel days. The rate has remained about 75-100 per hour depending on volume.
If you go on the road , you make more per day in most areas of medicine. This has not been true during my 20 year career.

The market is going to tighten more unfortunately. I predict a lot more of pathologist displacement as medicine evolves into value based structures. Change has accelerated in the last two years. No end in sight.
 
I did flee from US pathology... I am in a better place... literally like heaven... another country!!!! Absolutely love it here.
 
Prediction...article describing the massive shortage of pathologists due to pathologists leaving the country too practice. Above post will be the only reference.

Pathology the worst choice a person can make.
 
My buddy just lost his job as Medical director/pathologist and so far can't find anything, although it's only been a couple of months. He's a good pathologist but he's really got the gift of gab and can charm just about anyone he wants. No dice so far, he's very dispirited.
I like to look the the listings at the CAP , ASCP and other websites from time to time, sheesh what a joke! A lot of academic stuff but very few groups, looking for someone.
I got caught up in a reshuffling act in 2007 and it took me 2 1/2 years to land a good gig. I was starting to wonder if I would never work in pathology again. Finally I decided to take the plunge and do a fellowship at 52 years of age becuase it seems like they wouldn't even talk to me without that. Got this job just before taking one.
I know this will probably be my last really good job so i'm milking it to the bitter end.
Good luck to all of you
 
(deleted) Gotta stop whining and keep moving forward...
 
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Ishie1013 said:
I'm coming out of a great fellowship; I loved my residency program. I've sent off 50 jobs applications into the aether for three phone calls and two interviews, the results of which I'm endlessly waiting on. My loans are piling on to me, I really need to get out into the work force. 8% interest is no joke. I'm wavering between cautious optimism and utter hopelessness. Today was an utter hopelessness day. Everyone wants more experience; no one is hiring. Half of them, even in the boonies, won't even respond. Every day, I feel a little more sick and a little more stressed. I could care less about Christmas, even though it's the first time I've seen my family in years. I begin to regret everything I've done. I love pathology, but as I watch my colleagues from medical school now in their second year of practice while I *beg* an attending for more time to work on a project so I can get an abstract submitted, I feel as close to jealousy as I ever have. Maybe the job application number 51 will net me the dream job. As much as I love it, I wouldn't put others through it. No one wants you. *No* one. I read this board; I see the updates; I feel like there's no hope, and wonder, if that job number 51 or 75 or 101 doesn't come through, what then? I would never encourage others to follow this path. I should have listened.
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I have been trying to preach this from the rooftops for the last 10 years or so in this forum. I advise you go find another branch of medicine at this point in your young career. There is nothing you can do when you are trying to enter a saturated market that is becoming more and more saturated and all other kinds of regulatory and price control forces are against you.

Flee Pathology Now!!!
 
Ishie1013 said:
I'm coming out of a great fellowship; I loved my residency program. I've sent off 50 jobs applications into the aether for three phone calls and two interviews, the results of which I'm endlessly waiting on. My loans are piling on to me, I really need to get out into the work force. 8% interest is no joke. I'm wavering between cautious optimism and utter hopelessness. Today was an utter hopelessness day. Everyone wants more experience; no one is hiring. Half of them, even in the boonies, won't even respond. Every day, I feel a little more sick and a little more stressed. I could care less about Christmas, even though it's the first time I've seen my family in years. I begin to regret everything I've done. I love pathology, but as I watch my colleagues from medical school now in their second year of practice while I *beg* an attending for more time to work on a project so I can get an abstract submitted, I feel as close to jealousy as I ever have. Maybe the job application number 51 will net me the dream job. As much as I love it, I wouldn't put others through it. No one wants you. *No* one. I read this board; I see the updates; I feel like there's no hope, and wonder, if that job number 51 or 75 or 101 doesn't come through, what then? I would never encourage others to follow this path. I should have listened.
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Your story is very similar to mine, although you're doing better than I was doing because you at least got replies and interviews. It took me almost two years to land the good job that I have, and that was after I did 4 months of locums work.

I honestly don't think there is any other specialty in medicine where it takes over a year to find A job, let alone a good one...assuming you even get that far. There is simply no place in the US to tuck away 600 new pathologists every year. As for the retirement cliff we keep hearing about, it'll never happen as long as there is a glut of unemployed or underemployed pathologists floating around like water in a heavily clogged sink.

We as a field haven't hit rock bottom yet, but we're certainly heading that way. And things won't change for the better until one of two things happens. When either the FMGs stop applying to path residencies leading to program closures or academic departments start being shuttered with faculty layoffs because the market pressures affecting private practices finally caught up to the ivory tower folk, then we'll see changes.
 
