Jul 19, 2018
6
5
By now we are all aware of the significant salary cuts that Anthem has thrust upon many private practice groups. How long do you estimate it will be before those in the academic bubble begin to feel the pressure of unsustainably low reimbursements?

5, 10, 20 years?
 
  • Like
Reactions: dukeresident

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
Most academic programs (barring disasters like Hahnemann in Philly) are growing rapidly and robustly; particularly since larger academic institutions are swallowing other hospitals. I have only seen lots of jobs, lots of hiring, and plenty of growth in the past 8 years of being attending. I’ve seen no signs of slowing down, personally; at least in my geographical area.
 

AZpath

5+ Year Member
Nov 1, 2012
445
113
Status
Attending Physician
It total depends... I suspect most institutions have limited ability to monitor revenue per specialty. It is easier to see the RVUs by dept.
Overtime it may become apparent that revenue is taking a hit.
I am sure academic admins already think pathology is cost center and a necessary evil. Depts are appear to be loosing money when the revenue is buried inside of bundle payments
 
  • Like
Reactions: dukeresident

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,179
300
NOT behind a scope.
Status
Attending Physician
Most academic programs (barring disasters like Hahnemann in Philly) are growing rapidly and robustly; particularly since larger academic institutions are swallowing other hospitals. I have only seen lots of jobs, lots of hiring, and plenty of growth in the past 8 years of being attending. I’ve seen no signs of slowing down, personally; at least in my geographical area.
Well isn’t that special. I guess the field would be in superb shape if everyone went into academia as a junior instructor after their second fellowship. Please take off your blinders and look outside the doors of your ivory tower.
 

y2k_free_radical

2+ Year Member
Sep 25, 2015
290
134
Well isn’t that special. I guess the field would be in superb shape if everyone went into academia as a junior instructor after their second fellowship. Please take off your blinders and look outside the doors of your ivory tower.
What happened to the pathologists in the acquired systems?? I do applaud your missionary zeal and I am sure a sudden 40 % cut in your salary would have no affect.
 
Aug 20, 2018
119
101
What happened to the pathologists in the acquired systems?? I do applaud your missionary zeal and I am sure a sudden 40 % cut in your salary would have no affect.
If they are lucky they are absorbed into a community pathology division but in many cases they simply lose their job. A small group signing out 10K accessions / yr can easily be absorbed by a nearby large academic group and the sub-specialized academic attending only have to take a few more cases daily on their various services.

This is not growth but a zero sums game.

The best thing for job security in a small-ish hospital pathology dept is to be so far away from the academic center it is affiliating with that frozen coverage would be a problem.

This phenomena is also happening in radiology but to a lesser degree.

I am seeing a lot of this in my area.
 

y2k_free_radical

2+ Year Member
Sep 25, 2015
290
134
If they are lucky they are absorbed into a community pathology division but in many cases they simply lose their job. A small group signing out 10K accessions / yr can easily be absorbed by a nearby large academic group and the sub-specialized academic attending only have to take a few more cases daily on their various services.

This is not growth but a zero sums game.

The best thing for job security in a small-ish hospital pathology dept is to be so far away from the academic center it is affiliating with that frozen coverage would be a problem.

This phenomena is also happening in radiology but to a lesser degree.

I am seeing a lot of this in my area.
It often actually is less than a zero sums game
 

AZpath

5+ Year Member
Nov 1, 2012
445
113
Status
Attending Physician
I interviewed for a job at The Ohio State University for their community division about 15 years ago.
It amounted to frozen section coverage with a few hernia sacs and gallbladders to review. Everything else went to the mother ship.
No thanks
 
  • Like
Reactions: dukeresident

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
Well isn’t that special. I guess the field would be in superb shape if everyone went into academia as a junior instructor after their second fellowship. Please take off your blinders and look outside the doors of your ivory tower.
Hospital and academic Pathologists comprise greater than 50% of the Pathology workforce. Private practice Pathologists comprise less than 15-20%. The reality is that hospital and academic pathology are both growing constantly. Perhaps you don’t have experience in Academia but that’s the reality.

I have seen constant and if anything increasing growth at every academic institution I have been associated with over the past 10 years and it is still happening...

Large academic institutions have significantly more leverage and a louder voice in every way. A good thing for the upcoming changes arriving in healthcare...
 

octopusprime

2+ Year Member
May 6, 2016
231
187
Status
Attending Physician
Large academic institutions have significantly more leverage and a louder voice in every way. A good thing for the upcoming changes arriving in healthcare...
Note you're praising the large academic institution itself, not the individual physicians which comprise it... A louder voice than who? In what regard? What do large academic institutions suffer from that would necessitate them needing a louder voice??

Consolidation is great on paper and may get you a better price for purchasing power, but keep in mind that patients don't consolidate...they're still spread across the country by considerable distances, and the further you get from the epicenter of 'large academic institutions,' the more challenging it becomes to be a part of a consolidated system...except on paper of course.

Just look at the VA hospital system, the largest consolidated / integrated health care system in the US...if people think a national health system is going to function more like a well-oiled academic center than a larger scale VA with multiple times the problems, they're crazier than the people that think the VA is an optimized 'standard of care' health care system in the first place.
 
  • Like
Reactions: dukeresident

27G

5+ Year Member
Aug 8, 2013
30
8
Status
Hospital and academic Pathologists comprise greater than 50% of the Pathology workforce. Private practice Pathologists comprise less than 15-20%. The reality is that hospital and academic pathology are both growing constantly. Perhaps you don’t have experience in Academia but that’s the reality.

I have seen constant and if anything increasing growth at every academic institution I have been associated with over the past 10 years and it is still happening...

