Jobs galore!

[Med Director New England]

Alright - what are these locums jobs paying ?

I know we are paying traveling RNs > 200/ hr currently. Can locums pathologists even beat this ?

I hear about these opportunities too but if they are paying crap what good is that.

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Members don't see this ad.

 

[cmz]

I get quotes from $2000-$2200/day. It may be more in other areas, but I'm in TX.

 

[univlad]

I get quotes from $2000-$2200/day. It may be more in other areas, but I'm in TX.

Wow.. Last time I looked into doing locums is was about 700 or 800 per day--that was maybe 6 or 7 years ago though.

 

[cmz]

Wow.. Last time I looked into doing locums is was about 700 or 800 per day--that was maybe 6 or 7 years ago though.

I am not sure how much the agencies are extracting. I used to pay 1500/day for high-volume sign-out. 100% of that money went into the pathologist's pocket though since I didn't work with outside agencies like CompHealth, etc.

The 2000-2200/day quote is for someone who wants to signout 20 cases/day with light frozen duties. No call.

 

[deleted314957]

I am not sure how much the agencies are extracting. I used to pay 1500/day for high-volume sign-out. 100% of that money went into the pathologist's pocket though since I didn't work with outside agencies like CompHealth, etc.

The 2000-2200/day quote is for someone who wants to signout 20 cases/day with light frozen duties. No call.

This is finally great to see. I hope all y’all’s pockets get well lined!

 

[Spikebd]

This is finally great to see. I hope all y’all’s pockets get well lined!

Maybe the retirements really are happening

 

[The Professional]

This is okay news. We still have a long way to go before every resident is recruited like the professional they are supposed to be.

We still have a long way to go before every Pathologist is able to leverage his or her skills and have the upper hand in negotiations with hospitals, CMS, corporate pathology, malignant senior partner pathologists, etc.

 

[HowlPrenderghast]

Job postings at https://www.pathologyoutlines.com/jobs are at its highest in 5 years.

Interesting...

 

[shikimate]

I think old timers are finally realizing it's not worth it to trade cash for their life during COVID loll.

 

[Drifter76]

There are some on this board who are clearly part of the problem. Any information or situation that might serve as a headwind to their ability to exploit others is met with hostility. That is true for the corporate labs, exploitative private groups, and some on this board.
The uptick in postings on pathology outlines, for example, is still mostly low quality jobs. Corporate lab jobs, jobs with no partnership track and no opportunities for advancement, hospital employed jobs, etc.. I see no significant improvement in the numbers of actual decent jobs.

 

[Drifter76]

People aren’t interested in working for morbidly obese boomers who made it, but then proceeded to pull up the ladder behind them.

Why struggle through trays and trays of 200 slides a day when you could do yard work for 75% of the same pay and nowhere near the same liability.

They pull up the ladder behind them, then they come on here, pretend to be your buddy, and give you “advice”.

 

[SunBakedTrash]

There are some on this board who are clearly part of the problem. Any information or situation that might serve as a headwind to their ability to exploit others is met with hostility. That is true for the corporate labs, exploitative private groups, and some on this board.
The uptick in postings on pathology outlines, for example, is still mostly low quality jobs. Corporate lab jobs, jobs with no partnership track and no opportunities for advancement, hospital employed jobs, etc.. I see no significant improvement in the numbers of actual decent jobs.

No one owes you a “good” job. It’s on you to find it yourself. You should have figured this out before you applied into pathology. Someone has to work in the pathology salt mine, guess that guy is you until you decide to take some initiative and stop wasting space on this board.

 

[Drifter76]

No one owes you a “good” job. It’s on you to find it yourself. You should have figured this out before you applied into pathology. Someone has to work in the pathology salt mine, guess that guy is you until you decide to take some initiative and stop wasting space on this board.

Ha! So if we just apply to the right place and give a great interview with a firm handshake and a smile at the end, we can all have great job?
I have taken more initiative than anyone I know, and it has revealed the ugly truth about this field. What you don’t seem to get is that 90% or more of the jobs available in today’s market are in the salt mine. Of the other 10%, a significant portion are senior people who have worked themselves into a position where they can exploit other pathologists and eat someone else’s kill (and even those positions are highly susceptible to disruption by mergers/corporatization). That leaves a small fraction that might be “good jobs”. The point of my posts isn’t that pathology has been bad for me- the point is that it is bad across the board for people entering this field. I don’t know what your job is like in terms of practice setting, practice model, work load, compensation etc but there’s a very high probability that it is a “salt mine” as well. Some are simply in denial about this. I understand that it makes some people angry when you point out inconvenient facts that open or reopen wounds- people can be in denial about the fact that they are in mediocre jobs and/or being exploited, and the denial gives them some degree of tolerance for their situation. But it is important to air it all out so others who might contemplate entering this field truly understand what they are getting themselves in to. So I will continue to “waste space” on this board, as you put it, and you can do the same.