Just wait until fee for service goes away....When that happens, we will hit bottom as demand plummets. The people that think fee for service will be around for another 25 years or so are going to be in for a rude awakening.

Find alternative sources of income as soon as you can. Don't let pathology be your only way of making money.
 
Ishie.
Hang in there my friend. You'll get a job. Don't forget about Canada. It's not yet completely hopeless here, and you can get hired for a pretty decent wage (350-400k). The paperwork is not bad and takes about 3-6 months. Your U.S. credentials are good for 5 years. Bingo your working. Most of the jobs are close to the U.S border, so close to home.Worked well for me when I was absolutely at the end of my rope. Not even the stinking VA or military would give me a job. Just don't even think about Nova Scotia, 2016 combined tax rate of 59.7 percent. That's no typo, fifty nine point seven%
 
Thank you very much for the solid advice. I've been thinking long and hard about Canada a lot, and will likely start sending applications that direction next week, and I'm glad the process isn't that lengthy. One of the things that has had me concerned is that I feel like I'm closing in on when I can safely get state licensing squared away without sweating the deadline in most places. Thank you for listening.
 
Unsatisfactory said:
Ishie.
Hang in there my friend. You'll get a job. Don't forget about Canada. It's not yet completely hopeless here, and you can get hired for a pretty decent wage (350-400k). The paperwork is not bad and takes about 3-6 months. Your U.S. credentials are good for 5 years. Bingo your working. Most of the jobs are close to the U.S border, so close to home.Worked well for me when I was absolutely at the end of my rope. Not even the stinking VA or military would give me a job. Just don't even think about Nova Scotia, 2016 combined tax rate of 59.7 percent. That's no typo, fifty nine point seven%
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Just curious- is there more acknowledgement of our importance from Canadian clinicians (and administrators) and/or realization of our importance from the Canadian public?
 
Tissue issue said:
Just curious- is there more acknowledgement of our importance from Canadian clinicians (and administrators) and/or realization of our importance from the Canadian public?[/QUOT

I can only vouch for Manitoba, and it's pretty sweet here. The pay, schedule, low stress etc is very nice.

But best of all is not having to ass kiss the clinicians and beg for there stuff ( they have no other options just us). I practiced in the U.S. for 17 years and this is a breath of fresh air. Now, if I could just do something about the minus 40 degree winter, ticks and mosquitos.
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I would seriously consider going to Canada if I could convince my significant other to move further from family.

At this point, I do have regrets about going into pathology. 6 years of training and tons of networking has resulted in a single offer in a location that is less than ideal in a situation that isn't ideal and pay is the same as primary care. And I feel fortunate to have that. At least I can pay off student loans, though my lifestyle must remain at what it was during residency to accomplish that.

In my program, my situation seems about average. A few have offers they seem excited about while others have nothing at all.
 
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LADoc00 said:
I received an unsolicited call from Comp Health this week where the caller used the words "Impossible to place candidates into jobs in Pathology" which I immediately asked why and the caller responded there were literally zero opportunities opening for the past several months.

I have never heard that level of panic before. It was unusual and the call was quite awkward because after a long pause while sitting in my home office sipping a whiskey on ice I told "Yah, there is nothing I can do..." and the call ended.

Something that burst in the last few years has made a bad situation much much worse and I would predict it is the prostate code creation that destroyed that income stream combined with IHC income destruction and 88305 TC super cuts finally grinding down bigger groups that had been mills for 3rd/4th tier applicants for decades.
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But that would make B U PATHOLOGY similar to a lying lobbyist or politician
 
There is an upcoming shortage...said every year since at least the 90s. We are supposedly in a current shortage according to pathology publications. Nope, no shortage has ever happened or ever will.

Pathology is a for profit college trying to sell crap with the same lie every year.

Hope some US grads like Canada apparently.
 
There is strong vested interesting in training residents and fellows in pathology. We have always been horrible in regulating the supply. Academic pathologist are often shield by market demands. So they only see conditions through their experience.

The subspecialization craze has hit it many specialties.
Examples, orthopedic surgery and general surgery. Now, if you want to be marketable to do a total knee you should be total joint fellow or if you want do routine breast surgery you need a breast fellowship. Academic institutions have gone crazy with fellowships. Sounds familiar ?

Apparently, there is plenty of CMS fellowship funds for this. Some of my older surgeon friends tell me that limitations in hours and duties by residents leads to less hands on time so a fellowship is now necessary.

Ever expanding fellowships in pathology contributes to dislocations IMO. It causes more vested interests, more residents and fellows....
 
