Job market for pathologists

[2121115]

I think the disenfranchisement stems from the fact that other specialties like dermatology have not been oversaturated with practitioners and can therefore demand higher reimbursement and better job prospects. This is a job that, had these pathologists known what was required to obtain it, was within their reach at one point. People with whom they've graduated medical school, and with whom they feel no hierarchy, have become ROAD docs, whereas these pathologists regret the fact they pursued a relatively more difficult road without knowing the truth.

Regarding dermatology, there appears to be an unofficial hierarchy concerning training overlap with pathology. Whereas dermatologists can obtain dermpath fellowships and diagnose biopsies and excisions without any other pathology background, the opposite cannot be said about pathologists practicing dermatology. This portrays the impression that dermatologists are more skilled physicians and can quickly learn pathology, whereas pathologists do not have the skill to learn dermatology.

^^This^^

It isn't about what pathstudent is saying. It is the fact that we are not competing with other docs. It isn't like if the money doesn't come to pathologists then it goes to feed the homeless and help the poor. It goes to pad a dermatologist's wallet or buy a urologist a new luxury car. We need to compete better within the realm of other physicians. If reimbursement goes down for everyone that is a different ballgame.

Dermatologists think pathology is easy for the reasons mentioned above. However, dermatologists only sign out the easy skins which can certainly be learned in a few month-long rotations (easy skins are VERY easy, not so for the rest of dermpath).

---

Members don't see this ad.

 

[raider]

Substance-Sensible post.

Pathology is over-run by beta type losers.

These individuals are like weak mongrel dogs who are happy as long as someone doesn't kick them. Zero self esteem.

What we need are alphas who demand rather than ask and know what they are worth.

In this world, you do not back down from what is your meal.

 

[pathstudent]

I think the disenfranchisement stems from the fact that other specialties like dermatology have not been oversaturated with practitioners and can therefore demand higher reimbursement and better job prospects. This is a job that, had these pathologists known what was required to obtain it, was within their reach at one point. People with whom they've graduated medical school, and with whom they feel no hierarchy, have become ROAD docs, whereas these pathologists regret the fact they pursued a relatively more difficult road without knowing the truth.

Regarding dermatology, there appears to be an unofficial hierarchy concerning training overlap with pathology. Whereas dermatologists can obtain dermpath fellowships and diagnose biopsies and excisions without any other pathology background, the opposite cannot be said about pathologists practicing dermatology. This portrays the impression that dermatologists are more skilled physicians and can quickly learn pathology, whereas pathologists do not have the skill to learn dermatology.

CMS dictates reimbursement which the insurers follow. Dermatologists can't demand higher reimbursement. This is one regard in which medicine is not a free market.

What are ROAD docs.

 

[Substance]

CMS dictates reimbursement which the insurers follow. Dermatologists can't demand higher reimbursement. This is one regard in which medicine is not a free market.

What are ROAD docs.

Rates of reimbursement are dictated by the RUC committee. Nearly every specialty has representation. The better the representation, the more reimbursement can be dictated. Dermatologists, and pathologists, and any other field, can indeed demand higher reimbursement through their representation on the RUC. Furthermore, private practice and out of pocket payment can be above that of the RUC's dictation.

I do agree that medicine is not a free market. But that only applies to physicians.

ROAD is an acronym: Radiology Ophthalmology Anesthesiology Dermatology. These are the four classic fields with a high ratio of pay per hour worked; the ROAD to happiness, or the ROAD to riches, or both, as they say.

 

[pathstudent]

Rates of reimbursement are dictated by the RUC committee. Nearly every specialty has representation. The better the representation, the more reimbursement can be dictated. Dermatologists, and pathologists, and any other field, can indeed demand higher reimbursement through their representation on the RUC. Furthermore, private practice and out of pocket payment can be above that of the RUC's dictation.

I do agree that medicine is not a free market. But that only applies to physicians.

ROAD is an acronym: Radiology Ophthalmology Anesthesiology Dermatology. These are the four classic fields with a high ratio of pay per hour worked; the ROAD to happiness, or the ROAD to riches, or both, as they say.

How would an oversupply of pathologists effect the RUC decisions?

And CPT codes are published by medicare with the reimbursement rates that differ from state to state and sometimes from city to city within states. Whenever a group contracts with an insurance company they contract for 1.5 times medicare or 1.8 times medicare or whatever. Pathologists just can't charge whatever they want, as if they did, fee for service pathologists would lose their business quickly as disgruntled patients would give a lot of negative feedback to administrators and referring physicians.

I don't know if there are too many pathologists, although I think there could be, but I do know that medicine is a for profit business and for profit business generates for profit behavior which explains the job opportunities out there for newly minted BC/BE pathologists.

I like the ROAD thing.

In the 90s I heard someone refer to the PAR specialties (path, anesthesia, ad rads) as they were known for having cush schedules with ample time for golf in the afternoon. But that is no longer the case as everyone is working the rear end off to make the same money they were getting back then.

 

[Substance]

How would an oversupply of pathologists effect the RUC decisions?

The oversupply of pathologists creates an issue with the supply curve. More pathologists means they are considered less valuable. That's simple economics.

