How to save pathology immediately

[Vicinal]

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Completely stop CMS and Veterans Administration financial support of pathology residency salaries for 3 -5 years.
This will force programs to make the difficult but realistic decisions necessary to save the field. Either that or have a definite formula where CMS will only pay a percentage of trainee salary with direct correlation to number of accessions. As an example 15K accessions in AP will get 50% support for a full residency FTE. The rest has to be paid by the hospital and medical school.

 

[Unty]

Lol...good luck. People have made suggestions for the past 15 years here on sdn. Nothing has changed.

 

[Med Director New England]

Prolly too large of a first step, but I thinking this is a little tongue & cheek

no expansion of any program would be a good first start. And a close look at the struggling, 3rd tier programs would be a good idea. Many of these should be closed and some of the struggling programs are starting to autoamputate themselves anyhow based on a fraction of their recent trainees never entering the workforce.

 

[Pathological_Liar]

Academic pathologists are telling a very different story btw.
I was just at a meeting where one of the presentation moderators (an associate professor from some Southeast program) made an offhand remark about increasing residency positions to address "the shortage". No one questioned it. The entire audience of 500+ just accepted this narrative.
I've even heard VENDORS making references to the "pathologist shortage", which I'm sure they've picked up from attendees at these meetings.

Of course having experienced the private partner track job market for myself, I'm aware of the reality. But we literally can't even get members of our own field to stop making the problem worse. I'm envisioning private practice and academic path having some Gangs of New York-style brawl at a future USCAP meeting if the narrative doesn't change.

 

[Unty]

I’ll be ready to take out a few associate professors. Assistant, full professors and chairmen, bring them on!!!!!

 

[Vicinal]

There are some chair people making 1 million plus dollars without doing any clinical work. In multiple departments including path. NIH ROI salary caps at 180K so it is ridiculous especially in state run institutions. The hilarious part is that these are publicly available salaries published on sacbee. If you have the drive to achieve the mojo to run departments in the right institution , it seems like an amazing gig.

 

[Alteran]

I’ll be ready to take out a few associate professors. Assistant, full professors and chairmen, bring them on!!!!!

View attachment 292810

If you’re upset now, wait till the proposed up to 8% CMS cut to pathology services coming in 2021.

 

[Unty]

There are some chair people making 1 million plus dollars without doing any clinical work. In multiple departments including path. NIH ROI salary caps at 180K so it is ridiculous especially in state run institutions. The hilarious part is that these are publicly available salaries published on sacbee. If you have the drive to achieve the mojo to run departments in the right institution , it seems like an amazing gig.

Name one pathologist in academics who makes 1 mil. And it can’t be Leboit or his partners.

 

[pathslides]

I was just at a meeting where one of the presentation moderators (an associate professor from some Southeast program) made an offhand remark about increasing residency positions to address "the shortage". No one questioned it. The entire audience of 500+ just accepted this narrative.

why didn’t you say something or question it?

 

[Vicinal]

Look it up in sacbee

 

[FLY1]

My residency program with 18k surgical accessions/year recently got the approval to INCREASE total resident spots from 12 to 16

 

[Unty]

Ridiculous there are programs with the same number of surgicals with 8 residents.

 

[Unty]

My residency program with 18k surgical accessions/year recently got the approval to INCREASE total resident spots from 12 to 16

do you guys have pas? I sure hope not with all that cheap labor.

 

[FLY1]

do you guys have pas? I sure hope not with all that cheap labor.

We do have one PA

 

[Unty]

We do have one PA

that’s just plain ridiculous. 4 residents a year with 18,000 surgicals. Pathology really knows how to protect itself as a profession. We need to take a lesson from business minded derm folks. They aremuch more business savvy

 

[cmz]

My residency program with 18k surgical accessions/year recently got the approval to INCREASE total resident spots from 12 to 16

It's kind of sad but that's the reality. There are a lot of programs that exist where residents just study all day in preparation for boards. No real life experience other than a book...