 

[KeratinPearls]

There are some on this board who are clearly part of the problem. Any information or situation that might serve as a headwind to their ability to exploit others is met with hostility. That is true for the corporate labs, exploitative private groups, and some on this board.
The uptick in postings on pathology outlines, for example, is still mostly low quality jobs. Corporate lab jobs, jobs with no partnership track and no opportunities for advancement, hospital employed jobs, etc.. I see no significant improvement in the numbers of actual decent jobs.

To all: Get a job while the job market is supposedly “hot”.

I have a feeling the job market will revert back to the prepandemic levels once the current openings get filled by the current residency and fellowship grads.

I see a fair amount of academic jobs so if thats your cup of tea get moving.

You just got to take whatever job you can get, which is what happened to me. I lucked out big time for my own personal reasons.

 

[Drifter76]

Is that what you call it? That person came in here for months with doom and gloom and called out everyone who didn't agree that the job market was terrible (that we had our eyes closed to reality, not that we just disagreed). He said he was from a good program and was stuck in a terrible job and had no prospects or something to that effect. That he'd been looking for months but there was nothing. There was not honest discussion of the issues from him. If you disagreed on his points and provided an argument or evidence, he stated we were not the intended audience of his rants.

Then someone says he is recruiting for a good job and invites this person to apply. They do not. In fact I haven't seen him since.

To me that seems more like calling out BS- someone who just wants to gripe and complain.

A pathology/cytopathology job in podunk TX for 300k a year and no partnership track? So you go there and you're working hard while the guy in the next office is making almost double what you are for the same amount of work? And it sounds like there is an HCA contract involved which is likely to be lost within the next couple of years? And then what? I don't recall being "invited" to apply, but I respectfully decline.. doesn't sound like a "good" job to me. It sounds more like the kind of job that pencilneck would go home and cry to his wife about:

gbwillner said:
I walked away from a dream academic job to take it. By the end of my tenure, I wished I had never taken it and stayed in academia (I told my wife every day was the worst day of my life).

 

[cmz]

A pathology/cytopathology job in podunk TX for 300k a year and no partnership track? So you go there and you're working hard while the guy in the next office is making almost double what you are for the same amount of work? And it sounds like there is an HCA contract involved which is likely to be lost within the next couple of years? And then what? I don't recall being "invited" to apply, but I respectfully decline.. doesn't sound like a "good" job to me. It sounds more like the kind of job that pencilneck would go home and cry to his wife about:

gbwillner said:
I walked away from a dream academic job to take it. By the end of my tenure, I wished I had never taken it and stayed in academia (I told my wife every day was the worst day of my life).

Actually, my practice isn't in "Podunk, TX"... we offer partnership track but we require you to pony up like the rest of us did and contribute real money to the business. We're all young, dynamic and friendly. We ALL work hard, including the owners. Yes we have an HCA contract but it actually expires on 4/30 (next week). We were the ones who gave them notice we are leaving. I PM'd you about that. As of today, they have been begging us to come back to the table so help with the "transition." We had the opportunity to squeeze the hell out of the hospital while they found our replacements, but we're not that kind of group. We have dignity and value lifestyle over money. I can make tons of money for my group in other endeavors, so giving up a $1M contract means **** to me. In fact, I make more money outside of pathology and I already do quite well in my field.

And when I offered a general "300K" for a job.... that all depends on your level of expertise and how hard you work. Everything is negotiable. Let's say for example it is $300K base, people seem to forget about our final comp including healthcare, med-mal, 401K/profit-sharing, etc. So overall, you're probably closer to 375/400. I know a lot of practices that don't even offer med-mal or health insurance. It's OK if you decline my sh*tty opportunity presented -- you probably aren't a good fit for our group anyway. No loss on either side, right?

