Job market for pathologists

[Substance]

A busy henatipathologist probably gets reimbursed 500,000 for billing the professional component of interpreting flow, aspirates, clots, biopsies, lymph nodes and special stains and immunos. Either that pathologist ain't very busy or someone is making a hefty chunk of change.

The Medicare reimbusement for a 88305x2 85097 86060 88189 88311 88313 (the basic cpt codes for a simple bone marrow and flow not requiring additional studies) is about 400. Private insurers would get you closer to 500 or 600. So you would only need to do about 1-2 day an work full time to make 110,000. Of course there is the cost of transcription and reporting but that can all be covered by the insanely profitable technical component.

Why can't pathologists band together and create their own megalabs given that's where the money is. I know doctors are generally stubbon and hard to corral, but this would make the most sense in the long run.

I looked at that number above - 110 - and I laughed. Back here in Canada that's what pathologists used to make. Needless to say nobody went into it so they had to recruit a lot of FMGs, some of questionable competency, to do it. But then hundreds of people ended up getting bad test results (ie negative receptors in a receptor-positive cancer, which caused them to miss tamoxifen treatment, and many of them died) so the government, in its reactive way, increased the income to more than 3 times that. Now people are going into it.

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Members don't see this ad.

 

[WEBB PINKERTON]

No wonder they pay so low. The founder worked at Quest for 12 years.
The people on Jersey Shore make like 100,000 per episode. Gym, tan, sign out some surgicals...

http://siparadigm.com/aboutus.html

 

[WEBB PINKERTON]

Why can't pathologists band together and create their own megalabs given that's where the money is. I know doctors are generally stubbon and hard to corral, but this would make the most sense in the long run.

I looked at that number above - 110 - and I laughed. Back here in Canada that's what pathologists used to make. Needless to say nobody went into it so they had to recruit a lot of FMGs, some of questionable competency, to do it. But then hundreds of people ended up getting bad test results (ie negative receptors in a receptor-positive cancer, which caused them to miss tamoxifen treatment, and many of them died) so the government, in its reactive way, increased the income to more than 3 times that. Now people are going into it.

It would be hell trying to get a lab off the ground. Would be better off buying McDonalds franchises. For a new lab to stay in business it would have to have economy of scale quickly. Most pathologists didnt wanna invest in infrastructure, were greedy, and sold out giving rise to the faceless corporate entities we have today running the field. The future generation of pathologists got thown under the bus.

 

[NuckingFuts]

Why can't pathologists band together and create their own megalabs given that's where the money is. I know doctors are generally stubbon and hard to corral, but this would make the most sense in the long run.

I looked at that number above - 110 - and I laughed. Back here in Canada that's what pathologists used to make. Needless to say nobody went into it so they had to recruit a lot of FMGs, some of questionable competency, to do it. But then hundreds of people ended up getting bad test results (ie negative receptors in a receptor-positive cancer, which caused them to miss tamoxifen treatment, and many of them died) so the government, in its reactive way, increased the income to more than 3 times that. Now people are going into it.

Hundreds of people ended up getting bad test results because your government recruited a lot of FMGs, "some of questionable competency"?

That's very unfortunate for the victims and their loved ones.

Say old boy, do you have any data/sources to stake your claim?

Just curious.

 

[NuckingFuts]

It would be hell trying to get a lab off the ground. Would be better off buying McDonalds franchises. For a new lab to stay in business it would have to have economy of scale quickly. Most pathologists didnt wanna invest in infrastructure, were greedy, and sold out giving rise to the faceless corporate entities we have today running the field. The future generation of pathologists got thown under the bus.

An unhappy colleague thought it would be great to buy a fast-food franchise (which shall remain unnamed) and have a family member run it while he remained in practice.

He had the $250,000 start-up, but was rejected by the franchise because they didn't want a silent partner.

THE FRANCHISE DIDN'T WANT HIS CASH because they wanted HIM committed to the franchise all the way.

To this day I wonder if a franchise would actually do that.

 

[Substance]

Hundreds of people ended up getting bad test results because your government recruited a lot of FMGs, "some of questionable competency"?

That's very unfortunate for the victims and their loved ones.

Say old boy, do you have any data/sources to stake your claim?

Just curious.