 

[Unty]

It's kind of sad but that's the reality. There are a lot of programs that exist where residents just study all day in preparation for boards. No real life experience other than a book...

yup sad. I don’t know where our leaders are or if we have any. CP at some places is just a mini vacation sad to say. No education just read on your own.

 

[Zarniwoop]

No worries. Everything will be addressed at the USCAP 2020 annual meeting in LA on Tuesday, March 3, from 12-2. Several academics are going to shed light on the topic "Recruiting medical students for a career in pathology". Registration required, but there is a complimentary lunch.

 

[Unty]

No worries. Everything will be addressed at the USCAP 2020 annual meeting in LA on Tuesday, March 3, from 12-2. Several academics are going to shed light on the topic "Recruiting medical students for a career in pathology". Registration required, but there is a complimentary lunch.

talked with a medical student a few days ago who had no clue what pathologists do

 

[Vicinal]

Govt subsidized education for medicine was a good idea when it first started. Obviously it is no longer tenable. Pull the plug on the mismanaged cash flow. It will save billions of dollars and do a much needed reset.

 

[Vicinal]

Thought of another possibility.... turn pathology residency into a full on educational experience with no clinical responsibilities with one caveat; If residents are going to hang out and read for most of their rotations, CHARGE TUITION. That may solve the problem too. If anyone goes to USCAP please bring these ideas up and let us know how well they are received.

 

[Unty]

Thought of another possibility.... turn pathology residency into a full on educational experience with no clinical responsibilities with one caveat; If residents are going to hang out and read for most of their rotations, CHARGE TUITION. That may solve the problem too. If anyone goes to USCAP please bring these ideas up and let us know how well they are received.

talking the talk ain’t going to do nothing on here on sdn if you didn’t realize that yet....people been talking the talk for the past 15 years

 

[Vicinal]

Providing information for grass roots momentum sir.

 

[CDX-2]

My residency program with 18k surgical accessions/year recently got the approval to INCREASE total resident spots from 12 to 16

Am I reading this correctly...16 residents for 18K Accessions???????

Sounds like you only need to do grossing once / fortnight!!!

The lab I'm currently in has 2 registrars/residents.
Along with one assistant who does biopsy transfers, our surgical accessions was ~20K for 2019!!!
Needless to say both me and my co-registrar are grossing 5 days / week.

And I thought Australia's graduate oversupply was bad...

 

[path24]

You can't save this field. Just individual med students from making a very poor career decision. This field will not improve.

 

[y2k_free_radical]

Prolly too large of a first step, but I thinking this is a little tongue & cheek

no expansion of any program would be a good first start. And a close look at the struggling, 3rd tier programs would be a good idea. Many of these should be closed and some of the struggling programs are starting to autoamputate themselves anyhow based on a fraction of their recent trainees never entering the workforce.

Please explain with more details

 

[Napoleon1801]

Am I reading this correctly...16 residents for 18K Accessions???????

Sounds like you only need to do grossing once / fortnight!!!

The lab I'm currently in has 2 registrars/residents.
Along with one assistant who does biopsy transfers, our surgical accessions was ~20K for 2019!!!
Needless to say both me and my co-registrar are grossing 5 days / week.

And I thought Australia's graduate oversupply was bad...

I'm surprised residencies aren't required to post these numbers. There are some very low volume residencies out there.

 

[MetroPath]

I'm surprised residencies aren't required to post these numbers. There are some very low volume residencies out there.

Yeah I think these low volume places should be closed. That’s a good start.

 

[Thr0mbus]

This will never happen. Academic departments are subsidized to a great degree in labor and $$$ and have no reason to cut spots.

 

[Vicinal]

Billions and billions of dollars of tax payer funds just being wasted. Very unfortunate.

 

[gbwillner]

How to save the field long term:

1. Integrate and embrace new technologies into practice that improve pathologist efficiency
2. Identify new practice venues that have direct patient interaction or contain professional consultations that are required for proper patient management
3. Propose legislation and practice guidelines that remove non-pathologists from filling the same roles: likely areas include lab directorships, genetics, clinical chemistry, micro, medical examiner
4. Seek leadership that protects the interests of the practitioners in the field

Short term solution:

1. Hold "there can be only one"-style tournaments for senior residents at all program

 

[Iceman24]

some of the struggling programs are starting to autoamputate themselves anyhow based on a fraction of their recent trainees never entering the workforce.

