Is anyone here actually looking to jump ship?

[Glass Pusher]

There is a ton of negativity and frustration on here about pathology's current and future outlook. Most of it, I will agree, is warranted. It is beyond frustrating to get through a residency and see the number of fellowships people force themselves through keep adding up just to struggle to land a job. My big question is to find out if anyone is doing anything about it? Anyone switching residencies, going back to do another residency, getting additional training/education or even dropping out of medicine and switching careers completely? Thought maybe those that are could provide some avenues of advice and for those that aren't, maybe why they are deciding to stick it out despite being disillusioned and frustrated.

I personally have considered all these options and am actively pursuing non-clinical options despite having a top fellowship secured. I figured this was at least more productive than just being depressed and complaining.

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[WEBB PINKERTON]

Dropping out completely here. Glad I was able to at least stay employed in pathology the last few decades as I worked on my "out". Don't get excited if you are looking for work. My position will not be filled.

 

[cmz]

I'm kind of sad to see threads like this. If you're a hard-working, conscientious pathologist, you'll be welcome anywhere and you will find employment.

If you're considering switching residencies, there are a lot of things to consider (funding, in particular); and when you're done you'll still have to find employment and tackle the headaches that go along with running a practice (well, this is becoming less and less likely). Either way, you're in for a rough ride.

If you love pathology more than anything else, then stick with it. You would do yourself and the patients/referring physicians a service by sticking to your guns.

 

[LADoc00]

Dropping out completely here. Glad I was able to at least stay employed in pathology the last few decades as I worked on my "out". Don't get excited if you are looking for work. My position will not be filled.

You have a 20+ year work history? Huh? That would put you in your early to mid 50s.

Question 2: What is your out if I can ask? If its Top Secret, then what is your out in a general sense?

Thanks

 

[pongo]

I would not put much stock into what is written on this board. The people who are happily practicing pathology, who constitute essentially everyone I know, do not spend their time on message boards complaining. The few substandard trainees I encountered along the way blamed any difficulty in obtaining a job on everything but their own shortcomings. A favorite is the "crappy job market".

 

[WEBB PINKERTON]

You have a 20+ year work history? Huh? That would put you in your early to mid 50s.

Question 2: What is your out if I can ask? If its Top Secret, then what is your out in a general sense?

Thanks

I went all in in the early/mid 1990s and started buying up farmland. It has paid off in a big way and now I make more money from the farms than working in pathology.

If I were a young pathologist looking to invest for the future, put money into rental property. Farmland is too expensive at this point.

 

[LADoc00]

I went all in in the early/mid 1990s and started buying up farmland. It has paid off in a big way and now I make more money from the farms than working in pathology.

If I were a young pathologist looking to invest for the future, put money into rental property. Farmland is too expensive at this point.

GD!!!!!!! This was my plan...You beat me to it.

I'm going towards nut farming, low labor costs and high crop values.

 

[malchik]

Don't nut trees take about 20 years to mature? Almonds are delicious.

 

[Zeke McFlash]

I have misplaced my pants.

 

[pathstudent]

I am thinking about opening a wine and/or cheese shop.

 

[turtle1966]

GD!!!!!!! This was my plan...You beat me to it.

I'm going towards nut farming, low labor costs and high crop values.

In CA, a good option is, or was until recently, a Pot shop + Pot Prescribing doc. FBI was cracking down though on this.

 

[Johnny Sunshine]

If you're a hard-working, conscientious pathologist, you'll be welcome anywhere and you will find employment.

Certainly. Whether that employment with be anywhere you want to live, and under tolerable conditions however, is another thing entirely.

If you love pathology more than anything else, then stick with it. You would do yourself and the patients/referring physicians a service by sticking to your guns.

I'm glad there are those who love pathology "more than anything else", but if only the die-hards are interested in staying there may be something wrong.

The few substandard trainees I encountered along the way blamed any difficulty in obtaining a job on everything but their own shortcomings. A favorite is the "crappy job market".

I've seen this as well. But that doesn't mean all those who are unhappy with their job prospects are poor pathologists. I do agree this board is no place to get a representative sample of public opinion.


Personally, I enjoy pathology much more than any other branch of medicine. And outside of medicine, I think the only other job I would possibly enjoy more than pathology is designing and building theme environments (but that's a whole other story).

