? for community pathologists (ie. LADoc, pathdawg, et al)

[DarksideAllstar]

So I'm at a family med clinic for the next month in a "rural" location. And by rural, I mean I am in South Lake Tahoe, adjacent to Heavenly Ski Resort. Luckily for me, I only work 4 days a week in clinic, and the FP, knowing that I was going into path, introduced me to the lone pathologist who practices at the hospital up here. So q Friday I hang out and signout surgicals with her, etc. She mentioned to me that she does about 5000 specimens a year (including surgicals, biopsies, and cytology [no paps though]). She made the comment that its too much for one person, but not enough to support two pathologists. She does all of her own grossing (ie no PA) and does all the CP stuff. At one point I thought I heard that 4-5K specimens was a good number to support a pathologist in private practice, but I can't find the thread after searching for like the last half hour. How many specimens do you see as ideal to support a full time gag in pathology? I would imagine it partially depends on what you are seeing and what you can bill for, but all things being equal what's a decent figure to support maybe a salary of $200-250K/yr? I would love to eventually work in this area so I'm hoping that the volume increases over the next 5 years or so (or I can push her into retirement, whichever will do). Thanks.

PS- the snow this year is ****ty

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[Circumflex]

In addition to the surgical and cytologic specimens, I wonder how much of her income comes from the CP side. In the town where I grew up, there was a single pathologist and he made a killing, but I think a lot of that had to do with his reimbursement for reviewing every test done in the lab (CBCs, etc.).

 

[DarksideAllstar]

In addition to the surgical and cytologic specimens, I wonder how much of her income comes from the CP side. In the town where I grew up, there was a single pathologist and he made a killing, but I think a lot of that had to do with his reimbursement for reviewing every test done in the lab (CBCs, etc.).

Good point, although I thought I had read that this really doesn't dramatically impact $ as much as it did in the past. I should also add that this pathologist doesn't do marrows or FNAs.

 

[PathOne]

While I confess to be almost entirely ignorant of the ways of community practise, billing issues, etc etc etc, I think that you'd need to bear two things in mind:

1. The trend is clearly going towards ever more specilized diagnostic services. I think that'll increasingly put the one (wo)man settings under pressure. You'd have to send a lot away for consultations, and what if a large group starts to show interest in your customers, and lure them with in-house consultations, fancy new stainings, molecular tests, etc etc?
2. You'd be fairly dependent on changes in reimbursement for your services. If fees fall, you'd be really hurt. So will larger groups, but as per #1, they have the option to poach customers in a wider geographic area. That would be much more difficult for a solo practise.

Sorry for not being able to answer your main question.

 

[PathOne]

Oh, forgot to add a VERY important third point:

3. It's really hard running a solo practise, because you'll have nobody to discuss your findings with. I consider myself as a fairly experienced professional in my field, but I still discuss difficult cases with colleagues on a daily basis. Based on what I know now, I would NEVER go solo straight out of Residency or Fellowship. I simply wouldn't have enough experience.

THIS IS A VERY IMPORTANT POINT!!! (sorry for the caps, but I'm really serious about this)...

 

[djmd]

While 4-5k is about right per pathologist (which all the qualifiers) but one person only doesn't get divide anything.. call, etc... To take vacation she needs Locum Ts....

and she is right 2500 per is not enough for two full time pathologists...

 

[DarksideAllstar]

Oh, forgot to add a VERY important third point:

3. It's really hard running a solo practise, because you'll have nobody to discuss your findings with. I consider myself as a fairly experienced professional in my field, but I still discuss difficult cases with colleagues on a daily basis. Based on what I know now, I would NEVER go solo straight out of Residency or Fellowship. I simply wouldn't have enough experience.

THIS IS A VERY IMPORTANT POINT!!! (sorry for the caps, but I'm really serious about this)...

She definitely stressed this to me when I was talking to her about her set-up, and I definitely see the upshot to having people to show cases to. She's been in practice for almost 30 years and sends consults out on the "toughies" and for additional work-up as needed (ie beyond some basic IPOX) that she can't do in her histo lab. I think she'll often show cases to some colleagues in Carson (about 30 minutes away). Personally, I envision myself in a small group practice. I'm not sure I would ever "man-up" enough to go out on my own without some in-house backup at times.

