Good Salary Info??

[Molly Maquire]

Hi,

Someone posted a recently updated salary survey on another forum, and the numbers, especially for Path, appear too good to be true.

According to this survey, after three years, an average path doc can expect to make $321,000. Does this sound reasonable to anyone?

Below is the link:


http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

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[GreatPumpkin]

That is for private practice partnership level with a few years as partner. But that is probably right on target.

 

[GeneralTso]

Hey Rob,

i saw those figures too and I thought it too good to be true as well.

Generally, how many years does it take to make partner and is that for non fellowship trained pathologist, which I assume would make more at the partner level.

Could you also shed some light in why the job market was so sucky for path just a few years ago and what changed to make jobs more plentiful.

 

[Mindy]

Hey General Tso!

I know this was aimed at GP, but I think I have an understanding of the economic history of path. Prior to the advent of automated lab testing (i.e. pre-1960ish) pathologists had to have run all assays for clinicians by hand. This was obviously time and labor intensive and extremely costly. When automated technology became available, the time and labor factor dramatically decreased, productivity dramatically increased, yet pathologists made no adjustments in what they charged for the testing. So prior to medicare involvement, pathologists were making boatloads of money in the clinical pathology side.

Now... (probably rightly so) when Medicare started circa 1965, they obviously tried to find areas where they could reduce cost. As the technology was improving alongside Medicare's development, there was a time lag before pathologists got nailed. The dung flew in the 1980s when Medicare put caps on reimbursement for lab tests. All of a sudden the multimillion dollar pathologist earnings dropped like a brick. So pathologists, trying to preserve a semblance of their former worth worked harder cutting all ancillary staff... including other pathologists. This is the adjustment phase that the 1990s experienced: too much work divided over too few pathologists, with no job openings, and dramatic salary cuts. MUCH UNHAPPINESS...

So what's happening now? Like any business that cuts back to far, it realizes that it needs to expand eventually. We are now in the expansion phase.

So thats my understanding...

Mindy

 

[GeneralTso]

Thanks Mindy...lots of good info that reinforced what Ive heard from others (namely Medicare phucking up the economics). Any reason why the reuimsbursementrs for Rads film reading was spared so they get piece of the every action while lab testing was gutted. From my undertstaning, its what makes rads such a cash cow for most money losing hospitals while I guess it makes path less so or treading toward break even.

Also, anyone hazard a guess why novel lab testing/diagnostics in path is so deficient to justify new revenue streams or higher reimbursements. Rads also seems to have this down with thier virtual colonoscopy and standup MRIs. Those guys seem to come up with new money making schemes all the time.

I dont want to give the impression that Im dissing path. I think I would enjoy the work immensly (autopsies and body parts in a paper bag aside) but I want to get an understanding of all the dyanmics in play.

Also, congrats on your recent rez placement.

Originally posted by Mindy
Hey General Tso!

I know this was aimed at GP, but I think I have an understanding of the economic history of path. Prior to the advent of automated lab testing (i.e. pre-1960ish) pathologists had to have run all assays for clinicians by hand. This was obviously time and labor intensive and extremely costly. When automated technology became available, the time and labor factor dramatically decreased, productivity dramatically increased, yet pathologists made no adjustments in what they charged for the testing. So prior to medicare involvement, pathologists were making boatloads of money in the clinical pathology side.

Now... (probably rightly so) when Medicare started circa 1965, they obviously tried to find areas where they could reduce cost. As the technology was improving alongside Medicare's development, there was a time lag before pathologists got nailed. The dung flew in the 1980s when Medicare put caps on reimbursement for lab tests. All of a sudden the multimillion dollar pathologist earnings dropped like a brick. So pathologists, trying to preserve a semblance of their former worth worked harder cutting all ancillary staff... including other pathologists. This is the adjustment phase that the 1990s experienced: too much work divided over too few pathologists, with no job openings, and dramatic salary cuts. MUCH UNHAPPINESS...

