Healthcare passage for pathology

[2121115]

Gentlemen (and Ladies), what would you have done given my situation?
Say " no thank-you, I'll go down with the sinking ship"

I would have done exactly the same thing. However, I wouldn't come on here and tell everyone to quit complaining because it worked out for me.

---

Members don't see this ad.

 

[schrute]

I would have done exactly the same thing. However, I wouldn't come on here and tell everyone to quit complaining because it worked out for me.

If I had no choice, ie. had no leverage in the group, I would probably have to have done the same, though wouldn't come on here tell everyone my hosing them is tough s****.

 

[deleted314957]

my point was that i have seen and heard the gloom and doom for more than 30 years. TRFRA in 1981 was going to be the end of the world. All my peers seem to have done just fine. perhaps I demonstrare a serious lack of understanding of what the current generation (your peers) faces but it really sounded gloomy in my time too. Don't project your current attitude and fears as a resident into your reality 30 years from now.

 

[pathstudent]

You are a hoser of young pathologists. Reducing their incomes by 30% just so you could roll around in a porche. Yeah tough **** for all the future private practice pathologists in your group. You got yours.

 

[2121115]

you are a hoser of young pathologists

lol.

 

[deleted314957]

O.K. PATHSTUDENT, I got mine. Too bad you chose such a rotten field
where it is a certainty you will never get ahead because of "hosers" like me.

 

[schrute]

You are a hoser of young pathologists. Reducing their incomes by 30% just so you could roll around in a porche. Yeah tough **** for all the future private practice pathologists in your group. You got yours.

You've been drinking too much Elsinore.

 

[Freak]

Ok ... noob question.

How does one pathologist (or even a bunch selling their practices) lead to the death of private practice model. Could you not just start another new private practice to compete with the now "globally owned" one, or are the contracts with the hospitals exclusive and that is why people are buying out the practices.

 

[Parts Unknown]

O.K. PATHSTUDENT, I got mine. Too bad you chose such a rotten field
where it is a certainty you will never get ahead because of "hosers" like me.

Ah, don't worry. Nobody else here likes him much, either.

 

[LNsquasher]

I can understand selling your practice when in a position without leverage (ie. having the minority opinion in a group that wants to sell). What I don't find acceptable is when a private group promises future partnership to a young associate with no intention of ever making them a partner. A few years down the line they break the news, or maybe don't and wait for the person to just wander off and find a new job. This is not only dishonest, but an abuse of the cheap labor problem we have in pathology. Even the five-to-seven years to partnership tracks (and yes, these do exist) are unacceptable to me.

But what are you going to do? With the job market what it is, we have no real leverage...

 

[BrainPathology]

I did a surgical internship. I attended 6 months of undersea/divng/hyperbaric medicine with the navy. I spent 2 years as an undersea medical officer/GP. I then did the regular ap/cp. I then did FP w/the AFIP. I then spent 2 years as an attending at a major Naval training hospital. Got out and spent 4 years as an associate with a large private florida group. I then paid $230,000 cash buy in to become a partner. We sold about 6 years later. If that is "hosing" someone tough s***.

And we were not "stupid" to sell. We saw the gravy train coming to an end so we picked up about 3M each as long term capital gain rather than ordinary income.

And why retire? I like pathology, am medical director and solo pathologist
( with backing of a large local group) of a 175 bed community hospital, work about 7 hours /d sign out enough surgicals to make things interesting and make $400K+

Thanks for coming on here and sharing this. It's wonderfully entertaining to read the same people shrieking about the destruction of free enterprise, capitalism, freedom etc in the health care bill grilling you for developing a successful practice and profiting handsomly from it and at the same time being able to continue to practice what you enjoy. I say congratulations to you for doing what every small business owner works toward every day.

YOU are not responsible for MY success, nor are you responsible for anyone else's success here except your own. That is the problem with nearly all of the whiners on this board. Somebody "else" is keeping them down - or turning them into submissive homosexuals depending on what spin they put on their specific rant (as if there's somthing wrong with that particular lifestyle).

There are still plenty of ways to make and keep money in medicine. You can tell everyone who tells you that you hosed us to go f*ck themselves.

 

[rollwithit]

I have to agree with Thrombus.

"If that is "hosing" someone tough s***"

+

"We saw the gravy train coming to an end so we picked up about 3M each as long term capital gain rather than ordinary income."

=

"I'll take mine any way I can get it, the field be damned."