The RUC tends to award higher rates based on procedural expertise and training rigor and value. Having an overabundance of whichever field, be it pathology or family medicine etc, gives the impression that within the Type-A heaven/hell of medical school, the most common physicians are the ones that couldn't get the less common and more uniquely specialized training. Since there are many pathologists, the standards are probably lower than for dermatology, where there are far fewer. Therefore, pathology services are worth less. It's all about image.

Add to the mix the fact that many uncouth programs seem to be recruiting pathology residents from countries that no longer exist on the map solely for technician duties and what you have is a job market oversaturated with meek servile individuals who will race to the bottom just to have a job. I don't think there's a clause in the RUC/RVUs that prevents doctors for accepting less than reimursement rates.

 

[pathstudent]

The oversupply of pathologists creates an issue with the supply curve. More pathologists means they are considered less valuable. That's simple economics.

The RUC tends to award higher rates based on procedural expertise and training rigor and value. Having an overabundance of whichever field, be it pathology or family medicine etc, gives the impression that within the Type-A heaven/hell of medical school, the most common physicians are the ones that couldn't get the less common and more uniquely specialized training. Since there are many pathologists, the standards are probably lower than for dermatology, where there are far fewer. Therefore, pathology services are worth less. It's all about image.

Add to the mix the fact that many uncouth programs seem to be recruiting pathology residents from countries that no longer exist on the map solely for technician duties and what you have is a job market oversaturated with meek servile individuals who will race to the bottom just to have a job. I don't think there's a clause in the RUC/RVUs that prevents doctors for accepting less than reimursement rates.

You are just wrong. They don't sit around and say "there are more pathologists than there were 20 years ago, therefore an 88305 is worth less".

Reimbursment rates for pathology have remained stable or gone up slightly the last five years, therefore by your reasoning, the over supply of pathologists is correcting.

And it is not that pathologists reimbursements are low. They are great. It is just that there are things like Ameripath and senior partners that pay you 250k when your work was reimbursed 500k. It is called business.

 

[pathstudent]

You are just wrong. They don't sit around and say "there are more pathologists than there were 20 years ago, therefore an 88305 is worth less".

Reimbursment rates for pathology have remained stable or gone up slightly the last five years, therefore by your reasoning, the over supply of pathologists is correcting.

And it is not that pathologists reimbursements are low. They are great. It is just that there are things like Ameripath and senior partners that pay you 250k when your work was reimbursed 500k. It is called business.

It's also worth pointing out that global pathology reimbursement hasn't decreased much in recent years (although the PC for an 88305 has decreased from 80-90 to 35-40 over the last fifteen years), hospital based private practice pathologists have had their revenue decreased due to what we have talked about ad nauseum (uros realizing their biopsies were a gold mine, same with gastros and the competition from megalabs and academic inroads into community practice via so called "outreach" programs.)

 

[Enkidu]

Regarding dermatology, there appears to be an unofficial hierarchy concerning training overlap with pathology. Whereas dermatologists can obtain dermpath fellowships and diagnose biopsies and excisions without any other pathology background, the opposite cannot be said about pathologists practicing dermatology. This portrays the impression that dermatologists are more skilled physicians and can quickly learn pathology, whereas pathologists do not have the skill to learn dermatology.

That's an interesting point. But by all accounts dermatology-trained dermatopathologists are adequately trained, right? Would it be reasonable for pathology-trained dermatopathologists to practice some limited form of dermatology?

Ironically, most medical students would say that pathology is a much more difficult subject than dermatology, which in my school lasted about a week and seemed to consist entirely of vocabulary for describing skin lesions, if you ignore the portion that was dermatopathology.

 

[pathstudent]

That's an interesting point. But by all accounts dermatology-trained dermatopathologists are adequately trained, right? Would it be reasonable for pathology-trained dermatopathologists to practice some limited form of dermatology?

Ironically, most medical students would say that pathology is a much more difficult subject than dermatology, which in my school lasted about a week and seemed to consist entirely of vocabulary for describing skin lesions, if you ignore the portion that was dermatopathology.

I don't think you would be board eligible for dermatology after doing path to dermpath fellowship.

There was a recent article in the WSJ about a woman who bailed on path to go into cosmetic derm.

However without the board I don't think you could practice at most hospitals and you would probably have a tough time getting malpractice insurance.

 

[Enkidu]

I don't think you would be board eligible for dermatology after doing path to dermpath fellowship.

Right, my question was meant to be a little rhetorical. It doesn't seem reasonable to me either. But why does it seem to work the other way, particularly since pathology is seemingly more difficult than dermatology?

 

[pathstudent]

Right, my question was meant to be a little rhetorical. It doesn't seem reasonable to me either. But why does it seem to work the other way, particularly since pathology is seemingly more difficult than dermatology?

Because the dermatologists did a fellowship in dermatopathology therefore they are board eligible in dermatopathology. Doing a dermatopathology fellowship does not make you qualified to practice dermatology or be boarded in dermatology. C'mon isn't that obvious?

 

[Thrombus]

It is just that there are things like Ameripath and senior partners that pay you 250k when your work was reimbursed 500k. It is called business.

