Idea for presentation to ACGME

[LADoc00]

Due to the current job market and the mass excess of pathologists being trained, often to the trainees deteriment and the residency program's fat accounts receivable from ACGME, I have come to the conclusion we need to cut the spots offered per year from 450 to around 100 (comparable to radiation oncology). Considering the economic impact of this on smaller, more rural states, I feel those that should be cut the most drastically should be states with a mass excess of pathology services:California, Mass., New York, Conn, Georgia, Hawaii (yes they have a residency program here), South Carolina, IL, MO, Michigan, Texas and Washington state.

In California I purpose closing UCI, Loma Linda, Harbor and USC. In addition limiting UCSF-Stanford to 6 residents/year total between the 2, limiting UC Davis to 1 resident/year, UCSD 2 residents/year and UCLA to 4 residents/year. In addition, I purpose the closing of all non-academic training venues nationwide including Kaiser Permenante (if any still exist), private non-academic institutions and all VA training.

In Mass, I propose limiting the HMS system to a total 8 residents a year (which is absurdly generous) rather than the current 1,234,098 they now seem to train between MGH-BID-BWH. Maybe 3 at MGH, 1 BID and 4 BWH/BC. In addition, closing BU's program, UMass and all those other "I couldnt get into Harvard" type of places.

In Texas, completely eliminating independant fellowship training at MD Anderson and have UT residents/fellows rotate through for coverage. Cutting Baylor to 3 spots/year. Reducing S&W to 1 spot and eliminating the remainder.

NYC, eliminate independant training programs at Cornell, Columbia and NYU and having a 8 slot/year combined Metro NYC training route. Eliminating all other programs including Mt Sinai, Einstein whatever else.

In Missouri, limiting WashU to 4slots/year, closing Univ of Missouri, closing SLU.

The ACGME also needs to impose strict training limitations ala post doc funding for research, meaning you are limited to a maximum of 2 fellowship experiences (APCP + 2 boarded or unboarded years for a total of 6 max) and after that you must receive no payment. This is to force those in academic slavery to get a job or do something else.

*As with the Pentagon's BRAC, we dont take these recommendations lightly and we do understand that faculty at the above institutions will be forced to either hire real PAs or actually do work for their salary.

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Members don't see this ad.

 

[bananaface]

Close Stanford. It's trainees suck donkey balls.

 

[LADoc00]

Close Stanford. It's trainees suck donkey balls.

I would get assassinated.

 

[bananaface]

I would get assassinated.

Well, someone has to put a stop to that fetishist nonsense.

 

[LADoc00]

Well, someone has to put a stop to that fetishist nonsense.

Im trying to be serious here, Im starting a campaign to take to Congress to eliminate this government waste. The spending millions of dollars a year to overtrain pathologists solely to pad to the balance sheets of big academic institutions is criminal!!

 

[DrYo12]

Im trying to be serious here, Im starting a campaign to take to Congress to eliminate this government waste. The spending millions of dollars a year to overtrain pathologists solely to pad to the balance sheets of big academic institutions is criminal!!

Its like the guns for gifts campaign. Turn in your Board Cert in Path for a residency in FP.

 

[LADoc00]

I want this thread stickied!!

 

[b&ierstiefel]

Very interesting perspective there, LADoc00. I think many people out there like to discuss the problem. Talk talk talk talk talk. Few people offer possible solutions. If we truly are training too many residents given the existing job market situation, then perhaps we should cut # of spots. I'm just a lowly not-even-a-PGY-1-yet peon though so I have no opinion.

As for the whole research thingy, many postdocs apply for K08's early on in that phase of their training. So for those folks, the money would be coming from another funding mechanism.

 

[LADoc00]

Very interesting perspective there, LADoc00. I think many people out there like to discuss the problem. Talk talk talk talk talk. Few people offer possible solutions. If we truly are training too many residents given the existing job market situation, then perhaps we should cut # of spots. I'm just a lowly not-even-a-PGY-1-yet peon though so I have no opinion.

As for the whole research thingy, many postdocs apply for K08's early on in that phase of their training. So for those folks, the money would be coming from another funding mechanism.