Large academic institutions have significantly more leverage and a louder voice in every way. A good thing for the upcoming changes arriving in healthcare...
Most competent pathologist leave academics like it’s on fire after a short stint. The ones that stay are stuck.... they get sub-specialized and can’t look at anything except their thing. Academic pathology is broken big time. Most ancillary and molecular testing is sent out to commercial entities so in-house is IHC and just good ole H&E. The ACGME has such a low bar for allowing fellowships many crappy programs develop subpar fellowships with insufficient material or expertise .
What exactly has “academic”pathology accomplished of note in the last 15-20 years. All the PDL-1, ROS-1 etc molecular testing was developed by non pathologists. No one cares about another case report on some random entity or another variant of a polyp or large brown stain series. The majority of academic programs need to be shut down and the faculty fired. Immediately before our field goes completely down the toilet.
 

Alteran

10+ Year Member
Feb 10, 2008
254
108
Border war zone
Status
Attending Physician
Hospital and academic Pathologists comprise greater than 50% of the Pathology workforce. Private practice Pathologists comprise less than 15-20%. The reality is that hospital and academic pathology are both growing constantly. Perhaps you don’t have experience in Academia but that’s the reality.

I have seen constant and if anything increasing growth at every academic institution I have been associated with over the past 10 years and it is still happening...

Large academic institutions have significantly more leverage and a louder voice in every way. A good thing for the upcoming changes arriving in healthcare...
No better way to scare off potential applicants than to tell them they have virtually no shot at a private practice career. Any applicant we, as a field, would want is smart enough to figure out how unsavory academic medical practices can be. For those of you who don't know, the traditional academic career in pathology (or most other medical specialties) goes like this.
  1. Get an appointment as a clinical track assistant professor with pay at the 25-50th percentile as compared to your private practice peers, but still doing just as much work as them with the added pressure of teaching. While academic departments will say you only have to "participate" in research as it is only a few percentage points of your job's trinity of Service, Teaching, and Research, reality is you have to publish in sufficient quantity (even if you're not tenure-track) to get promoted. You will also be granted the distinction of doing all the things that all your older colleagues don't want to do (i.e. medical school teaching, resident lectures, tumor boards, etc.). You'll also get all of the terrible call schedules that no one wants. Basically, you're the department's work horse and your entry level academic job is to bill waaaaaaaaaay more than what they're paying you to support the inflated salaries of the department chair and full professors (effectively the "partners" of the department).
  2. After you work as an assistant professor with either no or marginal pay raises for a minimum of 7 years in most departments, you become eligible for promotion to associate professor, which in pathology only adds an additional $20-30k boost in pay from what I see in perusing multiple public academic salary databases.
  3. Get promoted to associate professor so you can finally buy a house and car that's better than middle middle-class as your student loans are still weighing you down. As an associate professor, you have a little more say in what specialties and services you can (and won't) do - but not by much mind you. Again, even though you're clinical track, guess what - you still have to publish even more (and it helps if you network too). Keep in mind, the promotion requirements vary greatly from dept to dept with sometimes nebulous and/or capricious standards depending on who the chair is and how much they like you.
  4. After another minimum 7 years of being an associate professor, you can come up again for promotion to full professor. Sounds great in name, but all it means is that you get only another modest boost in pay (anywhere from $30-40k). The real benefit in being professor is you now get the ability to effectively work less than what you're being paid. You've earned the right to subside off another's labor. This is where you can now make a career cataloging toenail diseases and be grossly overpaid for it.
  5. If you're really, really lucky and have done a good job of networking and making a name for yourself by publishing or as a well respected speaker, you can get a chairmanship which effectively boosts your pay to what an average private practice partner in pathology would make. Candidates for chairmanships have been in the field for 20+ years and have a reputation that usually proceeds them.
For those of you who are reading this and going "Geez, that's a myopic, uninformed, and pessimistic view of academic practice", just ask yourselves how many start out as assistant professors and make it all the way up to full professor. The rate of attrition is horrendous in academia, and for good reason. Most of it has to do with not wanting to be either party or subjected to the megalomaniac designs of department chairs and their chief lieutenants, the full professors. There are of course exceptions to the above - there are always exceptions. But as our field tends to aggregate the rather unexceptional as of late, academic departments don't have to treat new hires with any special privilege or perks.

And if you think I'm painting a bad picture of academia in general, I'm not. I'll give the following anecdote I saw with my own eyes in community practice just recently. A very well established oncology surgeon was not happy in his private practice job and the regional academic center in the same city just happened to be needing someone with this surgeon's experience. The surgeon applied for the job and the conversation with the surgery chair went something like this:
Chair: You're going to do general surgery cases as well as your oncology case load.
Surgeon: Nope. I'm only doing my oncology cases.
Chair: That's not what the posted job description is.
Surgeon: That may be what you're looking for, but that's not what I'm looking for. And last time I checked, no else in 1500 miles with my experience and expertise is looking for that either.
Chair: OK. But you're still taking general surgery call.
Surgeon: Guess again. I'm only doing my cases and call related to them.
Chair: Fine. We'll just adjust your pay to match the work.
Surgeon: Nope. I'm not taking a pay cut either. Figure it out or good luck getting someone else before your accreditation comes under the chopping block.
Chair: Hired.