Here you go:

http://www.cbc.ca/news/background/cancer/inquiry.html

It says that there was a "revolving door of pathologists". I can tell you that, based on it being NFLD, those pathologists were 99% FMG paths. Nobody in their right mind goes to live in NFLD - cold, dreary and isolated (and at that point poorly paid) - if they don't have to. The govt probably recruited them with onerous return-of-service contracts which they either bought out of or saw to completion before leaving.

Here's another one:

http://jnci.oxfordjournals.org/content/100/12/836.full

Lots of those FMG paths weren't even boarded by the Royal College. Maybe NFLD was the only place that would let them work. Desperation + desperation = race to the bottom.

This is what happens when your field is relegated to the lowest rung. People die.

Your residency programs could start by having radiology-level cutoffs and cut the FMG contingent to 10%. Take the intelligent people.

 

[Substance]

It would be hell trying to get a lab off the ground. Would be better off buying McDonalds franchises. For a new lab to stay in business it would have to have economy of scale quickly. Most pathologists didnt wanna invest in infrastructure, were greedy, and sold out giving rise to the faceless corporate entities we have today running the field. The future generation of pathologists got thown under the bus.

With that kind of attitude you can expect no changes.

 

[pathstudent]

No wonder they pay so low. The founder worked at Quest for 12 years.
The people on Jersey Shore make like 100,000 per episode. Gym, tan, sign out some surgicals...

http://siparadigm.com/aboutus.html

Wow I can't believe they are advertising a job for a board certified hematopathologist that pays so little. I bet the sales position they are advertising for doesn't do much worse.

 

[rollwithit]

With that kind of attitude you can expect no changes.

No joke. You don't have to have the label of "MBA" to be smart enough to develop a business plan, raise capital, accept risk, and get something going. Nothing but the pathologists themselves kept them from adapting before the "faceless corporate entities" did.

 

[lipomas]

Why can't pathologists band together and create their own megalabs given that's where the money is. I know doctors are generally stubbon and hard to corral, but this would make the most sense in the long run.

I looked at that number above - 110 - and I laughed. Back here in Canada that's what pathologists used to make. Needless to say nobody went into it so they had to recruit a lot of FMGs, some of questionable competency, to do it. But then hundreds of people ended up getting bad test results (ie negative receptors in a receptor-positive cancer, which caused them to miss tamoxifen treatment, and many of them died) so the government, in its reactive way, increased the income to more than 3 times that. Now people are going into it.

You mean like how Bostwick created his own lab? That worked out well for most pathologists.

Is this a full time job? Never mind, it is listed under "Full time jobs." Sounds like a really great job! (sarcasm)

 

[path or no path]

No wonder they pay so low. The founder worked at Quest for 12 years.
The people on Jersey Shore make like 100,000 per episode. Gym, tan, sign out some surgicals...

http://siparadigm.com/aboutus.html

probably after doing some laundry

 

[pathstudent]

These people that market these jobs know what they are doing. I have a good job but the fact that they know they can offer 110000 for a pathologist and fill it is troubling. Pathology is a wonderful discipline but seeing ads like this really bolsters the claims that there are a lot of **** pathology jobs.

 

[NuckingFuts]

Here you go:

http://www.cbc.ca/news/background/cancer/inquiry.html

It says that there was a "revolving door of pathologists". I can tell you that, based on it being NFLD, those pathologists were 99% FMG paths. Nobody in their right mind goes to live in NFLD - cold, dreary and isolated (and at that point poorly paid) - if they don't have to. The govt probably recruited them with onerous return-of-service contracts which they either bought out of or saw to completion before leaving.

Here's another one:

http://jnci.oxfordjournals.org/content/100/12/836.full

Lots of those FMG paths weren't even boarded by the Royal College. Maybe NFLD was the only place that would let them work. Desperation + desperation = race to the bottom.

This is what happens when your field is relegated to the lowest rung. People die.

Your residency programs could start by having radiology-level cutoffs and cut the FMG contingent to 10%. Take the intelligent people.

I can't tell whether you're a racist juvenile or just plain stupid in the way you express yourself.

Either way, I think ALL poor candidates need to be weeded out, irrespective of where they trained.

I work in a huge academic complex, and I'd say about half my colleagues are IMGs; about a quarter of our residents are IMGs; about a fifth of the folks I work with (attendings and residents) are dangerously inept- all of whom are not IMGs, yet all of whom need to be placed in some other specialty.