This could not be more illustrative of many in the medical profession who are unable to understand economics.

Too many workers = Large supply = Mucho less competitive wages

You try to find a businessman that can exploit a dermatologist like this.

 

[Substance]

Because the dermatologists did a fellowship in dermatopathology therefore they are board eligible in dermatopathology. Doing a dermatopathology fellowship does not make you qualified to practice dermatology or be boarded in dermatology. C'mon isn't that obvious?

Why is there no "dermatology" fellowship for newly-minted dermatopathologists? To say that dermatopathology can be learned in one year by non-pathologists but dermatology cannot be learned in one year by non-dermatologists is a very strange double-standard.

You mentioned that the PC of an 88305(whatever that is) was decreased, yet the TC was not. If you consider that there are urologists and dermatologists and probably a GI doc on the RUC then you can see why that has happened. If there was not an oversupply of pathologists then the megalabs and in-office labs would not exist since pathologists could find better work elsewhere, or set up their own labs and be competitive.

 

[caffeinegirl]

Why is there no "dermatology" fellowship for newly-minted dermatopathologists? To say that dermatopathology can be learned in one year by non-pathologists but dermatology cannot be learned in one year by non-dermatologists is a very strange double-standard.

Wow. Are you serious? Do you know what dermatology entails? The total body skin exam is just but a small part of the field. How about medical derm? Genodermatoses? Derm surgery? Bullous disease? Connective tissue disease? Being a board certified dermatologist entails quite a bit, and more than can be learned in one year. Not only is it about the vast array of diagnoses, but also the treatment, which many times includes immunomodulators.

As a pathologist, a dermatopathology fellowship entails 6 months of derm training. The level of derm training varies per program (everything from shadowing to being a de-facto first year resident). Even after the 6 months, there is no way I know the same amount as a senior derm resident. No way. And not even close to knowing as much as a derm attending.

And, a dermatologist doing a dermatopathology fellowship does 6 months of general surg path. That does not mean that after 6 months are they ready to sign out surg path independently. I mean, does a pathology resident in the middle of their first year have the ability to do independent sign out? Nope.

The dermatopathology fellowship includes 6 months of dermatopathology. For those coming from both pathology and dermatology backgrounds, that is enough..because you had prior training prior to the fellowship. Even then, the pathologist and dermatologist have different strengths entering the fellowship (pathologist in neoplastic and histologic subtleties, the dermatologist in the clinical differential diagnosis and knowledge of the clinical entities). The fellowship is meant to give each trainee a chance to leave the fellowship with sort of a level playing field.

Do I feel comfortable opening a derm clinic after my dermpath fellowship, which entailed being a de-facto first year resident for 6 months? Heck no. Would I be able to pass the dermatology boards after my dermpath fellowship? Nope. Would my co-fellow who was dermatology trained be able to pass the AP boards? Nope.

FYI: The derm boards include 36 unknkown dermpath slides and more unknown photomicrographs, which is more than I got in my AP exam..so the dermatology residents in my fellowship actually get more dermpath in their training than where I trained for pathology.

 

[pathstudent]

Word! I couldn't agree more.

So derm residents are better trained in dermpath than your typical path resident.

Do general derms sign-out their biopsies without a dermpath fellowship?

Wow. Are you serious? Do you know what dermatology entails? The total body skin exam is just but a small part of the field. How about medical derm? Genodermatoses? Derm surgery? Bullous disease? Connective tissue disease? Being a board certified dermatologist entails quite a bit, and more than can be learned in one year. Not only is it about the vast array of diagnoses, but also the treatment, which many times includes immunomodulators.

As a pathologist, a dermatopathology fellowship entails 6 months of derm training. The level of derm training varies per program (everything from shadowing to being a de-facto first year resident). Even after the 6 months, there is no way I know the same amount as a senior derm resident. No way. And not even close to knowing as much as a derm attending.

And, a dermatologist doing a dermatopathology fellowship does 6 months of general surg path. That does not mean that after 6 months are they ready to sign out surg path independently. I mean, does a pathology resident in the middle of their first year have the ability to do independent sign out? Nope.

The dermatopathology fellowship includes 6 months of dermatopathology. For those coming from both pathology and dermatology backgrounds, that is enough..because you had prior training prior to the fellowship. Even then, the pathologist and dermatologist have different strengths entering the fellowship (pathologist in neoplastic and histologic subtleties, the dermatologist in the clinical differential diagnosis and knowledge of the clinical entities). The fellowship is meant to give each trainee a chance to leave the fellowship with sort of a level playing field.

Do I feel comfortable opening a derm clinic after my dermpath fellowship, which entailed being a de-facto first year resident for 6 months? Heck no. Would I be able to pass the dermatology boards after my dermpath fellowship? Nope. Would my co-fellow who was dermatology trained be able to pass the AP boards? Nope.

FYI: The derm boards include 36 unknkown dermpath slides and more unknown photomicrographs, which is more than I got in my AP exam..so the dermatology residents in my fellowship actually get more dermpath in their training than where I trained for pathology.