Now I ask, anyone see that happening in a pathology academic department???
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
No better way to scare off potential applicants than to tell them they have virtually no shot at a private practice career. Any applicant we, as a field, would want is smart enough to figure out how unsavory academic medical practices can be. For those of you who don't know, the traditional academic career in pathology (or most other medical specialties) goes like this.
  1. Get an appointment as a clinical track assistant professor with pay at the 25-50th percentile as compared to your private practice peers, but still doing just as much work as them with the added pressure of teaching. While academic departments will say you only have to "participate" in research as it is only a few percentage points of your job's trinity of Service, Teaching, and Research, reality is you have to publish in sufficient quantity (even if you're not tenure-track) to get promoted. You will also be granted the distinction of doing all the things that all your older colleagues don't want to do (i.e. medical school teaching, resident lectures, tumor boards, etc.). You'll also get all of the terrible call schedules that no one wants. Basically, you're the department's work horse and your entry level academic job is to bill waaaaaaaaaay more than what they're paying you to support the inflated salaries of the department chair and full professors (effectively the "partners" of the department).
  2. After you work as an assistant professor with either no or marginal pay raises for a minimum of 7 years in most departments, you become eligible for promotion to associate professor, which in pathology only adds an additional $20-30k boost in pay from what I see in perusing multiple public academic salary databases.
  3. Get promoted to associate professor so you can finally buy a house and car that's better than middle middle-class as your student loans are still weighing you down. As an associate professor, you have a little more say in what specialties and services you can (and won't) do - but not by much mind you. Again, even though you're clinical track, guess what - you still have to publish even more (and it helps if you network too). Keep in mind, the promotion requirements vary greatly from dept to dept with sometimes nebulous and/or capricious standards depending on who the chair is and how much they like you.
  4. After another minimum 7 years of being an associate professor, you can come up again for promotion to full professor. Sounds great in name, but all it means is that you get only another modest boost in pay (anywhere from $30-40k). The real benefit in being professor is you now get the ability to effectively work less than what you're being paid. You've earned the right to subside off another's labor. This is where you can now make a career cataloging toenail diseases and be grossly overpaid for it.
  5. If you're really, really lucky and have done a good job of networking and making a name for yourself by publishing or as a well respected speaker, you can get a chairmanship which effectively boosts your pay to what an average private practice partner in pathology would make. Candidates for chairmanships have been in the field for 20+ years and have a reputation that usually proceeds them.
For those of you who are reading this and going "Geez, that's a myopic, uninformed, and pessimistic view of academic practice", just ask yourselves how many start out as assistant professors and make it all the way up to full professor. The rate of attrition is horrendous in academia, and for good reason. Most of it has to do with not wanting to be either party or subjected to the megalomaniac designs of department chairs and their chief lieutenants, the full professors. There are of course exceptions to the above - there are always exceptions. But as our field tends to aggregate the rather unexceptional as of late, academic departments don't have to treat new hires with any special privilege or perks.

And if you think I'm painting a bad picture of academia in general, I'm not. I'll give the following anecdote I saw with my own eyes in community practice just recently. A very well established oncology surgeon was not happy in his private practice job and the regional academic center in the same city just happened to be needing someone with this surgeon's experience. The surgeon applied for the job and the conversation with the surgery chair went something like this:
Chair: You're going to do general surgery cases as well as your oncology case load.
Surgeon: Nope. I'm only doing my oncology cases.
Chair: That's not what the posted job description is.
Surgeon: That may be what you're looking for, but that's not what I'm looking for. And last time I checked, no else in 1500 miles with my experience and expertise is looking for that either.
Chair: OK. But you're still taking general surgery call.
Surgeon: Guess again. I'm only doing my cases and call related to them.
Chair: Fine. We'll just adjust your pay to match the work.
Surgeon: Nope. I'm not taking a pay cut either. Figure it out or good luck getting someone else before your accreditation comes under the chopping block.
Chair: Hired.

Now I ask, anyone see that happening in a pathology academic department???
Not saying that at all. What you described isn’t wrong about how an academic career would evolve; but there is more to life than money. I look at myself and yes I have a lower salary compared to some of my private practice peers but what I do have is contentment and a lack of stress about funding, money, reimbursement, or all the stuff I see constant paranoia about from people in private practice.

Private practice is fading not just in Pathology but in virtually every field of medicine. Yes it will still exist but the market forces are against it. That’s not Pathology’s fault but that’s the fault of where our savagely broken, profit-driven system has taken us.

My academic career summarized? I have never “applied” for a job I have been recruited since my fellowship, my jobs have not been RVU based. I have been able to get involved and help transform medical education for the better. I am able to present at international meetings. I have received international recognition for my work. I love teaching residents. I get to work on projects I find “interesting”. I have never done any work in relation to billing codes nor am I involved in any matters pertaining to billing. I am constantly being recruited for bigger roles at other institutions but it’s not in my interest at the moment. On top of all of that I work in a small sub specialty solving cases that others cannot and wouldn’t attempt to. It is certainly satisfying to ME but yes not for everyone.

I agree academia is not for everyone; but the fact is that Pathology, like almost every other field of medicine, is heading towards a hospital-based or institution-based growth rather than a private sector growth. There are also plenty of opportunities in the industrial setting and biotech. I would like to hope that 10-20% of pathology stays private practice because it’s good for the field; but i feel its an upward battle at the moment.

Eventually we may go back to the model of hospitals who use contracted groups; a practice which was much more widespread 10+ years ago but at the moment all the momentum is with hospital-based and academic groups.

Regardless of the type of practice some of you are in; we should respect others choices and types of practice. I sympathize with the inner city community hospital pathologist just like I sympathize with a small private practice. We are all Pathologists at the end of the day and the goals should be the same—-to make the field robust and strong rather than weaken it by bickering.
 
Last edited:

yaah

Boring
Staff member
Administrator
15+ Year Member
Aug 15, 2003
27,955
337
Fixing in 10% neutral buffered formalin
Status
Attending Physician
Frequently this forum reads like an anti-capitalist screed.

-Big labs buying small labs is bad
-Physicians prioritizing something personally appealing, other than income or time off, are misguided
-Other physicians insourcing pathology is bad
-Insurance companies paying less is bad
-Increasing the number of trainees is bad
-Doing more work is bad
-People who are bad at their job should have multiple job offers and be competed for.

So much self-loathing too - I hate my job and everyone in it and everything is against me and it's all so unfair. No one should enter this field, this job I hate so much that I want to prevent others from entering it, this field that I am compensated well for and still continue to do after years of complaining. It's everyone else who is crazy and misguided, not me, the brave maverick who rants on internet forums. Definitely not me!

Me when I am not on these forums: :)
My mood five minutes after reading these forums: :arghh::mad::drowning::hungover::hurting:
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
Frequently this forum reads like an anti-capitalist screed.

-Big labs buying small labs is bad
-Physicians prioritizing something personally appealing, other than income or time off, are misguided
-Other physicians insourcing pathology is bad
-Insurance companies paying less is bad
-Increasing the number of trainees is bad
-Doing more work is bad
-People who are bad at their job should have multiple job offers and be competed for.