Seriously, what's with all the IMG badgering on our forum anyway? There are incompetent pathologists out there, just as there are incompetent clinicians- they're incompetent for reasons that may perhaps be beyond our collective comprehension.

P.S. In Amurrica we don't employ the term "Foreign Medical Graduate" anymore- them folk are referred to as "International Medical Graduates".

 

[rollwithit]

These people that market these jobs know what they are doing. I have a good job but the fact that they know they can offer 110000 for a pathologist and fill it is troubling. Pathology is a wonderful discipline but seeing ads like this really bolsters the claims that there are a lot of **** pathology jobs.

You can probably make 110k as a primary care physician at a free clinic. I'm wondering if this is a part time gig? The sales rep position below it indicates that it is full time and mentions some benefits. The MD job doesn't mention any of that.

If this is a legit full time posting, then yes, this is added evidence of there being too many pathologists, a lot of ignorant pushovers, or some combination of the both.

 

[Substance]

I can't tell whether you're a racist juvenile or just plain stupid in the way you express yourself.

Either way, I think ALL poor candidates need to be weeded out, irrespective of where they trained.

I work in a huge academic complex, and I'd say about half my colleagues are IMGs; about a quarter of our residents are IMGs; about a fifth of the folks I work with (attendings and residents) are dangerously inept- all of whom are not IMGs, yet all of whom need to be placed in some other specialty.

Seriously, what's with all the IMG badgering on our forum anyway? There are incompetent pathologists out there, just as there are incompetent clinicians- they're incompetent for reasons that may perhaps be beyond our collective comprehension.

P.S. In Amurrica we don't employ the term "Foreign Medical Graduate" anymore- them folk are referred to as "International Medical Graduates".

I do not see how what I say can be construed as racist, and I do not appreciate the insulting tone. I am merely concerned about the quality of medical education at institutions that are not LCME accredited. In fact, race has nothing to do with it since the Caribbean schools are also included in the places I am weary about, and those places are comprised of mostly white North Americans. They need to be weeded out just as much, if not moreso.

I had neglected to include in my above post that it is not my intention to badger physicians who were trained in other countries - that is not the point. In fact, there are many FMGs that are wonderfully skilled at whichever field they practice. The problem is the ones that aren't - such a varied level of educational quality abroad means that there really isn't a good way to gauge one's adeptness at medicine, and that our acceptance of their credentials as equal or near-equal is a gamble on patient safety. They can always go to an LCME accredited medical school - in fact lots of them do.

GIven your experience at the academic centre, with the great docs who trained abroad amongst the inept domestic folk(did they train at LMCE-accredited schools?), I would say that it supports the notion that pathology should really increase the standards to the same level as radiology, even if most of the spots don't fill. The good colleagues you work with would probably still make it through the cutoffs. Perhaps those inept people would be better off in other fields, as you so stated, or perhaps they shouldn't be boarded. Then again, all fields should have high standards.

 

[scienceguy19]

if the job offering 110k gets filled, it will be a bad sign.

then again, if one had a choice between a 4th fellowship (PGY-8) and a low paying job, one might choose the job.

You can probably make 110k as a primary care physician at a free clinic. I'm wondering if this is a part time gig? The sales rep position below it indicates that it is full time and mentions some benefits. The MD job doesn't mention any of that.

If this is a legit full time posting, then yes, this is added evidence of there being too many pathologists, a lot of ignorant pushovers, or some combination of the both.

 

[hesperion]

Just a curiosity question, has anyone used a recruiting service?

 

[scienceguy19]

I don't like the reasoning that, because the pathology resident is a FMG, or because of their language skills, they don't deserve a job after residency.

All of the foreign grads in internal medicine get a job after residency, so why should pathology be any different? And why are we spending government money to train residents whom we don't expect to get jobs?

In the end, everyone gets screwed, both american and foreign grad alike.

 

[deleted314957]

if ones communication skills suck---fmg, amg, martian or whatever, i am not going to hire them.

 

[dermpathdoc]

I'm an MS4 doing a path rotation right now, and I told the chair about how people on these forums are saying the path job market is bleak. She said that there are many jobs yet to be filled and that the people on the forums are probably the ones who have a hard time getting jobs and/or are unduly unsatisfied with their jobs or job prospects.

just attended the Association of Pathology Chairs meeting and a survey of residents and fellows for this year showed all seeking job s this year attained a job and were happy with them.

