How do rural pathologists make so much?

[YBNJay]

Currently working at a 15-person group in the mid-Atlantic ~31,000 cases per year. Making ~$250k total compensation as an employee. I have worked consistent 11-hour days since the start of the year. I consider myself very efficient and don't get distracted easily.

After catching up with someone I trained with recently, they mentioned they made $550k, last year. They currently work in a rural part of North Carolina doing general surg sign out. Their workload is similar to my own, yet they manage to make significantly more. What is the special sauce that makes this possible? Is my group bad at negotiating contracts or is there something that lets rural groups bill more than those in cities? I was under the impression that CPT codes reimbursed the same within a given state.

---

Members don't see this ad.

 

[gbwillner]

Making ~$250k total compensation as an employee.

That's your problem right there. You are working for a salary. I suspect your buddy is getting a share of revenue.

 

[YBNJay]

That's your problem right there. You are working for a salary. I suspect your buddy is getting a share of revenue.

Partners at my group did ~$325 last year for reference.

 

[deleted314957]

Currently working at a 15-person group in the mid-Atlantic ~31,000 cases per year. Making ~$250k total compensation as an employee. I have worked consistent 11-hour days since the start of the year. I consider myself very efficient and don't get distracted easily.

After catching up with someone I trained with recently, they mentioned they made $550k, last year. They currently work in a rural part of North Carolina doing general surg sign out. Their workload is similar to my own, yet they manage to make significantly more. What is the special sauce that makes this possible? Is my group bad at negotiating contracts or is there something that lets rural groups bill more than those in cities? I was under the impression that CPT codes reimbursed the same within a given state.

I almost threw up in my mouth at your first sentence.
I see that you have 15 people for 31k cases. That is 10k per person x3 and 3 foursomes of bridge! You wonder why you don’t make money?

 

[KeratinPearls]

The partners in your group are making $$$$ off of you it sounds like. They split profits amongst themselves.

 

[KeratinPearls]

Currently working at a 15-person group in the mid-Atlantic ~31,000 cases per year. Making ~$250k total compensation as an employee. I have worked consistent 11-hour days since the start of the year. I consider myself very efficient and don't get distracted easily.

After catching up with someone I trained with recently, they mentioned they made $550k, last year. They currently work in a rural part of North Carolina doing general surg sign out. Their workload is similar to my own, yet they manage to make significantly more. What is the special sauce that makes this possible? Is my group bad at negotiating contracts or is there something that lets rural groups bill more than those in cities? I was under the impression that CPT codes reimbursed the same within a given state.

I know people making a little less than you doing much less work. I hope you are on a partner track. If not, I’d leave.

This is a good example of the consequences of an oversupply. If employers or partners can pay you less to line their pockets and give you more work, some will.

If pathologists weren’t a dime a dozen they wouldn’t be able to pull this BS. I sure hope the people you work with are at least nice to you.

 

[Alteran]

I almost threw up in my mouth at your first sentence.
I see that you have 15 people for 31k cases. That is 10k per person x3 and 3 foursomes of bridge! You wonder why you don’t make money?

How many cases a day do you get? I can't imagine that it would be very many with 31,000 split 15 ways, something like 10 cases/day if split evenly? To think of it, if you're being paid $250K/year doing no more than a dozen cases per day, you're doing pretty well for the amount of effort you're putting in. If you're doing 30 cases/day or more routinely, you're getting hosed by your practice.

 

[shikimate]

I am curious, mathematically the daily case load is about 10 cases, but you're working 11hr days? Are they loading you up with complex resections while somebody takes all the quick biopsies?

 

[Rxor49]

Clearly a disconnect or miscommunication here. If you're working efficiently without distractions for 11 hours a day, you're one of the harder working pathologists I've heard of. But everyone's impression of the numbers is that you are way overstaffed. Would love to get more details.

My guess at an explanation for your lower comp would be that the partners have designed the practice to benefit their lifestyles, hiring abundant minions and distributing the work very unevenly. You should have a sense of whether everyone contributes equally...

 

[YBNJay]

I almost threw up in my mouth at your first sentence.
I see that you have 15 people for 31k cases. That is 10k per person x3 and 3 foursomes of bridge! You wonder why you don’t make money?