So much self-loathing too - I hate my job and everyone in it and everything is against me and it's all so unfair. No one should enter this field, this job I hate so much that I want to prevent others from entering it, this field that I am compensated well for and still continue to do after years of complaining. It's everyone else who is crazy and misguided, not me, the brave maverick who rants on internet forums. Definitely not me!

Me when I am not on these forums: :)
My mood five minutes after reading these forums: :arghh::mad::drowning::hungover::hurting:
Haha seriously. By far the most negativity I’ve ever seen is on these forums. I genuinely worry about some people here. Wish I could help them find contentment somehow...I’d be happy to help.

To all the residents and students looking at Path and reading SDN: IGNORE this savage negativity it is definitely not representative of the field and more a product of select negative personal experiences from what it seems.
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
Most competent pathologist leave academics like it’s on fire after a short stint. The ones that stay are stuck.... they get sub-specialized and can’t look at anything except their thing. Academic pathology is broken big time. Most ancillary and molecular testing is sent out to commercial entities so in-house is IHC and just good ole H&E. The ACGME has such a low bar for allowing fellowships many crappy programs develop subpar fellowships with insufficient material or expertise .
What exactly has “academic”pathology accomplished of note in the last 15-20 years. All the PDL-1, ROS-1 etc molecular testing was developed by non pathologists. No one cares about another case report on some random entity or another variant of a polyp or large brown stain series. The majority of academic programs need to be shut down and the faculty fired. Immediately before our field goes completely down the toilet.
Most academic Pathologists I know can easily leave academics if they wanted to; but they don’t want to. I can’t even begin to reply to the rest of your comments as they have very little substance and sound like someone who hasn’t had any significant exposure to academic medicine.

You may also want to read up about PD-L1 as it’s discovery was entirely academic. You can’t develop a test for something unless it’s discovered or deciphered.

I hope you also know that nothing becomes a standard of care or a valid diagnostic test until academic papers look at things and analyze them. So what does academia do? Well nearly everything and every stain you do and every ancillary study you order was studied in academia before it was accepted. So you may want to rethink your whole perspective.
 
Last edited:

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,179
300
NOT behind a scope.
Status
Attending Physician
Most competent pathologist leave academics like it’s on fire after a short stint. The ones that stay are stuck.... they get sub-specialized and can’t look at anything except their thing. Academic pathology is broken big time. Most ancillary and molecular testing is sent out to commercial entities so in-house is IHC and just good ole H&E. The ACGME has such a low bar for allowing fellowships many crappy programs develop subpar fellowships with insufficient material or expertise .
What exactly has “academic”pathology accomplished of note in the last 15-20 years. All the PDL-1, ROS-1 etc molecular testing was developed by non pathologists. No one cares about another case report on some random entity or another variant of a polyp or large brown stain series. The majority of academic programs need to be shut down and the faculty fired. Immediately before our field goes completely down the toilet.
Amen
 
  • Like
Reactions: dukeresident

y2k_free_radical

2+ Year Member
Sep 25, 2015
290
134
Frequently this forum reads like an anti-capitalist screed.

-Big labs buying small labs is bad
-Physicians prioritizing something personally appealing, other than income or time off, are misguided
-Other physicians insourcing pathology is bad
-Insurance companies paying less is bad
-Increasing the number of trainees is bad
-Doing more work is bad
-People who are bad at their job should have multiple job offers and be competed for.

So much self-loathing too - I hate my job and everyone in it and everything is against me and it's all so unfair. No one should enter this field, this job I hate so much that I want to prevent others from entering it, this field that I am compensated well for and still continue to do after years of complaining. It's everyone else who is crazy and misguided, not me, the brave maverick who rants on internet forums. Definitely not me!

Me when I am not on these forums: :)
My mood five minutes after reading these forums: :arghh::mad::drowning::hungover::hurting:
Insurance companies and big labs are monopolies in my state.Why should other doctors receive 50-67% of a pathologist's professional component?I object to being paid only $24 by BCBS for diagnosing malignancies such as breast.Private pathology is doomed when other pathologist consider this as good.There is no doubt that the over production of numbers of pathologists versus the need is the number one factor allowing the ever falling reimbursement rates .
 
Last edited:
  • Like
Reactions: dukeresident

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
Insurance companies and big labs are monopolies in my state.Why should other doctors receive 50-67% of a pathologist's professional component?I object to being paid only $24 by BCBS for diagnosing malignancies such as breast.Private pathology is doomed when other pathologist consider this as good.There is no doubt that the over production of numbers of pathologists versus the need is the number one factor allowing the ever falling reimbursement rates .
FYI this is literally the ONLY place where anyone talks about “overproduction” of Pathologists. I have never seen a single actual piece of evidence to support this. All analyses that have been released have supported a shortage, by quite a margin.
 
Aug 20, 2018
119
101
FYI this is literally the ONLY place where anyone talks about “overproduction” of Pathologists. I have never seen a single actual piece of evidence to support this. All analyses that have been released have supported a shortage, by quite a margin.
Stop it.

If there were a shortage no one would be doing two fellowships after residency. Two is now par.
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
Stop it.

If there were a shortage no one would be doing two fellowships after residency. Two is now par.
Utter nonsense. People do 2 fellowships because it’s become the norm. Again show me the facts here not the jaded misperceptions you guys are marinating in.
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
So you don’t think doing 2 or even 3 fellowships has anything to do with the job market ?
No. It’s become the cultural norm. When I did only 1 fellowship back in the early 2010s you should have seen my PDs face when I told him. It’s like I pulled a knife out! Sheer horror.

One of the reasons this 2 (or even 3) fellowship thing has risen is due to the increased IMG population who are able to prolong their visas etc to be “certain” they can land a job. Overcompensation for immigration issues. I think the whole thing is ridiculous. 1 fellowship should be the standard; 2 only IF someone genuinely wants to do 2 different things.
 