Now let those residents and fellows who sought a job this year and did not get one chime in!

 

[mlw03]

would bet a coffee the job get 20+ applicants. look on the map. oradell, nj is less than 20 miles from manhattan. they offer so little because they can, so long as people are willing to sacrifice much to live near nyc.

I came across this job posting at the following link: http://jama.careers.adicio.com/jobs/detail/49632460/181

SIPARADIGM LLC in Oradell, NJ, seeks Pathologist/Hematopathologist. Duties: Interpretation & rendering pathologic diagnosis of bone marrow biopsies & aspirates, lymph nodes specimens, surgical pathology specimens & samples submitted for cytogenetics, molecular & flow cytometry studies; including the appropriate scientific handling & work up of specimens, preparing & signing out pathology reports. Requires: MD or foreign equiv, Anatomical & Clinical Pathology residency & Hematopathology fellowship. Salary: $110,000/yr. CVs to [email protected]

Are you kidding me? 110,000 a year? Is this what we are worth now?
Are we going to keep on churning out graduates who will have either no jobs or low paying jobs?

Would we really be earning less than pharmacists and physicians assistants if there were not enough pathologists?

 

[Thrombus]

just attended the Association of Pathology Chairs meeting and a survey of residents and fellows for this year showed all seeking job s this year attained a job and were happy with them.

Now let those residents and fellows who sought a job this year and did not get one chime in!

LMAO!

The chairs have a vested interest in getting more pathology residents to subsidize their cush jobs. I bet if they conducted a survey at the county jail all the inmates would tell us they were innocent.

When I hear "all who sought a job attained a job and were happy with them" I immediately know this not to be true.

 

[deleted57552]

Happy with the job they have vs. happy to have a job -- this is a psychological boundary that may be blurred in some people's minds.

 

[handwriting]

$110,000 would sound better if it meant only working two days out of the week.

 

[LADoc00]

My opinion is: currently the job market for pathology is THE worst in modern history.


Reasons: Declining reimbursement + extremely poor 401K/market performance since 2008 + inability of new Pathology partner hires to obtain credit to buy out retiring partners has created a Perfect Storm of a total Greek deflationary spiral for new hire salaries.

This is then aggravated by a huge class of previously retired pathologists re-entering the market after a 4-5 year break because their retirement planning has gone into the toliet.

BUT, I see a huge break in about 5 years when many Pathologists literally beginning dying off. Once you start seeing these early 60s/late 50s Pathologists either becoming disabled or dying is when this will all crack open and begin a new era in the field.

 

[2121115]

My opinion is: currently the job market for pathology is THE worst in modern history

Even worse than the late '90's days of the infamous tripod website?

 

[LADoc00]

Even worse than the late '90's days of the infamous tripod website?

Yes, absolutely. In the mid to late 90s the point of reference for many pathologists was the pre-CLIA halcyon days when many owned their histo AND clin lab. It wasnt uncommon for some rural pathologists to make in excess of 2million in 1985 dollars or roughly 4.0m today, some making even several times that.
The shock of the late 90s job market in our field stemmed from what became a mass take over of the clinical labs by hospitals and the total erosion of the outpatient market by Quest etc. but overall the labor market for new grads really wasnt THAT BAD.

It was just massively worse than say radiology, which in the late 90s was exploding. If your buddy from med school now a radiologist was making 7 figs in 1998 and living in a house on the beach with a super model, then yes by comparison your life as a pathologist sucked.

BUT now it is truly bad.

 

[Substance]

Yes, absolutely. In the mid to late 90s the point of reference for many pathologists was the pre-CLIA halcyon days when many owned their histo AND clin lab. It wasnt uncommon for some rural pathologists to make in excess of 2million in 1985 dollars or roughly 4.0m today, some making even several times that.
The shock of the late 90s job market in our field stemmed from what became a mass take over of the clinical labs by hospitals and the total erosion of the outpatient market by Quest etc. but overall the labor market for new grads really wasnt THAT BAD.

It was just massively worse than say radiology, which in the late 90s was exploding. If your buddy from med school now a radiologist was making 7 figs in 1998 and living in a house on the beach with a super model, then yes by comparison your life as a pathologist sucked.