 

[Drifter76]

Actually, my practice isn't in "Podunk, TX"... we offer partnership track but we require you to pony up like the rest of us did and contribute real money to the business. We're all young, dynamic and friendly. We ALL work hard, including the owners. Yes we have an HCA contract but it actually expires on 4/30 (next week). We were the ones who gave them notice we are leaving. I PM'd you about that. As of today, they have been begging us to come back to the table so help with the "transition." We had the opportunity to squeeze the hell out of the hospital while they found our replacements, but we're not that kind of group. We have dignity and value lifestyle over money. I can make tons of money for my group in other endeavors, so giving up a $1M contract means **** to me. In fact, I make more money outside of pathology and I already do quite well in my field.

And when I offered a general "300K" for a job.... that all depends on your level of expertise and how hard you work. Everything is negotiable. Let's say for example it is $300K base, people seem to forget about our final comp including healthcare, med-mal, 401K/profit-sharing, etc. So overall, you're probably closer to 375/400. I know a lot of practices that don't even offer med-mal or health insurance. It's OK if you decline my sh*tty opportunity presented -- you probably aren't a good fit for our group anyway. No loss on either side, right?

I would not go near any group with an HCA contract, based on what I have seen. And I would strongly suggest others avoid them as well. What happens to your allegedly great financials when you lose this contract? If you make more money outside of pathology, why are you still in it? When people talk compensation, they don’t typically include employer cost of things like healthcare and med-mal- it is comparing apples to oranges.

 

[octopusprime]

I think part of the frustration lies in the reality that within pathology there is such a wide range of practice setups and income, and knowing that people pull in close to 7 figures with more vaca and an easier schedule is mentally frustrating, particularly if one's experience has been the contrary of that.

There's not a single pathologist that wouldn't prefer to make more money...but the difference between $300k and $600k is not simply a matter of "wanting" it or negotiating...other factors--aside from the obvious of PP vs employed/university-- are in play that have nothing to do with one's ambition or skills or drive.

First and foremost: regional differences in health insurance reimbursement rates. This results in massive variations in income, and coupled with completely random negotiations and hospital contracts, it can easily account for hundreds of thousands of dollars / partner / year. The only way to combat this is to aggressively look in MGMA data and know people.

Second--higher paying PP jobs simply don't exist in most large markets save a few mega groups that are really busy and / or impossible to make partner at, and the few hidden gems that have an ideal combo of volume, vaca and income are simply that: hidden from most applicants (because they're word of mouth or by association only).

Third: The grass is ALWAYS greener somewhere else. Every job has downsides and trade-offs; people on here that have hidden gem jobs may be more willing to make compromises they otherwise wouldn't make simply because of the money or vaca, and they aren't willing to uproot mid career. And aside from income, everyone has different expectations for workload, work environment, vaca, and colleagues.

 

[Drifter76]

I think part of the frustration lies in the reality that within pathology there is such a wide range of practice setups and income, and knowing that people pull in close to 7 figures with more vaca and an easier schedule is mentally frustrating, particularly if one's experience has been the contrary of that.

There's not a single pathologist that wouldn't prefer to make more money...but the difference between $300k and $600k is not simply a matter of "wanting" it or negotiating...other factors--aside from the obvious of PP vs employed/university-- are in play that have nothing to do with one's ambition or skills or drive.

First and foremost: regional differences in health insurance reimbursement rates. This results in massive variations in income, and coupled with completely random negotiations and hospital contracts, it can easily account for hundreds of thousands of dollars / partner / year. The only way to combat this is to aggressively look in MGMA data and know people.

Second--higher paying PP jobs simply don't exist in most large markets save a few mega groups that are really busy and / or impossible to make partner at, and the few hidden gems that have an ideal combo of volume, vaca and income are simply that: hidden from most applicants (because they're word of mouth or by association only).

Third: The grass is ALWAYS greener somewhere else. Every job has downsides and trade-offs; people on here that have hidden gem jobs may be more willing to make compromises they otherwise wouldn't make simply because of the money or vaca, and they aren't willing to uproot mid career. And aside from income, everyone has different expectations for workload, work environment, vaca, and colleagues.

I enjoy the work of pathology- of making a diagnosis, microscopy, histopathology, the clinical pathology I do, working with clinicians etc. But I believe the job market and market forces I’ve seen since coming out (with the exploitation and conditions imposed on us by outside forces) should be considered disqualifying to most of those considering pathology as a career choice.