 

[raider]

Lots of *****s on this forum. *****ic nonsense aside, the best thing that I see happening in medicine is the evolution of the nurse practitioner. Now there are nurse practitioners in dermatology. PAs do all or most thyroid FNAS. Who says that most of the biopsies in the future won't be done by PAs or NPs (even endos ;some NP in Alaska was doing it- a ***** can do that, actually come to think of it *****s are doing it right now). Even now a huge volume of derm samples is generated by PAs every day in many derm practices. Simple plan, go to an area with a shortage of dermatologists, hire two nurse practitioners in derm, open clinic under MD (your supervision) to do biopsies treatment etc.(many states allow this, some states even allow them to practice without MD supervision), have a small lab and read the stuff out.

But there are so many easier ways to make money and ,truthfully, from a money perspective medicine is and soon will be sucking the big one. There is no question that physician salaries are going to decline because remember medicare money is a "zero sum thing" and these days with all the focus on primary care, once the evening out happens (and it will for sure happen) primary care will make more while specialities(including pathology) will make less.

The real challenge in medicine has been and will always be diagnosis. The diagnostician will always be king. Never forget that. The people who get you specimens are nothing more than glorified technicians. Never forget to remind them their role if they overstep their boundaries and try to act as if they know what actual medicine is.

Be a diagnostician for one and one reason only, to develop and relish you unique gift and talent.

 

[caffeinegirl]

Do general derms sign-out their biopsies without a dermpath fellowship?

It's a geographic trend, in that it is more common on the West Coast for dermatologists to read their own BCC's, SCC's than on the East Coast.

And as for the comments about NP's doing biopsies...I am not going to be a glorified "biopsyist" to get $$ for procedures. The overhead is too much, the paperwork and acquiring of prior authorizations is too much, and the risk of complications and followup is too much for me to get into. I'm more productive and get more $$ for time by reading out 88305's than patient encounters.
As for being a supervisory MD of an NP biopsy practice..again, I wouldn't do it because 6 months of training, in which I did about 200(?) biopsies, is not the same as a full dermatology residency, and the liability is too much given my training. The better thing IMHO to do is to recruit multiple of these MD/NP practices to send their bx's to you...

 

[pathstudent]

The arrogance of Raider and Substance and pathologists in general about our clinician collegaues astounds me.

 

[DoctorMD1]

Wow. Are you serious? Do you know what dermatology entails? The total body skin exam is just but a small part of the field. How about medical derm? Genodermatoses? Derm surgery? Bullous disease? Connective tissue disease? Being a board certified dermatologist entails quite a bit, and more than can be learned in one year. Not only is it about the vast array of diagnoses, but also the treatment, which many times includes immunomodulators.

As a pathologist, a dermatopathology fellowship entails 6 months of derm training. The level of derm training varies per program (everything from shadowing to being a de-facto first year resident). Even after the 6 months, there is no way I know the same amount as a senior derm resident. No way. And not even close to knowing as much as a derm attending.

And, a dermatologist doing a dermatopathology fellowship does 6 months of general surg path. That does not mean that after 6 months are they ready to sign out surg path independently. I mean, does a pathology resident in the middle of their first year have the ability to do independent sign out? Nope.

The dermatopathology fellowship includes 6 months of dermatopathology. For those coming from both pathology and dermatology backgrounds, that is enough..because you had prior training prior to the fellowship. Even then, the pathologist and dermatologist have different strengths entering the fellowship (pathologist in neoplastic and histologic subtleties, the dermatologist in the clinical differential diagnosis and knowledge of the clinical entities). The fellowship is meant to give each trainee a chance to leave the fellowship with sort of a level playing field.

Do I feel comfortable opening a derm clinic after my dermpath fellowship, which entailed being a de-facto first year resident for 6 months? Heck no. Would I be able to pass the dermatology boards after my dermpath fellowship? Nope. Would my co-fellow who was dermatology trained be able to pass the AP boards? Nope.

FYI: The derm boards include 36 unknkown dermpath slides and more unknown photomicrographs, which is more than I got in my AP exam..so the dermatology residents in my fellowship actually get more dermpath in their training than where I trained for pathology.

Hi,

You sound like a very reasonable person. Could you let me know what is a job market for dermatopathologists now, please? What are starting and midcareer salaries?

Thank you very much for your time

 

[caffeinegirl]

Just wanted to add that I know of many dermatologist-dermatopathologists who split their time in clinic and at the scope. They are excellent clinicians and diagnosticians, who can use their knowledge of the histopathology to translate into clinical differential diagnoses. Many of them see themselves as dermatologists first, with a dermatopathology focus, and like the patient contact and management of disease.

 

[raider]

The difference between confidence and arrogance is a matter of perspective. And yes, on the cases I hold responsibility for I consider myself the best , bar none.

 

[pathstudent]

The difference between confidence and arrogance is a matter of perspective. And yes, on the cases I hold responsibility for I consider myself the best , bar none.

It is one thing to be confident in your work.

It is another to disparage and make insulting, spiteful remarks about other physicians, academic pathologists, senior partners in your group, and administrators.

BTW, pathologists are not the only ones who make diagnoses.