I generally agree with everything you saying and appreciate your input.
But not this time, unfortunately. The fact that trainees in particular program don't enter the workforce can't prevent this program from functioning. This is sad reality - PDs care about the fact that you graduated and passed the boards, that's it.

 

[Vicinal]

I generally agree with everything you saying and appreciate your input.
But not this time, unfortunately. The fact that trainees in particular program don't enter the workforce can't prevent this program from functioning. This is sad reality - PDs care about the fact that you graduated and passed the boards, that's it.

Agreed and as we all know solely passing the boards is a ridiculous metric for competence. Most residents pass the boards but do not learn how to work. The system seems to be set up for ultimate failure. Department chairs usually do not sign out clinical work and hire PDs that are sycophants with antiquated metrics such as board pass rates. No one would run their own households in such an abysmal manner. There is no reason to change things unless there is a massive insentive such as stopping government subsidization of training (or curtailing it based on definitive cost analysis metrics) and possibly changing the way CP and AP training are integrated. Many CP rotations are purely didactic and a waste of resident FTE. This is not to negate the importance of CP but many rotations do not “need” resident support for actual work and are pure study rotations. If we are matching only 50% of trainees that CMS support was intended (USgrads) then it seems ridiculous to allow this much tax payer subsidized funds to pay for many that have not paid into that base.

 

[LADoc00]

Am I reading this correctly...16 residents for 18K Accessions???????

Sounds like you only need to do grossing once / fortnight!!!

The lab I'm currently in has 2 registrars/residents.
Along with one assistant who does biopsy transfers, our surgical accessions was ~20K for 2019!!!
Needless to say both me and my co-registrar are grossing 5 days / week.

And I thought Australia's graduate oversupply was bad...

16 trainees on a mere 18000 cases/year is beyond insane. Even if you have 50% on autopsy+forensics+CP that is insane.

This is the equivalent of everyone trying to keep the highways clean only to have some garbage truck driver rolling down the street hurling crap in all directions. Thank you for being such a wretched human being whoever is running that program.

 

[deleted941485]

You can’t save pathology but you may be able to save yourself.

 

[Unty]

16 trainees on a mere 18000 cases/year is beyond insane. Even if you have 50% on autopsy+forensics+CP that is insane.

This is the equivalent of everyone trying to keep the highways clean only to have some garbage truck driver rolling down the street hurling crap in all directions. Thank you for being such a wretched human being whoever is running that program.

you forgot they also have an additional PA, who sits around and watches residents gross probably.

 

[FLY1]

Am I reading this correctly...16 residents for 18K Accessions???????

Sounds like you only need to do grossing once / fortnight!!!

The lab I'm currently in has 2 registrars/residents.
Along with one assistant who does biopsy transfers, our surgical accessions was ~20K for 2019!!!
Needless to say both me and my co-registrar are grossing 5 days / week.

And I thought Australia's graduate oversupply was bad...

To be fair, we are still 12 residents at the moment with the plan to increase the number gradually to 16. In my opinion, that is way too many residents for the volume we have. We gross 5 days/week as well and the grossing load is usually reasonable unless the PA is out for vacation.

 

[Unty]

I was once in a program with 18,000 and 8 residents and one surgpath fellow. Residents were grossing until 5- 6 pm most days. It was manageable.

poor management by our crappy leaders.

 

[CDX-2]

To be fair, we are still 12 residents at the moment with the plan to increase the number gradually to 16. In my opinion, that is way too many residents for the volume we have. We gross 5 days/week as well and the grossing load is usually reasonable unless the PA is out for vacation.

18,000 histology cases averages out to be ~69 cases / weekday.

If as you say, all 12 residents are grossing 5 days / week, then that means each of you are grossing 5 to 6 cases / day (with NO PA present).