 

[WEBB PINKERTON]

Interesting.. I wonder if you’d be willing to say that to my face? Is there a way to find out?
I’m not the one with “trash” as my name, Sunbakedtrash. You self labeled, and I see now that your self label suits you quite well. Why do I also suspect that the physical appearance of your avatar also suits you quite well? You impudent degenerate little prick..

There will no business conducted on continental grounds. Just walk away Drifter76

 

[octopusprime]

...I believe the job market and market forces I’ve seen since coming out (with the exploitation and conditions imposed on us by outside forces) should be considered disqualifying to most of those considering pathology as a career choice.

I agree with this, with the caveat that many other fields are facing similar issues just not as bad. I think currently employed pathologists in academics or corporate labs are massively taken advantage of [and those that don't think so are naive or blissfully ignorant] and everyone else lives in constant fear that their practice will be bought, replaced or generally "not there" due to a number of factors: hospital acquisition, corporate acquisition / being undercut, GI/Derm/GU overlords finding someone to do their 'in office lab' setup for cheaper...in the era of consolidated medicine and increasing corporate presence, pathology is ripe for the picking. Many other fields face similar problems with consolidation and corporate presence, our breed is just particularly easily to package into a box because we make widgets...we don't interact with patients, we simply generate reports and oversee CP.

 

[ScubaV]

Of course, internet tough guys are usually anything but in real life, but I doubt someone like him could really completely hide the vitriol in an interview.

 

[cmz]

I would not go near any group with an HCA contract, based on what I have seen. And I would strongly suggest others avoid them as well. What happens to your allegedly great financials when you lose this contract? If you make more money outside of pathology, why are you still in it? When people talk compensation, they don’t typically include employer cost of things like healthcare and med-mal- it is comparing apples to oranges.

I lose 1 small contract out of many. I am able to spend less time babysitting a hospital and pivot my group's energies elsewhere in outreach that feeds my private lab, which is successful. We have finite numbers of pathologists and PAs and techs. We may break even or at worst lose a couple hundred K. However, our time is more valuable than the couple hundred K we've lost. It was a lost contract regardless if we kept it another 3 months or 6 months.

Regarding why I still do pathology? I'm in my early 40s. I love my job. I love my community. This is my playground. I have a commitment to ensure that other people have a job so they can feed their families. I'm a small business owner with a lot on my plate. It keeps me alive.

When I talk compensation with employees, why not look at the whole picture? It's kind of silly to discount things like health insurance, 401K, med-mal, and other incidentals like medical license fees, etc. All of that adds up. It seems to me that you've never been on the end of being an owner and don't realize that you have to pay things like taxes, etc.

 

[caffeinegirl]

I lose 1 small contract out of many. I am able to spend less time babysitting a hospital and pivot my group's energies elsewhere in outreach that feeds my private lab, which is successful. We have finite numbers of pathologists and PAs and techs. We may break even or at worst lose a couple hundred K. However, our time is more valuable than the couple hundred K we've lost. It was a lost contract regardless if we kept it another 3 months or 6 months.

Regarding why I still do pathology? I'm in my early 40s. I love my job. I love my community. This is my playground. I have a commitment to ensure that other people have a job so they can feed their families. I'm a small business owner with a lot of my plate. It keeps me alive.

When I talk compensation with employees, why not look at the whole picture? It's kind of silly to discount things like health insurance, 401K, med-mal, and other incidentals like medical license fees, etc. All of that adds up. It seems to me that you've never been on the end of being an owner and don't realize that you have to pay things like taxes, etc.

You are very very lucky cmz! In my area, the competitive pressures from other larger groups, pod labs, and corporate labs makes it a nightmare to sustain a private lab. I love pathology as well, but can't find it sustainable to practice in that setting.

 

[sloh]

I agree with this, with the caveat that many other fields are facing similar issues just not as bad. I think currently employed pathologists in academics or corporate labs are massively taken advantage of [and those that don't think so are naive or blissfully ignorant] and everyone else lives in constant fear that their practice will be bought, replaced or generally "not there" due to a number of factors: hospital acquisition, corporate acquisition / being undercut, GI/Derm/GU overlords finding someone to do their 'in office lab' setup for cheaper...in the era of consolidated medicine and increasing corporate presence, pathology is ripe for the picking. Many other fields face similar problems with consolidation and corporate presence, our breed is just particularly easily to package into a box because we make widgets...we don't interact with patients, we simply generate reports and oversee CP.

Really good posts. All specialties (and many professions) can learn from this.

