Job Market Update

[Napoleon1801]

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Position posted last month on Pathologyoutlines at a mid-level academic in the midwest with starting pay at 130k with 11 applicants (most with a couple fellowships), now filled.

This is the future.

 

[gbwillner]

...N of 1.

In the past 2 years I've seen academic salaries (mostly good places; AP jobs at assistant prof) range from $170K-$250. Most private or industry jobs I've seen are over $250 starting. In academia, despite reimbursement problems, the rates are going up, but so is the on-service component of the job. There are also relatively fewer positions increasing the volume/attending.

 

[Thrombus]

Position posted last month on Pathologyoutlines at a mid-level academic in the midwest with starting pay at 130k with 11 applicants (most with a couple fellowships), now filled.

This is the future.

Sounds like they offered too much money.

 

[BrainPathology]

Position posted last month on Pathologyoutlines at a mid-level academic in the midwest with starting pay at 130k with 11 applicants (most with a couple fellowships), now filled.

This is the future.

Didn't you mean 1011 applicants? We all know that every group in the country gets at least 50 unsolicited CV's and cover letters asking for positions in places that aren't even hiring. Only 11 applicants for one job doesn't fit the narrative of doom that we must stick to here.

 

[Napoleon1801]

...N of 1.

In the past 2 years I've seen academic salaries (mostly good places; AP jobs at assistant prof) range from $170K-$250. Most private or industry jobs I've seen are over $250 starting. In academia, despite reimbursement problems, the rates are going up, but so is the on-service component of the job. There are also relatively fewer positions increasing the volume/attending.

Not disputing that there are better paying jobs out there, but how many applicants are going for them once they get listed? My point is that this position is less than desirable, yet lemmings are lining up for it. That can't be a good sign, can it?

 

[yaah]

Why is it less than desirable? Just because of the salary? How do you know it's less than desirable? I trained with several residents who thought a job like that was a good fit for them, they wanted nothing to do with private practice.

 

[path24]

Bet a ton of unemployed fellows are kicking themselves after seeing this. Almost a 10% chance at a job...you kill for those odds. (or is 11 just the "qualified applicants")

The salary is also letting everyone know their stance on the upcoming shortage.

 

[Substance]

Anything less than 300k for a specialty full-time is not ideal, especially when as a student you have the choice of doing anything else (unless you suck).

Good medical students will pick better options than that, always. Get dizzy from a scope and cut up corpses for 170k, or work from home for three times looking at a screen? Or run your own office for two times as much working 3 day weeks, with patients that actually want to get better (plus you could do the most lucrative part of path on the side here too while leaving out all of the other crap)?

Like science? Why slum it out in path after that PhD when you can learn how to treat patients with cancer using modern technology, with far more money, respect and fulfillment?

Path and primary care are stuck with the incompetents and really bad IMGs. Even the mommy-trackers do derm gas or rads.

Shouldn't all residency graduates be "qualified"? If the rhetoric is that there are "good jobs for qualified applicants" then some residency programs either suck, or their recruits suck - probably both. Why have them there at all?

Your field is nuts. Plain and simple. I don't get it. I can't see how a field's leadership can be proud of the field when half of the people in it are below average.

The quality, not quantity, of your manpower is what is important. I've seen far too many people be harmed by terrible IMGs and weak CMGs to think any differently. Your field has to shape up.

 

[Pathman1000]

Anything less than 300k for a specialty full-time is not ideal, especially when as a student you have the choice of doing anything else (unless you suck).

Good medical students will pick better options than that, always. Get dizzy from a scope and cut up corpses for 170k, or work from home for three times looking at a screen? Or run your own office for two times as much working 3 day weeks, with patients that actually want to get better (plus you could do the most lucrative part of path on the side here too while leaving out all of the other crap)?

Like science? Why slum it out in path after that PhD when you can learn how to treat patients with cancer using modern technology, with far more money, respect and fulfillment?

Path and primary care are stuck with the incompetents and really bad IMGs. Even the mommy-trackers do derm gas or rads.

Shouldn't all residency graduates be "qualified"? If the rhetoric is that there are "good jobs for qualified applicants" then some residency programs either suck, or their recruits suck - probably both. Why have them there at all?

Your field is nuts. Plain and simple. I don't get it. I can't see how a field's leadership can be proud of the field when half of the people in it are below average.

The quality, not quantity, of your manpower is what is important. I've seen far too many people be harmed by terrible IMGs and weak CMGs to think any differently. Your field has to shape up.

what's your field bro?

