Glut of Bad Programs and CAP

[pathres9999]

With the amount of bad programs that lead to poorly trained residents and oversaturation of the field, I am always stuck wondering if the members of CAP or the academic pathologists ever feel embarrassed about the situation. If not embarrassed, I would at least hope they would be a little concerned about patient safety in the future.

Unfortunately, I have heard of too many programs where residents sit around for majority of the day doing nothing, gross excessively (ie biopsies or other ditzels predominantly), board pass rates below 80%, or have no responsibility with actual pathology work (ie reading glass and writing reports). My question is, is CAP/ACGME really not aware of what is happening?

I feel like I know the answer but I'd like to gauge the room and hopefully it will serve as insight for prospective pathology students or who knows, maybe CAP/ACGME will start setting actual guidelines for resident education beyond 30 autopsies.

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[Allegri]

The ACGME surveys our program annually. Most of the questions are about work hour restrictions, abuse, and patient care hand-offs. The questions that have to do with quality of education are very broad and vague.

 

[gbwillner]

I'm not an expert in the process, but it seems ACGME surveys are inherently flawed in that they rely on bias for their information. Why would staff or even residents of a "bad program" incriminate the program? The effects would be self-deprecating.

 

[Alteran]

The ACGME surveys our program annually. Most of the questions are about work hour restrictions, abuse, and patient care hand-offs. The questions that have to do with quality of education are very broad and vague.

If the educational component of pathology residency programs were scrutinized at the level of a routine CAP inspection with actionable consequences, you'd see some real changes.

 

[KeratinPearls]

If there was an oral or practical after residency to determine actual competency in working up commonly encountered cases in surgpath, cyto (Gyn and nongyn), heme (bone marrows, lymph nodes) and CP commonly encountered issues, I wonder how many programs would fail.

i think this would truly test which programs need to be closed or at the very least put pressure on programs to get their **** together.

I get a feeling those who go to crappy programs do an extra year or two of fellowship training to make up for their lack of a good education and training in residency. Garbage in garbage out.

I’m not talking about multiple choice questions. I’m talking about can this person practice independently in a general pathology practice?

Every program should be able to train their residents to have the confidence to practice independently by the time they finish. If not, what have residents been doing for four years?

 

[HeyDalaron]

I asked ACGME about this a few years ago and they told me that the program requirements for pathology are taken on the words of program directors since the physicians who approve the establishment of residencies do not have any idea about what pathology entails. They basically get rubber stamped.

Non academic pathologists who care to enact beneficial change for this field could endeavor to join the ACGME approval committees and block the establishment of inadequate residency programs. I do not know how to do this.

 

[pathres9999]

If there was an oral or practical after residency to determine actual competency in working up commonly encountered cases in surgpath, cyto (Gyn and nongyn), heme (bone marrows, lymph nodes) and CP commonly encountered issues, I wonder how many programs would fail.

i think this would truly test which programs need to be closed or at the very least put pressure on programs to get their **** together.

I get a feeling those who go to crappy programs do an extra year or two of fellowship training to make up for their lack of a good education and training in residency. Garbage in garbage out.

I’m not talking about multiple choice questions. I’m talking about can this person practice independently in a general pathology practice?

Every program should be able to train their residents to have the confidence to practice independently by the time they finish. If not, what have residents been doing for four years?

I definitely agree with you. To me standardized tests are one of the worst ways to assess competence (unless memorizing esoteric factoids and being proficient with multiple choice means something more than I think it does).

Also, you are right about fellowships. It should be a nice bonus to education, not a hidden requirement. Four years is a long time to invest in a field where I would argue you learn by doing and being completely responsible for your cases/mistakes.

How interesting would it be to rotate a senior resident to other hospitals/programs for a month or two in which they could be assessed for clinical skills from people that don’t have an interest in graduating people through.

 

[pathres9999]

I'm not an expert in the process, but it seems ACGME surveys are inherently flawed in that they rely on bias for their information. Why would staff or even residents of a "bad program" incriminate the program? The effects would be self-deprecating.

I think it’s a classic case of an organization that inherently doesn’t care look like they do care. Perception vs reality. With visa concerns and residents who might be scared of being unemployed, I think things would have to be pretty desperate. And even if the survey flags a problem program, based on the loose guidelines ACGME has, it would be easy for a program to downplay problems, barring issues that make ACGME look bad.

 

[Med Director New England]

The problem is that most of the stakeholders benefit from too many programs / residents.

free labor - saving $ on PAs and support staff. Even non abusive top tier program have tremendous benefit of upper level path trainees functioning as attending after hours.

I’ve said this a couple of times now - the path community should pay close attention to rad onc. The same thing is happening to them but at a much faster pace (program expansion not matching need). Rad oncs have been all over SDN and other social media and it has worked. They have at least achieved getting academia to listen and stop expanding programs.

academia in the path world is still in the denial phase....someone needs to study ABP MOC data and proves more trainees are having difficulty getting jobs and doing more fellowships as a result

 

[AZpath]

The problem is that most of the stakeholders benefit from too many programs / residents.

free labor - saving $ on PAs and support staff. Even non abusive top tier program have tremendous benefit of upper level path trainees functioning as attending after hours.