 

[cmz]

You are very very lucky cmz! In my area, the competitive pressures from other larger groups, pod labs, and corporate labs makes it a nightmare to sustain a private lab. I love pathology as well, but can't find it sustainable to practice in that setting.

I'm fortunate to be in an area that is somewhat shielded from a lot of the mega corp labs infiltrating. In fact, the mega corp labs look to my lab to help with overflow and STAT cases. One thing that isn't exempt are the in-office labs. Things are becoming more challenging but we are choosing to not roll over and die. One day, everything that that my lab does might well become unsustainable. However, today is not that day and this has been the case for many years. It remains an almost certain possibility that we get swallowed into the conglomerate blob that is corporate America. This is no different than any other specialty. Anesthesia seems to always be someone's bitch. Radiology is becoming more centralized. Hospitalist groups are quite common. Every damn specialty is migrating into this model. What makes pathology so special?

 

[Alteran]

Really good posts. All specialties (and many professions) can learn from this.

It absolutely is difficult to maintain and staff a private pathology lab. But that's what is bringing home the bacon for us, and we wouldn't have survived the hospital acquisition had we not moved all our outreach out of their control.

In my area, I've seen the following happen over the past decade or so:
- All private radiology groups are building their own privately owned imaging facilities and moving all hospital-based referrals to their centers.
- All private GI docs are making their own POD labs and contracting out the PC services.
- All private Derm docs are making their own POD labs and either reading it themselves or contracting out the PC work.
- A cardiology group made their own heart hospital.
- Private pulmonologists are increasingly leaving hospital-based practice to the hospital employed physician group(s) and doing everything they can get away with either in their centers or outpatient facilities they have a vested interest in.
- Surgeons are moving their outpatient surgeries, which is most of their work, away from hospitals to surgical centers they have a vested interest in.

I don't profess to know what other regional markets are doing, but mine is aggressively reacting to big hospital chains and their administrative nonsense. These other specialties wouldn't be doing this if wasn't in their ultimate interest, headache and all. I don't see why pathology can't do the same. Our problem in pathology is that beta types seem to be overrepresented in our field and while we as a field sit around and bemoan our circumstance, we don't seem to be particularly motivated to change it like these other fields.

 

[cmz]

I agree with this, with the caveat that many other fields are facing similar issues just not as bad. I think currently employed pathologists in academics or corporate labs are massively taken advantage of [and those that don't think so are naive or blissfully ignorant] and everyone else lives in constant fear that their practice will be bought, replaced or generally "not there" due to a number of factors: hospital acquisition, corporate acquisition / being undercut, GI/Derm/GU overlords finding someone to do their 'in office lab' setup for cheaper...in the era of consolidated medicine and increasing corporate presence, pathology is ripe for the picking. Many other fields face similar problems with consolidation and corporate presence, our breed is just particularly easily to package into a box because we make widgets...we don't interact with patients, we simply generate reports and oversee CP.

You're so very correct. I think a lot of what we can do is get out there and bring a face to what we do. Interact with the people who bring you business. Find ways to bring them business, too. Make your referral source love you so much they can't live without you. Eventually, though... external pressures will win out. It's not an IF it's a WHEN.

Look at anesthesia... a lot of those guys are being enveloped into GI groups (mostly made up of CRNAs) and are directly employed. In office pathology is one thing. In office anesthesia is another. We live in a crazy exploitative world. In the post-COVID era, a lot of providers have opted more and more into joining the corporate medicine gig.

 

[caffeinegirl]

I'm fortunate to be in an area that is somewhat shielded from a lot of the mega corp labs infiltrating. In fact, the mega corp labs look to my lab to help with overflow and STAT cases. One thing that isn't exempt are the in-office labs. Things are becoming more challenging but we are choosing to not roll over and die. One day, everything that that my lab does might well become unsustainable. However, today is not that day and this has been the case for many years. It remains an almost certain possibility that we get swallowed into the conglomerate blob that is corporate America. This is no different than any other specialty. Anesthesia seems to always be someone's bitch. Radiology is becoming more centralized. Hospitalist groups are quite common. Every damn specialty is migrating into this model. What makes pathology so special?