 

[rollwithit]

what's your field bro?

Trolling.

 

[KluverB]

I can't see how a field's leadership can be proud of the field when half of the people in it are below average.

The quality, not quantity, of your manpower is what is important. I've seen far too many people be harmed by terrible IMGs and weak CMGs to think any differently. Your field has to shape up.

Thanks for the advise. I still don't get what possible interest you have wasting your time on a path forum if you're not doing path, much less medicine in the US.

Btw, show me a field in which more that half of the people are above average. (Hint: it's called the average for a reason 😛)

 

[Substance]

Thanks for the advise. I still don't get what possible interest you have wasting your time on a path forum if you're not doing path, much less medicine in the US.

Btw, show me a field in which more that half of the people are above average. (Hint: it's called the average for a reason 😛)

ROAD
Rad onc

 

[2121115]

ROAD
Rad onc

Rad onc has the same issues with the IOAS exception. Many urologists own their own radiation oncologists.

 

[Pathman1000]

Trolling.

what's your field bro? you're not in path either, are you?

 

[rollwithit]

what's your field bro? you're not in path either, are you?

Nope. Is this concerning? I'm not the one attacking the field. Bro? What is this, jersey shore?

 

[Overhauser]

what's your field bro?

Self-gratification via anonymous internet message boards.

 

[Substance]

Rad onc has the same issues with the IOAS exception. Many urologists own their own radiation oncologists.

Nowhere near as many as own pathology labs.

And for those attacking me, maybe you should go ask a few medical students, surgeons, or other colleagues for whom you work and see what they really think of pathologists.

There is a shortage...of pathologists who weren't knuckle-draggers coming in.

 

[KluverB]

ROAD
Rad onc

This ain't Lake Wobegon. Half of the people in each of those fields are below average.

 

[Substance]

This ain't Lake Wobegon. Half of the people in each of those fields are below average.

Depends on your vantage point. Mine is comparing the entry-level resident/medical student to their peers, not comparing residents within a discipline.

Derm residents are by and large top-notch clinically and academically (domestic trained high scorers, or exceptionally strong FMGs from world-class schools). By contrast, path residents and primary care residents are mostly below average (most FMGs and all domestic residents going abroad to proprietary for-profit medical schools are by definition below average).

----edited because I was painting all IMGs with the same brush, which was inappropriate----

 

[pathperson]

.......all domestic residents going abroad are by definition below average).

This is purely idiotic. ALL domestic residents who went to med school abroad are "by definition" below average? What are you talking about? Not all medical schools "abroad" are located in the Caribbean. A person with family or extensive experience living "abroad" who is offered a full scholarship to a top notch medical school "abroad" is not below average. This is the situation of someone in my world. The student never applied to med school in the US, took the full scholarship to one of the oldest and most prestigious institutions in Europe, and was awarded a free medical education in a foreign language the student had already mostly mastered because they were already living in that country. Rare, but happens. Technically an "IMG."

The medical education could claim to be better than what is offered in the US, as the student was constantly told on rotations in the US that they were head and shoulders above their peers who were US medical students. Rigorous written and oral exams, more hands-on training with patients (the student can actually draw blood, unlike the hapless US med students mocked in a NYT article earlier this week), and other aspects of the medical education come to mind.

The student is now a resident in a very competitive specialty in the US at another top notch institution, their #1 choice and in their own hometown. This person is American and wanted to come home, but is debt-free, bilingual and got an excellent education "abroad."

That doesn't sound very "below average" to me. Thankfully her residency program agreed.


Caribbean med schools have a pretty bad reputation here. I have also heard some things about some of the DO schools in the US being less rigorous as well, and I would rather accept a US citizen or non-US citizen who attended a truly excellent med school abroad than anyone who went to a crappy med school abroad or a crappy US med school....and yes they do exist.

On a different topic, there is now a new rule that DO and MD residencies are merging their accreditation systems; this was decided a few months ago. Now all DOs can apply to all MD residencies and fellowships, and vice versa. This will make it easier for DOs to get into MD residencies, and vice versa, so if you do one for med school, and another for residency it will make it easier for fellowship to recognize where you did residency. I get that, and I know no residency MUST accept or even interview DO applicants if they don't want to, but the whole thing is just weird. You can check out all the buzz on the DO forums here.