This is the solution. Eliminate the goverment spigot that academic programs, specifically chairmans are drawing upon to produce outstanding accounting sheets and for huge pay bonuses and the whole issue would self correct. The entire lifestyle of every honest pathologist would benefit from this and the trainees themselves would HIGHLY benefit from more one-on-one instruction, better post graduate job opportunities and the interaction with trained Pathology Assistants who can instruct them in proper grossing techniques.

 

[LADoc00]

Let me break down the numbers:

THE MATH
Figure on average program A is taking 6 residents/year for a 4 year training cycle = 24 residents
In addition, the program has 2 heme, 2 cyto, 6 surg path/organ system fellows, 1 molecular, 1 blood bank/TM = 12 fellows
Total of 36 positions fully funded by the ACGME. The way the ACGME works is money is withdrawn from an earmarked account from Social Security Adminstration (ever wonder why SS is going bankrupt?? This is one reason) to give each residency program salary + 1 matching dollar for every salary dollar to offset "training costs."
So lets say those 36 positions have a mean salary of $45,000/year, that means payroll is getting 45,000x36=1.62 million to pay the residents and the department is pocketing 1.62 million for training costs. Training costs?! Can you imagine a program spending that much for conferences, free lunches, books, computers, scopes and lab coats for only 36 people? HELL NO. Hence the remainder goes to the department's bottom line admixed with the accounts receivable.

THE MOTIVE
Now, the chairman shows up to high level staff meeting at the medical center with a bottom line that is kicking the crap out all the other departments. Why? Because there's more to the story, read on...

See, part of the compensation for pathology includes gross pathology and technical billing. The price insurers pay takes into account the cost related to preprocessing a specimen before the attending sees it as a glass slide.

THE SAVINGS
Normally, grossing is either done by staff MDs or often by PAs, PAs even though they arent MD need to attend additional schooling after a BS in science and on average are paid over $90,000 per annum. Adding benefits to this, a PA would cost the department around 140K while an additional pathologist at least 200K.

Then assume that at any one time roughly 10 of the 24 residents are involved in preprocessing of specimens and in addition likely 1-2 fellows are involved in their supervision. If you make the assumption that do to the added experience, a PA is worth about 1.5-2 residents in terms of efficiency, that would be savings of at least 5-6 PAs for the department, a net gain of another $840,000 to the department's bottom line for residents to do the work.

GRAND TOTAL

In the end, the revenue generated from having these residents for a department is nearly 2.5 million dollars a year. But really the picture is more complex than this.

ACADEMIC SCREW JOB
Due to the flood of trainees in the market, academic pathologists are pinned into a corner with their current position. Department chairs knowing that their renal path attending, cardiopul path attending or whatnot couldnt get a job on the outside are at a huge advantage for salary negotiation. The amount billed vs. salary for each academic patholgist is insane, after costs are subtracted, an academic pathologist often is getting paid less than a quarter for every dollar they should get. Where is the other 3 quarters going? Research? No research is a separated entity with a separate budget. Back to the teaching of residents? No, that was supposed to be covered by the ACGME funds. Hmmmm. Where would for a faculty of say 20 staff pathologists, an amount on the order of over $4,000,000 going??

 

[bananaface]

Im trying to be serious here, Im starting a campaign to take to Congress to eliminate this government waste. The spending millions of dollars a year to overtrain pathologists solely to pad to the balance sheets of big academic institutions is criminal!!

Let me explain: You are a pathologist so no one is going to take what you say seriously. Do something useful with your enegry. Go to the kitchen and make me a pie.

 

[LADoc00]

bump, this is my great opus thread. It will not be usurped!!

 

[bananaface]

bump, this is my great opus thread. It will not be usurped!!

Get to work on that pie!

*edit*
coconut cream or apple, please

 

[b&ierstiefel]

Let me break down the numbers:

THE MATH
Figure on average program A is taking 6 residents/year for a 4 year training cycle = 24 residents
In addition, the program has 2 heme, 2 cyto, 6 surg path/organ system fellows, 1 molecular, 1 blood bank/TM = 12 fellows
Total of 36 positions fully funded by the ACGME. The way the ACGME works is money is withdrawn from an earmarked account from Social Security Adminstration (ever wonder why SS is going bankrupt?? This is one reason) to give each residency program salary + 1 matching dollar for every salary dollar to offset "training costs."
So lets say those 36 positions have a mean salary of $45,000/year, that means payroll is getting 45,000x36=1.62 million to pay the residents and the department is pocketing 1.62 million for training costs. Training costs?! Can you imagine a program spending that much for conferences, free lunches, books, computers, scopes and lab coats for only 36 people? HELL NO. Hence the remainder goes to the department's bottom line admixed with the accounts receivable.