While 4-5k is about right per pathologist (which all the qualifiers) but one person only doesn't get divide anything.. call, etc... To take vacation she needs Locum Ts....

and she is right 2500 per is not enough for two full time pathologists...

Yeah, she brings someone up from Vegas about 8 wks/yr when she goes on vacation. Thanks for the info guys I kinda had a hunch that a place would need to see 8-10K/yr for two full time people.

 

[pathdawg]

Personally, I don't think signing out 5k cases a year (including surgicals AND gyn- and non-gyn cytology) is alot at all. Then again, considering that she also does all grossing, that could seem like a decent workload. Most pathologists in a community hospital setting see more than that. I know I do more than 5k and I have enough free time to screw around with you guys. Then again, I don't gross, so I am sure that makes a big difference.

I agree that true solo work like she does is far from ideal, especially for the newbie attending.

 

[LADoc00]

So I'm at a family med clinic for the next month in a "rural" location. And by rural, I mean I am in South Lake Tahoe, adjacent to Heavenly Ski Resort. Luckily for me, I only work 4 days a week in clinic, and the FP, knowing that I was going into path, introduced me to the lone pathologist who practices at the hospital up here. So q Friday I hang out and signout surgicals with her, etc. She mentioned to me that she does about 5000 specimens a year (including surgicals, biopsies, and cytology [no paps though]). She made the comment that its too much for one person, but not enough to support two pathologists. She does all of her own grossing (ie no PA) and does all the CP stuff. At one point I thought I heard that 4-5K specimens was a good number to support a pathologist in private practice, but I can't find the thread after searching for like the last half hour. How many specimens do you see as ideal to support a full time gag in pathology? I would imagine it partially depends on what you are seeing and what you can bill for, but all things being equal what's a decent figure to support maybe a salary of $200-250K/yr? I would love to eventually work in this area so I'm hoping that the volume increases over the next 5 years or so (or I can push her into retirement, whichever will do). Thanks.

PS- the snow this year is ****ty

Interestingly Im quite familiar with that STahoe pathologist. She has a part timer that is old school MGH trained, Dr. Mindy Cooper-Smith who is an incredible reference for business stuff.

I have no idea what her payor mix is up there. She also took on a smaller hospital and has to do some driving now (think it is in Douglas, Nev.).

In my payor mix which may very well be the best in all of California (other top ones would be Carmel-Monterey-Pebble Beach, Newport Beach and Malibu/SM/PP), I can convert 5,000 surgicals into roughly 1.2m gross just in terms of professional billings. That isnt considering med directorship fees, Cp lab pro. billing for non-Medicare part A or autopsy fees(which can vary alot from 40,000/year to more than 250K).

You can convert back from that number to get your data.

I can tell you 5,000 is nothing for 1 person in hardcore mode. I know of a guy who did >10,000 year. I do more than 5,000 easy.

In terms of powerplayin and getting the contract for that Tahoe hospital(s), I think the Reno group may have an eye on it after she is gone. A good way to position yourself would be to get some locums opps while you are in fellowship and get to know admin.

Given the incredibly crappy path environment of Vegas, I fear all of NV doesnt have much to really offer an ambitious young pathologist.

 

[pathstudent]

Interestingly Im quite familiar with that STahoe pathologist. She has a part timer that is old school MGH trained, Dr. Mindy Cooper-Smith who is an incredible reference for business stuff.

I have no idea what her payor mix is up there. She also took on a smaller hospital and has to do some driving now (think it is in Douglas, Nev.).

In my payor mix which may very well be the best in all of California (other top ones would be Carmel-Monterey-Pebble Beach, Newport Beach and Malibu/SM/PP), I can convert 5,000 surgicals into roughly 1.2m gross just in terms of professional billings. That isnt considering med directorship fees, Cp lab pro. billing for non-Medicare part A or autopsy fees(which can vary alot from 40,000/year to more than 250K).