I am surprised no one brought it up on this forum as another thing to freak out about how pathology will now be overrun with DOs and this will definitely be the downfall of humanity. No one will hire any pathologists now for sure, since only DOs will go into pathology, yada yada yada.

But hey, tomorrow is a new day, full of promise and new opportunity to proclaim the coming end of the world, so go nuts.

 

[Substance]

.......all domestic residents going abroad are by definition below average).

This is purely idiotic. ALL domestic residents who went to med school abroad are "by definition" below average? What are you talking about? Not all medical schools "abroad" are located in the Caribbean. .

I agree. I have edited the above post to reflect that. Pardon my oversight.

 

[bberlioz]

Any comment on the new paper from Arch Pathol Lab Med?

"The Incredible Shrinking Billing Codes"
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2014-0041-ED

I think the main problem lies in the lack of awareness by the general public of what pathologists do. When patients finally understand that their entire oncologic management and outcome depends on the pathologist's assessment (diagnosis, prognosis and prediction), maybe there will be stronger lobbying for stricter quality assurance in surgical pathology, and increased funding.

What is the point to save a few dollars on accurate diagnostic if it compromises the direction of thousand of dollars of chemo + rad onc treatment?

Food for thought.

 

[Substance]

Any comment on the new paper from Arch Pathol Lab Med?

"The Incredible Shrinking Billing Codes"
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2014-0041-ED

I think the main problem lies in the lack of awareness by the general public of what pathologists do. When patients finally understand that their entire oncologic management and outcome depends on the pathologist's assessment (diagnosis, prognosis and prediction), maybe there will be stronger lobbying for stricter quality assurance in surgical pathology, and increased funding.

What is the point to save a few dollars on accurate diagnostic if it compromises the direction of thousand of dollars of chemo + rad onc treatment?

Food for thought.

Nobody knows what you do.

To the layman, and to most of your colleagues, pathologists equal one of two things:

1. pathologist = autopsies

2. pathologist = steward of automated laboratory machines

Your professional society does nothing to dispel those images.

 

[Pollux]

Path and primary care are stuck with the incompetents and really bad IMGs. Even the mommy-trackers do derm gas or rads.

Depends on your vantage point. Mine is comparing the entry-level resident/medical student to their peers, not comparing residents within a discipline.

Derm residents are by and large top-notch clinically and academically (domestic trained high scorers, or exceptionally strong FMGs from world-class schools). By contrast, path residents and primary care residents are mostly below average (most FMGs and all domestic residents going abroad to proprietary for-profit medical schools are by definition below average).

As an FMG, I take offense to your statements above. I'm not a US citizen and went to a foreign medical school. I had top-notch USMLE scores (276/99, 279/99) and US clinical experience. I knew I would have been competitive applying to many other specialties, but I chose Pathology because I pursued what I loved. I'm in my last year of residency now, and could not have been happier with that decision, despite my realistic appraisal of the current job market.

Coincidentally, I got my resident in service exam score back today, and I obtained the highest overall score on the exam amongst all pathology residents in the country (694/>99). Please think before you stereotype all IMG/FMGs and regarding us, as a whole, as inferior species.

 

[Substance]

As an FMG, I take offense to your statements above. I'm not a US citizen and went to a foreign medical school. I had top-notch USMLE scores (276/99, 279/99) and US clinical experience. I knew I would have been competitive applying to many other specialties, but I chose Pathology because I pursued what I loved. I'm in my last year of residency now, and could not have been happier with that decision, despite my realistic appraisal of the current job market.

Coincidentally, I got my resident in service exam score back today, and I obtained the highest overall score on the exam amongst all pathology residents in the country (694/>99). Please think before you stereotype all IMG/FMGs and regarding us, as a whole, as inferior species.

You did well and I am not referring to individuals such as yourself.

I am merely stating a "more likely than not" scenario, mainly that a greater proportion of US individuals who go to for profit proprietary offshore medical schools and IMGs from foreign countries that match to pathology are below average than other more competitive fields.

I am not including medical schools that have good reputations such as ones from Commonwealth nations that so happen to accept foreign students as a way to subsidize their domestic ones. McGill in Canada does this (it accepts more Americans than non-Quebecer Canadians). The offshore schools I refer to are ones where the primary motive of the school is profit, not excellence.

