Jobs

[coroner]

I interviewed for a job in upstate NY 375 starting with 100k bonus. No joke. Group of maybe 3 or 4 pathologists.

I didn’t get the job but they exist and aren’t common. It was near the Canadian/NY border. It’s what I would call boofoo but can be Fantasy Island to others like Webb Pinkerton.

It was the best package I saw for any pathologist job when I interviewed.

I have seen/heard of a few jobs like these for someone just starting out of fellowship. The 2 main factors that these types of jobs had from my observation usually meet one or both of the following criteria: 1) They are employed/salaried positions. So it's RVU-based and even for brand new pathology grads, the hospital compensates close to the MGMA mean. or 2) It's out in the styx, so pretty much all doctors on staff are well compensated in order to recruit them to come out there.

I've never heard of 300K+ starting for pp for a new grad. But I have heard of a few jobs starting that high if meeting the criteria as described above. It's actually private practice (and academics) that tends to be much lower starting out. But the top-end in pp is often higher as well...if one makes partner and there's financial equity.

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[KeratinPearls]

I have seen/heard of a few jobs like these for someone just starting out of fellowship. The 2 main factors that these types of jobs had from my observation usually meet one or both of the following criteria: 1) They are employed/salaried positions. So it's RVU-based and even for brand new pathology grads, the hospital compensates close to the MGMA mean. or 2) It's out in the styx, so pretty much all doctors on staff are well compensated in order to recruit them to come out there.

I've never heard of 300K+ starting for pp for a new grad. But I have heard of a few jobs starting that high if meeting the criteria as described above. It's actually private practice (and academics) that tends to be much lower starting out. But the top-end in pp is often higher as well...if one makes partner and there's financial equity.

It sure as hell was the styx

 

[deleted314957]

As LaDOC has said before and it deserves repeating, this field has a HUGE gap between the haves and the have nots. There used to be more haves and fewer have nots. That trend is continuing.

 

[KeratinPearls]

“You can be either a 1. Chief
2. Indian. The former typically makes lots of money. The latter usually makes a comfortable salary. Fellowship has no effect on Chief or Indian status.”-LADoc00

 

[KeratinPearls]

Every time I convince myself to stick it out I end up coming back to these threads and getting scared off again.

Is there any benefit to finishing a CP program (1 more year) before switching to another specialty other than having a fall back plan if the subsequent residency doesn't work out?

I keep hearing that the transfusion job market is "okay". Is it significantly more "okay" than the descriptions above

Every time I convince myself to stick it out I end up coming back to these threads and getting scared off again.

Is there any benefit to finishing a CP program (1 more year) before switching to another specialty other than having a fall back plan if the subsequent residency doesn't work out?

I keep hearing that the transfusion job market is "okay". Is it significantly more "okay" than the descriptions above?

I just posted a job in the Jobs thread for you in transfusion. Best of luck.

 

[Drifter76]

We talk a lot about private practice and partnership here.
How much of this is impacted by the general trend of employed physicians verses private practice?
The last information I have has is that PP is down to about 25% for all physicians.

I don't see that much change in pathology so far. That is PP groups are mostly stable in AZ.
That might not be true elsewhere.
There has been acceleration of venture capital buying the big bucks specialties such as Urology.
Hospital physician employment continues to grow and smaller private practices continue to disappear.

Physician ownership of a pathology practice might be a fairly uncommon in 10-20 years.

Yes I think that is part of it. I think it is one of multiple factors all working together to create a perfect storm- a lower proportion of PP jobs plus declining reimbursements plus consolidations/mergers of practices and hospital systems with increased volatility, plus more practices willing to exploit people, and possibly even an increasing proportion of pathologists coming out who will tolerate being exploited, for various reasons. And of course the massive oversupply of pathologists created by academia..

 

[Drifter76]

Some of the material on this forum really made me think is there any alternate universe of pathology that me, my colleagues and pathology friends don't know about. This is what I know, its up to any one who is reading to believe it or not.

a) As of today there are 570 open jobs on pathoutlines alone. Probably 6-7 were posted just today. There are likely 550-600 path grads coming out every year. Not all of them want to do PP. A lot of path jobs never get posted on pathoutlines or advertised at all.

b) I personally know around 50-60 pathologists in last 13-14 years. Through residency, fellowships and professional societies. Almost all of them seem content with their positions.