All the same, I'm looking for an "out". Loving the science only goes so far. At some point, the negatives due to the environment and various restrictions outweigh the satisfaction of the practice. I have a few investments and alternative job options which are promising, but unfortunately none of them would allow me to make my student loan payments. If that debt were not an issue, I'd be gone.

 

[Glass Pusher]

Certainly. Whether that employment with be anywhere you want to live, and under tolerable conditions however, is another thing entirely.



I'm glad there are those who love pathology "more than anything else", but if only the die-hards are interested in staying there may be something wrong.



I've seen this as well. But that doesn't mean all those who are unhappy with their job prospects are poor pathologists. I do agree this board is no place to get a representative sample of public opinion.


Personally, I enjoy pathology much more than any other branch of medicine. And outside of medicine, I think the only other job I would possibly enjoy more than pathology is designing and building theme environments (but that's a whole other story).

All the same, I'm looking for an "out". Loving the science only goes so far. At some point, the negatives due to the environment and various restrictions outweigh the satisfaction of the practice. I have a few investments and alternative job options which are promising, but unfortunately none of them would allow me to make my student loan payments. If that debt were not an issue, I'd be gone.

I echo your sentiments entirely, Johnny Sunshine. A lot of the defense of the current path market seems to be along the lines of "everyone gets a job." My experiences agree with this, but that doesn't mean things are great, good or even mediocre. If our field waits until people en masse are not able to find a job to do anything about the market, it will be far too late to accomplish anything substantive.

As an aside, LADoc, you may be on to something with that nut farm idea. Between all the health claims of nuts and the huge growth in nut milks, it looks like a strong market and those things sure aren't cheap.

 

[LADoc00]

I would not put much stock into what is written on this board. The people who are happily practicing pathology, who constitute essentially everyone I know, do not spend their time on message boards complaining. The few substandard trainees I encountered along the way blamed any difficulty in obtaining a job on everything but their own shortcomings. A favorite is the "crappy job market".

I will add that often when I hear a younger pathologist state everything is a-okay with their group, it is because they NO CLUE whatsoever about how the group is actually being run. They couldnt tell you how much they have in AR. They couldnt tell you what contracts needed to be strategically cancelled. What the drop in 88342 codes will do. What the hospital CEO plans with the next renewal of the contract etc.

They clock punchers, pikers who ask how much vacation they will get and when they can go home at night.

 

[yaah]

I will add that often when I hear a younger pathologist state everything is a-okay with their group, it is because they NO CLUE whatsoever about how the group is actually being run. They couldnt tell you how much they have in AR. They couldnt tell you what contracts needed to be strategically cancelled. What the drop in 88342 codes will do. What the hospital CEO plans with the next renewal of the contract etc.

They clock punchers, pikers who ask how much vacation they will get and when they can go home at night.

Well, I'm sure that's true with some people, especially because an increasing proportion of med school graduates are prioritizing lifestyle above all else. But it certainly isn't true with everyone. Our group is in a good position. And most people in our group have a clue. There are challenges of course but if there weren't challenges it wouldn't be realistic.

I would suggest that generalizing is rarely that helpful. I would also suggest that sometimes young pathologists actually do get it and you are presuming things that aren't true. But in many cases you are probably right.

 

[pongo]

I will add that often when I hear a younger pathologist state everything is a-okay with their group, it is because they NO CLUE whatsoever about how the group is actually being run. They couldnt tell you how much they have in AR. They couldnt tell you what contracts needed to be strategically cancelled. What the drop in 88342 codes will do. What the hospital CEO plans with the next renewal of the contract etc.

They clock punchers, pikers who ask how much vacation they will get and when they can go home at night.