 

[BrainPathology]

Substance-Sensible post.

Pathology is over-run by beta type losers.

These individuals are like weak mongrel dogs who are happy as long as someone doesn't kick them. Zero self esteem.

What we need are alphas who demand rather than ask and know what they are worth.

In this world, you do not back down from what is your meal.

Alphas don't whine constantly on internet forums ok?

 

[caffeinegirl]

Could you let me know what is a job market for dermatopathologists now, please? What are starting and midcareer salaries?

The job market is good for pathology trained dermatopathologists, but not so good if you're geographically restricted, as is the case with pretty much all specialties. Starting salaries depend on your practice location (academics, private practice with surg path, commercial lab), and range from 150K-300K+. Midcareer salaries are also dependent on your location, position (partner vs. nonpartner, assistant prof vs. full-prof, etc). I suggest you check out pathologyoutlines.com/jobs.html for available positions with descriptions and salaries. The ASDP website also has job postings.

 

[raider]

Roaring, not whining.

Who other than excellent surgical pathologists makes a "definitive diagnosis" of cancer on teeny weeny biopsies. No one else in medicine has the balls or brains for that kind of decision making (of course they will put on a show as if they could).

An excellent surgical pathologist is the best type of physician, in my opinion. And thats who one should strive to be on a daily basis.

 

[HbyHA]

Word! I couldn't agree more.

So derm residents are better trained in dermpath than your typical path resident.

Do general derms sign-out their biopsies without a dermpath fellowship?

when i did my Derm Path rotation (which is a separate Derm run dept in my hospital) the Derm residents rocked all the unknown slides full of random inflammatory dermatoses and blistering disorders i'd never heard of. and yet they didn't know what cartilage looked like under the microscope because they hadn't seen it since med school (it was an accessory tragus).

it's breadth vs. depth.

 

[caffeinegirl]

Agree with your experience HbyHa..when it comes to inflammatory dermatoses, the derm residents have an advantage since they know the clinical picture and pathophysiology of those diseases. As for the neoplastic disorders, granulomatous, adnexal, etc..if it's not classic, then it's tougher for them...remember, they're trained in a "pattern-recognition" method, whereas pathologists are trained not just about pattern recognition but also about the subtleties of histological findings, with an emphasis on neoplasia. Each trainee has different strengths and weaknesses, which the dermpath fellowship hopefully addresses. In fellowship, I spent a lot more time in clinical derm learning about medical conditions, whereas my cofellow spent his time in surg path learning about the histopathology of tumors.

 

[pathstudent]

Why is there no "dermatology" fellowship for newly-minted dermatopathologists? To say that dermatopathology can be learned in one year by non-pathologists but dermatology cannot be learned in one year by non-dermatologists is a very strange double-standard.

You mentioned that the PC of an 88305(whatever that is) was decreased, yet the TC was not. If you consider that there are urologists and dermatologists and probably a GI doc on the RUC then you can see why that has happened. If there was not an oversupply of pathologists then the megalabs and in-office labs would not exist since pathologists could find better work elsewhere, or set up their own labs and be competitive.

How dare you. Dermatopathology can be learned in six months by dermatologists not 1 year. And to think you could learn derm in one year is absurd and totally arrogant.

Do you have any idea how hard it is to match in derm? The average derm resident profile at any derm program is tiers above the average path resident profile for the same university.

Back when I was at UCSF there was a path resident who referred to herself as a "derm reject". She interviewed and ranked over 20 derm programs, but you know where she matched, her first non-derm back-up, UCSF pathology. I don't want to get into a "top 5" argument, but most people consider UCSF pathology a good match for a pathology applicant. Well, you can match into UCSF pathology and still not be able to touch derm anywhere.

And the fact that you don't know what an 88305 is ,means any comments you have about pathology reimbursement/supply and demand should be ignored.

 

[cjw0918]

Just wanted to give hope to any fellows still looking for a job this July. I just got a job offer this week from the fifth place I interviewed, and I accepted the position. I was geographically restricted and each of these five opportunities took a lot of networking and cold-calling since Nov. to unearth.

While the position I have accepted may not be ideal for a lot of folks, I think it is great for me. And really that's what it's all about- finding the right job for YOU. Be persistent and try not to get too discouraged. It really does feel like the end of the world sometimes, but it WILL happen. Good luck to all.

 

[pathstudent]

Just wanted to give hope to any fellows still looking for a job this July. I just got a job offer this week from the fifth place I interviewed, and I accepted the position. I was geographically restricted and each of these five opportunities took a lot of networking and cold-calling since Nov. to unearth.

While the position I have accepted may not be ideal for a lot of folks, I think it is great for me. And really that's what it's all about- finding the right job for YOU. Be persistent and try not to get too discouraged. It really does feel like the end of the world sometimes, but it WILL happen. Good luck to all.

 

[moonraker]

.

 

[Sir James Bond]

What an exceptionally lively discussion this has become. Boom boom cheerio!

 

[raider]

Money making capacity and nonsense hospital politics and hierarchy aside, as far as pure brain power goes, surgical pathology is by far the most difficult field of medicine to be really good at.