THE MOTIVE
Now, the chairman shows up to high level staff meeting at the medical center with a bottom line that is kicking the crap out all the other departments. Why? Because there's more to the story, read on...

See, part of the compensation for pathology includes gross pathology and technical billing. The price insurers pay takes into account the cost related to preprocessing a specimen before the attending sees it as a glass slide.

THE SAVINGS
Normally, grossing is either done by staff MDs or often by PAs, PAs even though they arent MD need to attend additional schooling after a BS in science and on average are paid over $90,000 per annum. Adding benefits to this, a PA would cost the department around 140K while an additional pathologist at least 200K.

Then assume that at any one time roughly 10 of the 24 residents are involved in preprocessing of specimens and in addition likely 1-2 fellows are involved in their supervision. If you make the assumption that do to the added experience, a PA is worth about 1.5-2 residents in terms of efficiency, that would be savings of at least 5-6 PAs for the department, a net gain of another $840,000 to the department's bottom line for residents to do the work.

GRAND TOTAL

In the end, the revenue generated from having these residents for a department is nearly 2.5 million dollars a year. But really the picture is more complex than this.

ACADEMIC SCREW JOB
Due to the flood of trainees in the market, academic pathologists are pinned into a corner with their current position. Department chairs knowing that their renal path attending, cardiopul path attending or whatnot couldnt get a job on the outside are at a huge advantage for salary negotiation. The amount billed vs. salary for each academic patholgist is insane, after costs are subtracted, an academic pathologist often is getting paid less than a quarter for every dollar they should get. Where is the other 3 quarters going? Research? No research is a separated entity with a separate budget. Back to the teaching of residents? No, that was supposed to be covered by the ACGME funds. Hmmmm. Where would for a faculty of say 20 staff pathologists, an amount on the order of over $4,000,000 going??

an excellent analysis. i'll take your word for it.

so where IS the $4,000,000+ going?

 

[LADoc00]

I want to General Accounting Office and the FBI to look into this, this REEKS OF AN ENRON!

Given the # of pathology training programs, someone is siphoning hundreds of millions out of the social security fund and laughing all the way to the bank.

 

[beary]

The ACGME must hold off on implementing your plan until next year when I have matched.

 

[bananaface]

The ACGME must hold off on implementing your plan until next year when I have matched.

No worries. Nothing is happening until I get my pie. I have a feeling it'll be a long while.

 

[b&ierstiefel]

The ACGME must hold off on implementing your plan until next year when I have matched.

you'll have to pay LaDoc00 $4,000,000.

do you have four meeeeellion dollahs?

 

[beary]

you'll have to pay LaDoc00 $4,000,000.

do you have four meeeeellion dollahs?

Actually I do. I invested my babysitting money in Enron and had inside information so I got out just in time.

 

[bananaface]

Actually I do. I invested my babysitting money in Enron and had inside information so I got out just in time.

You too? You should become a pharmacist. You're too damn smart for pathology.

 

[beary]

You too? You should become a pharmacist. You're too damn smart for pathology.

I was thinking about pharmacy today when I was at Walgreens. They all wear these short-sleeve white coat things, over their shirt and tie. But the white coat has short sleeves.

Do you wear a short-sleeved white coat at your work? I wear a short white coat, but it has long sleeves.

 

[bananaface]

I was thinking about pharmacy today when I was at Walgreens. They all wear these short-sleeve white coat things, over their shirt and tie. But the white coat has short sleeves.

Do you wear a short-sleeved white coat at your work? I wear a short white coat, but it has long sleeves.

My white coat does have short sleeves. If I had long sleeves they'd get pretty dirty. If I wanted to bring a long sleeved white coat I could. I just choose to wear what the company provides. Actually if I didn't want to wear a coat, I think I could get away with that too as long as I wear my nametag.