You can convert back from that number to get your data.

I can tell you 5,000 is nothing for 1 person in hardcore mode. I know of a guy who did >10,000 year. I do more than 5,000 easy.

In terms of powerplayin and getting the contract for that Tahoe hospital(s), I think the Reno group may have an eye on it after she is gone. A good way to position yourself would be to get some locums opps while you are in fellowship and get to know admin.

Given the incredibly crappy path environment of Vegas, I fear all of NV doesnt have much to really offer an ambitious young pathologist.

1.2 million sounds pretty good. How much has to go to expenses like billing, clerical etc..?

 

[DarksideAllstar]

Interestingly Im quite familiar with that STahoe pathologist. She has a part timer that is old school MGH trained, Dr. Mindy Cooper-Smith who is an incredible reference for business stuff.

I have no idea what her payor mix is up there. She also took on a smaller hospital and has to do some driving now (think it is in Douglas, Nev.).

In my payor mix which may very well be the best in all of California (other top ones would be Carmel-Monterey-Pebble Beach, Newport Beach and Malibu/SM/PP), I can convert 5,000 surgicals into roughly 1.2m gross just in terms of professional billings. That isnt considering med directorship fees, Cp lab pro. billing for non-Medicare part A or autopsy fees(which can vary alot from 40,000/year to more than 250K).

You can convert back from that number to get your data.

I can tell you 5,000 is nothing for 1 person in hardcore mode. I know of a guy who did >10,000 year. I do more than 5,000 easy.

In terms of powerplayin and getting the contract for that Tahoe hospital(s), I think the Reno group may have an eye on it after she is gone. A good way to position yourself would be to get some locums opps while you are in fellowship and get to know admin.

Given the incredibly crappy path environment of Vegas, I fear all of NV doesnt have much to really offer an ambitious young pathologist.

Thanks dude. I'm never going back to Vegas--ever. I would really enjoy setting the entire state of Nevada on fire and watching it burn to the ground. From what I hear LMC pretty much runs things down there anyhow. Aren't there a couple groups in Reno (Western and I can't think of the other's name right now)? I do know that this So Lake Pathologist runs a cash lab in Carson, didn't know about the place in Douglas tho. Cooper-Smith is who she brings up for LT. Probably way too early for me to strategically plot the take over of the universe (or at least Tahoe), but I appreciate the ideas. I'm open to other ski-resortish areas (Jackson WY, Sun Valley ID, Bishop (Mammoth Lakes) CA) so hook me up if you know someone.

 

[LADoc00]

Thanks dude. I'm never going back to Vegas--ever. I would really enjoy setting the entire state of Nevada on fire and watching it burn to the ground. From what I hear LMC pretty much runs things down there anyhow. Aren't there a couple groups in Reno (Western and I can't think of the other's name right now)? I do know that this So Lake Pathologist runs a cash lab in Carson, didn't know about the place in Douglas tho. Cooper-Smith is who she brings up for LT. Probably way too early for me to strategically plot the take over of the universe (or at least Tahoe), but I appreciate the ideas. I'm open to other ski-resortish areas (Jackson WY, Sun Valley ID, Bishop (Mammoth Lakes) CA) so hook me up if you know someone.

I know/have friends of friends that are in all those places. There was an opening in Mammoth a few years back even. All are pretty much solo gigs. Jackson can be particularly isolating.

I dont think you want to go solo right out the gates. I would at least have 1-2 years of junior attendings under my belt first.

In terms of strategy, 99% of it is simply right place-right time.

 

[b&ierstiefel]

OK...this is the thread that is best applicable for the following question:

So let's say, a few folks from a residency program want to start their own business after residency & fellowship. The folks involved would have expertise in a specific subspecialty and the major subspecialties would be covered by the service. For instance, there would be the GI guy. There would be the Cyto gal. Derm dude too. A GU macdaddy. And a heme person. How would this group set things up? How would this group advertise? What's the best way to attract business and get established?