c) Here is the starting salaries and mid career salaries of some of them.
Gen surg path, NE starting 310 K. 6 years out 385K
Gen surg path +Heme PP partnership tract MW - 3 years to partner. Made partner. Currently making $700K plus
Dermpath only NE. Started at $400K 6 years ago. Not sure what she is making right now
Surg path + cyto, hospital employed in mid atlantic. starting 380K, this was BTW this year
Dermpath only switched job last year after 7 years. Starting base $450 K plus bonus
Molecular in industry starting base $300K plus stock options
Academic dermpath starting in MW. low volume. $350K
Academic TMBB NE starting $225K 60/40 clinical plus research
Gen surg + cyto 3 year partnership tract pacific northwest. Not sure of starting salary. Made partner. Currently making around $500K

d) Every single resident at my residency and fellowship program received multiple job offers. Its a mid tier program for what it is worth. At least 2 of them with serious red flags (substance abuse, major personality issues etc.) also got multiple offers.

Any medical student/resident contemplating job market etc. Should really do their own research and talk to practicing pathologists both community and in PP and then make their own decisions rather then getting dissuaded by reading anonymous internet forums. Also, keep in mind the alternatives and talk to physicians in other specialties and look at their work hours, level of stress and money they make. The reality is the average salary for in patient IM is around $250K, ID and endo below or low 200's. PCM, around $300-350. Gen Cards $400-450K. GI $450-500. Gen derm $375-450. These are the fields with comparable levels of training. Apart from derm, their works hours are much worse than path. Pathology job market will likely never be like primary care, derm, ENT etc. Its not ideal and if its up to me I will certainly close down at least 30% of programs and reduce slots by at least 30-40%. If that happens we will become like derm or ENT in few years. When I am teaching medical students, I tell them the truth, I tell them that If you are geographically restricted and have huge student loans don't do pathology and chose one of the procedural specialties or IM with subspecialty. If they are not geographically restricted , I encourage them to pursue pathology if they like the field and have aptitude for it. The sole purpose of me writing this message is I absolutely love pathology and I feel as practicing pathologists we owe it to our specialty to get the honest word out and attract the best and brightest to our field. Adios !

a) I don’t think it is actually that many jobs open at any one time. I think it is a lot of postings that have already been filled that are counted in that number, and the postings are still up. I looked at what was posted yesterday on path outlines and it is a few academic jobs plus two private jobs with no stated partnership track plus an Ameripath job- pretty low quality stuff as best I can tell.

b) I know even more pathologists. You get to know a lot of people when you move around as much as I have. I wouldn’t say that most of the ones I know are content. I think there is a subset that is relatively content, and they seem to fall into one of 3 categories: some late career/retirement age people who got in before things completely went to hell, a few charmed individuals who either got very lucky or benefited from nepotism, and some who are either very naive or have extremely low expectations for their career/professional respect/compensation/etc. I think some IMGs fall into that last category, and overall I suspect IMGs may tend to have higher satisfaction levels in pathology than US grads. They have significantly less debt (not talking about Americans going to Caribbean schools- I know those are expensive) and I think many are very happy they were able to land jobs in the US making a 6 figure salary and actually stay here. Also, it probably doesn’t seem like quite as big a deal to have to relocate 1,000 miles for a job if you are already 7,000 miles from home.

c) You listed several people there who allegedly started at around 400k or higher. To put that in perspective, in 10 years of practice - mostly private practice- I have never made anything close to that. I haven’t even broken 300k. I think my high water mark has been about 280k. I also work with 2 dermpaths who are both 5-7 years out of training, and neither of them make over 300k. Why would a group pay someone 400 a year who has never even signed out a case when you can get quality people close to mid career who have a lot of experience for less than that? I’m not saying there’s anything wrong with new people making that. I think we should be able to get that kind of money- the problem is that for the most part we don’t. At least not any more. I am way underpaid, but knowing that and being able to do something about it in this kind of market are two entirely different things.

d) I know numerous people with zero red flags who are excellent Pathologists and very well trained who had to spend years looking just to get a single offer for a low quality job in a remote location. I can’t imagine any new people with major red flags coming out and getting multiple offers in pathology, unless it is akin to the nepotism situation that I mentioned earlier. I suppose, if Hunter Biden were a pathologist…

 

[Drifter76]

“You can be either a 1. Chief
2. Indian. The former typically makes lots of money. The latter usually makes a comfortable salary. Fellowship has no effect on Chief or Indian status.”-LADoc00

And if you have invested years of your life, years of sweat equity, had to spend the majority of your life performing at very high levels academically to get where you are, hundreds of thousands in high interest student loan debt, why would you then choose a specialty where you’ll do another 5-7 years in postgraduate training just to enter a field where 98%+ will be Indians. Pick a field where you can be a chief. Pick a field where you at least have a fighting chance to work hard, perform at a high level, and become a chief on merit. Pathology isn’t that field.
And this chief vs Indian analogy, in my mind, isn’t just about money. It is also about professional respect, autonomy, and many other things.