We have 4 part timers, which complicates things a bit. (I know, I know...) I'd say our average daily case load is probably a bit lower than most, but a very significant amount of time is taken up with administrative BS, due to the hospital refusing to hire decent lab support staff.

 

[tiredguy]

So how many cases are you signing out and what is the split of sign out time vs “admin BS” time in those 11 hours? How much vacation? Is this partnership track or not? Are you sure partners are only making 325? Do they even sign out?

 

[Guest8]

This isn't adding up well. We have 14 people for around 50K cases per year, couple part-timers (although 0.8 or 0.9 share), and everyone is >$500K. And we're not generally working 11 hour days. We also do all the lab admin, tumor boards/conferences, and serve on various hospital committees. And have 8wks vacation. I think your practice just has too many pathologists.

 

[deleted314957]

This isn't adding up well. We have 14 people for around 50K cases per year, couple part-timers (although 0.8 or 0.9 share), and everyone is >$500K. And we're not generally working 11 hour days. We also do all the lab admin, tumor boards/conferences, and serve on various hospital committees. And have 8wks vacation. I think your practice just has too many pathologists.

Agree. I averaged 10 k and was solo lab medical director.
Standard ~180 bed suburban hospital. No CNS or transplants. Biopsy heavy, admittedly. This practice, at that pace equaled an income of ~$725/yr in 1992. That is well over 1 M today. Probably impossible today.

 

[WEBB PINKERTON]

I told you to go rural. Create a brand, build an empire.

 

[cmz]

If your billing company is Change then you're also probably losing millions of dollars.

 

[Nurse_Ratched]

If your billing company is Change then you're also probably losing millions of dollars.

Would you be willing to elaborate on this?

 

[cmz]

Would you be willing to elaborate on this?

Are you planning to sue me for something if I spill the beans?

 

[Nurse_Ratched]

Are you planning to sue me for something if I spill the beans?

The group I am a part of uses Change. I'm not involved with the business side of the practice, but I always like to know how exactly I'm being screwed over even if I can't do anything about it.

 

[Guest8]

The group I am a part of uses Change. I'm not involved with the business side of the practice, but I always like to know how exactly I'm being screwed over even if I can't do anything about it.

We use Change and they've certainly gone downhill the last several years. Lots of billing expiring past the possible billing window. Audits that show not all charges were accurately billed. Too much going to collection rather than being appropriately billed in the first place. We keep expecting things to improve after they change our account manager, etc but we might be looking to "change" to someone else real soon.

 

[cmz]

We use Change and they've certainly gone downhill the last several years. Lots of billing expiring past the possible billing window. Audits that show not all charges were accurately billed. Too much going to collection rather than being appropriately billed in the first place. We keep expecting things to improve after they change our account manager, etc but we might be looking to "change" to someone else real soon.

Make the move. Place is a cesspool. I'm being too kind, though.

 

[deleted314957]

We use Change and they've certainly gone downhill the last several years. Lots of billing expiring past the possible billing window. Audits that show not all charges were accurately billed. Too much going to collection rather than being appropriately billed in the first place. We keep expecting things to improve after they change our account manager, etc but we might be looking to "change" to someone else real soon.

This sounds like an old, recurring nightmare of mine.

 

[Dave CX]

I've heard good things about McKesson

 

[Napoleon1801]

Currently working at a 15-person group in the mid-Atlantic ~31,000 cases per year. Making ~$250k total compensation as an employee. I have worked consistent 11-hour days since the start of the year. I consider myself very efficient and don't get distracted easily.

After catching up with someone I trained with recently, they mentioned they made $550k, last year. They currently work in a rural part of North Carolina doing general surg sign out. Their workload is similar to my own, yet they manage to make significantly more. What is the special sauce that makes this possible? Is my group bad at negotiating contracts or is there something that lets rural groups bill more than those in cities? I was under the impression that CPT codes reimbursed the same within a given state.

Is $250k your starting salary? Are you on a partnership track? If the answer to both is "no" you're likely getting screwed by your employer.

 

[Drifter76]

Is $250k your starting salary? Are you on a partnership track? If the answer to both is "no" you're likely getting screwed by your employer.

I tend to think that anyone outside academia, working full time, with a reasonably high caseload, who isn’t making 400k+ is likely getting screwed by their employer- even in places where the payer mix isn’t great. The exception would be, if you are on a partnership track in your first few years out of training and haven’t made partner yet.