True, there is a variability of interest in running a business amongst "young pathologists", but you are not the only one who owns their practice. I found plenty of opportunity for equity partnership during my job hunt, including several groups who own their own free-standing histology and molecular labs (sadly, the grandfather sunset..). I did not want to be employed, and I didn't have to be. My only reason for posting was to encourage the original poster to go out and actually talk with practicing pathologists, rather than rely on this message board. And your academic "mentors" are not helpful if that route doesn't interest you - they have no idea. In the middle of training I got so freaked from reading this board that I printed off some of LADoc's eloquently scathing commentaries about the specialty and job market during his job search. I showed it to fellows who were job hunting, and it was in no way reflective of their experience. From recent posts, it seems to me like things have worked out for LADoc. Maybe it is horrible on the west coast, I don't know, the three jobs I interviewed for on that coast were both employed and not attractive to me. The status quo of every medical specialty is threatened right now. Despite all of the problems facing pathology, our practice is still thriving, and I am neither disillusioned nor frustrated. If you have a "top notch" fellowship (assuming general competence), a decent personality, communication skills, and common sense, you will have opportunity. Pushing solid trainees away from the field hurts us all, because all of those residency spots will be filled by someone less capable.

 

[LADoc00]

I didnt generalize, hence why I said "often when I hear a younger pathologist."

I can say I honestly dont remember actually posting anything when I was looking for a job as I had one before I joined the website...I think? Fact check me on that.

In fact, Im fairly certain of the original old crew who posted here (Yaah and the Andy guy who went to BWH) I was the only employed (yes I was employed when I started) staff-type guy. I think I had a job before Andy even interviewed at BWH and now he is off doing something all science'y with his MDPhD. But fact check me on that too as Im very sleep deprived these days.

I believe I actually joined as I was signing out some crazy number of bone marrows in a basement closet converted to be my office in LA, hence my name. I was perusing the possibility of leaving my job and getting a KO8 to transition into some cush CP faculty position somewhere.

Or I might have been a fellow? Dunno...

I will say this: joining a group and being a "partner" (equity or not) is a very very different bird than being THE managing partner. I am constantly having to walk "partners" through crap like their billing snafus and what not before I finally give up and ask for the big kid in charge. I find it very sad most groups have no hand off in the leadership role, leaving some of the most important and most sensitive work in the hands of the "Old Guy." And consequently I am watching group after group fail once the Old Guy exits.

 

[pongo]

Apologies if I'm remembering incorrectly - it is a foggy 8 or 9 year old memory. You were in on the conversation, but maybe the post I printed and showed around wasn't yours. I've barely been on this site since then- I've been checking lately to see what people are thinking about the recent cuts.

I stayed away from "partnerships" with hierarchical structure, especially those with silent or managing partners. I found several opportunities with equal ownership and income distribution, which is hard to pull off with more than 6 or 7 docs. Ideally most partners have at least some interest in all the legal, accounting, HR, compliance, marketing, etc aspects of owning a practice. I chose a practice with a mid-career guy who is a whiz to learn from. He handles most of the contracts and negotiations, but every decision requires group approval.

 

[Pathwrath]

Anyone switching residencies, going back to do another residency, getting additional training/education or even dropping out of medicine and switching careers completely?

Not quite yet. If the next ten years are like the previous ten, I will be out before this decade ends. I've saved enough.

We just had our first lay-offs in our lab, ever. Very difficult. Any other owners out there letting good techs go because of Obamacare?

 

[WEBB PINKERTON]

Been a lot of layoffs in my area. Techs and pathologists. One of my old stomping grounds closed up shop after over 50 years in business. Another large prominent lab with lot of history finally bit the dust after years of decline. A few of the pathologists got a gig working for a small histology lab started by a histotech. Not sure how stable that place will be but at least it is work. The others are SOL cause there are NO jobs in pathology around here.

Hard to solely blame obamacare. I've been watching labs close and lay people off for years. People wont be able to claim they dont know any out of work pathologists pretty soon. We ALL will know of some.

 

[Pathwrath]

Hard to solely blame obamacare. I've been watching labs close and lay people off for years. People wont be able to claim they dont know any out of work pathologists pretty soon. We ALL will know of some.

You're right, of course, the rot set in awhile ago, but the lay-offs in my lab this year were a direct result of "reform".

 

[Whiskeyjack]

Kinda on topic.... anyone got any advice of how to 'prepare ones house' before handing in a resignation letter.
No bad blood just got a better offer somewhere else. No restrictive covenants will be broken. Just want to make sure I do it right with as little angst as possible.

 

[BU Pathology]

Kinda on topic.... anyone got any advice of how to 'prepare ones house' before handing in a resignation letter.
No bad blood just got a better offer somewhere else. No restrictive covenants will be broken. Just want to make sure I do it right with as little angst as possible.