So what's happening now? Like any business that cuts back to far, it realizes that it needs to expand eventually. We are now in the expansion phase.

So thats my understanding...

Mindy

 

[GreatPumpkin]

Yep, Mindy has it nailed from what I have gathered. Add to that the big push to managed care and you have the makings of a terrible job market. Now after years of contraction it seem the market is expanding again.

Even in the worst of years there was not a huge unemployed pathologist problem. People just didn't necessarily get their choice of jobs. FMGs have always had it tougher though. Private practice groups still have a significant percentage of "good ol boy network" groups. With the prejudices associated with that.

Even now you can have a problem finding a job if you limit your search to one city or one area of the country only. Pathology is too small a specialty to limit yourself this way.

Partnership tract is usually 3 to 5 years. Sometimes you have to "buy" into the partnership. Usually it would make no difference in pay whether you are specialty trained or not once you make partner, but that may be a difference on whether you get hired at all.

The size and the business of the practice will effect the money. The area of the country will also affect the money. Areas with fewer managed care patients will mean better reimbursement. Also, more affluent areas will mean better reimbursement. Also, the type of specimens you normally get will effect the money too. Florida pathologists do a ton of skin cases which are good for their bottom line.

 

[Global Disrobal]

I agree with Mindy and GP on their assessments of the Pathology Market.

Specialty training (based on what friends in the market tell me) doesn't necessarily mean more money, however it does equal increased marketability.

On the job issue, a common misconception is that many "non-pathology" folk will look at CAP or other entities to assess the number of jobs available, not knowing that the core of Path jobs are through word of the mouth and recommendations from faculty to hiring persons.

Thats my two cents worth!@

BTW Congrats Mindy on MGH!

GD

 

[GeneralTso]

Originally posted by GreatPumpkin


Even in the worst of years there was not a huge unemployed pathologist problem. People just didn't necessarily get their choice of jobs. FMGs have always had it tougher though. Private practice groups still have a significant percentage of "good ol boy network" groups. With the prejudices associated with that.

Even now you can have a problem finding a job if you limit your search to one city or one area of the country only. Pathology is too small a specialty to limit yourself this way.

Partnership tract is usually 3 to 5 years. Sometimes you have to "buy" into the partnership. Usually it would make no difference in pay whether you are specialty trained or not once you make partner, but that may be a difference on whether you get hired at all.

The size and the business of the practice will effect the money. The area of the country will also affect the money. Areas with fewer managed care patients will mean better reimbursement. Also, more affluent areas will mean better reimbursement. Also, the type of specimens you normally get will effect the money too. Florida pathologists do a ton of skin cases which are good for their bottom line.

Could you elaborate on the "old boy network". I took to this to mean a bunch of old white males with a certain pedigree hogging up all the specimens and securing contracts for all the specimens in a large geographic area so you have to play with them to eat. Between them and the Quests/Ameripath, I guess hanging a shingle would be out of question.

You also seem to also suggest that fellowship training is the price of entry into the private sector rather than enhancing ones earnings power. That seems to be the norm for most areas of medicine where employers have the upper hand so I guess thats neutral.

Which specimens get top coin these days anyway? When you talked about Florida and the skin volume there, I would think that an elderly population like that would have more medicare and managed care encroachment depressing rembursement. But I guess volume trumps better reimbursement so hooking up with a practice with high volume is key, no?

 

[Mindy]

Here is my prediction (i.e. fairly worthless, based on little evidence other than the trend of pathology economics):

*Radiology reimbursement is going to experience the same hardships as pathology once the technological advances stabilize. *

I don't think this means that radiologists are going to be standing in unemployment lines, but I do think the sky high salaries are going to fall.

Mindy

P.S. Thanks GD. I am going to respond to your other thread soon... I don't think you'll have anything to worry about next year, though.

 

[Molly Maquire]

Yeah, it seems like as soon as the Feds are about to catch up with the Rads guys, they just invent another study, isotope, etc.