 

[BlondeDocteur]

Funnily enough, the lifestyle fields-- the famous ROAD specialties-- often have lower physicians satisfaction scores. Choosing anything for extrinsic reasons rather than intrinsic love of the game usually doesn't hold up in the long term. Dermatologists aren't too pleased with their field, as a whole (though they more than any other specialty are likely to say that if they could do it all over again, they'd pick the same field). These fields in my experience attract people who are often bitter, disillusioned and/or profit-motivated. They scored highly and did well and feel like they can squeeze themselves into a competitive field, so do so.

If anything, path suffers from a stereotype that it & radiology attract the socially awkward, the people who can't hack it in the interpersonal environment of the wards. I don't think there is any shred of truth to a perception that other doctors, or the public, think pathologists are idiots. It's seen as a cerebral, intellectual, eccentric field, for people who enjoyed the first 2 years of med school more than the last two. Frankly at my school the bottom-feeders went into primary care & psychiatry. This does not mean that pathology as a discipline is difficult to gain acceptance to, but like anything, the top echelon of programs is packed full of amazing, interesting, accomplished people.

Since I have yet to complete a single day of path residency, I will still speak as a 'clinician.' I think surgeons respect pathologists immensely. I've said before, one of the first things I was trained to do was to look at the name, not the final diagnosis, on the path report. We interface with pathologists daily in huge multidisciplinary conferences and tumor boards, and for our oncologic, endocrine, and transplant cases our clinical care and surgical care would absolutely grind to a halt without them. I think there is a little bit of pity from surgeons in that they feel pathologists are missing out on the glamor and adrenaline of medicine-- very few would want to change places. But to say that a surgeon's first thought upon corresponding with his/her pathologist colleague is "oh, you poor thing" or "watch out, this guy is probably borderline mentally deficient" is absurd.

 

[icpshootyz]

Thanks Blonde. I've had similar interactions with the clinicians I read cases for. And as a dermpath, we are very well respected by dermatologists who we read cases for. I don't know why Substance has this idea that all other docs look down on pathologists, that certainly has not been my experience at all. Maybe his/her hospital has bad pathologists, who knows. At the facilities I work we are very much respected by our clinician colleagues.

 

[Jonassen]

Path and primary care are stuck with the incompetents and really bad IMGs. Even the mommy-trackers do derm gas or rads.

I wouldn't diss primary care. Aside from supply and demand, there's another economic truism in life:
Whoever sees the money first or is the one shaking the hand in each major business transaction, makes the most money.

In medicine, that would mean the PCPs, first line specialists like derm and the surgeons. In the business world, they would be known as the "front office" or the revenue generators. Of course the insurance and management guys see the money even earlier.

Fee for service ironically is what has kept the cost-side "back office" medical specialties such as anesthesia, radiology, rad onc and path in the running for so long. The eventual retirement of fee for service in favor of ACOs is going to crush these specialties, because the money pool is going to first go through the PCPs and surgeons (they bring in the patients). The administrators will always in time kiss ass to the real revenue generators. With fee for service, it didn't matter as long as your code paid a defined amount, but if you get rid of fee for service, watch out because the truism will come back to play.

 

[pathstudent]

I wouldn't diss primary care. Aside from supply and demand, there's another economic truism in life:
Whoever sees the money first or is the one shaking the hand in each major business transaction, makes the most money.

In medicine, that would mean the PCPs, first line specialists like derm and the surgeons. In the business world, they would be known as the "front office" or the revenue generators. Of course the insurance and management guys see the money even earlier.

Fee for service ironically is what has kept the cost-side "back office" medical specialties such as anesthesia, radiology, rad onc and path in the running for so long. The eventual retirement of fee for service in favor of ACOs is going to crush these specialties, because the money pool is going to first go through the PCPs and surgeons (they bring in the patients). The administrators will always in time kiss ass to the real revenue generators. With fee for service, it didn't matter as long as your code paid a defined amount, but if you get rid of fee for service, watch out because the truism will come back to play.

Totally agree with that. Hospital systems will seek out pathologists and anesthisologists that will accept the job for the lowest salary. Yes there will still be talk of quality but hospital admins, internal medicine types followed by subspecialty surgeons will control the flow of money in the coming decades. And you know people care more about then history, service and quality? Money. Radiologists will be hit hard too. But they still have a little more clout as a group. But pathologists, anesthesiologists and hospitalists will be treated like housekeeping, food service, other cost centers in the hospital.