 

[Smoothbrain]

Hi guys. I don't really know the job market really well here in the U.S. What fellowships would you guys recommend for good employment opportunities (besides forensic pathology)?

 

[Spikebd]

Hi guys. I don't really know the job market really well here in the U.S. What fellowships would you guys recommend for good employment opportunities (besides forensic pathology)?

The big ones.

Basic surgical pathology
Hematopathology
Cytopathology
Dermatopthology
Blood Banking
Molecular

All fine choices. Job market heating up in general.

 

[futuredoc331]

“You can be either a 1. Chief
2. Indian. The former typically makes lots of money. The latter usually makes a comfortable salary. Fellowship has no effect on Chief or Indian status.”-LADoc00

On this topic, is it that exceedingly difficult to become the chief at this point? Or is it just that most people don't want to?

I recently had an attending mention that they were approached by a couple of guys who were not affiliated with medicine at all, I believe they were IT people, who approached him about being lab director of a lab they opened up for Covid testing. They were supposedly profiting millions of dollars and had set up several labs across part of the country.

Why aren't pathologists doing this? Is there no other profitable sector of lab medicine?

 

[KeratinPearls]

And if you have invested years of your life, years of sweat equity, had to spend the majority of your life performing at very high levels academically to get where you are, hundreds of thousands in high interest student loan debt, why would you then choose a specialty where you’ll do another 5-7 years in postgraduate training just to enter a field where 98%+ will be Indians. Pick a field where you can be a chief. Pick a field where you at least have a fighting chance to work hard, perform at a high level, and become a chief on merit. Pathology isn’t that field.
And this chief vs Indian analogy, in my mind, isn’t just about money. It is also about professional respect, autonomy, and many other things.

On this topic, is it that exceedingly difficult to become the chief at this point? Or is it just that most people don't want to?

I recently had an attending mention that they were approached by a couple of guys who were not affiliated with medicine at all, I believe they were IT people, who approached him about being lab director of a lab they opened up for Covid testing. They were supposedly profiting millions of dollars and had set up several labs across part of the country.

Why aren't pathologists doing this? Is there no other profit

Chief: Entrepreneur/business owner

Indian: Pathologist working for Quest signing out 100 biopsies a day. A minion.

 

[futuredoc331]

Chief: Entrepreneur/business owner

Indian: Pathologist working for Quest signing out 100 biopsies a day. A minion.

My understanding is that it is becoming exceedingly difficult to start and run your own practice or lab in today's environment. That's why so many are being consolidated or closing.

Are there opportunities out there and the typical pathologist just isn't willing to go for it?

 

[Drifter76]

My understanding is that it is becoming exceedingly difficult to start and run your own practice or lab in today's environment. That's why so many are being consolidated or closing.

Are there opportunities out there and the typical pathologist just isn't willing to go for it?

Independent labs, for the most part, aren’t nearly as profitable as they used to be because of reimbursement cuts. I’ve heard a lot of stories of people starting small independent labs, running them for just a few years, and then flipping them for 10+ million, but I think the window for making that kind of money closed a while ago. The one area where there is still half way decent reimbursement is molecular path, so there’s maybe still a little opportunity there for people who have the background and can start a molecular lab.

 

[Drifter76]

As LaDOC has said before and it deserves repeating, this field has a HUGE gap between the haves and the have nots. There used to be more haves and fewer have nots. That trend is continuing.

I suspect that, moving forward and starting with the current crop coming out, haves will be almost nonexistent. The current haves who are equity holders will find lucrative ways to liquidate or sell off their equity without any of it getting passed on to the next generation of pathologists. Most of it will get transferred to corporate labs, venture capitalists, healthcare systems, etc..

 

[Zarniwoop]

If you like the manta "work hard and you will succeed", then pathology isn't the right place.

It is souring when the end result all of those years of education and hard work is a soul crushing job. Throw in alimony payments to really make yourself feel good at the end of the day!

 

[Zarniwoop]

On a positive note, high paying pathology jobs can be soul crushing too (still better than a low paying one, though).

 

[coroner]

On a positive note, high paying pathology jobs can be soul crushing too (still better than a low paying one, though).

Because they almost always come with higher volume, more contracts, and more people to make happy to sustain those higher incomes which equates to more stress and sacrificing the work/life balance.

Lifestyle jobs with cush hours rarely break the top income bracket in pathology...unless you're an old-timer exploiting rookie, wannabe-partners.