Your tough "s****" attitude isn't justified because you're ahead of me in training, and your $3 mil comes from future employees relegated to the lab salary (a la Ameripath).

Yes you did sell us out. Many people no longer have the opportunity to pay 230K cash to become a partner because you ran off with 3 million $.

You made it worse for business savy upcoming pathologists who now have their career reduced to a dead end employee model. Yes thats great right before retirement, but many of us did not go into this to take orders from some business admin.

Whoah, people. It's a little harsh making the fella come across as a bad guy. I'm sure each of you feels you have the right to sell whatever valuable assets you may have. If somebody wants to purchase something that I own at a nice earnings multiple and there is a significant amount of uncertainty down the road regarding maintaining those earnings I produce from that asset, I’m thinking hard about selling. You would be ignorant otherwise.

What duty does a private practice pathologist have in ensuring that many low headcount private practice pathology groups exist in the future? Is it better model for patient care, or is it a better model to “share the wealth” amongst individual practicing physicians and not a boardroom of MBA execs? It’s not like the MBA minds are practicing medicine. They are figuring out how to use available resources, lean it up, and make a profit.

Granted, it’s nice to “take care of your own”, but if there’s a better and/or more efficient way of carrying out a process, it’s going to happen. I’m sure the vast majority of physicians would love to continue the status quo, work in small practices, scratch their beards, and make a high income. Unfortunately for physicians, someone is always waiting on the fringe to exploit those who maintain the status quo. (I’m not talking about the science itself, I’m talking about the business practices).

Pathology (and Medicine) is not immune to the forces that are present in any other industry. This guy can’t help it that the nature of pathology (operations are easily centralized) sets itself up to be a prime candidate for somebody to raise capital, buy practices, consolidate admin, and turn it into something profitable on a much larger scale.

Hopefully, the beef is with the people forcing the change and feel that it’s a bad model for patient care. If you honestly think the large lab trend is bad for pathology and patients, then your only option is “prove smaller scale has a better value, and then sell the **** out of it”.

Otherwise, what you have is a good old fashioned case of sour grapes. Don’t get me wrong, physicians possess unique skills and have gone through more than enough education/training to be able to earn a very very nice wages or earnings. But, no matter what you think, physicians don’t DESERVE it. You still have to be on you A game and think of ways to do things better than the next if you want to be the guy that reaps the most profits. American physicians are among the brightest people in the world, but they are also among the most naïve. No matter what the past image of the “typical doctor” was, you can’t go on assuming that everything will remain the same and that any change faced is inherently bad. If you are smart enough to become a physician, you are smart enough to figure out the best/most efficient way to serve patients. If bigger is better in this case, sorry, it is what it is. +1 for the MBA guy who outsmarted the physician and figured out a way to make them work for them.

I’m sure the response to that most recent paragraph will be “hey, jerkoff, I just want to be fairly compensated for the extra years of education/training/debt/hard work I went through”. I’ll go ahead and respond in advance: I agree. You should be. But, you can and will be fairly compensated as an employee as well, if that’s what finds its way as being the best way to serve patients. Remember, you have a unique skill set that you can leverage into a nice living. If you want to be the boss and want to avoid being an employee as if it’s the plague, figure out how to become the boss. The MBA kids aren’t going to be reading slides any time soon…

To quote the great Ric Flair, “To be the man, you gotta beat the man!”

(Sorry for the rant, it’s likely not entirely relevant to the responses I quoted. It just fueled the fire for a couple of thoughts I’ve had recently. Fire away!)

 

[deleted314957]

I am pretty new to this fourm and the thread but I have seen some areas of interest. When I first got my job in FL with a large and prestegious private group in FL I had a few things going for me--- I was a AP/CP/FP Navy product . Because of my 2 years remaining obligation to the navy I served as a staff pathologist at a large big name navy hospital ( we are talking mid 80's). I had a solid clinical internship with about 2 1/2 basic clinical medicine practice afterward. It put me in a position where i did not have to compete with folks fresh out residency or fellowship. The old guard clinicians who ran things at the community hospital where I got assigned LOVED that. I was the first pathologist that they had that they considered a "real" doctor because i spent a couple years as a "gp". (I have been the sole pathologist and Lab Medical Director there for the past 20 years) This all took some time off my idealized projection but it worked out for the best. I think the military, particularly in this era when education is so exhorbitant is a good "entree" if not a career. I got a free ride thru med school ( in-state tuition at U of I in 1974 about $500/sem!!! Thy got a real deal with me), pay at that time as an intern and then the obligatory GP-general medical officer (which i look back on fondly) lets you start a family, you have no debt, and the residency/fellowship/staff pay kicks ass compared to your civilian counterparts. Plus I have the nostalgia of having been a steely-eyed killer of the deep with a submarine squadron.