 

[BlondeDocteur]

There are so many checks and balances in place to prevent that doomsday-type scenario from happening. For starters the surgical services wouldn't exactly thrive without competent anesthesiologists or pathologists. A few lawsuits, a few botched anesthetics or missed diagnoses or incorrectly called frozen sections with recurrences, etc... If you're right and money reigns supreme then imagine the money which would go into defending all these suits or paying out damages. Imagine all the frustrated surgeons leaving for greener pastures due to the incompetence of their colleagues with the resultant loss of income. Then the resultant rise in salaries, invisible hand-style, to attract better people.

Unless you're positing some kind of mass conspiracy wherein every single hospital in the nation simultaneously sets physician reimbursement to exactly the same level, it ain't gonna happen.

At least in pathology there is no temptation to replace MDs with midlevels.

I actually think the next big market correction will be (is) radiology reimbursement.

 

[vistaril]

There are so many checks and balances in place to prevent that doomsday-type scenario from happening. For starters the surgical services wouldn't exactly thrive without competent anesthesiologists or pathologists. A few lawsuits, a few botched anesthetics or missed diagnoses or incorrectly called frozen sections with recurrences, etc... If you're right and money reigns supreme then imagine the money which would go into defending all these suits or paying out damages. Imagine all the frustrated surgeons leaving for greener pastures due to the incompetence of their colleagues with the resultant loss of income. Then the resultant rise in salaries, invisible hand-style, to attract better people.

Unless you're positing some kind of mass conspiracy wherein every single hospital in the nation simultaneously sets physician reimbursement to exactly the same level, it ain't gonna happen.

At least in pathology there is no temptation to replace MDs with midlevels.

I actually think the next big market correction will be (is) radiology reimbursement.

your perception of the field you are about to enter is very very different from the perception others have of it. Including(apparently) many other pathologists.

And that's not meant to be critical, as I say that coming from the one field that has a more negative perception(with even poorer job opps) than pathology.

 

[Substance]

There are so many checks and balances in place to prevent that doomsday-type scenario from happening. For starters the surgical services wouldn't exactly thrive without competent anesthesiologists or pathologists. A few lawsuits, a few botched anesthetics or missed diagnoses or incorrectly called frozen sections with recurrences, etc... If you're right and money reigns supreme then imagine the money which would go into defending all these suits or paying out damages. Imagine all the frustrated surgeons leaving for greener pastures due to the incompetence of their colleagues with the resultant loss of income. Then the resultant rise in salaries, invisible hand-style, to attract better people.

Unless you're positing some kind of mass conspiracy wherein every single hospital in the nation simultaneously sets physician reimbursement to exactly the same level, it ain't gonna happen.

At least in pathology there is no temptation to replace MDs with midlevels.

I actually think the next big market correction will be (is) radiology reimbursement.

It all comes down to math.

The surgical services are doing just fine with CRNAs at present. From a corporate perspective, one or two dead patients and the resulting malpractice payouts might still make the use of unqualified practitioners profitable if the volume is high enough.

Same with pathology. Since errors aren't particularly immediate in pathology, corporate interests are probably just fine with a few missed diagnoses by some incompetents because by the time the lawsuits come around, the interest and profit gained in the savings from paying the pathologists less may very well likely cover the malpractice payouts and then some.

I was also under the impression that malpractice falls under the domain of the practitioner moreso than the institution. If a stupid pathologist employee screws up at Quest, does Quest hold any liability?

 

[WEBB PINKERTON]

People should forget about pathology and go back to school to be an actuary. They are going to be a VITAL part of the health care "teams" of the future. Corners will need to be cut in areas like pathology and gas once payments are bundled. Hospitals will be overpaying for the first line specialists who will keep their supply and demand in check.

Oh and you will actually be recruited for jobs after actuary training, unlike pathology where you have to brown nose and network like crazy to find all those non-posted jobs.

 

[LADuck00]

People should forget about pathology and go back to school to be an actuary. They are going to be a VITAL part of the health care "teams" of the future. Corners will need to be cut in areas like pathology and gas once payments are bundled. Hospitals will be overpaying for the first line specialists who will keep their supply and demand in check.

Oh and you will actually be recruited for jobs after actuary training, unlike pathology where you have to brown nose and network like crazy to find all those non-posted jobs.

Nobody wants to do math all day.

 

[Johnny Sunshine]

Not even I, who have a degree in it.

Besides, I wouldn't be surprised if computer algorithms will soon be able to comb though massive amounts of data so efficiently, actuaries will become obsolete as well. As well as researchers performing correlation studies...

 

[rollwithit]

Not even I, who have a degree in it.