Jul 31, 2018
57
59
Sorry, but academia has zero appeal for me. Out of fellowship I made $260k/yr in private practice with 8 weeks off/year, paid stipend to take call, partnership track after 2 years. My co-residents that stayed at the mothership made $140k/yr as junior attendings, less vacation (although more "off-service" weeks that seem like a giant waste of time), more call, expected to supplement their income with grant money (PITA), and minimal hope of reaching even my initial salary in a decade. They were in no way happier than I was/am.
 

octopusprime

2+ Year Member
May 6, 2016
231
187
Status
Attending Physician
...but there is more to life than money. I look at myself and yes I have a lower salary compared to some of my private practice peers but what I do have is contentment and a lack of stress about funding, money, reimbursement, or all the stuff I see constant paranoia about from people in private practice.
You mean the stuff that dictates the viability of your job? That does not imply academics is free from financial constraints/concerns, it just means you're so far down the totem pole it's of "no concern to you"...is that what you wish the profession to be relegated to? Happy go-lucky employees with no concern for the how or why of their employment, just contentment they get a paycheck?

Private practice is fading not just in Pathology but in virtually every field of medicine. Yes it will still exist but the market forces are against it. That’s not Pathology’s fault but that’s the fault of where our savagely broken, profit-driven system has taken us.
The funny thing about utilitarianism and academicians is the delusion required to think profit doesn't matter for academic centers, or that all that government funding is bottomless and just free for the taking. I don't think anyone disagrees profit is a confounding issue in medicine, but profit can never be removed any time there is a service provided for a price. The notion that academic centers are somehow immune from this is asinine.

I am able to present at international meetings. I have received international recognition for my work. I love teaching residents. I get to work on projects I find “interesting”.
I'm sorry why does that matter? Aside from stroking your ego? What strokes your ego is not what strokes mine. Conversely...
I never have to travel for work...
I love being able to save vast sums of money for retirement and the financial security of my wife and children...
I get to come and go on my own terms with extreme autonomy...

I have never done any work in relation to billing codes nor am I involved in any matters pertaining to billing. I am constantly being recruited for bigger roles at other institutions but it’s not in my interest at the moment.
Again, not a point I would necessarily brag on, being ignorant on the details that dictate how you get your paycheck.

I agree academia is not for everyone; but the fact is that Pathology, like almost every other field of medicine, is heading towards a hospital-based or institution-based growth rather than a private sector growth. ...

Regardless of the type of practice some of you are in; we should respect others choices and types of practice. I sympathize with the inner city community hospital pathologist just like I sympathize with a small private practice. We are all Pathologists at the end of the day and the goals should be the same—-to make the field robust and strong rather than weaken it by bickering.
I appreciate your sentiment, and yes at the end of the day we are all pathologists working toward the same goal. But the approach to academics that you highlight--punch clock, work, punch clock, go home, repeat--is not how the real world works, in medicine or otherwise, unless you just want to flip burgers or sell Verizon plans. Any time there is money exchanging hands for a service, there's profit--whether you call it profit or a handsome salary for a non-profit organization, it doesn't matter...people are still making money. And that money doesn't magically appear in your bank account...there's a reason you're making 'X' dollars vs 1/2 'X' vs "2 -3 x 'X', and if you don't care at all about the how or why, you're not selfless and more caring or somehow free from the influence of money, you're just blissfully ignorant.

But I'll tell you who is not blissfully ignorant about finances--the people that dictate how much you get paid (reimbursed) for what you do--CMS and private insurers. The former will always be there, and even if we somehow fix this 'savagely-broken profit-driven system', the latter is still going to be there in some capacity, getting blood from whatever stones they can. This isn't fear mongering or fatalist or self-loathing, it's acknowledging trends and bracing for the future.

Like I've said before, I don't consider myself any less committed to patient care because I get paid closer to what I'm actually generating in revenue, and I wouldn't think taking a pay cut would make me more entitled to a larger claim of such a commitment.
 

octopusprime

2+ Year Member
May 6, 2016
231
187
Status
Attending Physician
And I would add that not all academicians are Rirriri-esque world-renowned experts...most, in fact the vast majority of academic institution affiliated pathologists, are clinical-track / non-tenure-track non-researchers that for a host of reasons, choose--reluctantly and graciously--the hallowed & insulated walls of academia.
 
Last edited:
Jul 30, 2018
451
369
Why is it so difficult to answer the workforce question? Self interest? Even the dominating Confounders. Honestly a third party consultant should be able to
Pull this off granted they haven’t been told what the conclusions should be ahead of time.
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
You mean the stuff that dictates the viability of your job? That does not imply academics is free from financial constraints/concerns, it just means you're so far down the totem pole it's of "no concern to you"...is that what you wish the profession to be relegated to? Happy go-lucky employees with no concern for the how or why of their employment, just contentment they get a paycheck?


The funny thing about utilitarianism and academicians is the delusion required to think profit doesn't matter for academic centers, or that all that government funding is bottomless and just free for the taking. I don't think anyone disagrees profit is a confounding issue in medicine, but profit can never be removed any time there is a service provided for a price. The notion that academic centers are somehow immune from this is asinine.


I'm sorry why does that matter? Aside from stroking your ego? What strokes your ego is not what strokes mine. Conversely...
I never have to travel for work...
I love being able to save vast sums of money for retirement and the financial security of my wife and children...
I get to come and go on my own terms with extreme autonomy...


Again, not a point I would necessarily brag on, being ignorant on the details that dictate how you get your paycheck.


I appreciate your sentiment, and yes at the end of the day we are all pathologists working toward the same goal. But the approach to academics that you highlight--punch clock, work, punch clock, go home, repeat--is not how the real world works, in medicine or otherwise, unless you just want to flip burgers or sell Verizon plans. Any time there is money exchanging hands for a service, there's profit--whether you call it profit or a handsome salary for a non-profit organization, it doesn't matter...people are still making money. And that money doesn't magically appear in your bank account...there's a reason you're making 'X' dollars vs 1/2 'X' vs "2 -3 x 'X', and if you don't care at all about the how or why, you're not selfless and more caring or somehow free from the influence of money, you're just blissfully ignorant.