 

[deleted314957]

Hi guys. I don't really know the job market really well here in the U.S. What fellowships would you guys recommend for good employment opportunities (besides forensic pathology)?

That’s almost like asking “ what is your favorite red bird other than a cardinal.” If employment is #1, forensics is #1.

 

[gbwillner]

My understanding is that it is becoming exceedingly difficult to start and run your own practice or lab in today's environment. That's why so many are being consolidated or closing.

Are there opportunities out there and the typical pathologist just isn't willing to go for it?

Yes, I think this is correct. Starting a business includes taking risk and burning cash. Most physicians are risk adverse, unless that comes in the form of buying an unnecessary vacation property.

There are tons of opportunities, but you need to know how to access them, and they don't become available by being a good pathologist.

I want to add that the consolidation in medical practice is across the board and is in no way limited to this field

 

[gbwillner]

I'm just going to say it... based on the unending negative comments re: private practice, I urge those in training to consider staying in academia. Academic jobs are good jobs. You may take home less, but you won't be a miserable SOB like so many in this forum.
I think pathologists are generally "type B" individuals and are usually not cut out for the rigors of the private practice marketplace. I get that you want to take home a bigger cut of what you produce... now enter a world where the rest of your colleagues (and middlemen) want the same- including a piece of your cut. Why should the oncology practice send you business if they can't somehow profit by doing so? This is the real world. The minute someone comes in with a lower price point or figures out how to get around Stark laws better you are gone. Sometimes it is not so easy to sleep at night.
Stay in academia... and you just don't worry about these things so much. It's all someone else's issue to deal with. Go to work, focus on your interesting cases, maybe do some teaching, go home, sleep well.

 

[deleted314957]

I'm just going to say it... based on the unending negative comments re: private practice, I urge those in training to consider staying in academia. Academic jobs are good jobs. You may take home less, but you won't be a miserable SOB like so many in this forum.
I think pathologists are generally "type B" individuals and are usually not cut out for the rigors of the private practice marketplace. I get that you want to take home a bigger cut of what you produce... now enter a world where the rest of your colleagues (and middlemen) want the same- including a piece of your cut. Why should the oncology practice send you business if they can't somehow profit by doing so? This is the real world. The minute someone comes in with a lower price point or figures out how to get around Stark laws better you are gone. Sometimes it is not so easy to sleep at night.
Stay in academia... and you just don't worry about these things so much. It's all someone else's issue to deal with. Go to work, focus on your interesting cases, maybe do some teaching, go home, sleep well.

GB makes a good point. Unless you are a go getter who has mastered the 3 A’s. Academia is a comfy womb. I found that a clinical background, albeit limited, just gave me instant street cred. I was a new type of critter and they loved me for 25 years.

 

[futuredoc331]

I'm just going to say it... based on the unending negative comments re: private practice, I urge those in training to consider staying in academia. Academic jobs are good jobs. You may take home less, but you won't be a miserable SOB like so many in this forum.
I think pathologists are generally "type B" individuals and are usually not cut out for the rigors of the private practice marketplace. I get that you want to take home a bigger cut of what you produce... now enter a world where the rest of your colleagues (and middlemen) want the same- including a piece of your cut. Why should the oncology practice send you business if they can't somehow profit by doing so? This is the real world. The minute someone comes in with a lower price point or figures out how to get around Stark laws better you are gone. Sometimes it is not so easy to sleep at night.
Stay in academia... and you just don't worry about these things so much. It's all someone else's issue to deal with. Go to work, focus on your interesting cases, maybe do some teaching, go home, sleep well.

Do academic contracts limit what you can do outside of your primary job? Can you still be a part time medical director somewhere else if you want to boost your income?

 

[deleted314957]

Sure they can. And if someplace needs a medical director, they can plug you right in there. BUT, don’t think it will raise your income. That money goes to “ the department “. It may hasten your promotion from assistant instructor to instructor however.

 

[Med Director New England]

Do academic contracts limit what you can do outside of your primary job? Can you still be a part time medical director somewhere else if you want to boost your income?

Any employer will make you disclose any work you do outside of your full time job and may not allow it.
Not unreasonable - it could be competitive with your group and / or interfere with your ability to do your regular job

 

[Alteran]

Any employer will make you disclose any work you do outside of your full time job and may not allow it.
Not unreasonable - it could be competitive with your group and / or interfere with your ability to do your regular job

A lot, if not all employment contracts are written such that the entirety of your professional expertise is to be spent on that position and no professional services may be utilized or billed outside of the employer's financial structure. This is where I think the clinical fields have a big advantage over pathology and radiology. As most of their billing structures are set up as "you eat what you kill", most clinical practices couldn't care less what you do on your dime so long as you don't affect or impede the rest of the practice by either function or reputation.