Give as much notice as possible, so that the group can begin planning. It takes several weeks to months to recruit a pathologist, get them credentialed etc.

 

[Kunu]

I am planning on leaving practice to start my own board of pathology- the National Board of Pathology (NBP). I will charge candidates $3800 for certification and hire the rudest most impersonable *itch I can find to answer the phone and give them an email tag of NBPMary. Candidates will have to travel to NBP headquarters at the Mandalay Bay Hotel in LAs Vegas every 3.5 years because studies have shown that patients feel safer when their pathologists are board tested more frequently. The board questions will be recycled from textbooks written in the 1930's focusing on extraneous minutia seen once or twice in the careers of 1 out of 14,000 pathologists and the exam will be administered by an IT support outfit from Maldova that will smoke, fail and disintegrate within the first 3 weeks of testing. After passing the exam, diplomats will have to revisit my MOC website yearly and click 2 or three boxes of incoherent questions to maintain board certification and for this i will charge them $50.00. I won't be accountable to anyone nor will I have to in anyway justify the excessive charges because you physicians can afford it whatever I charge. I figure I can net $100 million in a few years and then retire comfortably.

 

[Inez2000]

Kunu, don't hold back, tell us how you REALLY feel about the ABP!

 

[dermpathdoc]

Kunu, don't hold back, tell us how you REALLY feel about the ABP!

Or the AOBPa if applicable? There is an alternate board for the DO pathologists in case you didn't know

 

[Inez2000]

Or the AOBPa if applicable? There is an alternate board for the DO pathologists in case you didn't know

I didn't know that, the DO in my program took the test with the rest of us in Tampa at ABP.

 

[dr.weiner]

Hey guys... I'm actually jumping on the ship. I'm a living, breathing fellow in training who recently accepted a partnership track position with a completely equitable, stable path group doing very well financially. I've been reading doom and gloom on this board for years. There's great information on here but a lot of tormented internet souls. It's a tough market, no question, but I ended up getting essentially a dream job. Geographic flexibility was key for me though.

 

[Inez2000]

Congrats that is sweet!

 

[dermpathdoc]

I didn't know that, the DO in my program took the test with the rest of us in Tampa at ABP.

DOs have that choice...it is up to them to make the decision to go AOA or ABP for certification. Most go ABP because it is easier and they know the exam formats front he shelf exams. AOA is really not that different

 

[pathstudent]

Hey guys... I'm actually jumping on the ship. I'm a living, breathing fellow in training who recently accepted a partnership track position with a completely equitable, stable path group doing very well financially. I've been reading doom and gloom on this board for years. There's great information on here but a lot of tormented internet souls. It's a tough market, no question, but I ended up getting essentially a dream job. Geographic flexibility was key for me though.

Ask your group how financially stable they are after a 50 percent cut to 88305 TC, a 70% cut to 88342 PC, and next years cuts to fish and likely 88307 of equal magnitude. I don't think stability is possible in the current climate.

 

[WEBB PINKERTON]

Hey guys... I'm actually jumping on the ship. I'm a living, breathing fellow in training who recently accepted a partnership track position with a completely equitable, stable path group doing very well financially. I've been reading doom and gloom on this board for years. There's great information on here but a lot of tormented internet souls. It's a tough market, no question, but I ended up getting essentially a dream job. Geographic flexibility was key for me though.

Many of us started out sounding just like this. I remember taking my first job and thinking I was set for life. Stability disappears quickly in this field I have noticed. Things can change in the drop of a hat as we are all finding out with the latest cuts.

Come back to the board in a few years.

 

[jp123ok]

I am planning on leaving practice to start my own board of pathology- the National Board of Pathology (NBP). I will charge candidates $3800 for certification and hire the rudest most impersonable *itch I can find to answer the phone and give them an email tag of NBPMary. Candidates will have to travel to NBP headquarters at the Mandalay Bay Hotel in Las Vegas every 3.5 years because studies have shown that patients feel safer when their pathologists are board tested more frequently. The board questions will be recycled from textbooks written in the 1930's focusing on extraneous minutia seen once or twice in the careers of 1 out of 14,000 pathologists and the exam will be administered by an IT support outfit from Maldova that will smoke, fail and disintegrate within the first 3 weeks of testing. After passing the exam, diplomats will have to revisit my MOC website yearly and click 2 or three boxes of incoherent questions to maintain board certification and for this i will charge them $50.00. I won't be accountable to anyone nor will I have to in anyway justify the excessive charges because you physicians can afford it whatever I charge. I figure I can net $100 million in a few years and then retire comfortably.