I’ve said this a couple of times now - the path community should pay close attention to rad onc. The same thing is happening to them but at a much faster pace (program expansion not matching need). Rad oncs have been all over SDN and other social media and it has worked. They have at least achieved getting academia to listen and stop expanding programs.

academia in the path world is still in the denial phase....someone needs to study ABP MOC data and proves more trainees are having difficulty getting jobs and doing more fellowships as a result

Yeh,

Rad Oncs residents are pissed. Are community Rad Oncs worried about oversupply too?
The directors are starting to listen.
Still, the number of positions cut are still small from reading the Rad Onc SDN forum.

They increased the number of positions by 70-80% over the last decade as the number of procedures fell.
It is going to take some big cuts to right that ship.

It might happen pathologist residents are more passive than Rad Onc. They never held the CA[Ps feet to the fire.

 

[gbwillner]

Yeh,

Rad Oncs residents are pissed. Are community Rad Oncs worried about oversupply too?
The directors are starting to listen.
Still, the number of positions cut are still small from reading the Rad Onc SDN forum.

They increased the number of positions by 70-80% over the last decade as the number of procedures fell.
It is going to take some big cuts to right that ship.

It might happen pathologist residents are more passive than Rad Onc. They never held the CA[Ps feet to the fire.

There is a BIG difference IMO.

CAP's main interests lie with the labs, not the pathologists; these are not necessarily the same people with the same motivations. This is probably not true of Rad Onc.

 

[HeyDalaron]

There is a BIG difference IMO.

CAP's main interests lie with the labs, not the pathologists; these are not necessarily the same people with the same motivations. This is probably not true of Rad Onc.

Would it be a good idea for pathologists to separate out from CAP and establish a separate representative organization? The interests of the leadership and the membership appear to have decoupled.

 

[mdpathology]

This discussion is very general and gossipy. This is misinformation. In fact, there has never been--in general--higher quality of pathology residency programs. This is an active area for the CAP, but I'm not familiar with the ACGME. I know our residency program recently had our ACGME assessment and it was serious and not at all just a "rubber stamp." If one of you has a different experience, please share it. Over the past 25-30 years there has been a consolidation or elimination of weaker programs. There may be some weak programs out there--just like in every specialty.

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start and you can use your first job to gain experience and look for a better job!

The major force behind residents doing fellowships is not poor residency training but market demands. Patients and clinicians create expectations on pathology departments and groups to have pathologists who have subspecialty expertise and this is gained only through fellowship training. Check out the Susan B. Komen website for this as it relates to breast cancer, but it's true up-and-down the board. This is a trend that is consumer-driven--and hospitals, patients, and clinicians are our consumers! Fellowship training was not common (or expected) when I trained in the 90s, especially for those going into community practice, but the world has changed.

Check out these references.

 

[Med Director New England]

This discussion is very general and gossipy. This is misinformation. In fact, there has never been--in general--higher quality of pathology residency programs. This is an active area for the CAP, but I'm not familiar with the ACGME. I know our residency program recently had our ACGME assessment and it was serious and not at all just a "rubber stamp." If one of you has a different experience, please share it. Over the past 25-30 years there has been a consolidation or elimination of weaker programs. There may be some weak programs out there--just like in every specialty.

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start and you can use your first job to gain experience and look for a better job!

The major force behind residents doing fellowships is not poor residency training but market demands. Patients and clinicians create expectations on pathology departments and groups to have pathologists who have subspecialty expertise and this is gained only through fellowship training. Check out the Susan B. Komen website for this as it relates to breast cancer, but it's true up-and-down the board. This is a trend that is consumer-driven--and hospitals, patients, and clinicians are our consumers! Fellowship training was not common (or expected) when I trained in the 90s, especially for those going into community practice, but the world has changed.

Check out these references.

just curious your opinion on why US grads are increasingly migrating away from applying to pathology - if all’s well with job market

Finding ANY job ANYwhere is not good enough for most talented individuals who spend 4 years in med school + 4 years in residency + fellowship(s) + 6 figures in debt. They want and deserve good jobs.

 

[HeyDalaron]

This discussion is very general and gossipy. This is misinformation. In fact, there has never been--in general--higher quality of pathology residency programs. This is an active area for the CAP, but I'm not familiar with the ACGME. I know our residency program recently had our ACGME assessment and it was serious and not at all just a "rubber stamp." If one of you has a different experience, please share it. Over the past 25-30 years there has been a consolidation or elimination of weaker programs. There may be some weak programs out there--just like in every specialty.

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start and you can use your first job to gain experience and look for a better job!

The major force behind residents doing fellowships is not poor residency training but market demands. Patients and clinicians create expectations on pathology departments and groups to have pathologists who have subspecialty expertise and this is gained only through fellowship training. Check out the Susan B. Komen website for this as it relates to breast cancer, but it's true up-and-down the board. This is a trend that is consumer-driven--and hospitals, patients, and clinicians are our consumers! Fellowship training was not common (or expected) when I trained in the 90s, especially for those going into community practice, but the world has changed.