 

[gbwillner]

Any employer will make you disclose any work you do outside of your full time job and may not allow it.
Not unreasonable - it could be competitive with your group and / or interfere with your ability to do your regular job

I agree but the key here is may. I've seen academic jobs where docs get to keep up to half of their personal consult revenue, or that do allow you to act as a lab director at other facilities, provided they are not competitors with your institution (think niche industrial labs).

 

[Iceman24]

I've seen academic jobs where docs get to keep up to half of their personal consult revenue

It might be like a handful of people for the entire country and you know that, of course.

 

[Drifter76]

On a positive note, high paying pathology jobs can be soul crushing too (still better than a low paying one, though).

At least you’d have the one thing going for you. Money isn’t everything, but something is better than nothing. A lot of discussion suggests that pathology is a good lifestyle field- that you’ll likely have good hours even if nothing else is going your way. If your pay is low, no opportunity for advancement, undesirable location etc- well at least you’ll be going home at 4:00 every day. And if you do have a heavy workload with long hours, it likely translates into at least a reasonable income.
However, that is often not the case. It depends on the job. I worked for a large corporate lab (one of the big two), straight out of training, where I was pulling 70-80 hour weeks and making 200k. It was close to sweat shop working conditions, with massive volumes of cases being dumped on me. Of course I didn’t want the job but it was the lesser of two evils (working there versus being unemployed) so I took it.
I stayed there almost two years until I finally found something else, but the something else was a private practice where I was making low 200s with no partnership track. You might think that, if the pay is that low in a non-partner-track private job, maybe the volume would be correspondingly low. However, the partners were making over 500k, close to 600, and the only way they could maintain that with their payer mix and reimbursement cuts was to have large numbers of low paid underlings working hard to subsidize their bonus checks. I was often the one there at 7 pm signing out cases while several of the partners tended to disappear after 3 pm. I left both of these jobs within a few years, and was quickly replaced in both cases by a straight-out-of-training IMG with no prior sign out experience and no ties to the area.
These are just a couple of examples of the kinds of low quality jobs that await our new people coming out, where they’ll be heavily exploited and treated almost like indentured servants, working very hard for pretty mediocre pay in order to prop up the fat cats and shareholders. Many people will burn through years of their careers just trying to find a place where they can work without being taken advantage of.
This was my experience my first few years out, and I was pretty competitive academically with good training and resume. If I’d been a mid to bottom tier candidate I don’t know how things would’ve played out- could’ve been even uglier I suppose.

 

[Drifter76]

Yes, I think this is correct. Starting a business includes taking risk and burning cash. Most physicians are risk adverse, unless that comes in the form of buying an unnecessary vacation property.

There are tons of opportunities, but you need to know how to access them, and they don't become available by being a good pathologist.

I want to add that the consolidation in medical practice is across the board and is in no way limited to this field

I don’t see that as the primary problem - that people are too risk averse. Some may be but that is beside the point. I don’t see people having opportunities that they are passing up due to being too risk averse- I see people not having the opportunity in the first place.
I can understand someone being too risk averse to start a business, but why would they then make an even riskier move like going into pathology, after all the time, money etc they have invested in their careers. The choice just to go into pathology, for a medical student in today’s climate, is riskier and more of a losing proposition, than most small business startup situations.
I agree that there are “tons of opportunities”- just not for new people entering the field of pathology. The opportunity lies in other career paths, and that will continue to be the case for the foreseeable future. As I said earlier, I have kept up with several classmates from medical school who went into other fields, who got partnership track jobs straight out of training, made partner, and are still in their first job. The difference between me and them is not that they are less risk averse and that somehow aided them; none of them started their own practice from scratch. The difference is that they went into specialties where there is still some opportunity, the supply-demand ratio of the job market is reasonable, and most people are treated somewhat fairly, while I went into a field where the supply-demand is unnaturally skewed towards oversupply and most new people are being exploited.
Finally, it is true that consolidation (and other negative factors such as reimbursement cuts) is across the board and causing most careers in medicine to become less desirable over time. That is certainly not unique to pathology. However, the rate of decline has been much more rapid and pronounced in pathology compared to most other specialties for the reasons previously discussed.