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Specialization is the definite trend. But what is interesting is that private groups want more than specialization. Having an area of expertise that is common and important clinically to the instutition is vital. But you can't have that for everything that pathologists do in most hospitals. Even large hospitals can't have experts for everything (plus a backup so vacations can happen). But unfortunately a lot of residents are finishing training hyperspecialized.

When I used to see residents who wanted to go into a certain specialty (like say hemepath) use a lot of their elective time to do more hemepath, I wondered about the utility of that. I got my job in part because I used all my elective time in residency on cyto and hemepath, and when I started my job I cover cyto and hemepath without a fellowship. Now that our group is facing actual retirements (yes, it is happening for multiple in our group, dates have been set) the problem of how to replace what they do is major. Replacing their specialties will not be the hard part. The hard part will be replacing their general duties without a couple of us who are more generalized sucking up even more general stuff. Specialization is important due to efficiency and clinical competence, but it can also be limiting.

When we start hiring in a year or two, who are we going to hire? The person who went pure GI path and can't read out anything else?
 
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AZpath said:
There is strong vested interesting in training residents and fellows in pathology. We have always been horrible in regulating the supply. Academic pathologist are often shield by market demands. So they only see conditions through their experience.

The subspecialization craze has hit it many specialties.
Examples, orthopedic surgery and general surgery. Now, if you want to be marketable to do a total knee you should be total joint fellow or if you want do routine breast surgery you need a breast fellowship. Academic institutions have gone crazy with fellowships. Sounds familiar ?

Apparently, there is plenty of CMS fellowship funds for this. Some of my older surgeon friends tell me that limitations in hours and duties by residents leads to less hands on time so a fellowship is now necessary.

Ever expanding fellowships in pathology contributes to dislocations IMO. It causes more vested interests, more residents and fellows....
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Tons of general surgeons in my area do breast cancer, and tons of general orthos do knees around here.

You are correct for radiology though, they definitely are specialized at this point
 
There is more than one wise pathologist who have told me the field does not have more than 10-12 years left in it. From massive payments cuts to changing screening recommendations designed to ration care to disruptive technology, there are simply too many factors arrayed against our discipline to not face the reality at this point. Im not being super negative, Im literally just relaying what many of the smartest business types in the field of Pathology are thinking and saying in whispers to each other.

If you are planning to generate any quality income beyond say 2025, I would rethink that and plan your career accordingly.
 
It was easy to disrupt the rads as their stuff has been digitilized for a long time , just a few administrative hoops to jump through and now a Filipino rad in Manila signs out the CT for 5 bucks.

I was recently blown away by the rapid advances in digital pathology. Mind bending clarity and zoom at all levels moving the image by swiping the screen zooming in out with fingers and thumbs like on the phone. It wont be long before a portion of the cases are signed out by foreign pathologists for a fraction of the cost, and then a few years latter the flood gates open.
 
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"It was easy to disrupt the rads as their stuff has been digitilized for a long time , just a few administrative hoops to jump through and now a Filipino rad in Manila signs out the CT for 5 bucks.

I was recently blown away by the rapid advances in digital pathology. Mind bending clarity and zoom at all levels moving the image by swiping the screen zooming in out with fingers and thumbs like on the phone. It wont be long before a portion of the cases are signed out by foreign pathologists for a fraction of the cost, and then a few years latter the flood gates open."

Foreign radiologists can't sign out US radiology scans, and foreign pathologists won't be able to sign out US pathology slides, either. Both Radiology and Pathology are medical specialties, and to practice medicine on US patients requires US board certification and licensing. There is no such thing as outsourcing US medicine to foreign countries unless it is by US physicians. And they have no motivation to make $5/CT or $5/slide when they can get paid the same as any other US physician.
 
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Unsatisfactory said:
It was easy to disrupt the rads as their stuff has been digitilized for a long time , just a few administrative hoops to jump through and now a Filipino rad in Manila signs out the CT for 5 bucks.

I was recently blown away by the rapid advances in digital pathology. Mind bending clarity and zoom at all levels moving the image by swiping the screen zooming in out with fingers and thumbs like on the phone. It wont be long before a portion of the cases are signed out by foreign pathologists for a fraction of the cost, and then a few years latter the flood gates open.
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It is highly unlikely that this will happen. People thinking this way have probably never worked in a setting where they signed out surgical pathology. Regardless of the ease of moving digital files around most pathologist do not like to S/O digitally. What is more likely to happen is that all pathologists will be salaried with a stricter RVU formulas for salaries. There will be consolidation and the pathologist will work in a setting where pay is standardized and correlated to reimbursement and RVU. This will seem like the only sustainable way to save social security and Medicare. The special deals where some make 1.2 million and others make 160K will be less common and the peak of the Gaussian distribution will be about 225K with a range of 180K to 350 K.
 