Check out these references.

"There has never been --in general--higher quality of pathology residency programs."

Pathology Residency Program

,

www.westchestermedicalcenter.org

 

[fecalith]

"There has never been --in general--higher quality of pathology residency programs."

Pathology Residency Program

,

www.westchestermedicalcenter.org

Anatomic Pathology
- 18,000 Surgical Specimens
- 70 Autopsies
- 1,200 GYN
- 2,600 Non-GYN
- Urologic
- Effusions
- Pulmonary
- CFS
- GI

and 3 residents per year? PATHETIC...

 

[deleted314957]

This is all from an academic I bet.

 

[pathres9999]

This discussion is very general and gossipy. This is misinformation. In fact, there has never been--in general--higher quality of pathology residency programs. This is an active area for the CAP, but I'm not familiar with the ACGME. I know our residency program recently had our ACGME assessment and it was serious and not at all just a "rubber stamp." If one of you has a different experience, please share it. Over the past 25-30 years there has been a consolidation or elimination of weaker programs. There may be some weak programs out there--just like in every specialty.

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start and you can use your first job to gain experience and look for a better job!

The major force behind residents doing fellowships is not poor residency training but market demands. Patients and clinicians create expectations on pathology departments and groups to have pathologists who have subspecialty expertise and this is gained only through fellowship training. Check out the Susan B. Komen website for this as it relates to breast cancer, but it's true up-and-down the board. This is a trend that is consumer-driven--and hospitals, patients, and clinicians are our consumers! Fellowship training was not common (or expected) when I trained in the 90s, especially for those going into community practice, but the world has changed.

Check out these references.

Not to be mean, but your post is the misinformation. I have heard anecdotal evidence very frequently from other residents about some problem programs that would shock and astound you (ie less than 80% board pass rate, less than 10,000 surgical specimens per rotation site, etc). While one could say this is all anecdotal, I think the most telling aspect about this is that there is no verifiable way of assessing a program's competency. You should ask yourself why is it that CAP isn't more strict about assessing resident program quality, yet for some reason is so much more demanding of its lab inspections.

There also has not been a substantial consolidation/elimination of any programs, so it is disingenuous to say that as well.

As for the job market, I find it an embarrassment that one has to "geographically flexible" for a professional career that requires the extensive training that pathology requires. The implication is that room for negotiation is limited, as well as finding better counteroffers if you get stuck in a undesirable job. In addition, you should be more careful reviewing your sources before thinking they support your argument. They use metrics such as finding jobs within 3 to 5 years (a long lead time) with 50% employment within 2 years after graduation for 2008 to 2012 (first source). The second paper, from 2017, states 116 locations (out of 35% survey response) are seeking at least one pathologist (not a guaranteed spot mind you) when currently in 2021 there are 605 categorical positions. Even if locations were going to hire more than one, and assuming every location not surveyed are also looking for hiring, there is still a disproportionate amount of graduates. I think the papers you provided are clear examples of people publishing a paper, stating one thing but secretly hoping people won't look too deeply into the data.

As Med Director New England had mentioned, US medical grads are avoiding pathology, and it is not because "pathologists are groovy".

 

[Med Director New England]

Not to be mean, but your post is the misinformation. I have heard anecdotal evidence very frequently from other residents about some problem programs that would shock and astound you (ie less than 80% board pass rate, less than 10,000 surgical specimens per rotation site, etc). While one could say this is all anecdotal, I think the most telling aspect about this is that there is no verifiable way of assessing a program's competency. You should ask yourself why is it that CAP isn't more strict about assessing resident program quality, yet for some reason is so much more demanding of its lab inspections.

There also has not been a substantial consolidation/elimination of any programs, so it is disingenuous to say that as well.

As for the job market, I find it an embarrassment that one has to "geographically flexible" for a professional career that requires the extensive training that pathology requires. The implication is that room for negotiation is limited, as well as finding better counteroffers if you get stuck in a undesirable job. In addition, you should be more careful reviewing your sources before thinking they support your argument. They use metrics such as finding jobs within 3 to 5 years (a long lead time) with 50% employment within 2 years after graduation for 2008 to 2012 (first source). The second paper, from 2017, states 116 locations (out of 35% survey response) are seeking at least one pathologist (not a guaranteed spot mind you) when currently in 2021 there are 605 categorical positions. Even if locations were going to hire more than one, and assuming every location not surveyed are also looking for hiring, there is still a disproportionate amount of graduates. I think the papers you provided are clear examples of people publishing a paper, stating one thing but secretly hoping people won't look too deeply into the data.

As Med Director New England had mentioned, US medical grads are avoiding pathology, and it is not because "pathologists are groovy".

I doubt mdpathology will respond.

note they only formed an account a few days ago apparently after 25+ years experience in the field.

about “substantial program contraction” claim by md path this is false. Total pathology residency slots have trended up over the last 20 years & many in academia are pushing for more expansion.