BUT now it is truly bad.

This is kind of interesting. Wasn't it the early 90s when radiology was the least competitive field? Funny how things change...

I never knew paths made that much in the 80s. Up here in Canada path was paid pittance until a bunch of patients died due to a lack of qualifications of the pathologists. So they increased the pay to normal levels to try to get good people back into the field. But I digress..

What do you say is the most lucrative 7fig field now, and for the future? If you were a student going into medicine, what specialty would you pick today?

 

[KeratinPearls]

Yes, absolutely. In the mid to late 90s the point of reference for many pathologists was the pre-CLIA halcyon days when many owned their histo AND clin lab. It wasnt uncommon for some rural pathologists to make in excess of 2million in 1985 dollars or roughly 4.0m today, some making even several times that.
The shock of the late 90s job market in our field stemmed from what became a mass take over of the clinical labs by hospitals and the total erosion of the outpatient market by Quest etc. but overall the labor market for new grads really wasnt THAT BAD.

It was just massively worse than say radiology, which in the late 90s was exploding. If your buddy from med school now a radiologist was making 7 figs in 1998 and living in a house on the beach with a super model, then yes by comparison your life as a pathologist sucked.

BUT now it is truly bad.

I would trust LADocs word over anyone on this board. I have talked to him over the years on SDN and he knows how it really is in private practice. Just a FYI to everyone.

 

[KeratinPearls]

This is kind of interesting. Wasn't it the early 90s when radiology was the least competitive field? Funny how things change...

I never knew paths made that much in the 80s. Up here in Canada path was paid pittance until a bunch of patients died due to a lack of qualifications of the pathologists. So they increased the pay to normal levels to try to get good people back into the field. But I digress..

What do you say is the most lucrative 7fig field now, and for the future? If you were a student going into medicine, what specialty would you pick today?

I think you have to be a business type to making that kind of money.

 

[LADoc00]

This is kind of interesting. Wasn't it the early 90s when radiology was the least competitive field? Funny how things change...

I never knew paths made that much in the 80s. Up here in Canada path was paid pittance until a bunch of patients died due to a lack of qualifications of the pathologists. So they increased the pay to normal levels to try to get good people back into the field. But I digress..

What do you say is the most lucrative 7fig field now, and for the future? If you were a student going into medicine, what specialty would you pick today?

Radiology at least from my research was always pulling down big bucks but the technology advances in the 90s (while really all Path had was immunos coming on board for new revenue) is what catapulted them to the no1 earning spot or at least top 5 among specialists.

Honestly if I was a 3rd or 4th "med student" today, I would be hard pressed to find a 7fig field (and probably not really care because I would be focused on the opposite sex tbh. Even your old standbys like Spinal Ortho or Cards arent pulling that down often. Really the guys doing well now often are playing both sides of the field: meaning they own or part own the surgery center they are referring people to. This will likely be outlawed or more severely curtailed in the future though.

 

[LADoc00]

I would trust LADocs word over anyone on this board. I have talked to him over the years on SDN and he knows how it really is in private practice. Just a FYI to everyone.

Uh thanks...

Was my street cred diminshed by a long absence?

Hopefully one day I can return here and give my "Peace Out" thread when I finally decide to call it quits and head to Bora Bora.

 

[Xinlitik]

What does the deep future look like for Pathology? Not in terms of oversupply, but in terms of encroachment by molecular diagnostics, computer image analysis, and potentially outsourcing? I am a medical student who is quite interested in Pathology, but I am worried whether these are real obstacles in the future or boogie men of 50 years from now.

 

[Substance]

What does the deep future look like for Pathology? Not in terms of oversupply, but in terms of encroachment by molecular diagnostics, computer image analysis, and potentially outsourcing? I am a medical student who is quite interested in Pathology, but I am worried whether these are real obstacles in the future or boogie men of 50 years from now.

Honestly I think that tumor classification will be automated once the genetics are figured out. Think about it, most of path is just taxonomy. We don't have a good way to classify tumors aside from getting someone to provide their subjective opinion on it. Once the genetics are teased out, tumor classification will be automated and done by lab techs, just like CBCs and lytes.

Molecular imaging will kill metastatic workups too. Most tumor classification will be done by radiology in the future.