As octopusprime mentioned - yes, we are part of a larger trend in medicine. However, we are acutely succumbing to market pressures because we provide a "widget" commodity and are not patient facing. In addition, our "widget" volume is less than radiology (and we also can have longer turnaround times). Combine that with an oversupply of pathologists who are willing to take the lower paying jobs and you have the situation where we are at today. Consolidation and VC/PE takeovers are happening in the majority of medical specialties- with an employee rather than partner model. However, the staffing and reimbursement issues are vastly different than pathology. So yes, pathology is a special situation because we do not have the similar payment structure and unit volume as other specialities.

 

[gyngyn]

Disagree with dignity and respect.
Recent posts that did not adhere to this expectation have been removed.

 

[caffeinegirl]

You're so very correct. I think a lot of what we can do is get out there and bring a face to what we do. Interact with the people who bring you business. Find ways to bring them business, too. Make your referral source love you so much they can't live without you. Eventually, though... external pressures will win out. It's not an IF it's a WHEN.

Complete agree with this. The local "face-to-face" model will only work for so long. When the referring providers' insurance contracts change, or they consolidate/get bought out your personal relationships will not trump the overall business model. In pathology, the preparation and rendering of a diagnosis is not geographically restricted, since you can ship the specimen anywhere. This is what separates us from other specialties - the consolidation and economies of scale.

 

[deleted314957]

I lose 1 small contract out of many. I am able to spend less time babysitting a hospital and pivot my group's energies elsewhere in outreach that feeds my private lab, which is successful. We have finite numbers of pathologists and PAs and techs. We may break even or at worst lose a couple hundred K. However, our time is more valuable than the couple hundred K we've lost. It was a lost contract regardless if we kept it another 3 months or 6 months.

Regarding why I still do pathology? I'm in my early 40s. I love my job. I love my community. This is my playground. I have a commitment to ensure that other people have a job so they can feed their families. I'm a small business owner with a lot on my plate. It keeps me alive.

When I talk compensation with employees, why not look at the whole picture? It's kind of silly to discount things like health insurance, 401K, med-mal, and other incidentals like medical license fees, etc. All of that adds up. It seems to me that you've never been on the end of being an owner and don't realize that you have to pay things like taxes, etc.

As re: your last paragraph; clearly he hasn’t and he doesn’t.

 

[deleted314957]

It absolutely is difficult to maintain and staff a private pathology lab. But that's what is bringing home the bacon for us, and we wouldn't have survived the hospital acquisition had we not moved all our outreach out of their control.

In my area, I've seen the following happen over the past decade or so:
- All private radiology groups are building their own privately owned imaging facilities and moving all hospital-based referrals to their centers.
- All private GI docs are making their own POD labs and contracting out the PC services.
- All private Derm docs are making their own POD labs and either reading it themselves or contracting out the PC work.
- A cardiology group made their own heart hospital.
- Private pulmonologists are increasingly leaving hospital-based practice to the hospital employed physician group(s) and doing everything they can get away with either in their centers or outpatient facilities they have a vested interest in.
- Surgeons are moving their outpatient surgeries, which is most of their work, away from hospitals to surgical centers they have a vested interest in.

I don't profess to know what other regional markets are doing, but mine is aggressively reacting to big hospital chains and their administrative nonsense. These other specialties wouldn't be doing this if wasn't in their ultimate interest, headache and all. I don't see why pathology can't do the same. Our problem in pathology is that beta types seem to be overrepresented in our field and while we as a field sit around and bemoan our circumstance, we don't seem to be particularly motivated to change it like these other fields.

We are no different. We need to get our asses as far away from hospitals as humanly possible.

 

[KeratinPearls]

Dr Paull seems to get it.

He has some common sense.

 

[deleted941485]

View attachment 353764View attachment 353765

Dr Paull seems to get it.

View attachment 353766

He has some common sense.

Problem is I don’t think they do it consciously but yes limited supply is the only thing that helps

 

[KeratinPearls]

Problem is I don’t think they do it consciously but yes limited supply is the only thing that helps

Who knows if they do it consciously or not. Derms limit their supply because they know what would happen if they graduate tons of residents. Botox, lasers, injectables and Ulthera treatments will cost pennies to consumers since everyone and their moms will be opening a Derm practice on every corner (like general dentists). Low quality applicants will be applying en masse and the field will degrade over time.

 

[deleted314957]

Too many academic gatekeepers who benefit and suffer no downside. 100% our doing.

 

[caffeinegirl]

I would also add that at least in my neck of the woods, the academic centers are merging and/or taking over smaller community hospitals - and staffing them with academic pathologists at academic-level salaries. I don't know if others have experience with this , but I would assume that this is just another model of an employed staff pathologist with the expectations of an academic clinical track.