During the same period of time the field of pathology has had massive consolidation of groups, former free standing small PP groups absorbed by academia into community divisions or by commercial labs, formation of more efficient boutique labs pushing high volumes, path using extenders for grossing freeing up path time, better LIS’s increasing path productivity, more PHDs handling CP roles, etc...

To summarize their are many forces that have led to pathologists being far more productive in 2021 than the 1990s or even 2000s. So much that I estimate a well supported path can do the work that took 1.5 - 2 paths 25 years ago.

this is why it is important to really to be mindful of the number of residency spots for pathology trainees. It is critical to not overtrain and better to err on the side of undertraining. If med students start hearing of bidding wars for the service of paths, loan forgiveness, 50K sign ok bonuses - all common in other fields — good US trained students will come back.

 

[octopusprime]

This discussion is very general and gossipy. This is misinformation. In fact, there has never been--in general--higher quality of pathology residency programs. This is an active area for the CAP, but I'm not familiar with the ACGME. I know our residency program recently had our ACGME assessment and it was serious and not at all just a "rubber stamp." If one of you has a different experience, please share it. Over the past 25-30 years there has been a consolidation or elimination of weaker programs. There may be some weak programs out there--just like in every specialty.

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start and you can use your first job to gain experience and look for a better job!

The major force behind residents doing fellowships is not poor residency training but market demands. Patients and clinicians create expectations on pathology departments and groups to have pathologists who have subspecialty expertise and this is gained only through fellowship training. Check out the Susan B. Komen website for this as it relates to breast cancer, but it's true up-and-down the board. This is a trend that is consumer-driven--and hospitals, patients, and clinicians are our consumers! Fellowship training was not common (or expected) when I trained in the 90s, especially for those going into community practice, but the world has changed.

Check out these references.

It is not "gossipy", it's the reality for those of us unsheltered from the practice of medicine in an academic bubble.

And there is definitively, absolutely, without-a-doubt, a glut of pathology trainees. It's not a matter of obtaining one's "dream job" fresh out of residency, it's about having more options than 'academic vs corporate lab', which are the overwhelming majority of openings because of consolidation, corporate expansion and ever declining reimbursement forcing increasing volume per pathologist as the only means to maintain income.
[It's funny I have to explicitly spell this out to my financial planner when she's projecting retirement numbers...my income isn't going to match inflation or carry an annual "pay increase"...if anything, considering inflation and corporate competition and Biden taxes, my income will decidedly go down]

No trainee--whether it's a pathology grad, radiology, FP, hospitalist, et al--should expect a 3-5 yr post-graduate period of "beggars can't be choosers" whereby any job is a viable option. That's such a load of $h*t. Right, because at age 31-34, most freshly-minted physician attendings want to spend the next interval of their career gaining some more experience at a job for which he/she has no vested interest. People don't' want to waste time, effort and max earning potential years towards a partnership or academic position they have no intention of making/keeping because it's a stepping-stone job. That should be the exception, not the expectation.

I'm sorry kids, @mdpathology is just flat out ignorant...an attending entrenched in a care-free academic system with blinders to life outside his/her little bubble. It's palpable ignorance. What a farce.

 

[octopusprime]

... because of consolidation, corporate expansion and ever declining reimbursement forcing increasing volume per pathologist as the only means to maintain income....

And don't pretend that these "market forces" are not impacted by supply. Consolidation of private and hospital based labs... the expansion of LabCorps, Quest, Ameripath, etc... one pathologist in 2021 doing the work of multiple pathologists in 1991... All of these realities are made possible and increasingly popular/easy because there is no shortage of pathologists willing to underbid each other, and consequently, employers willing to do the same. And that's not to suggest creating an 'artificial shortage' is the goal, but rather a supply that doesn't continually undermine the demand by basing training needs on academic department prestige & posterity & grossing demands as opposed to the pulse of the non-academic market (which is where the majority of us live).

 

[mdpathology]

This is all from an academic I bet.

Not really. I've practiced in rural, suburban community, and academic practices, so I feel I have a broad idea of what's out there. However, I have only practiced in the Midwest, so do not have a good idea what it's like in other regions of the country.

 

[mdpathology]

just curious your opinion on why US grads are increasingly migrating away from applying to pathology - if all’s well with job market

Finding ANY job ANYwhere is not good enough for most talented individuals who spend 4 years in med school + 4 years in residency + fellowship(s) + 6 figures in debt. They want and deserve good jobs.

I get it--everyone wants a good job, especially with the things you cited. I reckon it depends on what you define as a "good" job. To me, the best thing once you get a job is to keep you eyes out for a "better" job. This is the only way to keep pathology groups and departments "honest." Unfortunately, pathologists have a tendency to "suffer in silence" and become resentful. My experience is that if word gets out that you're looking, management tends to get more focused on your needs. If not, time to hit the road.