I'm bearish on path.

 

[Xinlitik]

Honestly I think that tumor classification will be automated once the genetics are figured out. Think about it, most of path is just taxonomy. We don't have a good way to classify tumors aside from getting someone to provide their subjective opinion on it. Once the genetics are teased out, tumor classification will be automated and done by lab techs, just like CBCs and lytes.

Molecular imaging will kill metastatic workups too. Most tumor classification will be done by radiology in the future.

I'm bearish on path.

Thanks for the reply. That sounds like what I've been seeing. In the lab I work in for instance, I learned that we're making pretty rapid progress on imaging of AB and tau deposits. I don't know how pathology can compete when this technique is applied to other markers for other diseases in the coming decades. But I am only an MS2 so I am far from the person to predict it.

 

[LADoc00]

Im going to be contrarian here. I dont think Molecular Genetics will subvert morphology by LM, at least not for 100+ years and maybe not even then.

LM morphology reads by Pathologists are just too cheap by comparison. If anything, the financial strains on the industrialized world with the rising healthcare costs will collapse the "personalized medicine" crusades and biopharma in general.

Think of what is coming as more of a mini-Dark Age, governments/payors/providers will be:
1.) digging deep for the cheapest possible delivery of care
2.) government funded research and academia in general will either nearly perish in some countries (Greece, Spain, Italy etc) or go on life support (US, Britian, Germany) due to unprecendented financial strains of the massive demographic group in the elderly range
3.) salaries will at first be severely depressed from forced internal devaluation only to be followed by uncontrolled inflationary waves as leaders buckle to unpopular austerity, so private innovation in biopharma will come to a dramatic end/reduction

overall, the innovation we have known for roughly 100 years and the pace of that innovation will dramatically come to a grinding halt.

mark my words.

 

[Arctic Char]

i've been on this side of prognostication for a while now, despite the molecular pathology fellows in my department and their "molecular explosion" theories. its the cost, stupid. nice to be corroborated by LAdoc00, always a sane voice on here. Welcome back

 

[Silent Cool]

Im going to be contrarian here. I dont think Molecular Genetics will subvert morphology by LM, at least not for 100+ years and maybe not even then.

LM morphology reads by Pathologists are just too cheap by comparison. If anything, the financial strains on the industrialized world with the rising healthcare costs will collapse the "personalized medicine" crusades and biopharma in general.

Think of what is coming as more of a mini-Dark Age, governments/payors/providers will be:
1.) digging deep for the cheapest possible delivery of care
2.) government funded research and academia in general will either nearly perish in some countries (Greece, Spain, Italy etc) or go on life support (US, Britian, Germany) due to unprecendented financial strains of the massive demographic group in the elderly range
3.) salaries will at first be severely depressed from forced internal devaluation only to be followed by uncontrolled inflationary waves as leaders buckle to unpopular austerity, so private innovation in biopharma will come to a dramatic end/reduction

overall, the innovation we have known for roughly 100 years and the pace of that innovation will dramatically come to a grinding halt.

mark my words.

Ron Paul for president.

 

[Silent Cool]

Radiology at least from my research was always pulling down big bucks but the technology advances in the 90s (while really all Path had was immunos coming on board for new revenue) is what catapulted them to the no1 earning spot or at least top 5 among specialists.

Honestly if I was a 3rd or 4th "med student" today, I would be hard pressed to find a 7fig field (and probably not really care because I would be focused on the opposite sex tbh. Even your old standbys like Spinal Ortho or Cards arent pulling that down often. Really the guys doing well now often are playing both sides of the field: meaning they own or part own the surgery center they are referring people to. This will likely be outlawed or more severely curtailed in the future though.

LADoc,

Do you see Radiology suffering the same situation at Pathology in ~10 years Re:market saturation? The number of rads training spots went up almost 10X in 1999 I believe, and over the past few years the market has become more saturated. May rads are doing 2 fellowships to get employed.

 

[thebouque]

What does the deep future look like for Pathology? Not in terms of oversupply, but in terms of encroachment by molecular diagnostics, computer image analysis, and potentially outsourcing? I am a medical student who is quite interested in Pathology, but I am worried whether these are real obstacles in the future or boogie men of 50 years from now.