 

[LADoc00]

Damnit! Respect my authori-tah!

No more jokes on this thread, no pie for you!!!

 

[b&ierstiefel]

you really need to do something about that sand in your vagina.

 

[LADoc00]

you really need to do something about that sand in your vagina.

enough with the random comments!!

 

[bananaface]

Damnit! Respect my authori-tah!

No more jokes on this thread, no pie for you!!!

But MAAAHHHMM. I want some PIEEE.

 

[beary]

 

[bananaface]

Word.

LADoc00 had better be bringin' that pie.

 

[LADoc00]

BUMP, I will not be disrespect-tated!

 

[yaah]

'Tis a reasonable idea. Perhaps a bit of an overextension. Why eliminate so many programs? Our program, for example, would have a hard time subsisting on fewer residents unless they hired more PAs. Perhaps your proposal should include more duties taken up by ancillary staff.

 

[b&ierstiefel]

'Tis a reasonable idea. Perhaps a bit of an overextension. Why eliminate so many programs? Our program, for example, would have a hard time subsisting on fewer residents unless they hired more PAs. Perhaps your proposal should include more duties taken up by ancillary staff.

bingo!

 

[bananaface]

BUMP, I will not be disrespect-tated!

Get back in the kitchen where you belong!

 

[geddy]

'Tis a reasonable idea. Perhaps a bit of an overextension. Why eliminate so many programs? Our program, for example, would have a hard time subsisting on fewer residents unless they hired more PAs. Perhaps your proposal should include more duties taken up by ancillary staff.

If I understand LADoc correctly, his idea to limit the nunber of residents would require both the hiring of more ancillary staff while also ending the federal support system for residents. A department can hire 1 PA to do the work of 2 residents, but it would be losing money by doing so - paying for a PA comes out of the departmental budget, uncompensated. Funding for residents comes from the federal government, so having more residents is cheaper.

My understanding of this is far from complete, but from what I understand, the SSA pays the same flat amount for each resident everywhere in the country. If 2 programs pay 35K or 42K, the rest of that balance goes to the department for training expenses, insurance, etc. The program paying 35K thus pockets more. Is this true?

One more set of questions. How is the number of residents determined? If a program wants to increase it's resident number, how does it do it? Is the resident limit set for the whole hospital (e.g. the feds say you can have 200 residents/year for the hospital and the hospital administrators determine which deparment gets how many) or do the departments themselves receive an allotment from the SSA? Just curious...

Fascinating discussion, though.

 

[LADoc00]

If I understand LADoc correctly, his idea to limit the nunber of residents would require both the hiring of more ancillary staff while also ending the federal support system for residents. A department can hire 1 PA to do the work of 2 residents, but it would be losing money by doing so - paying for a PA comes out of the departmental budget, uncompensated. Funding for residents comes from the federal government, so having more residents is cheaper.

My understanding of this is far from complete, but from what I understand, the SSA pays the same flat amount for each resident everywhere in the country. If 2 programs pay 35K or 42K, the rest of that balance goes to the department for training expenses, insurance, etc. The program paying 35K thus pockets more. Is this true?

One more set of questions. How is the number of residents determined? If a program wants to increase it's resident number, how does it do it? Is the resident limit set for the whole hospital (e.g. the feds say you can have 200 residents/year for the hospital and the hospital administrators determine which deparment gets how many) or do the departments themselves receive an allotment from the SSA? Just curious...

Fascinating discussion, though.

There are 2 mechanisms by which residents are limited:
One is a total cap by ACGME/SSA on the number of residents at a particular hospital, this is based on #beds, #inpatient admissions per day and most importantly (and many dont realize) #discharges.
Then there is cap imposed by speciality boards. For example even if Mass General was under the total limit of ACGME funded training slots they could not just have 3 more dermatology or ENT residents if they were already at the max under the stipulations of those boards.

AND THIS IS WHERE ANOTHER WHOLE SCAM COMES IN.
See some specialities boards (READ NOT PATH) tightly control the number of residents at each program thus stabilizing the job market. Exceeding your number of residents is the ultimate no no for a PD. In fact they would rather have you kidnap 9 year old girls than have 1 extra dermatologist trained. Thus everyone makes money by the limitation of supply! Simple economics actually.