But I'll tell you who is not blissfully ignorant about finances--the people that dictate how much you get paid (reimbursed) for what you do--CMS and private insurers. The former will always be there, and even if we somehow fix this 'savagely-broken profit-driven system', the latter is still going to be there in some capacity, getting blood from whatever stones they can. This isn't fear mongering or fatalist or self-loathing, it's acknowledging trends and bracing for the future.

Like I've said before, I don't consider myself any less committed to patient care because I get paid closer to what I'm actually generating in revenue, and I wouldn't think taking a pay cut would make me more entitled to a larger claim of such a commitment.
You are dead set, along with a small group of people here; on highlighting the private sector of a field in which the private sector is represented by a very small number of overall Pathologists.

No I don’t wish to do billing. For me that is not an advanced task in any way; it’s more on the tedious and unsatisfying realm of “work” which only interferes with my skill set. Most academic Pathologists feel the same way as I do. Academic Pathologists far outnumber private practice Pathologists and I will keep reminding you of this.

We don’t have punch clocks or quotas like private practice. We don’t work like robots. We take time to teach, to collaborate between departments. It’s not comparable to private lab workflow. Non RVU based for the jobs I’ve had.

Listen the bottom line here is YOU don’t have to be into academia just like *I* don’t have to be into private practice. I would never remotely consider a private position unless it was a biotech or private industry position but that’s my opinion. If one of my residents chose a private position I’d be happy for them to find what they like.

my bottom line is everyone should learn to appreciate other types of practice rather than lynch others for their pathway.
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
And I would add that not all academicians are Rirriri-esque world-renowned experts...most, in fact the vast majority of academic institution affiliated pathologists, are clinical-track / non-tenure-track non-researchers that for a host of reasons, choose--reluctantly and graciously--the hallowed & insulated walls of academia.
Most people in academia are (very) happy to be in academia. Have no idea why you’d say “reluctantly”. It’s easy to chase money; much harder to chase one’s true interests. I know very few people who left academia for private jobs the ones I do know left for private biotech jobs.

Tenure track? Non-tenure has become the new standard for the past many years. Research depends on people; some do more some do less. I know plenty of Pathologists that are 50% research. There are also people like myself who are working on research and largely clinical.

I don’t understand private practice very well but I do understand academia fairly well. You can surely educate me about your work rather than focusing on dragging academia down.
 
Last edited:

y2k_free_radical

2+ Year Member
Sep 25, 2015
290
134
Not saying that at all. What you described isn’t wrong about how an academic career would evolve; but there is more to life than money. I look at myself and yes I have a lower salary compared to some of my private practice peers but what I do have is contentment and a lack of stress about funding, money, reimbursement, or all the stuff I see constant paranoia about from people in private practice.

Private practice is fading not just in Pathology but in virtually every field of medicine. Yes it will still exist but the market forces are against it. That’s not Pathology’s fault but that’s the fault of where our savagely broken, profit-driven system has taken us.

My academic career summarized? I have never “applied” for a job I have been recruited since my fellowship, my jobs have not been RVU based. I have been able to get involved and help transform medical education for the better. I am able to present at international meetings. I have received international recognition for my work. I love teaching residents. I get to work on projects I find “interesting”. I have never done any work in relation to billing codes nor am I involved in any matters pertaining to billing. I am constantly being recruited for bigger roles at other institutions but it’s not in my interest at the moment. On top of all of that I work in a small sub specialty solving cases that others cannot and wouldn’t attempt to. It is certainly satisfying to ME but yes not for everyone.

I agree academia is not for everyone; but the fact is that Pathology, like almost every other field of medicine, is heading towards a hospital-based or institution-based growth rather than a private sector growth. There are also plenty of opportunities in the industrial setting and biotech. I would like to hope that 10-20% of pathology stays private practice because it’s good for the field; but i feel its an upward battle at the moment.

Eventually we may go back to the model of hospitals who use contracted groups; a practice which was much more widespread 10+ years ago but at the moment all the momentum is with hospital-based and academic groups.

Regardless of the type of practice some of you are in; we should respect others choices and types of practice. I sympathize with the inner city community hospital pathologist just like I sympathize with a small private practice. We are all Pathologists at the end of the day and the goals should be the same—-to make the field robust and strong rather than weaken it by bickering.
CAREFUL-your comrade in arms YAAH might find some of your statements anti capitalist as he accuses we community pathologists as being.
 

rirriri

easy
15+ Year Member
Oct 16, 2002
1,927
29
Status
Attending Physician
CAREFUL-your comrade in arms YAAH might find some of your statements anti capitalist as he accuses we community pathologists as being.
Pretty sure Yaah and myself respect each other enough to understand that we are merely presenting our own perspectives and opinions about the matter. I don’t criticize private practice on the whole; I criticize people who criticize the entire field of pathology (like some here) and who think their private practice experiences are somehow solely and entirely representative of the field. They are not. We can definitely acknowledge there are positive experiences and negative experiences. Bad private practices and good ones. Bad academic programs and good ones. Bad community jobs and good ones. The key word is diversity and diversity of experiences.

I have started to receive private messages supporting my statements from people who are too scared to post on this forum; not good! Let’s try to create a neutrality that allows people to share their experiences rather than share only their criticisms.
 

octopusprime

2+ Year Member
May 6, 2016
231
187
Status
Attending Physician
You are dead set, along with a small group of people here; on highlighting the private sector of a field in which the private sector is represented by a very small number of overall Pathologists.

No I don’t wish to do billing. For me that is not an advanced task in any way; it’s more on the tedious and unsatisfying realm of “work” which only interferes with my skill set. Most academic Pathologists feel the same way as I do. Academic Pathologists far outnumber private practice Pathologists and I will keep reminding you of this.

We don’t have punch clocks or quotas like private practice. We don’t work like robots. We take time to teach, to collaborate between departments. It’s not comparable to private lab workflow. Non RVU based for the jobs I’ve had.