 

[Med Director New England]

Interesting posts…
Couple of comments
- RIP drifter (?thrombus)
- lots of mention of 7 figure salaries, 600k, etc…really?! What % of paths make that now
- a big problem with the lack of negotiating power of paths is that there are tons of academic paths who could easily do 25% more work then they do currently, some academic groups also have multiple job posting at all times but somehow they get by. Guess what folks those aren’t real jobs - still way to many of us.

 

[HeyDalaron]

Wouldn't the US government want to pay less for health care? Residency spots are expensive! You'd think it'd be easy to convince the government that there are too many pathology spots. It's not their problem that academic programs need grossing scut monkeys.

Why aren't pathologists lobbying in this way?

 

[caffeinegirl]

Wouldn't the US government want to pay less for health care? Residency spots are expensive! You'd think it'd be easy to convince the government that there are too many pathology spots. It's not their problem that academic programs need grossing scut monkeys.

Why aren't pathologists lobbying in this way?

The amount of residency spots is decided by the ACGME, which in turn gets their information from the academic departments - the cycle continues.
The US government is interested in paying less for healthcare - the recurrent annual cuts to reimbursements are proof of that, as well as bundling of payment. These cuts make more of an impact than cutting residency spots.

 

[KeratinPearls]

There was a post on Twitter for an open pathology spot at Thomas Jefferson I believe a month ago. Several IMGs replied. One guy in particular in their Twitter handle mentioned he was “Passionate about Internal Medicine”. Another guy was applying to internal medicine as well but prob didn’t match. So this open Pathology spot was their hopes of getting a position in the US of A.

You can’t make this stuff up.

 

[deleted314957]

There was a post on Twitter for an open pathology spot at Thomas Jefferson I believe a month ago. Several IMGs replied. One guy in particular in their Twitter handle mentioned he was “Passionate about Internal Medicine”. Another guy was applying to internal medicine as well but prob didn’t match. So this open Pathology spot was their hopes of getting a position in the US of A.

You can’t make this stuff up.

My ostomy bag just filled quickly

 

[Alteran]

Wouldn't the US government want to pay less for health care? Residency spots are expensive! You'd think it'd be easy to convince the government that there are too many pathology spots. It's not their problem that academic programs need grossing scut monkeys.

Why aren't pathologists lobbying in this way?

The amount of residency spots is decided by the ACGME, which in turn gets their information from the academic departments - the cycle continues.
The US government is interested in paying less for healthcare - the recurrent annual cuts to reimbursements are proof of that, as well as bundling of payment. These cuts make more of an impact than cutting residency spots.

The number of residency spots for each program is determined by ACGME and though funding for these spots is primarily from CMS, it's not the only source. VA hospitals that have strong ties to nearby academic centers pay for many of these spots, including pathology. And a source that doesn't get mentioned often is the academic department or parent institution itself. There's nothing to stop any residency department from internally funding as many spots as they want up to the ACGME approved limit.

From my anecdotal experience in looking at pathology programs, about half the spots are paid for by CMS. The remainder of the spots are paid for by a combination of VA funding, institutional funding/grants, and internal funding by the department. Clearly the government doesn't believe we need more pathologists because I would bet good money that they haven't expanded any CMS spots for pathology in a loooong time. But ACGME keeps approving more spots for pathology that departments are only too happy to find alternate sources of funding for.

Therefore, in my opinion the real problem is with ACGME. If ACGME didn't keep authorizing spots for programs of dubious quality but that can somehow manage to fund those spots outside of CMS, like HCA associated programs, we'd be in a better place.

 

[caffeinegirl]

The last time the government expanded CMS funding for GME programs was about 1,000 more spots in 2020 - and most of these are primary care in rural areas...these spots will be increased and announced in the coming years.
For more info on funding in GME spots (which is what Alteran was alluding to) check out the FAQ from the ACGME

ACGME Frequently Asked Questions

www.acgme.org

Completely agree with Alteran here - the ACGME authorizes many more non-CMS funded spots, based on applications from the sponsoring institution. It's in the academic departments' (or HCA, etc) to get more spots - if they have the funding, and there doesn't seem to be a "gatekeeper" to see if those spots are actually needed. I went to a good academic program - which had no clue about the actual workforce data or private practice (and they had one of the top CAP higher-ups who was in charge of that). This was 10+ years ago, but still.... the workforce data and CAP groupthink here is from academic departments. Keep in mind where their bias is.