 

[mdpathology]

And don't pretend that these "market forces" are not impacted by supply. Consolidation of private and hospital based labs... the expansion of LabCorps, Quest, Ameripath, etc... one pathologist in 2021 doing the work of multiple pathologists in 1991... All of these realities are made possible and increasingly popular/easy because there is no shortage of pathologists willing to underbid each other, and consequently, employers willing to do the same. And that's not to suggest creating an 'artificial shortage' is the goal, but rather a supply that doesn't continually undermine the demand by basing training needs on academic department prestige & posterity & grossing demands as opposed to the pulse of the non-academic market (which is where the majority of us live).

Of course, market forces shape supply--isn't that obvious? But the 1991 pathologist was probably underemployed and receiving money for just occupying a seat. Everybody, including MDs, has to show value, which is related to productivity and this has been amplified by computing and new technology.

I agree--creating an artificial shortage is not a solution. Been there, done that--wasting a 5th year as a "credentialing requirement" that was clumsily put in place to decrease supply. Mission accomplished--it dissuading medical students from going into pathology and then the academic know-it-alls panicked again in the mid-90s that the sky was falling because people weren't going into pathology.

 

[mdpathology]

It is not "gossipy", it's the reality for those of us unsheltered from the practice of medicine in an academic bubble.

And there is definitively, absolutely, without-a-doubt, a glut of pathology trainees. It's not a matter of obtaining one's "dream job" fresh out of residency, it's about having more options than 'academic vs corporate lab', which are the overwhelming majority of openings because of consolidation, corporate expansion and ever declining reimbursement forcing increasing volume per pathologist as the only means to maintain income.
[It's funny I have to explicitly spell this out to my financial planner when she's projecting retirement numbers...my income isn't going to match inflation or carry an annual "pay increase"...if anything, considering inflation and corporate competition and Biden taxes, my income will decidedly go down]

No trainee--whether it's a pathology grad, radiology, FP, hospitalist, et al--should expect a 3-5 yr post-graduate period of "beggars can't be choosers" whereby any job is a viable option. That's such a load of $h*t. Right, because at age 31-34, most freshly-minted physician attendings want to spend the next interval of their career gaining some more experience at a job for which he/she has no vested interest. People don't' want to waste time, effort and max earning potential years towards a partnership or academic position they have no intention of making/keeping because it's a stepping-stone job. That should be the exception, not the expectation.

I'm sorry kids, @mdpathology is just flat out ignorant...an attending entrenched in a care-free academic system with blinders to life outside his/her little bubble. It's palpable ignorance. What a farce.

The only thing that's palpable is your anger, but I understand why. I'm not in any academic bubble, for sure, and have practiced in rural, community, and academic settings. I don't have experience in commercial labs.

Yes, pathology--and medicine in general--faces a lot of challenges that threaten reimbursement. I'm seriously concerned about income too. I didn't mean to suggest that "any job is a viable option." On the other hand, I don't think residency or fellowship prepares you for how to get a (good) job like, for example, people in the financial or engineering sectors do. The vast majority of jobs are not posted in Archives or CAP Today, but are out there by "word-of-mouth." As I assume you would, I fault academic places for not doing more to network for their graduates or at least point them to places to learn about this.

 

[octopusprime]

I am angry; it angers me that people in academics routinely come on here and push the same crap about the market being "just fine" and there being no oversupply when they occupy a minor component of practicing pathologists yet have 100% control over the training. You have community practice / PP saying over and over and over that we don't need more pathologists, and academics responding over and over and over that we do. Why the discrepancy? Why the dichotomous perception? It's not simply ironic that 100% of training centers rely 100% on residents to gross specimens (and offset the workload & learning curve with a few PAs). Or that large corporate outfits--who also support a large pool of applicants--continue to commoditize laboratory services, the pathologic diagnostic portion of which is viewed as ancillary to the overwhelming revenue generation the clinical lab provides.

If every institution in the country shaved 1 resident/PGY off the payroll, how is that a bad thing for the field, aside from forcing academics to manage the grossing load differently and forcing corporate outfits to offer better compensation/work environments?

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start and you can use your first job to gain experience and look for a better job!

This is an extremely biased perception of the workforce and expectations for a career. Maybe your experience moving around from rural to community to finally academic serves as your example of what is to be expected, but it's not the norm, nor should it be. I'm not comparing (nor is anyone else) pathology to finance or engineering, but rather other medical specialties. Yes the process of finding a job can be tenuous across many specialties, but at the end of the day, academic and corporate entities stand to benefit TREMENDOUSLY from having a large surplus of applicants.

 

[deleted314957]

Of course, market forces shape supply--isn't that obvious? But the 1991 pathologist was probably underemployed and receiving money for just occupying a seat. Everybody, including MDs, has to show value, which is related to productivity and this has been amplified by computing and new technology.

I agree--creating an artificial shortage is not a solution. Been there, done that--wasting a 5th year as a "credentialing requirement" that was clumsily put in place to decrease supply. Mission accomplished--it dissuading medical students from going into pathology and then the academic know-it-alls panicked again in the mid-90s that the sky was falling because people weren't going into pathology.