Has there been any decrease in light microscopy (LM) because of immunohistochemistry? No, it's an ancillary test. The same will apply to molecular and cytogenetics. LM will always be the basis of pathology and tumor/tissue diagnosis, just like taking a good history and performing a physical exam is the basis of clinical medicine. Family physicians and psychiatrists won't be outsourced by computer programs. Also you're mentioning computer image analysis. No program so far will be able to analyze a slide and spit out a diagnosis. Digital slides aren't even the norm in path labs! Don't worry, the number of biopsies and surgical resections is increasing, the future is bright for pathology.

 

[pathstudent]

Completely agree. To me the "personalized healthcare" is a sham and pure creation from self promotion by drug companies and researchers.

If we are concerned about decreasing healthcare costs we can't continue to approve payments for Targeted Therapies that extend life by months but add hundreds of thousands of dollars to healthcares expenses.

If you can develop another gleevec, awesome, but few malignancies are so simple in ther pathogenesis and not due to a single genetic aberration.

We would be way better off taking that money and spending it on reducing obesity and promoting healthy lifestyles. But drug companies can't make money off promoting healthy lifestyles and researcher can't fund their labs with it.

 

[leu345]

Well, we are doing the same morphology classification for decades. It certainly will still play a role in a initial diagnosis and looking at margins, but morphological diagnosis has limited meaning by itself. Personalized medicine is a process, a slow one, waiting for technology and research to catch up. But it will be here, though maybe not in our generation.

Completely agree. To me the "personalized healthcare" is a sham and pure creation from self promotion by drug companies and researchers.

If we are concerned about decreasing healthcare costs we can't continue to approve payments for Targeted Therapies that extend life by months but add hundreds of thousands of dollars to healthcares expenses.

If you can develop another gleevec, awesome, but few malignancies are so simple in ther pathogenesis and not due to a single genetic aberration.

We would be way better off taking that money and spending it on reducing obesity and promoting healthy lifestyles. But drug companies can't make money off promoting healthy lifestyles and researcher can't fund their labs with it.

 

[Arctic Char]

Agree strongly with pathstudent on this. if you think personalized medicine is legit, read the package insert for zelboraf. then contemplate that "this is the best we can do?"

 

[mlw03]

yeah, on board with pathstudent here. by far the best bang for your healthcare dollar is to reduce smoking and obesity rates. nothing else would even come close. spend 2 hours walking around your average suburban mall to see the problem up close.

 

[pathstudent]

Well, we are doing the same morphology classification for decades. It certainly will still play a role in a initial diagnosis and looking at margins, but morphological diagnosis has limited meaning by itself. Personalized medicine is a process, a slow one, waiting for technology and research to catch up. But it will be here, though maybe not in our generation.

No we are not doing the same mophology classification for decades. It is refined all the time.

My point is is that most targeted therapies have been an abysmal failure for most solid tumors due to the numerous genetic abnormalities most solid tumors need to achieve metastatic potential. And even if we can get to the point where we say this cancer needs these five drugs to block the various oncogenic pathways, we can't afford to spend 80,000 a month to keep people alive. Unfortunately oncologists don't help at all either. I can't tell you how many tumor boards I have been to where I have seen age 90 or over patients presented to discuss treatment for their metastatic lung, pancreatic, melanoma or whatever cancer. Oncologists don't make money by not giving chemo.

To improve the health of the nation we should spend money or weight loss, better diet and effective screening of cancers. But like I said before, you have too many entities whose bank accounts are dependent on people being sick.

Molecular testing will be integrated into traditional morphologic diagnosis like it has been in hemepath but it won't be eliminating the microscope in our lifetime.

 

[LADoc00]

LADoc,

Do you see Radiology suffering the same situation at Pathology in ~10 years Re:market saturation? The number of rads training spots went up almost 10X in 1999 I believe, and over the past few years the market has become more saturated. May rads are doing 2 fellowships to get employed.

Rads is already there. The older guys in the field arent retiring like as they once did. In fact, from the Rads old timers I just had lunch with, their net worth is probably 1/2 at the end of their career than those who got out in the 90s.

Rads attendings are working longer and harder than ever before clogging up the new hire cycle. And there are many more Rads training slots as Path ones so I expect the crapstorm to hit that field very soon.