Besides, I wouldn't be surprised if computer algorithms will soon be able to comb though massive amounts of data so efficiently, actuaries will become obsolete as well. As well as researchers performing correlation studies...

Not only that, but you still have to be good at selling the services, which can be quite difficult at understanding the value behind at times.

It's a solid career choice but requires a lot of hard work and sacrifice - like any good career. Even after the education portion, it takes the better part of a decade to pass the licensing exams and all that fun stuff. Even then, you are probably looking at a salary the bottom 10-20% of pathologists earn - assuming you've managed to progress within your firm, bank, insurance co, etc.

 

[BlondeDocteur]

It all comes down to math.

The surgical services are doing just fine with CRNAs at present. From a corporate perspective, one or two dead patients and the resulting malpractice payouts might still make the use of unqualified practitioners profitable if the volume is high enough.

Same with pathology. Since errors aren't particularly immediate in pathology, corporate interests are probably just fine with a few missed diagnoses by some incompetents because by the time the lawsuits come around, the interest and profit gained in the savings from paying the pathologists less may very well likely cover the malpractice payouts and then some.

I was also under the impression that malpractice falls under the domain of the practitioner moreso than the institution. If a stupid pathologist employee screws up at Quest, does Quest hold any liability?

1) Pathology's errors can be apparent in as short a time as days to weeks (for example, a mis-called frozen section where the final report disagrees, but treatment decisions have already been taken). Or minutes, in blood banking.

2) If a large, systemic error such as a missed diagnosis resulting in irreversible surgery, radiation, chemotherapy, etc occurs, then the resultant suit will often target both the practitioner(s) as well as the institution-- deeper pockets. Whether or not such a suit is defensible or winnable is another question entirely, of course.

Dead wood is always a liability.

 

[LADoc00]

Most important errors in Pathology are only seen YEARS later in terms of malpractice. Frozen section misses that are picked up the next day are NOT actionable malpractice incidents.

This is VERY important for all you noob pathologists to realize. There is a published rate of missed frozens that is not zero.

Meanwhile your biggest hits will come from FALSE NEGATIVES. Cases called benign that are indeed positive and caught much later when the patient is identified as Stage IV etc.

Ignore the fools who tell you false positives are where most of the hits will come. Its all about FNs which is why most group QC operations are a joke. Unless they plan on double reading negatives as well as new positives, they are not catching the most dangerous sleepers.

Pathologists are named in suits where they are employees in large institutions but the real target is the institution, who doesnt have the same 1/3m max award amount their insurance will cover.

On a side note, I have NEVER known a pathologist to get nabbed in a malprac where they hit his/her personal wealth in the process. Im sure it has happened but it is rare.

Malprac is there but honestly is a fairly small side show in our profession and this is coming from a guy who sees as many cases fly by his scope as anyone in US.....

 

[2121115]

Ignore the fools who tell you false positives are where most of the hits will come. Its all about FNs which is why most group QC operations are a joke. Unless they plan on double reading negatives as well as new positives, they are not catching the most dangerous sleepers.

Agree 100%.

Most groups will double read a new malignancy, which is all well and good. But you need a systematic QC process that includes called-benign cases as well. With the way that surgical pathology has become more intricate and competition for specimens has increased, the future of general practice community hospital-based pathology is robust QC with showing of cases pre-signout. Trust me, you can still tell who is pulling their weight and contributing even with a robust intradepartmental consult system (maybe even more so, perhaps easier to tell). Some of the strongest most experienced pathologists I know share cases frequently. I am not saying you need to share every tubular adenoma, but use good judgement. Does your diagnosis differ from the clinical impression? Should you run a quick representative slide by the fellowship-trained expert in your group? If you haven't seen an example of this diagnosis in a long time should you run it by someone? It doesn't have to require having someone in the group reviewing every slide in a 30 block case, but you have to use good judgement and err on the side of caution. If you do it right, it doesn't take too much time. If you don't do it at all, eventually bad things happen.

 

[LADoc00]

If you properly develop yourself as a master pathologist, you will learn to rely on instinct to guide algorithms to manage risk.

If you sense something is off, stop and get a consult. Even if that sense is minor and you are tired and want to get the hell out of work on a Friday afternoon. Put things aside and come back to them. Get up and get a coffee etc.

There are lots ways to build yourself into an extremely risk-proof diagnostician. Regardless, mistakes will happen and the real pros are those that can manage these situations BEFORE they turn into lawsuits.