Too bad learning a little clinical medicine (your “wasted” 5th year) upset you. And let’s bring it back if it keeps the medical community from drowning in pathologists. And I come from well before the 5th year “requirement” that many folks turned into some kind of useless BS. I don’t know what institution you are at now (i am assuming academia, may be wrong) but Stevie Wonder can see there are too many paths. A shop that does 20k surgicals with proportional cyto with a good PA needs NO MORE than 4 pathologists and that is with one of them off at any given time. Been there, done that. No paps (let quest/lc do ‘em) and none of these stupid (95% of the time) “adequacy” checks. That’s the kind of stuff my partners and associates were doing in 1991 and it may have contributed to my (very) low 8 figure retirement.
Too many paths today feel abused if they have to do something not covered by one of their fellowships or if they have to do more than 8k surgicals per year. Call me a hard case or a but y’all are too G.D. lazy nowadays.

 

[HeyDalaron]

The only thing that's palpable is your anger, but I understand why. I'm not in any academic bubble, for sure, and have practiced in rural, community, and academic settings. I don't have experience in commercial labs.

Yes, pathology--and medicine in general--faces a lot of challenges that threaten reimbursement. I'm seriously concerned about income too. I didn't mean to suggest that "any job is a viable option." On the other hand, I don't think residency or fellowship prepares you for how to get a (good) job like, for example, people in the financial or engineering sectors do. The vast majority of jobs are not posted in Archives or CAP Today, but are out there by "word-of-mouth." As I assume you would, I fault academic places for not doing more to network for their graduates or at least point them to places to learn about this.

If "word of mouth" is the best way to find a job, then there are too many people looking for jobs.

Recruiters should be desperate to find good talent. If the markets were good, we'd see ads everywhere.

 

[octopusprime]

Too bad learning a little clinical medicine (your “wasted” 5th year) upset you. And let’s bring it back if it keeps the medical community from drowning in pathologists. And I come from well before the 5th year “requirement” that many folks turned into some kind of useless BS. I don’t know what institution you are at now (i am assuming academia, may be wrong) but Stevie Wonder can see there are too many paths. A shop that does 20k surgicals with proportional cyto with a good PA needs NO MORE than 4 pathologists and that is with one of them off at any given time. Been there, done that. No paps (let quest/lc do ‘em) and none of these stupid (95% of the time) “adequacy” checks. That’s the kind of stuff my partners and associates were doing in 1991 and it may have contributed to my (very) low 8 figure retirement.
Too many paths today feel abused if they have to do something not covered by one of their fellowships or if they have to do more than 8k surgicals per year. Call me a hard case or a but y’all are too G.D. lazy nowadays.

Hey I think plenty of us would love the opportunity for 8k surgicals...and CP billing...and 1991 reimbursement levels...and much lower complexity cases for heme...etc, etc, etc... A not insignificant part of the "laziness" nowadays originates from factors related to those issues. If you spent some years in the military THEN did private practice and were still able to generate a low-8-figure retirement , you did something that's not rare today because of laziness but because it's just damn near impossible.

 

[deleted314957]

Hey I think plenty of us would love the opportunity for 8k surgicals...and CP billing...and 1991 reimbursement levels...and much lower complexity cases for heme...etc, etc, etc... A not insignificant part of the "laziness" nowadays originates from factors related to those issues. If you spent some years in the military THEN did private practice and were still able to generate a low-8-figure retirement , you did something that's not rare today because of laziness but because it's just damn near impossible.

I just made sure I worked harder than any of my partners or associates for my 25 yrs post Navy. Retired 2013.

 

[KeratinPearls]

This discussion is very general and gossipy. This is misinformation. In fact, there has never been--in general--higher quality of pathology residency programs. This is an active area for the CAP, but I'm not familiar with the ACGME. I know our residency program recently had our ACGME assessment and it was serious and not at all just a "rubber stamp." If one of you has a different experience, please share it. Over the past 25-30 years there has been a consolidation or elimination of weaker programs. There may be some weak programs out there--just like in every specialty.

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start This discussion is very general and gossipy. This is misinformation. In fact, there has never been--in general--higher quality of pathology residency programs. This is an active area for the CAP, but I'm not familiar with the ACGME. I know our residency program recently had our ACGME assessment and it was serious and not at all just a "rubber stamp." If one of you has a different experience, please share it. Over the past 25-30 years there has been a consolidation or elimination of weaker programs. There may be some weak programs out there--just like in every specialty.

Moreover, there is no "glut." If a new Board-certified AP/CP pathologist wants a job, she can find a job and a good job. BUT, it might not be your "dream job" or in a place that you had your heart on living. Who does? It is a start and you can use your first job to gain experience and look for a better job!

The major force behind residents doing fellowships is not poor residency training but market demands. Patients and clinicians create expectations on pathology departments and groups to have pathologists who have subspecialty expertise and this is gained only through fellowship training. Check out the Susan B. Komen website for this as it relates to breast cancer, but it's true up-and-down the board. This is a trend that is consumer-driven--and hospitals, patients, and clinicians are our consumers! Fellowship training was not common (or expected) when I trained in the 90s, especially for those going into community practice, but the world has changed.