SO! If a hospital suddenly gets busier or expands, excess resident slots get authorized by ACGME/SSA but there are only so many places those bodies can go. They have to go into fields like IM, peds and FM (or PATH) because those areas dont cap. Thus as the demand and business of healthcare booms, the RICH AKA RADS/RAD ONC/DERM/OPHTHO/ORTHO WILL GET RICHER AND THE POOR WILL GET POORER!!!

 

[Smitty]

First of all, PAs make 90K/yr?! ****!

Second, I'm also taking LADOC's word for it, but if he's right then this whole situation is truly ****ED UP! Why the hell isn't path limiting the number of residents (I'm guessing it has to do with the millions going to academic purses), and what can we as residents (or soon to be residents) do about it?

 

[LADoc00]

First of all, PAs make 90K/yr?! ****!

Second, I'm also taking LADOC's word for it, but if he's right then this whole situation is truly ****ED UP! Why the hell isn't path limiting the number of residents (I'm guessing it has to do with the millions going to academic purses), and what can we as residents (or soon to be residents) do about it?

Folks this is literally the tip of the iceberg honestly. Underneath the sea's surface is the mother of all sh*tstorms waiting for us.

The only way things will change is a violent revolutionary-type movement in my opinion.

 

[bananaface]

First of all, PAs make 90K/yr?! ****!

I'd guess the natinal average is about 70K. It's highly variable by region. Not that many make 90K.

 

[LADoc00]

I'd guess the natinal average is about 70K. It's highly variable by region. Not that many make 90K.

In fact in the PA in office right next to me is make $105,000 plus a pension.

PAs commonly make over 90 once they have more than 3-4 year of exp.

 

[bananaface]

In fact in the PA in office right next to me is make $105,000 plus a pension.

PAs commonly make over 90 once they have more than 3-4 year of exp.

visit salary.com

And remember, you live in an area with a higher cost of living. Of course they get a bit more there.

ps - When do I get my pie?

 

[LADoc00]

visit salary.com

And remember, you live in an area with a higher cost of living. Of course they get a bit more there.

ps - When do I get my pie?

Salary.com is completely worthless, for most fields its a huge underestimate because they include trainees making next to nothing and often dont include proper valuation of yearly bonuses. Great for civil service jobs like teaching or police/fire but the site is worthless for the professional areas.

And I made you a pecan pie last night but I ate the damn thing already!

 

[bananaface]

Hmm. It works okay for pharmacy since it's last update. It used to underestimate due to old data.

I never ate a pecan pie before. It doesn't sound that appetizing. I'm still holding out for apple.

 

[Smitty]

See some specialities boards (READ NOT PATH) tightly control the number of residents at each program thus stabilizing the job market. Exceeding your number of residents is the ultimate no no for a PD. In fact they would rather have you kidnap 9 year old girls than have 1 extra dermatologist trained. Thus everyone makes money by the limitation of supply! Simple economics actually.

So why are things so different in path? Is it because there is such a dichotomy between academics and private prac in path?

 

[Smitty]

By the way pecan pie (that's pee-can, not pucan) is a truly Southern thing. I actually don't like it though; too sticky. Nothing beats a good chocolate pie or coffee cake

 

[QuietSylph]

I knew two young PAs in the Midwest who made $90-100K at a teaching hospital, no problem. They worked long hours though.

 

[gungho]

By the way pecan pie (that's pee-can, not pucan) is a truly Southern thing. I actually don't like it though; too sticky. Nothing beats a good chocolate pie or coffee cake

Only a Yankee says "pee-can"-true Suthern'rs say "puh-kahn' " (and it's "prah-leen" not "pray-leen" for praline). I'm Southern born 'n bred and I didn't like pecan pie, either, till later in life, but it's pretty good now.

 

[Smitty]

Only a Yankee says "pee-can"-true Suthern'rs say "puh-kahn' " (and it's "prah-leen" not "pray-leen" for praline). I'm Southern born 'n bred and I didn't like pecan pie, either, till later in life, but it's pretty good now.

No way. Ok, maybe rich plantation owning Mint Julep sipp'n Suthern'rs from Georgia say "puh-kahn", but everybody else says "pee-can". At least they do where I'm a frum