How many grossing benches are in your lab, considering the volume is 18,000 cases / year???

Or are each of you only spending like 1 hour each day to gross the 5-6 cases?

How many blocks do you usually do each day ?


In my current lab of 2 registrars (residents) and 1 lab assistant and 20,000 histology cases,

Me and my co-registrar are grossing 5 days / week, and we gross for 4.5 - 6 hours each day.

I gross anywhere from 25 - 60 cases / day depending on the complexity (ranging from biopsy transfers to mastectomies).
This usually ends up being 100 - 160 blocks / day.

Don't get me wrong, I'd love for my current lab to have 3 registrars instead of 2.


But I think 12 residents in your lab is waaaaaaayyyyyyyyy too many, let alone 16.

I'm pretty sure that number could be halved to 6 residents, and you'd still survive!

 

[Thr0mbus]

To be fair, we are still 12 residents at the moment with the plan to increase the number gradually to 16. In my opinion, that is way too many residents for the volume we have. We gross 5 days/week as well and the grossing load is usually reasonable unless the PA is out for vacation.

Give my ONE good PA and ONE good partner and I WILL TAKE OVER YOUR LAB BY MYSELF. 16 RESIDENTS! LMAO!!! PATHOLOGY LEADERSHIP IS A JOKE! ACADEMIC PATHOLOGISTS HAVE RUN THIS PROFESSION INTO THE GROUND!!!!

 

[Unty]

Give my ONE good PA and ONE good partner and I WILL TAKE OVER YOUR LAB BY MYSELF. 16 RESIDENTS! LMAO!!! PATHOLOGY LEADERSHIP IS A JOKE! ACADEMIC PATHOLOGISTS HAVE RUN THIS PROFESSION INTO THE GROUND!!!!

welcome back Thrombus!!!!! We missed you.
I agree. Our leaders don’t protect our field like the business saavy derm folks do unfortunately.

 

[y2k_free_radical]

welcome back Thrombus!!!!! We missed you.
I agree. Our leaders don’t protect our field like the business saavy derm folks do unfortunately.

and radiology and ophthalmology et cetera ad nauseum

 

[Unty]

and radiology and ophthalmology et cetera ad nauseum

you will never see someone posting in any of these forums with the header “I Have low board scores so I think family Medicine peds or path” are the only options left for me.”

 

[FLY1]

18,000 histology cases averages out to be ~69 cases / weekday.

If as you say, all 12 residents are grossing 5 days / week, then that means each of you are grossing 5 to 6 cases / day (with NO PA present).

How many grossing benches are in your lab, considering the volume is 18,000 cases / year???

Or are each of you only spending like 1 hour each day to gross the 5-6 cases?

How many blocks do you usually do each day ?


In my current lab of 2 registrars (residents) and 1 lab assistant and 20,000 histology cases,

Me and my co-registrar are grossing 5 days / week, and we gross for 4.5 - 6 hours each day.

I gross anywhere from 25 - 60 cases / day depending on the complexity (ranging from biopsy transfers to mastectomies).
This usually ends up being 100 - 160 blocks / day.

Don't get me wrong, I'd love for my current lab to have 3 registrars instead of 2.


But I think 12 residents in your lab is waaaaaaayyyyyyyyy too many, let alone 16.

I'm pretty sure that number could be halved to 6 residents, and you'd still survive!

I think there is a misunderstanding. We have 12 residents total but only 3 residents are on the surgical pathology service at a time.

Grossing varies because we have a very inconsistent PA, but overall the residents on SP usually gross 2 big cancer cases +/- a few small benign stuff everyday.

Biopsies are taken care of by the techs.

The average caseload for sign out is ~20 cases/day for each resident including biopsies and resections.

With increasing the number of residents from 12 to 16, the plan is to increase the number of residents on SP from 3 to 4.

 

[Unty]

I think we can all agree from posts here from employers that graduates are not well rounded or are not competent to practice in a general pathology community practice. Some thing must be done.

Some folks go looking for a private practice job in a large group covering multiple hospitals and just want to sign out GI. Sh#t doesn’t work like that sorry.