Check out these references.

I read up to your second sentence.

There are plenty of bad programs out there.

There are programs where CP is so bad trainees just drop the CP certification and just go AP only.

A good start would be to eliminate programs with poor CP training. No teaching, residents just sitting around on CP rotations aka a mini vacation, weak didactics.

 

[deleted314957]

I read up to your second sentence.

There are plenty of bad programs out there.

There are programs where CP is so bad trainees just drop the CP certification and just go AP only.

A good start would be to eliminate programs with poor CP training. No teaching, residents just sitting around on CP rotations aka a mini vacation, weak didactics.

Couldn’t agree more. CP needs to be a rigorous two years.
After 23 years as a medical director I was very, very thankful mine was. Even in the s****y Navy my heme, clinical chemistry, blood bank and medical micro were ALL ONE-ON-ONE. Just me and the sub specialist. I don’t think the big names do that. To them, the only thing that counts is establishing a name in ANYTHING in AP.

Most internists, medicine sub specialists and those who use blood or blood products have little to no respect for the pathologist as a clinical consultant as regards clinical pathology questions which are in their area of practice. All they want is a lab that gives them timely and accurate results. They know you don’t know any clinical pathology.

 

[Drifter76]

I’m about a decade out of training now, and based on what I’ve seen and experienced during that time, mdpathology’s rosy view of the job market in pathology has absolutely zero basis in reality. I think even some of the more pessimistic people posting here aren’t pessimistic enough, compared to my own experience.

 

[deleted314957]

I’m about a decade out of training now, and based on what I’ve seen and experienced during that time, mdpathology’s rosy view of the job market in pathology has absolutely zero basis in reality. I think even some of the more pessimistic people posting here aren’t pessimistic enough, compared to my own experience.

And you are a “decade” out of training?! What the f do you do (at a time where you should be kinda settled ten years out)?

 

[Drifter76]

And you are a “decade” out of training?! What the f do you do (at a time where you should be kinda settled ten years out)?

Well after a “decade” out of f ing training I’d like to have a decent f ing job but apparently in pathology as it currently exists, that is too much to f ing ask for. I could easily be “kinda settled ten years out” if I’d chosen a different specialty. I count about 5 people from my medical school class that I’ve somewhat kept in touch with over the years- one went into anesthesia, a couple did ortho, one went into radiology, and one did urology. Every single one of them got a partnership track private practice job at what seemed to be a reasonable place and location, straight out of training, and every one is still in their first job. My path has been quite different because I committed the cardinal sin of choosing pathology. Pathology is a garbage specialty.

 

[caffeinegirl]

I agree with Drifter76 - the job market even for people 10 years out is abysmal compared to 10+ years ago. Less partnership track positions and lower starting pay, worse contracts, and you are more of a peon than a physician.

 

[Drifter76]

I remember hearing people say that, once you have at least 3 or 4 years of work experience, your stock goes up a little and opportunities open up a bit more. Maybe you’d just be stuck in some crap situation for a couple of years then you can move on to something halfway decent. But I can’t say that I’ve really seen that. I even wonder if in some cases people coming straight out of training with no work experience are preferred because employers can pay them less and they are a little easier to take advantage of. And there are definitely more than a few employers in the pathology market that love hiring people they can take advantage of.

 

[path24]

Pathology is a field of lies (job market, future, partnership, shortage, pay...etc.) You are a commodity. Only getting worse. I have been seriously saying the same thing for 10+ years. It is in YOUR best interest to stay away from this field.

 

[deleted314957]

By y’all’s accounts it is getting much worse. when several years experience don’t count for beans.

 

[Allegri]

I am almost 10 years out of training and have been considering, albeit casually, possible moves for more than a year. I am not finding many attractive options yet. I may be too specialized.

 

[WEBB PINKERTON]

Better go rural if you want a better life.

Networking never ends in this field, keep doing it no matter how far out you are. Otherwise, you have very little chance of a good job.

 

[gbwillner]

Pathology is a field of lies (job market, future, partnership, shortage, pay...etc.) You are a commodity. Only getting worse. I have been seriously saying the same thing for 10+ years. It is in YOUR best interest to stay away from this field.

Lies aside, all docs in all specialties are becoming commodities. Some specialties hang on and have more agency than others.

 

[gbwillner]

I agree with Drifter76 - the job market even for people 10 years out is abysmal compared to 10+ years ago. Less partnership track positions and lower starting pay, worse contracts, and you are more of a peon than a physician.

I think these perspectives are certainly valid but are also anecdotal. There are lots of paths out there very happy with their positions and have lots of opportunities. I remember 5-10 years ago there was a dramatic shift upwards in terms of starting salary for newly-minted Paths. Maybe that has subsided now. Looking at salary data paths always seem do do pretty well for being so lowly-regarded and having no call.