Not only do you have to know about all diseases in-depth(clinical ,histo, treatment) but you must know it so well that your acceptable rate for error is zero percent. Patients lives hinge on a flick of your pen. if you doubt that for a second wait till you or your loved one develops a bump which all physicians (internists, radiologists, surgeons) think is suspicious. Then , when the surgical pathologist give you that benign diagnosis, then and only then will you realize who one of the most , if not the most, important physician in medicine is (if you have half a brain which excludes the majority of people anyway).

An author of a small book on pathology has put forth the following attributes of a good surgical pathologist (I agree with him and these are the sort of people I am talking about when I say surgical pathologist i do not mean "single speciality/coward pathologists"(unless you are one of your kind in your selected niche and not avoiding being good at all organs because of laziness, limited mental capacity etc. ) or "admin/loser type pathologists" or "research type pathologist (not the good kind who actually has an inquisitive mind but the kind that entered research because they were too afraid to make real diagnoses) or clinical pathologists (very very different bird from the surgical pathologist), I am talking about the supersleuth of medicine-if you are that sort of person you are guaranteed my respect as are all "good" physicians from other specialities). Anyway, back to the author's words"

"the pathologist should have:wisdom of an owl,eyes of a falcon,hands of a surgeon,descriptive skills of a poet, memory of a camera, organization skills of a computer software, consistency of an automated machine, searching power of an internet searching engine, interconnection of ideas as a network, decision making of a politician". I will also add "heart of a lion" and "confidence of a matador".

And congratulations cjw0918. Best of luck for the future. I am sure you will do great.

 

[zao275]

Raider, what book is that quote from? I like it.

 

[raider]

The Skillful Pathologistathology Concepts page 43 By Osama Sharif Eldin MBBS Ch,MSc,PhD (Senior Lecturer in Pathology;School of Medicine and Medical Sciences University College of Dublin (UCD) ireland) First Edition 2008; ISBN 978-1-4092-1012-2 (it is a decent primer of basic surgical pathology concepts ;probably helpful for surg path exams too as a quick refresher).

 

[Ombret]

The derm/dermpath track is what all of pathology used to look like. Before surgical pathology existed as a specialty, before Ackerman and his generation, surgeons were their own pathologists.

Over the years it became apparent that surg path should be its own specialty, but dermpath stayed on the fence. Often cited reasons for this: dermatologists had an above-average liking for pathology, kept it in their training when others dropped it, and perhaps pathology plays a bigger part in clinical dermatology than other fields (or so they claim; the only way this makes sense to me personally is just that derm has so damned many different diagnostic entities). I have often wondered if these things are really intrinsic to derm, or if gynecology or some other field could have gone the same way.

Conclusions: (1) Given the intertwined history of these fields and the prima facie evidence of derm-trained dermpaths being very good at what they do, I think we have to accept the status quo as an uneasy truce and just be glad that we are not currently fighting turf battles with EVERY clinical specialty for the right to do our job. (2) Never forget that historically other specialties HAVE questioned whether they can have some of our lunch money and in fact we may have taken it from them in the first place. (3) You need to do an excellent job so that your work will be legitimately valuable. When I see surgical pathologists at my institution taking 1.5 hours to call back "atypical cells" on a frozen, that does not make a very good case for pathology's continued existence.

 

[schrute]

... There is no question that physician salaries are going to decline because remember medicare money is a "zero sum thing" and these days with all the focus on primary care, once the evening out happens (and it will for sure happen) primary care will make more while specialities(including pathology) will make less.

While I agree there is an emphasis on primary care nowadays in terms of what is politically popular, that won't necessarily translate into a flip-flop of incomes. The income disparity is ridiculous between PC and the specialties, though I don't think path fits the mold....cards/onc/gas/GI/derm guarantee big bucks...FP generally doesn't...path could go either way and is very regionally variable.

Interesting data on physician salaries of 22 different specialties (path not being one of them, of course...):

http://www.medscape.com/sites/public/physician-comp/2011

When 20% of cardiologists report income (with benes) above $500k, and as a whole they still think they're underpaid (linked article), I'm not very reassured...

 

[krld]

This is an awesome thread.

As I read the doom and gloom posted I wonder - Does anyone see an increasing need for pathologists as medicine becomes more "personalized" with multivariate genetic/proteomic tests being developed for everything from infectious disease to cancer? Or is this wishful thinking??

Thanks in advance. As an outsider path looks really interesting, especially Molecular Path...

 

[oldfatman]

Substance-Sensible post.

Pathology is over-run by beta type losers.

These individuals are like weak mongrel dogs who are happy as long as someone doesn't kick them. Zero self esteem.

What we need are alphas who demand rather than ask and know what they are worth.

In this world, you do not back down from what is your meal.

You're my mongrel dog, raider. My meal. I could eat you for breakfast. Not that there is much there. Maybe a light snack for the old fat man.

90% of dermatopathology (by volume) can be done by a minimally competent surgical pathologist.

The ONLY reason people even talk about skin ditzels with such fascination is that there are barriers to entry to the field (getting a derm residency or a dermpath fellowship) and thus higher wages and more jobs.