 

[Drifter76]

I'm just going to say it... based on the unending negative comments re: private practice, I urge those in training to consider staying in academia. Academic jobs are good jobs. You may take home less, but you won't be a miserable SOB like so many in this forum.
I think pathologists are generally "type B" individuals and are usually not cut out for the rigors of the private practice marketplace. I get that you want to take home a bigger cut of what you produce... now enter a world where the rest of your colleagues (and middlemen) want the same- including a piece of your cut. Why should the oncology practice send you business if they can't somehow profit by doing so? This is the real world. The minute someone comes in with a lower price point or figures out how to get around Stark laws better you are gone. Sometimes it is not so easy to sleep at night.
Stay in academia... and you just don't worry about these things so much. It's all someone else's issue to deal with. Go to work, focus on your interesting cases, maybe do some teaching, go home, sleep well.

The gist of your argument seems to be, if I were to paraphrase it and add the proper perspective, “Private practice pathology for new people seems to have reached a point where it is EVEN WORSE than academia, so just stay in academics.” The first part of that statement may be correct, but the solution is not to take the lesser of two bad options. The solution is to avoid the field entirely.
I can’t speak for others, but I personally have no problem dealing with the “rigors of private practice”, as I routinely worked 100+ hour weeks as a surgical intern and resident. The problem I have is the lack of opportunity. I also have no desire for a “piece of someone else’s cut”. There’s a difference between being a thief yourself and pointing out others’ thievery.
“Miserable SOB”- and how would you describe the exploiters? Ignore them and blame the victim? Your moral compass needs adjusting.

 

[deleted314957]

If you have no geographic restriction it is not too difficult to become solo med director in a smaller rural place where you get a director fee and eat what you kill. I do not know of any available and have not been looking but know several folks who have done that. You may circuit ride over a sig area time to time as welol but this can all pay well.

 

[gbwillner]

It might be like a handful of people for the entire country and you know that, of course.

I'm not so sure. There are entire departments with this model.

 

[gbwillner]

The gist of your argument seems to be, if I were to paraphrase it and add the proper perspective, “Private practice pathology for new people seems to have reached a point where it is EVEN WORSE than academia, so just stay in academics.” The first part of that statement may be correct, but the solution is not to take the lesser of two bad options. The solution is to avoid the field entirely.
I can’t speak for others, but I personally have no problem dealing with the “rigors of private practice”, as I routinely worked 100+ hour weeks as a surgical intern and resident. The problem I have is the lack of opportunity. I also have no desire for a “piece of someone else’s cut”. There’s a difference between being a thief yourself and pointing out others’ thievery.
“Miserable SOB”- and how would you describe the exploiters? Ignore them and blame the victim? Your moral compass needs adjusting.

I think you are a "glass half empty" kind of person. It seems that you paint yourself as some sort of victim, as if you have no agency. It seems you are pissing into the wind.

The difficulties I mentioned in PP are not hours worked. It's the stress and uncertainty of operating a business, maintaining contracts, and managing professional and administrative staff.

 

[Dave CX]

Chief: Entrepreneur/business owner

Indian: Pathologist working for Quest signing out 100 biopsies a day. A minion.

Do the math. LabCorp pays their independent contractors 10$ per slide. At that volume you're looking at upwards of 3k per day. I'd rather be a minion pulling 700k per year (actually I am) then a hospital chief making 400K

 

[fecalith]

I'm not so sure. There are entire departments with this model.

Almost all the attendings are medical directors of small network hospitals at my department.

 

[fecalith]

Do the math. LabCorp pays their independent contractors 10$ per slide. At that volume you're looking at upwards of 3k per day. I'd rather be a minion pulling 700k per year (actually I am) then a hospital chief making 400K

sign me up!

 

[Iceman24]

Almost all the attendings are medical directors of small network hospitals at my department.

Do they keep the portion of their personal consult revenue?

 

[Iceman24]

I'm not so sure. There are entire departments with this model.

For instance?

 

[Med Director New England]

If you have no geographic restriction it is not too difficult to become solo med director in a smaller rural place where you get a director fee and eat what you kill. I do not know of any available and have not been looking but know several folks who have done that. You may circuit ride over a sig area time to time as welol but this can all pay well.

Mike - most new grads are not well rounded enough and couldn’t handle such a job. Training now is so super sub-specialized that not many newbies can sign bread and butter from all organ systems, confidently call out leukemia or blood parasites on peripheral smears, handle a basic blood bank and basic CP at a smallish hospital, be savy enough to navigate politics of a hospital, etc.

Also many toil in academia for a while signing out too narrow of a focus with no CP - and thus become less capable of this sort of a job even though experienced.

 

[Drifter76]

For instance?