 

[Drifter76]

Pathology is a field of lies (job market, future, partnership, shortage, pay...etc.) You are a commodity. Only getting worse. I have been seriously saying the same thing for 10+ years. It is in YOUR best interest to stay away from this field.

I agree. If I had it to do over, there’s no way in hell I’d choose pathology.

 

[Drifter76]

I think these perspectives are certainly valid but are also anecdotal. There are lots of paths out there very happy with their positions and have lots of opportunities. I remember 5-10 years ago there was a dramatic shift upwards in terms of starting salary for newly-minted Paths. Maybe that has subsided now. Looking at salary data paths always seem do do pretty well for being so lowly-regarded and having no call.

Enough anecdotes strung together starts to make a pretty compelling case series. I don’t recall any dramatic shift upward in salaries when I came out, which was right after the Obamacare turmoil. It seemed like the jobs for new grads went from scarce to almost nonexistent around that time. No call? I take call all the time. I believe most hospital based paths take call. I was in the hospital for a 1 am liver harvest last night, while on call.

 

[Drifter76]

I think these perspectives are certainly valid but are also anecdotal. There are lots of paths out there very happy with their positions and have lots of opportunities. I remember 5-10 years ago there was a dramatic shift upwards in terms of starting salary for newly-minted Paths. Maybe that has subsided now. Looking at salary data paths always seem do do pretty well for being so lowly-regarded and having no call.

I think there is a bit of a generational divide when it comes to opportunity. Most of the people I know of who have had the kinds of opportunities I would want are over the age of 55 or so. Maybe if I’d come out at least a decade earlier I would’ve had something decent. I don’t know that the overall supply- demand was great even then but at least a higher percentage of the jobs that were there were decent ones- more partnership track private practice jobs with small to mid size groups rather than what you see so much of today: corporate lab jobs, hospital employed jobs, employed jobs with large groups where there is no partnership track and they run their pyramid scheme and bilk their underlings, practices with a sole pathologist owner and a bunch of employed underlings, etc.
You had the one year about 15 years ago where 2 classes graduated together (due to AP/CP going from 5 years to 4) that flooded the market, and then if you go back farther, prior to the late 90s a lot of programs left their unfilled spots (after the match) open rather than filling them with foreign grads. I’m sure that made a big difference too.
If the job market was even halfway reasonable, then there’s no way in hell I would be living in the Midwest right now.

 

[Drifter76]

Better go rural if you want a better life.

Networking never ends in this field, keep doing it no matter how far out you are. Otherwise, you have very little chance of a good job.

I’m not opposed to rural.. would much prefer a small town/city in the southeast and really have no desire to live in any of the large urban cosmopolitan trendy places that get talked about a lot- Boston, SF, Dallas etc. But I personally haven’t seen much more opportunity in rural or small town locations than in the bigger cities where it is supposedly hardest to find anything.
The city I currently live in is bigger than ideal for me. I was recruited here under false pretenses so here I am.

 

[caffeinegirl]

I do think that one of the causes for the big disconnect about the job market is the due to the cultural divide between academia and private practice. This is true in other specialties as well, but is a greater divide in our specialty due to the fact that we are a commodity (ie. provide a service to other physicians). Academia does not train residents to know about the economics of pathology reimbursement, costs of laboratory set up and operating costs, how to negotiate contracts with your hospital, marketing and customer service, and many other things which are vital in private practice. The market pressures in private practice are immense compared to academics. The perspective about the health of our field really depends on your practice setting and experience. I again strongly support Drifter76's comments here - I would say it is more than "just a case series" at this point.

 

[dr.weiner]

I know most will crap all over my positive anecdote. Maybe I'm just lucky, but those who have a good deal are a lot less likely to have a reason to post on SDN.

I am roughly 10 years out of training, have only been in private practice, and have moved around a bit, but always on my own terms. Good private jobs are still around. My senior colleagues have been fair and generous with me. I'm not the smartest nor was the best trainee, but am friendly and can communicate well. I've learned admin skills on the job and my colleagues like me in that role.

Hope everyone out there finds a position they like. My only advice is to keep hustling and be personable. Path is a niche field and turnover is low. You have to be opportunistic and constantly vigilant about open positions and the field at large. I check job boards everyday out of curiosity, even though I'm not looking. Part of my constant vigilance is checking SDN routinely for 15+ years.

Private groups want diagnostic competence of course, but in my opinion, it's more important that people like having you around, you can wear different hats for the group, and you are constantly hustling to try to improve your group's standing/workflow/culture (while efficiently managing your service caseload). If you can do all those things, any group should make you partner, or at least make it worth your while. If they don't, move on. Best of luck everyone.

 

[caffeinegirl]

I'm not going to crap over your anecdote dr.weiner, and kudos to you for your success. I also know of several of my colleagues who are doing fine private practice. And yes, there is a bias towards people who don't do well will post about it or talk about it more. However, I do think that there is a larger proportion of pathologists who are not in your position compared to other specialties.
I do wonder dr.weiner how much of your moving around involved geographic moves as well? For those of us who are geographically restricted, being able to move on to a better opportunity out of the region is not really an option.