To boil things down, there now seems to be a lot of job angst. The navy removed that for me. It was a great residency, my academic quals were superior, fellowships almost seemed to be a given. When you get out after initial obligation ( my example) you have ap/cp/fellowship boards, 2 years experience as a real attending, no debt, and you probably are on your way to a decent nest egg for your age.

Long post, but if you want to "sacrifice" a few years take a look at the military. (in retrospect, none of it was a sacrifice for me)

 

[Granular]

I thank mikesheree for sharing parts of his professional and financial CV. If we had more input from experienced folks like him, I think it would help those of us starting out to better assess the landscape and adapt to it. I also think it is off base to blame him or anyone else, including the MBA admin types, for the business model, job and financial situation we face as young pathologists. Everyone before us sought to optimize their situation, and we must do the same. Maybe we need to go to night school for our MBAs, or organize for the purpose of publicizing abusive practices by employers by name, or develop "concierge" pathology practices in anticipation of a two-tiered health system, or take some other drastic measures to optimize our situations. Someone is going to need us - patients, or surgeons, or hospitals, or pathology companies. It sucks that there are too many of us, and that this is a barrier to our expectations being met, but the environment demands that we anticipate and adapt to what is going on. I wish the old millionaire pathologists would go away (I certainly would with $3 million+), but I guess they aren't going to. I need to figure out how to get the money they are still getting. I don't know the solution, but I know that the old ways of making the money are not there for me. Healthcare reform will probably even make this harder. Bottom line is that someone is still going to be making money in pathology, and despite the environment and obstacles - it behooves young pathologists with energy, ability, and creativity to make sure it is us.

 

[path24]

MBAs can buy pathologists because of the oversupply. They would be buying cardiologists, surgeons...etc. if these people were dumb enough to create too many. Pathologists have created their own problem. You have "leaders" (actually *****s) talking about a shortage. So people will continue to exploit pathologists in the coming future also....thanks "leaders"

 

[BrainPathology]

MBAs can buy pathologists because of the oversupply. They would be buying cardiologists, surgeons...etc. if these people were dumb enough to create too many. Pathologists have created their own problem. You have "leaders" (actually *****s) talking about a shortage. So people will continue to exploit pathologists in the coming future also....thanks "leaders"

Typical answer to the well thought out advice of the post above it. It's almost Pavlovian.

On an unrelated notw, I just read a muscle biopsy taken for arm pain in a woman with proven genetic causes of hypercoaguability, and deep vein thromboses in the arm at the time of biopsy. There is at least 1 example of this kind of nonsense every week where I am (most assuredly NOT a second rate community or academic program). Every time I see this I get a little closer to ADVOCATING, instead of just anticipating with some reservations, the bundling of payments for all conditions.

This is simply "mining" your patients for money. No other word for it, and it's disgusting and far too common.

 

[Pingu]

On an unrelated notw, I just read a muscle biopsy taken for arm pain in a woman with proven genetic causes of hypercoaguability, and deep vein thromboses in the arm at the time of biopsy. There is at least 1 example of this kind of nonsense every week where I am (most assuredly NOT a second rate community or academic program). Every time I see this I get a little closer to ADVOCATING, instead of just anticipating with some reservations, the bundling of payments for all conditions.

This is simply "mining" your patients for money. No other word for it, and it's disgusting and far too common.

To me, this seems more like CYA than mining your patients for money. The pools of trial lawyers are tiled in mosaic by patients like this who have every symptom logically pointing towards one thing but it winds up being something else entirely.

 

[BrainPathology]

To me, this seems more like CYA than mining your patients for money. The pools of trial lawyers are tiled in mosaic by patients like this who have every symptom logically pointing towards one thing but it winds up being something else entirely.

I'm sure that happens sometimes, I just don't buy that in a lot of cases though. A muscle biopsy isn't without risk and in a patient with normal CK, a diagnosed coagulopathy already confirmed by genetics, and the findings of deep thromboses in the affected arm there just isnt any good reason for this. You can SAY that you're afraid of lawyers and that you're FORCED to take the fee you get for the procedure, but come on.