Most fields of pathology are far more interesting than skin ditzels. INCLUDING clin path.

The field of medicine is being eroded by extenders. Doctors cost more and the government does not want to pay. The country is out of money to tax/borrow/spend because the manufacturing base was GIVEN to Asia. Soon all there will be left will be the entertainment industry and a bunch of unemployed citizens watching the tube all day and scrounging for junk food.

 

[Ombret]

Does anyone see an increasing need for pathologists as medicine becomes more "personalized" with multivariate genetic/proteomic tests being developed for everything from infectious disease to cancer?

People fretting about the future of pathology (most notably our professional societies) often hope this will be true, but I highly doubt it. The need for pathologists will be stable over the next 50 years. Medicine changes very slowly and these personalized medicine assays will only ever apply to 1% of clinical decisions (totally made up number, but people do estimate that 40% of clinical decisions are currently made based on pathology overall; I believe that includes lab medicine results; another large fraction is based on radiology). COSTS related to pathology may increase as these assays get ordered more.

What worries me is that these assays tend to "disintermediate" the pathologist. Because they are reported on glossy paper in plain English, the pathologist starts to get taken out of the loop. By oversimplifying the diagnostic/prognostic task, they make our work look unnecessary or simplistic. But I do agree with you: the science behind them is interesting and there is even a chance that these new methods will improve people's health.

 

[raider]

You're my mongrel dog, raider. My meal. I could eat you for breakfast. Not that there is much there. Maybe a light snack for the old fat man.

I like clowns. They are funny.

 

[oldfatman]

I like clowns. They are funny.

I like people who laugh at my jokes.

 

[Mordak]

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]--> I am a young mid-western medical student who wants to be a pathologist. The more I read about this post, the more it seems that these threads concerning the pathology job market, while starting out with amicable aims, end up useless and unimpressive.

I think the first unfortunate thing, and sadly I think it is perpetuated from my own narcissistic facebook-loving-generation, is the belief that a medical degree offers entitlement to a life of wonder, excitement, riches, and dates with supermodels. Suppose it to be true that there is indeed an actual problem with the pathology job market. What does this actually mean? You can't find employment in your dream city?... You wish someone would make it easier for you?... Do heads need to roll because of your unfortunate circumstance?

My own personal belief is that no one owes you anything. Pathology wasn't invented for you or me to have a job. At this point in time maybe it is true that there are too many pathologists for everyone to be living in the land of milk and honey. Maybe pathologists will need to be more "clinically oriented" (I still do not know what this means, the pathologists I see interact several times a day with consulting physicians and surgeons, with their opinions valued most high, that is, if you are a reputable pathologist and good communicator). Then again, maybe they don't. You must adapt to the job market as well as your current family situation. Other people will not do it for you. If you feel that things need to change then the answer is to adapt. As an example, if it takes three fellowships to get your dream job in the sunshine state, stop whining and get to work. If you need to work a less desirable job for years to support yourself and your family and your second family (student loans), then you do it. Prioritize, set goals, and do your job, and by all means do it well.

I believe that success, in the medical arena, is a product of hard work to attain a degree of cerebral "competency" as well as an understanding of the additional traits that make you employable. For the majority of the working world, they are not one in the same.

It seems the answer to the dilemma set forth is to therefore develop a strategy of how to be a better, more effective candidate that will make you employable. If this is undesirable or cannot be done, then the solution is to make do with what is possible and hope for the best. I think it would be far more useful to find peoples' answers to the following:

What places are hiring? What are some "hidden gems" of "podunk" mid-west suburbia where jobs, according to this forum, are seemingly plentiful. To go along with this, what are some unforeseen benefits of moving into the "less desirable" places for employment. What are some agencies or organizations that seem particularly helpful placing new pathologists? What do pathology employers want in their new hires?

I guess what I am calling for is more constructive discussion about the individual solutions to this, as I perceive it, a largely individual problem.

After all, it appears that most people agree that the job market in podunk states where I am at, appears largely healthy and/or less competitive. ...That doesn't seem like a global phenomena to me.

 

[2121115]

<!--[if gte mso 9]><xml> <w:worddocument> <w:view>normal</w:view> <w:zoom>0</w:zoom> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> </w:compatibility> <w:browserlevel>microsoftinternetexplorer4</w:browserlevel> </w:worddocument> </xml><![endif]--><!--[if gte mso 10]> <style> /* style definitions */ table.msonormaltable {mso-style-name:"table normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"times new roman";} </style> <![endif]--> i am a young mid-western medical student who wants to be a pathologist. The more i read about this post, the more it seems that these threads concerning the pathology job market, while starting out with amicable aims, end up useless and unimpressive.

I think the first unfortunate thing, and sadly i think it is perpetuated from my own narcissistic facebook-loving-generation, is the belief that a medical degree offers entitlement to a life of wonder, excitement, riches, and dates with supermodels. Suppose it to be true that there is indeed an actual problem with the pathology job market. What does this actually mean? You can't find employment in your dream city?... You wish someone would make it easier for you?... Do heads need to roll because of your unfortunate circumstance?