 

[CDX-2]

I think there is a misunderstanding. We have 12 residents total but only 3 residents are on the surgical pathology service at a time.

Grossing varies because we have a very inconsistent PA, but overall the residents on SP usually gross 2 big cancer cases +/- a few small benign stuff everyday.

Biopsies are taken care of by the techs.

The average caseload for sign out is ~20 cases/day for each resident including biopsies and resections.

With increasing the number of residents from 12 to 16, the plan is to increase the number of residents on SP from 3 to 4.

Oh I see, so I'm guessing you're only on SP for 3 months? That makes sense then.

I'm very surprised that your hospital has 9 residents on Forensics / Autopsy / CP at any time.

I would've thought that they'd put more residents on for SP coz it's more labour intensive (from the grossing)...

 

[deleted314957]

I think there is a misunderstanding. We have 12 residents total but only 3 residents are on the surgical pathology service at a time.

Grossing varies because we have a very inconsistent PA, but overall the residents on SP usually gross 2 big cancer cases +/- a few small benign stuff everyday.

Biopsies are taken care of by the techs.

The average caseload for sign out is ~20 cases/day for each resident including biopsies and resections.

With increasing the number of residents from 12 to 16, the plan is to increase the number of residents on SP from 3 to 4.

Excuse me but i almost exploded my ileostomy bag when I read y’all s/o ~20 cases/d, bx’s and resection. Holy S***!
No wonder people feel they must do fellowships. We did 80-100/day and this is no exaggeration.Some were vas deferens and others were commando procedures but we saw it all and we saw a LOT
of it. 20 cases per day is grossly inadequate. We only had one resident at a time on surg path at a time, rarely 2.
Our rotation was d1 freeze, d2 gross, d3 read, d4 sign out.
This was pretty much pre PA’s so the attendings grossed on the 3/4 days a resident wasn’t. Some attendings (like me) did a ton of sugicals while the blood banker, clinical chemist, medical microbiologist, etc did much less but EVERYONE did surgical pathology. When i finished, I was SURE I could function well (perhaps not excel from the start) in any hospital in the country except for Mayo and their FS craziness.


Sent from my iPad using Tapatalk

 

[CDX-2]

Excuse me but i almost exploded my ileostomy bag when I read y’all s/o ~20 cases/d, bx’s and resection. Holy S***!
No wonder people feel they must do fellowships. We did 80-100/day and this is no exaggeration.Some were vas deferens and others were commando procedures but we saw it all and we saw a LOT
of it. 20 cases per day is grossly inadequate. We only had one resident at a time on surg path at a time, rarely 2.
Our rotation was d1 freeze, d2 gross, d3 read, d4 sign out.
This was pretty much pre PA’s so the attendings grossed on the 3/4 days a resident wasn’t. Some attendings (like me) did a ton of sugicals while the blood banker, clinical chemist, medical microbiologist, etc did much less but EVERYONE did surgical pathology. When i finished, I was SURE I could function well (perhaps not excel from the start) in any hospital in the country except for Mayo and their FS craziness.
Sent from my iPad using Tapatalk

Lol I actually thought reporting 20 cases / day for a resident was a lot. Also for their lab, 18,000 accessions is ~69 cases / day.

In my current lab, because of all the grossing (5 days/week for up to 6 hours/day),
I'm only able to report 2 - 10 cases / day (which is still more than my previous lab ironically)...

I always try to look at the slides of the large specimens that I cut (the following day), even if I don't have time to type a draft report.

Perhaps that's why my AP training will be 6 (or even 7) years long...

 

[Sawback3]

This is why the number of residency slots should be limited to 1 per year at most community hospital level programs. It's no wonder why new graduates with AP/CP + 1-2 fellowships need to be spoon-fed like babies...

 

[Unty]

Close low performing community hospital programs! Job market is tight already. We don’t need anymore applicants flooding pathology who use it as a backup because it’s not competitive to get into!

we need to learn from dermatology in regards to how to protect your profession!