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icpshootyz said:
"It was easy to disrupt the rads as their stuff has been digitilized for a long time , just a few administrative hoops to jump through and now a Filipino rad in Manila signs out the CT for 5 bucks.

I was recently blown away by the rapid advances in digital pathology. Mind bending clarity and zoom at all levels moving the image by swiping the screen zooming in out with fingers and thumbs like on the phone. It wont be long before a portion of the cases are signed out by foreign pathologists for a fraction of the cost, and then a few years latter the flood gates open."

Foreign radiologists can't sign out US radiology scans, and foreign pathologists won't be able to sign out US pathology slides, either. Both Radiology and Pathology are medical specialties, and to practice medicine on US patients requires US board certification and licensing. There is no such thing as outsourcing US medicine to foreign countries unless it is by US physicians. And they have no motivation to make $5/CT or $5/slide when they can get paid the same as any other US physician.
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I share your skepticism but after doing some research I admittedly wasn't aware of quite how much remote radiology has taken off.......

http://www.darkdaily.com/nighthawk-...hology-laboratories-be-next-706#axzz3wPZWBC9O

A slide mill can use US pathologists and negotiate directly with hospital administrators.
 
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Unless someone really invents a "middle out" file compression algorithm, there will be an extra added cost of ensuring that you have adequate bandwith AND physical storage to make this all work. Do you think a rural area is going to have multiple gigabit peers with every major internet backbone? I don't think so. Maybe large metropolitan areas stand more of a chance, but it won't be cheap.

I love digital pathology and fully support it, but I see it being used more as a tool of a remote "intradepartmental consultant service." You will still need to have a physical presence at the hospital. Maybe the number of jobs will be reduced as things get more compartmentalized and centralized... hrm...
 
We already have slide mills all over the country. Tissue moves at the blink of an eye from point A to point B. What are slide mills going to do when they have to handle a complex tumor resection case and they need to examine the gross specimen? Does someone make a perfect 3D model of specimen and digitally send them the data? What about cytopath? Is it possible to make whole slide images for cytology?

You can't really compare pathology to radiology. I know I'm being facetious but radiology is 2D for the most part and the differential diagnosis always includes metastatic carcinoma, lymphoma, or infection.
 
Digital pathology has significant drawbacks when compared to conventional methods. In particular, it delays turn around time, adds significantly to cost and is inferior when compared to conventional glass slides for making a diagnosis. As a result of these limitations I don't see digital pathology being a big threat to pathologists jobs anytime soon.
 
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Tissue issue said:
I share your skepticism but after doing some research I admittedly wasn't aware of quite how much remote radiology has taken off.......

http://www.darkdaily.com/nighthawk-...hology-laboratories-be-next-706#axzz3wPZWBC9O

A slide mill can use US pathologists and negotiate directly with hospital administrators.
Click to expand...

The point is that all of those services still require US-licensed physicians. NightHawk radiology simply places US radiologists in Australia (or wherever). There is no such thing as outsourcing radiology (or pathology) to some third world radiologist for $5/CT scan, and there won't be unless the US drastically changes the requirements for practicing medicine on US patients.
 
Our institution hired a radiologist last year who was working for Nighthawk. He acted like the radiology job market sucks and that was all he could find.

There are much more disruptive forces to worry about than digital pathology. Don't waste time being concerned about it.
 
The important fact about digital pathology versus rads is that in surgical pathology you still have to gross, process, embed, cut, and stain the slides. In Rads the sensor is digital and you can go from detector to sensor digitally.... Don't you people understand this... If you re going to cut a slide anyway, store it, why bother scanning it to take up server space so you can theoretically outsource. There are no robots that can cut 5 micron sections to mechanize histology. People that come up with this digitizing pathology BS are oncologists or non-pathologists that live in an alternate universe. There are too many urologists, gastroenterologist a, dermatologists that make millions of dollars from the technical component of pathology. If someone invents a technology that will circumvent making slides, they will disappear form the earth because in urology alone, millions are made from the technical component of making slides. Yes even with G-Codes.
 
There are certainly ways to make digitization of slides cost-effective vs glass.
 
Digitization still requires the glass slide to be made. The only benefit after that is that you can send a digital file wherever you want without having to mail the physical slides. So the time to get a consult or second opinion, or to get a path read from far away is drastically reduced. But you still need someone to physically make a glass slide which is then scanned in and digitized, it doesn't remove that step at all.
 
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