 

[deleted314957]

I have said before, or perhaps alluded to the REAL gatekeepers cracking down and the effect would not take years. Also, many, many more weak prospects would be weeded out. AND, it wasn’t a very popular stance. But it would work.

Those gatekeepers are the esteemed academics who comprise the ABP.

Drop the pass rate on the boards to what it was in the dark ages. ~60% combined pass on both in first sitting. That would even keep the jerks who are “passionate about IM”from considering path as a pumpkin-wagon default.
As it stands now, with the astoundingly high rates of passage, no wonder we have so many marginal players. Hell, after 45 years of being married to me, my wife has probably absorbed enough path via osmosis alone to squeak by the boards as they currently stand.

 

[pathres9999]

Dropping pass rates on a multiple choice exam doesn't really seem like a great solution and doesn't guarantee good pathologists.

As far as the job market is concerned, it always feels like I am being peed on and told its refreshing rain by the community. I think we need a little more self respect for a professional role that requires such extensive training and expertise. But hey, maybe the person who is responsible for majority of the diagnosis both on AP and CP doesn't really deserve to be compensated and autonomous.

*shrug*

 

[deleted314957]

Dropping pass rates on a multiple choice exam doesn't really seem like a great solution and doesn't guarantee good pathologists.

As far as the job market is concerned, it always feels like I am being peed on and told its refreshing rain by the community. I think we need a little more self respect for a professional role that requires such extensive training and expertise. But hey, maybe the person who is responsible for majority of the diagnosis both on AP and CP doesn't really deserve to be compensated and autonomous.

*shrug*

Yah, it does. I disagree. May not GUARANTEE it but it sure as hell will raise the bar while getting rid of those who have no clue. But it’s not very “nice” or “pc” to “do that to somebody” when in actuality they did it to themselves. But you get those who bemoan such cruelty because you have derailed some poor soul who spent years……yada, yada.
They spent years NOT learning what they were expected to learn. YOU had to learn it, I had to learn it, but we give a pass to a bottom 50%er who didn’t? Oh, but I guess it was not their fault.

 

[pathres9999]

Yah, it does. I disagree. May not GUARANTEE it but it sure as hell will raise the bar while getting rid of those who have no clue. But it’s not very “nice” or “pc” to “do that to somebody” when in actuality they did it to themselves. But you get those who bemoan such cruelty because you have derailed some poor soul who spent years……yada, yada.
They spent years NOT learning what they were expected to learn. YOU had to learn it, I had to learn it, but we give a pass to a bottom 50%er who didn’t? Oh, but I guess it was not their fault.

You are making a false equivalence that the boards is a good marker for a good pathologist and not a person who is good at taking tests with a pathology theme. I have known terrible pathologist but good test takers make it through. I am not saying that the test couldn’t establish minimal competency but to just cut out those under 40th percentile does not really make sense other than to instill fear and really make it so we have no US grads.

Also, I don’t really care about the “pc” aspect, as I do agree a lot of resident should be fired based on language competency alone, but it would require other better modalities. I would say integrated clinical rotations with internal medicine / surgery, having core competencies other than 30 autopsies, independent sign out fourth year, and internal service exams (based on slides like PIP) would make problems harder to hide.

 

[deleted314957]

You are making a false equivalence that the boards is a good marker for a good pathologist and not a person who is good at taking tests with a pathology theme. I have known terrible pathologist but good test takers make it through. I am not saying that the test couldn’t establish minimal competency but to just cut out those under 40th percentile does not really make sense other than to instill fear and really make it so we have no US grads.

Also, I don’t really care about the “pc” aspect, as I do agree a lot of resident should be fired based on language competency alone, but it would require other better modalities. I would say integrated clinical rotations with internal medicine / surgery, having core competencies other than 30 autopsies, independent sign out fourth year, and internal service exams (based on slides like PIP) would make problems harder to hide.

I could not agree more with the excellent points you make in your last paragraph. And I believe there is certainly some validity in your first paragraph arguments. Although my suggestion would work quickly, it is draconian. But, by the time you get to your boards, I don’t think there are many “ poor test performers” left after the gauntlet we/they all have run. There ARE a not insignificant number of folks who have chosen to largely piss away 4 years of learning opportunity though. Clin path, anyone?