I’m also very skeptical of some of these Pollyanna-ish claims about opportunities in academia. While there may be a rare exception, I think the vast majority of academic opportunities (especially for more junior people) are going to be pretty bottom of the barrel. No medical student or resident should count on being able to go into academic pathology and get any kind of sweet (or even reasonable) deal. The few situations that offer more opportunity (financial or otherwise) are going to disproportionately involve older generation pathologists who were able to get in years ago, closer to the ground floor, before the bottom fell out.

 

[coroner]

a) I don’t think it is actually that many jobs open at any one time. I think it is a lot of postings that have already been filled that are counted in that number, and the postings are still up. I looked at what was posted yesterday on path outlines and it is a few academic jobs plus two private jobs with no stated partnership track plus an Ameripath job- pretty low quality stuff as best I can tell.

You’re probably right that the total number of jobs posted is not reflective of what is open right at this exact moment since are posted for 6 months or until they are filled. I’m sure some employers fill their positions and never tell the website to remove it and they stay up there. As far as “pretty low quality stuff”, that’s in the eye of the beholder. If you’re not interested in academics, that is going to disqualify probably 40-60% of ads right there. And, there could be a great job, but it’s in an area you consider geographically undesirable, so you would write it off immediately. It’s going to be a hodgepodge of ads, and what you find “low quality” may be someone else’s dream job. "One man's trash is another man's treasure" - Ancient Chinese proverb

b) I know even more pathologists. You get to know a lot of people when you move around as much as I have. I wouldn’t say that most of the ones I know are content. I think there is a subset that is relatively content, and they seem to fall into one of 3 categories: some late career/retirement age people who got in before things completely went to hell, a few charmed individuals who either got very lucky or benefited from nepotism, and some who are either very naive or have extremely low expectations for their career/professional respect/compensation/etc. I think some IMGs fall into that last category, and overall I suspect IMGs may tend to have higher satisfaction levels in pathology than US grads. They have significantly less debt (not talking about Americans going to Caribbean schools- I know those are expensive) and I think many are very happy they were able to land jobs in the US making a 6 figure salary and actually stay here. Also, it probably doesn’t seem like quite as big a deal to have to relocate 1,000 miles for a job if you are already 7,000 miles from home.

I don’t know as many pathologists as you guys claim, but I know enough to have discussed their job status and get a general consensus. I would say most of the pathologists I know are content enough to stay at their current location. Although, I never asked them this question specifically. I assume that is the case because if they were discontent, then most of them would be leaving their jobs which isn’t so. So, I figure the majority are content. Having said that, if you asked would they be willing to leave for a better opportunity, that percentage would be likely be higher. But, that doesn’t necessarily mean they are miserable.

c) You listed several people there who allegedly started at around 400k or higher. To put that in perspective, in 10 years of practice - mostly private practice- I have never made anything close to that. I haven’t even broken 300k. I think my high water mark has been about 280k. I also work with 2 dermpaths who are both 5-7 years out of training, and neither of them make over 300k.

I agree those starting numbers are high. But, I don’t think he’s lying; only passing on what he’s heard through the grapevine. Again, no one knows what anyone makes unless you’ve seen their tax return. But for the sake of continuing the discussion, assume those are true or at least in the ballpark. If you haven’t broke 300K in 10 yrs of pp, I don’t know what to say. That is certainly possible under various circumstances e.g. 1. Working in a very low volume place 2. Being geographically restricted so you can’t/won’t look around too far away for better offers 3. Cheapskate bosses 4. Terrible luck. My hunch is it could be one of those factors or a combination of more than one, but if none of those factors applied, with your credentials, then you should easily find a job paying 300K+. Maybe not tomorrow or next week, but eventually. If you're talking 500K+ though, that's another story…

Why would a group pay someone 400 a year who has never even signed out a case when you can get quality people close to mid career who have a lot of experience for less than that? I’m not saying there’s anything wrong with new people making that. I think we should be able to get that kind of money- the problem is that for the most part we don’t. At least not any more. I am way underpaid, but knowing that and being able to do something about it in this kind of market are two entirely different things.

Because not every group is cutthroat looking to bilk off their partners. There’s actual positions out there where the volume is high enough, the payor mix is generous, and the contracts are lucrative where all partners share the wealth equitably. And they are willing to do so with whom they choose to hire based on their credentials, competence, and character. Those groups are not all looking for the cheapest mid-career scope monkey on the block to push glass. In fact, I know of a group that specifically only hires people right out training (or very close to). They never advertise, and all hires are through contacts/networking from their alma maters. And, from what I gather, they earn in the 400-500K range.

d) I know numerous people with zero red flags who are excellent Pathologists and very well trained who had to spend years looking just to get a single offer for a low quality job in a remote location. I can’t imagine any new people with major red flags coming out and getting multiple offers in pathology, unless it is akin to the nepotism situation that I mentioned earlier. I suppose, if Hunter Biden were a pathologist…

Sometimes it isn’t red flags that make or break someone’s chances. Case-in-point to both of your examples. Employers in our job market can choose to be picky. So something that is not a red flag, or shouldn’t be may still be enough for employers to give a CV a pass. Again, it’s hard to make generalizations unless we know each person’s situation.