Setting up your own Board sounds like a great idea. Remember to include lots of out of focus pictures on the exams too, especially on the cytology part... Why would anyone need to see detail to sign out cytology?

 

[2121115]

Give as much notice as possible, so that the group can begin planning. It takes several weeks to months to recruit a pathologist, get them credentialed etc.

This is reasonable, but don't tell them a thing until you are SURE about the next job. Otherwise things could get dicey for you.

 

[2121115]

Hey guys... I'm actually jumping on the ship. I'm a living, breathing fellow in training who recently accepted a partnership track position with a completely equitable, stable path group doing very well financially. I've been reading doom and gloom on this board for years. There's great information on here but a lot of tormented internet souls. It's a tough market, no question, but I ended up getting essentially a dream job. Geographic flexibility was key for me though.

This is key. Location plays a HUGE role in the job market.

 

[Kilgoretrout 65]

I am planning on leaving practice to start my own board of pathology- the National Board of Pathology (NBP). I will charge candidates $3800 for certification and hire the rudest most impersonable *itch I can find to answer the phone and give them an email tag of NBPMary. Candidates will have to travel to NBP headquarters at the Mandalay Bay Hotel in LAs Vegas every 3.5 years because studies have shown that patients feel safer when their pathologists are board tested more frequently. The board questions will be recycled from textbooks written in the 1930's focusing on extraneous minutia seen once or twice in the careers of 1 out of 14,000 pathologists and the exam will be administered by an IT support outfit from Maldova that will smoke, fail and disintegrate within the first 3 weeks of testing. After passing the exam, diplomats will have to revisit my MOC website yearly and click 2 or three boxes of incoherent questions to maintain board certification and for this i will charge them $50.00. I won't be accountable to anyone nor will I have to in anyway justify the excessive charges because you physicians can afford it whatever I charge. I figure I can net $100 million in a few years and then retire comfortably.

Only $50.00? You should hire a consultant to examine your billing practices.

 

[yaah]

Hey guys... I'm actually jumping on the ship. I'm a living, breathing fellow in training who recently accepted a partnership track position with a completely equitable, stable path group doing very well financially. I've been reading doom and gloom on this board for years. There's great information on here but a lot of tormented internet souls. It's a tough market, no question, but I ended up getting essentially a dream job. Geographic flexibility was key for me though.

Yeah you have to take everything you read with a grain of salt. In the real world you will find all kinds of opinions. Healthcare and pathology specifically are challenging and are becoming more so particularly with all the the reimbursement changes and adminstrative burdens. But many groups have been and remain in excellent shape to navigate it. Don't forget that the changes are not just hitting SOME people, they are hitting everyone. You need to be smart and focused and work hard, and associate yourself with the right people. But it is not all doom and gloom.

Then again, you will also find that some people will just always be negative about everything. And others will minimize everything negative and rely on hope. Neither is appropriate, although being negative all the time does work for some people because it is how they stay focused and alert.

 

[pathstudent]

Yeah you have to take everything you read with a grain of salt. In the real world you will find all kinds of opinions. Healthcare and pathology specifically are challenging and are becoming more so particularly with all the the reimbursement changes and adminstrative burdens. But many groups have been and remain in excellent shape to navigate it. Don't forget that the changes are not just hitting SOME people, they are hitting everyone. You need to be smart and focused and work hard, and associate yourself with the right people. But it is not all doom and gloom.

Then again, you will also find that some people will just always be negative about everything. And others will minimize everything negative and rely on hope. Neither is appropriate, although being negative all the time does work for some people because it is how they stay focused and alert.

I consider myself hopeful and positive, but I don't think anyone can say if they are in excellent shape to navigate these "challenges" as I don't believe anyone knows when we will have hit bedrock. As tough as the current cuts have been they are not life changing for the partners in my group but they will be for junior associates and future hires as we can simply not make any of our junior people parterns and hire more part time pathologists and reduce our time off. That is one way to ameliorate the cuts. However everything I read talks about bundled payments in the near future and that is an end-game scenario for private practice pathology groups whether they are big or small.