 

[Gut Shot]

OK...this is the thread that is best applicable for the following question:

So let's say, a few folks from a residency program want to start their own business after residency & fellowship. The folks involved would have expertise in a specific subspecialty and the major subspecialties would be covered by the service. For instance, there would be the GI guy. There would be the Cyto gal. Derm dude too. A GU macdaddy. And a heme person. How would this group set things up? How would this group advertise? What's the best way to attract business and get established?

Just hire DPL and let him do it all.

 

[dermpathdoc]

Thanks dude. I'm never going back to Vegas--ever. I would really enjoy setting the entire state of Nevada on fire and watching it burn to the ground. From what I hear LMC pretty much runs things down there anyhow. Aren't there a couple groups in Reno (Western and I can't think of the other's name right now)? I do know that this So Lake Pathologist runs a cash lab in Carson, didn't know about the place in Douglas tho. Cooper-Smith is who she brings up for LT. Probably way too early for me to strategically plot the take over of the universe (or at least Tahoe), but I appreciate the ideas. I'm open to other ski-resortish areas (Jackson WY, Sun Valley ID, Bishop (Mammoth Lakes) CA) so hook me up if you know someone.

Why not going back to vegas???
I am an experienced Dermpath trying desperately to relocate to west/west coast, due to family exigencies...have actually been interviewing for the last 5-8 years without success....problem??? I think they all want a newbie resident with no business sense...Is vegas more of the same?

 

[pathstudent]

OK...this is the thread that is best applicable for the following question:

So let's say, a few folks from a residency program want to start their own business after residency & fellowship. The folks involved would have expertise in a specific subspecialty and the major subspecialties would be covered by the service. For instance, there would be the GI guy. There would be the Cyto gal. Derm dude too. A GU macdaddy. And a heme person. How would this group set things up? How would this group advertise? What's the best way to attract business and get established?

I don't really think you can claim "expertise" after fellowship, but I guess it would be good to market it that way. I think you still don't know **** after fellowship. It takes years to master.

 

[b&ierstiefel]

I don't really think you can claim "expertise" after fellowship, but I guess it would be good to market it that way. I think you still don't know **** after fellowship. It takes years to master.

Very true...gotta start somewhere though, right? I guess that's why this kind of thing happens rarely or not at all and most people after fellowship just join an already established group or something.

 

[pathstudent]

Very true...gotta start somewhere though, right? I guess that's why this kind of thing happens rarely or not at all and most people after fellowship just join an already established group or something.

Yeah unless you are willing to move to exurbia I think you have to spend some time in an established group building contacts and gaining experience or academia building a reputation and gaining experience and then you could try going out on your own with some friends.

 

[djmd]

OK...this is the thread that is best applicable for the following question:

So let's say, a few folks from a residency program want to start their own business after residency & fellowship. The folks involved would have expertise in a specific subspecialty and the major subspecialties would be covered by the service. For instance, there would be the GI guy. There would be the Cyto gal. Derm dude too. A GU macdaddy. And a heme person. How would this group set things up? How would this group advertise? What's the best way to attract business and get established?

I would say that it would be almost impossible, and most likely extremely unwise for a bunch of new grads to set up their own business. You need experience...

 

[DarksideAllstar]

Why not going back to vegas???
I am an experienced Dermpath trying desperately to relocate to west/west coast, due to family exigencies...have actually been interviewing for the last 5-8 years without success....problem??? I think they all want a newbie resident with no business sense...Is vegas more of the same?

Uhh....cause I grew up in Vegas and dislike/HATE it for many reasons beyond those related to medicine/pathology (although I have some of those reasons, too). Some of the following might include: I would never have a family here, the schools suck(high schools and colleges) and even the private ones aren't much better. The housing market is priced too high and on par with locations that to me seem more desirable. I hate sprawl-- I might as well live in LA, at least there is a beach. The weather sucks like 5 months of the year--- you really cant do anything outside whatsoever.

Its only redeeming quality: a good place to get drunk.

 

[mcfaddens]

Its only redeeming quality: a good place to get drunk.

You forgot getting high on meth and all of those crazy hookers