Listen the bottom line here is YOU don’t have to be into academia just like *I* don’t have to be into private practice. I would never remotely consider a private position unless it was a biotech or private industry position but that’s my opinion. If one of my residents chose a private position I’d be happy for them to find what they like.

my bottom line is everyone should learn to appreciate other types of practice rather than lynch others for their pathway.
Your disdain for "menial tasks" does not elevate the relevance or importance of your skill set above them, it just happens to coincide with the disdain others have for paying you what you're worth. Listen I don't think us out here in the trenches LIKE to do billing and other tedious "non advanced tasks"...but it's requisite to understanding the whole billing process [which, like it or not, is just as important in your department as it is mine, I just happen to have responsibility in that regard]...and it puts things into far greater perspective when you realize there is a price tag attached to your actions, both in terms of your livelihood and your impact on patients.

I don't care how happy people say they are in academics. What I care about is people pushing the idea that academics is great because one can kick back, ignore all the details and implications behind their work, yuck it up with other high minded folks over a beer at some insignificant international conference on the classification of ganglion cysts, and let the world burn around them because they're safe inside the walls of the tower.
 

y2k_free_radical

2+ Year Member
Sep 25, 2015
290
134
Pretty sure Yaah and myself respect each other enough to understand that we are merely presenting our own perspectives and opinions about the matter. I don’t criticize private practice on the whole; I criticize people who criticize the entire field of pathology (like some here) and who think their private practice experiences are somehow solely and entirely representative of the field. They are not. We can definitely acknowledge there are positive experiences and negative experiences. Bad private practices and good ones. Bad academic programs and good ones. Bad community jobs and good ones. The key word is diversity and diversity of experiences.

I have started to receive private messages supporting my statements from people who are too scared to post on this forum; not good! Let’s try to create a neutrality that allows people to share their experiences rather than share only their criticisms.
It speaks volumes that those private posters fear public discourse.Type B personalities who will never fight the erosion of the business side of pathology--and LA DOC called me a wuss.
 
Jul 31, 2018
57
59
Your disdain for "menial tasks" does not elevate the relevance or importance of your skill set above them, it just happens to coincide with the disdain others have for paying you what you're worth. Listen I don't think us out here in the trenches LIKE to do billing and other tedious "non advanced tasks"...but it's requisite to understanding the whole billing process [which, like it or not, is just as important in your department as it is mine, I just happen to have responsibility in that regard]...and it puts things into far greater perspective when you realize there is a price tag attached to your actions, both in terms of your livelihood and your impact on patients.

I don't care how happy people say they are in academics. What I care about is people pushing the idea that academics is great because one can kick back, ignore all the details and implications behind their work, yuck it up with other high minded folks over a beer at some insignificant international conference on the classification of ganglion cysts, and let the world burn around them because they're safe inside the walls of the tower.
That's the thing - SOMEONE in ririri's academic practice is doing the billing. SOMEONE is worried about retaining specimen volume, building client outreach, working with hospital administration to recruit surgeons who will send specimens to the path department. It may not be ririri, but I can guarantee you members of their group are doing so. Academics isn't some magical happy land where RVUs, volume, and billing don't matter. Those things matter in every single department. It's just that ririri isn't doing it. And that's fine - I don't directly do the billing, much client outreach, or other management issues in my private practice. But I am acutely aware of those things, I attend all our business meetings to discuss those things, and I am fully invested in improving those things as a partner in the group.
 

Nilf

15+ Year Member
Mar 20, 2003
725
39
Dancing on the graves of my enemies
Visit site
Status
Attending Physician
Frequently this forum reads like an anti-capitalist screed.

-Big labs buying small labs is bad
-Physicians prioritizing something personally appealing, other than income or time off, are misguided
-Other physicians insourcing pathology is bad
-Insurance companies paying less is bad
-Increasing the number of trainees is bad
-Doing more work is bad
-People who are bad at their job should have multiple job offers and be competed for.

So much self-loathing too - I hate my job and everyone in it and everything is against me and it's all so unfair. No one should enter this field, this job I hate so much that I want to prevent others from entering it, this field that I am compensated well for and still continue to do after years of complaining. It's everyone else who is crazy and misguided, not me, the brave maverick who rants on internet forums. Definitely not me!

Me when I am not on these forums: :)
My mood five minutes after reading these forums: :arghh::mad::drowning::hungover::hurting:
Not at all. I can only speak for myself, and I bet most of the private practice pathologists who post here are capitalistic to the bone. They, including myself, simply point out the harsh reality of pathologists' place in the pecking order of capitalism. I am all for supply and demand, laissez-faire capitalism. And the supply-and-demand curve dictates that TOO MANY TRAINEES --> LOW SALARIES AND CRAPPY/FEW JOBS. I'm not trying to bend the curve. I just wish our academic leaders would cut the number of trainees. And if this reality scares some medical students away from pathology, or ruins someone's mood, then so be it.
 
Last edited:

pongo

Junior Member
10+ Year Member
Jan 28, 2005
40
23
Status
Hospital and academic Pathologists comprise greater than 50% of the Pathology workforce. Private practice Pathologists comprise less than 15-20%. The reality is that hospital and academic pathology are both growing constantly. Perhaps you don’t have experience in Academia but that’s the reality.

I have seen constant and if anything increasing growth at every academic institution I have been associated with over the past 10 years and it is still happening...

Large academic institutions have significantly more leverage and a louder voice in every way. A good thing for the upcoming changes arriving in healthcare...

This keeps getting repeated and is wildly misleading. Academic pathologists are lumped in with and negotiate alongside the academic center's "physician group", and tend to command much more favorable rates than those outside of academia. Academic physicians also have other responsibilities (research, teaching), which provide revenue sources outside of CPT codes. So it is understandable why an academic is less concerned about negative market forces.

All those outside of academia (true private practice, employed community hospital physicians, big lab employees, botique lab employees, in-office lab dwellers, etc) have much more in common with each other, and comprise the majority of the pathology workforce. Even many of those community hospitals that have an affiliation with an academic center are on there own in regards to negotiations with third party payers and overall economics. So please stop saying the concerns expressed on this forum only apply to 15-20% of the workforce.