 

[deleted314957]

Pingu and Brain Pathology, I can see both sides of your argument and I have dealt with it for ~30 years. When that nonsense is scheduled do you 1) call the surgeon and tell him there is no need to do this and you will talk to the medicine guy to make nice with everybody? ( the surgeon does like the money though if you had not interfered) 2) call the medicine guy and tell him to have the surgeon stand down. (and make the medicine guy feel you think he is stupid) 3) have the bx come on down to the lab and forgo the nonsense of snap freezing ,glut for EM, etc and just dump it in formalin and sign it out as normal muscle with some comment about the lack of clinical indication 4) same as choice #3 but s/o with no comment whatsoever. 5) etc. etc.....

You get the idea---this is the ART of medicine and it ain't easy and there
isn't always one right answer. Part of the answer lies in the 3 A's of pathology---affability, availability and ability ( generally in that order) and always with the rule of primum non nocere.

 

[pathstudent]

The pathology bill on a muscle bx runs about 5000 so why not just play stupid like we do with 12 sector path biopsies and just pocket the cash.

 

[BrainPathology]

Pingu and Brain Pathology, I can see both sides of your argument and I have dealt with it for ~30 years. When that nonsense is scheduled do you 1) call the surgeon and tell him there is no need to do this and you will talk to the medicine guy to make nice with everybody? ( the surgeon does like the money though if you had not interfered) 2) call the medicine guy and tell him to have the surgeon stand down. (and make the medicine guy feel you think he is stupid) 3) have the bx come on down to the lab and forgo the nonsense of snap freezing ,glut for EM, etc and just dump it in formalin and sign it out as normal muscle with some comment about the lack of clinical indication 4) same as choice #3 but s/o with no comment whatsoever. 5) etc. etc.....

You get the idea---this is the ART of medicine and it ain't easy and there
isn't always one right answer. Part of the answer lies in the 3 A's of pathology---affability, availability and ability ( generally in that order) and always with the rule of primum non nocere.

I usually just vent on here, feel a little bit better and sign it out.

I don't have the authority to comment that there is a lack of clinical indication. I tried and was overruled, and basically just told to live with it as part of trying to foster good relations with the other services (which is actually valid I suppose).

1 and 2 are great options. When I can actually get into a position to have all the biopsies reviewed before they are processed for full routine enzyme histochemistry I'd like to experiment with variations on those.

 

[BrainPathology]

The pathology bill on a muscle bx runs about 5000 so why not just play stupid like we do with 12 sector path biopsies and just pocket the cash.

Playing stupid does two things:

1. It eventually becomes reflexive and you're not playing anymore

2. Anyone around you will just believe that you're stupid

I don't get excited about either of those options. But maybe that's one of the nebulous nuances of medicine taught at one of the high powered programs you advocate incessantly for here. Pocketing cash at the expense of your intellectual integrity is something I don't quite get yet.

 

[pathstudent]

Playing stupid does two things:

1. It eventually becomes reflexive and you're not playing anymore

2. Anyone around you will just believe that you're stupid

I don't get excited about either of those options. But maybe that's one of the nebulous nuances of medicine taught at one of the high powered programs you advocate incessantly for here. Pocketing cash at the expense of your intellectual integrity is something I don't quite get yet.

I am being facetious. I strongly disagree with packaging cases to make the most money possible (I see the prostate biopsy example as one of the most severe abuses).

 

[BrainPathology]

I am being facetious. I strongly disagree with packaging cases to make the most money possible (I see the prostate biopsy example as one of the most severe abuses).

I know you were.. but I've just been dying to get a dig against the huge east coast schools that you love.

 

[dermpathdoc]

To summarize the PATHOLOGY RELEVANT points in today's historic burning (and/or crapping upon) of the US Constitution:

In 2011, reimbursement for Medicare from all other speciality physicians, including Pathologists will be reduced and given to primary care doctors.

In 2013, this law will begin bundling payments to hospitals for all services rendered for patients with Medicare. The implication for this is beyond huge.

This is on top of whopping increases on taxes for most of us in the upper income levels.

I would probably not match into Pathology with the bundled payment scenario that is about to occur. I would expect incomes to drop 50-75% and/or all private pathologists to be relegated to salaried hospital employees unless there is some drastic change in the pipelines (like physicians all decide to drop Medicare, 2nd civil war etc).

I hate to say it: The End is Nigh.

Ummm you are in an upper income level/tax bracket??
I envy you...

 

[bronx43]

LADoc is a respected poster here? I guess I must have seen only his childish douchebag posts.