 

[leu345]

It maybe refined, but basically we are doing the same thing over the decades. For most of the malignancies, we were not able to tell anything else besides it is a malignant tumor, or it is a morphologically malignant tumor. That is clearly not enough. On the other side, moecular classfication, which already started in hemepath, will give you more info regarding the biology of the malignancies. It may not results in a cure of the disease tomorrow, as you noticed, but it is a process and it is happening.

I can understand that we pathologists are used to the role of a "morphologist", and we feel threatened by the idea of making diagnosis without a microscope. But if we can not fight it, we should embrace it. My personal view is that if pathology fail to take a leading role in the trend of molecular diagnosis, other people including those in medical genetics will. When that happens, the future of pathology will be indeed abysmal.

No we are not doing the same mophology classification for decades. It is refined all the time.

My point is is that most targeted therapies have been an abysmal failure for most solid tumors due to the numerous genetic abnormalities most solid tumors need to achieve metastatic potential. And even if we can get to the point where we say this cancer needs these five drugs to block the various oncogenic pathways, we can't afford to spend 80,000 a month to keep people alive. Unfortunately oncologists don't help at all either. I can't tell you how many tumor boards I have been to where I have seen age 90 or over patients presented to discuss treatment for their metastatic lung, pancreatic, melanoma or whatever cancer. Oncologists don't make money by not giving chemo.

To improve the health of the nation we should spend money or weight loss, better diet and effective screening of cancers. But like I said before, you have too many entities whose bank accounts are dependent on people being sick.

Molecular testing will be integrated into traditional morphologic diagnosis like it has been in hemepath but it won't be eliminating the microscope in our lifetime.

 

[gbwillner]

I can understand that we pathologists are used to the role of a "morphologist", and we feel threatened by the idea of making diagnosis without a microscope. But if we can not fight it, we should embrace it. My personal view is that if pathology fail to take a leading role in the trend of molecular diagnosis, other people including those in medical genetics will. When that happens, the future of pathology will be indeed abysmal.

This. Genomic medicine will change everything whether we like it or not. It is still in its infancy and no, it will not eliminate the microscope. It will, however, give us one more tool to maximize our ability to guide therapeutics. We can either stand by and let clinicians send all their specimens to some national lab to do this work, or internalize these tests in our own departments. Do you realize we can already get reimbursed for next-gen based sequencing of gene panels ($7500) or exome capture (not from insurance but from other institutions) (~10K)? Now are you interested?

 

[WEBB PINKERTON]

This. Genomic medicine will change everything whether we like it or not. It is still in its infancy and no, it will not eliminate the microscope. It will, however, give us one more tool to maximize our ability to guide therapeutics. We can either stand by and let clinicians send all their specimens to some national lab to do this work, or internalize these tests in our own departments. Do you realize we can already get reimbursed for next-gen based sequencing of gene panels ($7500) or exome capture (not from insurance but from other institutions) (~10K)? Now are you interested?

Sound like a sales rep. I remember one bragging about how much Urovysion paid. Telling us how much money we were gonna be making. Then one day the government cut reimbursement for the test in half.

 

[MOHS_01]

This. Genomic medicine will change everything whether we like it or not. It is still in its infancy and no, it will not eliminate the microscope. It will, however, give us one more tool to maximize our ability to guide therapeutics. We can either stand by and let clinicians send all their specimens to some national lab to do this work, or internalize these tests in our own departments. Do you realize we can already get reimbursed for next-gen based sequencing of gene panels ($7500) or exome capture (not from insurance but from other institutions) (~10K)? Now are you interested?

Sounds like a ****ing racket to me. Anyway, to the poster asking what students today should go into to make good $$ -- good luck. I don't see any great bright spots -- anywhere. Truthfully, I'd consider kicking back and taking some PCP short path, maybe FM with little call, take the gov't subsidies, and call a doctor whenever someone needs one. Why work your **** off and not get paid for it?

The multi-million per annum noted above is a rarity these days. Outside of privately owned major dermpath labs and the occasional full service urology group with limited ownership and busy employees, I've not heard of these numbers in the past several years. Were I to be paid for my labors today as I was in 2007 I would be north of 7 figures; the asshats at the AMA decided to offer us up at CMS's sacrificial altar and put an end to that (as inappropriate and in as clear a violation of plain language that it was, but I digress).

Best of luck. It's not looking good for providers going forward.