My own personal belief is that no one owes you anything. Pathology wasn't invented for you or me to have a job. At this point in time maybe it is true that there are too many pathologists for everyone to be living in the land of milk and honey. Maybe pathologists will need to be more "clinically oriented" (i still do not know what this means, the pathologists i see interact several times a day with consulting physicians and surgeons, with their opinions valued most high, that is, if you are a reputable pathologist and good communicator). Then again, maybe they don't. You must adapt to the job market as well as your current family situation. Other people will not do it for you. If you feel that things need to change then the answer is to adapt. As an example, if it takes three fellowships to get your dream job in the sunshine state, stop whining and get to work. If you need to work a less desirable job for years to support yourself and your family and your second family (student loans), then you do it. Prioritize, set goals, and do your job, and by all means do it well.

I believe that success, in the medical arena, is a product of hard work to attain a degree of cerebral "competency" as well as an understanding of the additional traits that make you employable. For the majority of the working world, they are not one in the same.

It seems the answer to the dilemma set forth is to therefore develop a strategy of how to be a better, more effective candidate that will make you employable. If this is undesirable or cannot be done, then the solution is to make do with what is possible and hope for the best. I think it would be far more useful to find peoples' answers to the following:

What places are hiring? What are some "hidden gems" of "podunk" mid-west suburbia where jobs, according to this forum, are seemingly plentiful. To go along with this, what are some unforeseen benefits of moving into the "less desirable" places for employment. What are some agencies or organizations that seem particularly helpful placing new pathologists? What do pathology employers want in their new hires?

I guess what i am calling for is more constructive discussion about the individual solutions to this, as i perceive it, a largely individual problem.

After all, it appears that most people agree that the job market in podunk states where i am at, appears largely healthy and/or less competitive. ...that doesn't seem like a global phenomena to me.

lol.

Spoken like a true medical student.

 

[Thrombus]

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]-->
After all, it appears that most people agree that the job market in podunk states where I am at, appears largely healthy and/or less competitive. ...That doesn't seem like a global phenomena to me.

Let us know how you feel when that "podunk state" job has a rep from lab in California that just took most of your business and your group has no other solution but to downsize your job. Oh wait, that will already have happened by the time you get to "the show".

I can only say this: I had similar lines of thinking when I was a medical student. You are not bigger than "the system" no matter how far above the rest of your class you were.

 

[raider]

These f-ckers and their ilk (ad below)are mushrooming all over the US. Now that you have said goodbye to prostate, derm and GI biopsies, heme specimens get ready to say bye bye to Gyn biopsies too. Check out the credential of the "corporate staff" fu-king low life pHDs and MBA types. So now we are going to slave for these people. Outreach for private practice pathology is so dead. F that. Oversupply is killing us.

"Anatomic pathologist, full-time. Position available for full time Surgical Pathologist with AP Board Certification and NYS license. Significant experience in GYN pathology required. Additional experience in dermatopathology or GI pathology desirable. The position is located in our Long Island facility in Farmingdale New York. The Laboratory is a growing midsized regional laboratory with an emphasis on woman's health and cutting edge diagnostics. Competitive salary and benefits will be provided.

Enzo Clinical Labs, a full service clinical reference laboratory. We are one of the leading regional labs in the country, as we combine the extensive testing capabilities of a large laboratory with the convenience and personalized service of a local one. Enzo was one of the area's first laboratories to be awarded the prestigious College of American Pathologist (CAP) accreditation. This award indicates that Enzo has passed an extremely rigorous series of inspections far more sophisticated than those mandated by licensing authorities.

Enzo Clinical Labs is much more than a highly respected clinical laboratory. Our lab is utilized extensively to demonstrate the benefits of gene-based products developed at Enzo Life Sciences. It also plays an important role in the development of and performance of tests used to support the ongoing trials of Enzo Therapeutics".

 

[WEBB PINKERTON]

ENZO is losing a lot of money. Look at their financials the last few quarters. My bet is that they go out of business or get bought out. A bigger threat is BioReference labs. They are really making a mess for a lot of us out there. Offering a bunch of "home brewed" molecular tests. I can't wait till Bostwick goes out of business. They have closed a lot of locations in recent years (arizona, tenn, richmond, new york).

 

[raider]

ENZO is losing a lot of money. Look at their financials the last few quarters. My bet is that they go out of business or get bought out. A bigger threat is BioReference labs. They are really making a mess for a lot of us out there. Offering a bunch of "home brewed" molecular tests. I can't wait till Bostwick goes out of business. They have closed a lot of locations in recent years (arizona, tenn, richmond, new york).

Thanks WB, will check out the POS you mentioned. Good to know not all pathologists on this form are clueless losers. Some people are actually cognizant of the true state of affairs.

 

[Mace1370]

I will be starting third year soon and pathology is on my list of specialties that I am interested in. Having read most of this thread, I am a little concerned about the job market since I will probably be forced to stay in my current area.

However, I am in the military and will be working for them for 7 years after my residency/fellowships due to my payback. Once I separate from the military, would my CV be more or less competitive than most of the pathologists looking for civilian jobs? I assume more competitive since I will have 7 years of work experience, but I thought I would ask to clarify.