I wonder if there are new tests on the horizon (using genetic testing), that can bring Path back to the glory days.

I'm an MS II, and right now Path is my top choice. But I have to say, the money and job opportunities of Rads are mightly tempting (not that money is my primary motivation, of course

PS: Why is there so much money in Dermpath, is it just the volume or is the reimbursement different?

 

[GreatPumpkin]

Lot of questions, lets see.

Good ol boy network- yep old white men in control of most of the path private practice groups. So path not unlike most industries where these are the upper level folks has some of the same discrepencies in hiring. Like Global said most path jobs are found by word of mouth. So these people control who they even even consider. This is why FMGs have a tougher time in the private practice market.

Not many pathologists can start out on their own, hospitals normally have long term contracts with their pathologists. It is not like family practice where you can graduate and start your own business. I don't know any solo practice pathologists. I guess there may be some out there. But if so they prob started out in a group then struck out on their own.

Biopsies are where the money is in path right now. The specimens are easy to gross in and fast to read out. This is why skin is so good. Big complex specimens are a loss of money in terms of opportunity cost. So high volume biopsies can non-pap smear cytology is where the money is made. Pap smears are bad bad bad. To much liability to little payment.

So you can see why dermpath and cytopath training is very sought after. Derm more than cyto.

 

[Voxel]

I think there will be a general trend across all medical specialties that will lower reimbursements. Especially, since medicare is doing across the board cuts (ie 4-5% this year), although there were some pushes do delay or reverse the cuts in congress. I won't get into the medicare reimbursement formula here, but needless to say there is factor, (you can call it X), that gets applied/multiplied to each procedure and when that goes down, reimbursements go down at a certain rate.

The thing with rads is that the demand, currently and for the foreseeable future, outstrips the supply. Same thing is happening in anesthesia. And probably pathology and every other specialty because of the baby boomers. It's very hard to ignore this demographic trend.

The whole thing with any specialty is that new you need to push the envelope in terms of evolutionary and revolutionary technology. This is one of the few ways to keep up the price point for any product or service. For example, evolutionary means finding more ways to make the same technology useful, such as functional MRI of the brain or PET imaging for cancer. For example revolutionary, means finding new different based technology ie thermal imaging and the like. I think genetic/molecular technology could very well be the next "big thing" in path (ie revolutionary technology). I have seen some of the molecular gene chips used for cancers such as lymphoma and it looks promising (at least in terms of prognosis and soon that may spill over to treatment strategies).

In terms of salaries, think the salary service quote there is a reflection of the market in the midwest, where it seems they do most of their placements for various specialties.


*I hope technologies never stabilize in radiology* Radiology has pushed the envelope for the past 25 years, but past performances cannot be used to predict future performance.

Anyway, what does Vox know about business matters anyway?

 

[augmel]

the problem with all of this is that the cost of medical care is already getting prohibitively expensive. if every specialty spends it's time finding new ways to make more money, fewer and fewer people will have access to that technology. the government will continue to cut reimbursements to try to bail itself out. then the docs will bitch and start moving into "executive" practices and everything will go down in a fiery ball to hell. ok, ok, so maybe that is a little extreme. i'm all for technology, but when it means million dollar salaries for specialists and less medical care for more and more people, then we need to examine what is really important. sorry to get on my high horse, but if there was half as many threads about medicine as service as there are about all the shiny things we can buy once we're done, i'd be a little less sensitive.

 

[Voxel]

Augmel,

I want the new advances in diagnosis in treatment, don't you? Granted I am biased, but many of my non-medicine friends say the same thing. The only problem is that people don't want to pay for it. The question is: does society want to pay for it and at what price?

That's a separate debate all together. Let's not entangle these two threads. If you want to disucuss this issue further augmel, start a new thread in the general residency forum. I also be glad to comment on some of the other things you have written, but I don't want you to reply in this thread.