 

[turtle1966]

Yeah you have to take everything you read with a grain of salt. In the real world you will find all kinds of opinions. Healthcare and pathology specifically are challenging and are becoming more so particularly with all the the reimbursement changes and adminstrative burdens. But many groups have been and remain in excellent shape to navigate it. Don't forget that the changes are not just hitting SOME people, they are hitting everyone. You need to be smart and focused and work hard, and associate yourself with the right people. But it is not all doom and gloom.

Then again, you will also find that some people will just always be negative about everything. And others will minimize everything negative and rely on hope. Neither is appropriate, although being negative all the time does work for some people because it is how they stay focused and alert.

I agree that one has to take a balanced view of a situation. However, there are extraordinary times, like presently, when one should be led by intuition, experience and by sound millennial principle of "supply and demand", rather than by the self-serving arguments of an "hypothetical doom" in the next 10-15 years.

Seldom, great decisions of the past were made collectively, or meticulous planned, rather made by "Leaders" of vision in a steady fashion. Pathology leaders, present and past, deserve a resounding F grade in this regard. They have mismanaged the field, led us astray into the minefield and been misrepresenting our present and future, for as long as (over 30 years) I can remember. They will go to the end of world to find reasons why supply should be increased, but refuse to smell the stench of lack of demand under their nose. All this, apparently, for miserly comfort of the chair they sit on.

There is a fundamental difference in the career flexibility of pathologists, viz-a-viz, a cardiologist, surgeons, etc. Most pathologists are one trick ponies. Just this fact should have prompted our "leaders" to be extra sensitive to supply.

This over-supply has filled the quivers of corporate labs with "despised" "poorly trained" Board Certified pathologists. According to Mick Raich, a pathology consultant, their average salary is around 200-220k as opposed to 550k for those in private practice. It is just a matter of time before those "poorly trained" pathologists will be lined up against those in private practice. If you do not believe me, just mark my word and revisit it in 5 years.

I am reminded of starving artists and philosophers galore; I presume that they went into their respective careers, with their eyes wide open, led by their "innate homing instinct" or "irrepressible love" of the respective fields. I presume the same is true for some or many of us, however, I suspect many more were misled by "sales-pitch or code of silence" of those who preceded them.

My advice to medical students contemplating Pathology, for genuine love of pathology, is to do at least one year of clinical medicine prior Pathology residency, lest you become a one trick pony. In a great scheme of life, one extra year of clinical medicine will be worth far more than one year of fellowship, and it will afford you so many more professional possibilities. In my opinion, if you have an opportunity to go for a premier residency program versus a regional program, you should ALWAYS go for a premier program, because you should always aim high and you will learn at the feet of the greats, not from afar, and although it may not guarantee you a good job, you will be the first ones to be invited to the table, at least. Remember that you should be more than your CV. You should always be looking high and explore here and there; if you do, you will be the first one to taste the morsel. Obviously, how much you should pay for this is matter of your life philosophy.

I know of a pathologist who easily makes well over 1 M and has flexible day hours without evening or weekend calls. I suppose he enjoys his career very much. However, I know of many more not so fortunate, so overall, I am down in Pathology as a career choice for others.

 

[Gut Shot]

My big question is to find out if anyone is doing anything about it? Anyone switching residencies, going back to do another residency, getting additional training/education or even dropping out of medicine and switching careers completely?

I am waiting until our Q1 finances come back to make a decision, but if the margins take too big a hit I will bailing out of medical practice at the end of 2015. I am fortunate to have some non-clinical opportunities available in fields that are actually growing, but it would take me about 2 years to make a full pivot. This would not be voluntary, mind you. I enjoy the practice of pathology immensely, but the RUC has been hacking at my bottom line like it's shawarma, and there comes a point when something has to give.

 

[WEBB PINKERTON]

Law schools are finally seeing a drop in enrollment. Fewer people will eventually go into pathology with the job market being so bad. Word will get out as more and more pathologists find themselves unemployed. Just a shame it will take the field hitting rock bottom for it to happen.

http://www.businessweek.com/articles/2013-07-16/law-school-enrollment-plummets-but-not-at-harvard