OK, carry on. This conversation is great entertainment. Just about every stereotype I have about both academic and non-academic pathologists has been confirmed.
 

pathslides

2+ Year Member
Aug 7, 2016
254
135
Status
Attending Physician
Path is great. If you like it, you should do it but do community path. I would say 25%-33% of academic institutions actually produce consistent worthwhile “research”. The remaining places just put out predominately garbage that is of no clinical significance mainly so the pions can get promoted. Why anyone would willingly choose academics is beyond me.
 

MetroPath

7+ Year Member
Apr 3, 2012
171
41
Status
Resident [Any Field]
  • Like
Reactions: dukeresident

yaah

Boring
Staff member
Administrator
15+ Year Member
Aug 15, 2003
27,955
337
Fixing in 10% neutral buffered formalin
Status
Attending Physician
Not at all. I can only speak for myself, and I bet most of the private practice pathologists who post here are capitalistic to the bone. They, including myself, simply point out the harsh reality of pathologists' place in the pecking order of capitalism. I am all for supply and demand, laissez-faire capitalism. And the supply-and-demand curve dictates that TOO MANY TRAINEES --> LOW SALARIES AND CRAPPY/FEW JOBS. I'm not trying to bend the curve. I just wish our academic leaders would cut the number of trainees. And if this reality scares some medical students away from pathology, or ruins someone's mood, then so be it.
Then don't do the job. Be a true capitalist. I'm a capitalist but I'm also a realist. Medicine has many socialized aspects. The only true capitalists in medicine are the cash-only people. If you want more regulations, reductions, etc, that isn't capitalist. It's ok to admit that! Currently the applicant pool market supports having a lot of pathology residency spots - if it didn't, they wouldn't get filled. There are perverse and incorrect incentives to be sure, but that isn't the whole story. If it was truly 100% better to pick a FM spot instead of pathology, there would be no unfilled FM spots and more unfilled path spots.

Here's my perspective - the number of overall trainees IMHO is too high. But not because it's flooding the market and reducing salaries. It's too high because there are too many programs that aren't training pathologists adequately. In my world, we need more well-trained, competent pathologists who can multitask. We have a hard time finding them. If you scare pathologists away from the field you're probably scaring away a lot of the ones with high potential to be good colleagues. But maybe not. I have no idea. No one can or will do that study because the field is too small to have meaningful statistical results from any such study. The biggest problem I have with this is that many smaller hospitals and crappier jobs get used to having pathologists who don't add a lot of value. It reduces respect for the field and for those of us in it.

And why do people do multiple fellowships? It isn't usually because they can't find a job. I'm sure it is for some more marginal candidates, but not for everyone for certain. Many just don't feel competent to sign out certain things without extra training. That's an indictment of programs in part, but also a reflection of how complicated our jobs are.

So how do you find out which programs should be closed? Also something I have no idea about. Maybe ask them where their graduates are after 5-10 years. If they're all in reference labs or academic instructor programs and still actively looking for a better job, that's a negative. If they're in a good job and only considering leaving for an ideal situation or location, that's a positive.

"academics vs private" is an OK thing to debate but generally when people talk about it they bias it from their own perspective. There are parts of the academic life that appeal to me - more stability, more "administrative" time, more specialized focus, more colleagues, often larger hospitals. But there are also parts of private life that appeal to me - better compensated (by far), less research focus, less time around specialized academics, less travel and speaking engagements, more freedom in a sense.
 

octopusprime

2+ Year Member
May 6, 2016
231
187
Status
Attending Physician
"academics vs private" is an OK thing to debate but generally when people talk about it they bias it from their own perspective. There are parts of the academic life that appeal to me - more stability, more "administrative" time, more specialized focus, more colleagues, often larger hospitals. But there are also parts of private life that appeal to me - better compensated (by far), less research focus, less time around specialized academics, less travel and speaking engagements, more freedom in a sense.
True, though essentially everyone who has entered PP the last few decades likely spent 4-5 years at a large academic center, and their experiences are likely what pushed them in a direction.

I cherish the idea of being in a university setting...not even in a path department, just collegiate atmosphere. Best years of my life were leading up to medical school...it was busy, driven, lots of hours, dedicated, unobstructed by non academic pursuits, mentally challenging...I was an uber nerd in every science club and just loved it. And my time in college was only bested by medical school...I love didactics...I think that's why so many are attracted to pathology in the first place: they become jaded by the field of clinical medicine and prefer the cerebral nature of pathology, the potential for more pure scientific pursuits, and the schedule that affords it.

But not all academic environments are created equal, and many are not welcoming, forgiving or inclusive. So when given the choice to work just as hard for more income, more autonomy and more vacation, it can be hard to turn it down, particularly if you have a chip on your shoulder.
 
Last edited:

27G

5+ Year Member
Aug 8, 2013
30
8
Status
Most academic Pathologists I know can easily leave academics if they wanted to; but they don’t want to. I can’t even begin to reply to the rest of your comments as they have very little substance and sound like someone who hasn’t had any significant exposure to academic medicine.

You may also want to read up about PD-L1 as it’s discovery was entirely academic. You can’t develop a test for something unless it’s discovered or deciphered.

I hope you also know that nothing becomes a standard of care or a valid diagnostic test until academic papers look at things and analyze them. So what does academia do? Well nearly everything and every stain you do and every ancillary study you order was studied in academia before it was accepted. So you may want to rethink your whole perspective.
Actually you are conflating pathology department academics and crappy programs as whole with true academics. Pathology academics is what I am criticizing. You may not realize this but many diagnostic discoveries are made in biotech and not academic departments. There was a time when academic pathology was the center of knowledge in the interface between medicine and science. This is definitely no longer the case. What you do is not academics. PDL-1 and prognostic markers were not developed in pathology academic departments such as the one you describe.
 
  • Like
Reactions: dukeresident