The sole purpose of me writing this message is I absolutely love pathology and I feel as practicing pathologists we owe it to our specialty to get the honest word out and attract the best and brightest to our field. Adios !

Mario doesn't come on here very often and this was his first post in about a year. He dropped his 2 cents worth and wasn't interested in further discussion. Peace out Mario ✌️ See you in a year...maybe

 

[Drifter76]

Do the math. LabCorp pays their independent contractors 10$ per slide. At that volume you're looking at upwards of 3k per day. I'd rather be a minion pulling 700k per year (actually I am) then a hospital chief making 400K

I’ve worked for them both as an employee and as part of a group contracted by them. I don’t know of any pathologist employed by them, except for their CMO, making that kind of money. When I was contracted by them, labcorp billed for the services then payed the group based on a scale they had for each professional billing code (not per slide). I don’t remember all the numbers but I remember they were pretty low, maybe twenty something for an 88305 and $50 for an 88307 or something like that. The only way you’d come out ahead (versus billing direct, without the corporate middleman) would be if a pretty high percentage of the accounts receivable were uncollected, or a very bad payer mix. We were signing out a lot of bigger, more complex specimens that were 88307 and 88309 so I’m guessing the $10 per slide would’ve been a much better deal for the group.

 

[Drifter76]

I think you are a "glass half empty" kind of person. It seems that you paint yourself as some sort of victim, as if you have no agency. It seems you are pissing into the wind.

The difficulties I mentioned in PP are not hours worked. It's the stress and uncertainty of operating a business, maintaining contracts, and managing professional and administrative staff.

The glass isn’t half empty, it is pretty much entirely empty as best I can tell. And there is very little agency for people once they are stuck in this field, unless you count moving from one bad job to another as “agency”. People looking at pathology as a career need to know this before they make a huge mistake. I just wish people had warned me when I was at that stage, 15 years ago. It would’ve been the best piece of advice I could’ve hoped for. I’m not “painting myself” as anything. I’m stating what I’ve seen and been through, and what others I know have been through, which is in direct contradiction to many of the Pollyanna-ish comments by others, and you can decide for yourself how to characterize it. I have seen very little opportunity in pathology despite spending a decade looking for something decent. After doing very well academically in medical school, getting good training, training under a well known expert in my subspecialty, etc etc, I have had:
1. A corporate lab job where I got to
sit in a closet 13 hours a day and weekends, signing out a very high volume for low 200s.
2. A private job with no partnership track where I was stuck at the bottom of a two tiered system, exploited by partners who wanted to have a bunch of minions to subsidize their bonus checks (with no known opportunity for advancement)
3. A job with a group who basically told me that, if only I would move my family 1000 miles to an unfamiliar region of the country, I would have a stable partnership track job. I found out that group was losing their main hospital contract less than 3 months after starting there.
I have numerous co-residents and acquaintances in pathology who have struggled and had similar types of issues (lied to, taken advantage of, or just very low quality jobs with no real opportunity for improvement or advancement). At the same time, I have numerous acquaintances from medical school who went into other fields like anesthesia, radiology, urology, ortho etc who without exception have done relatively well.
What I “paint myself” as is beside the point. What matters is what is actually happening- the hard, cold facts- and what it means for new people entering the field.. doesn’t make any difference to me whether you like it or not or whether you might have a harder time staffing your gross room with pgy-1s come next July.

 

[fecalith]

Do they keep the portion of their personal consult revenue?

I am not 100% sure. But the start pay is in the 300K's and there is no state income tax.

 

[deleted314957]

I’m also very skeptical of some of these Pollyanna-ish claims about opportunities in academia. While there may be a rare exception, I think the vast majority of academic opportunities (especially for more junior people) are going to be pretty bottom of the barrel. No medical student or resident should count on being able to go into academic pathology and get any kind of sweet (or even reasonable) deal. The few situations that offer more opportunity (financial or otherwise) are going to disproportionately involve older generation pathologists who were able to get in years ago, closer to the ground floor, before the bottom fell out.

I don’t recall anyone implying academia out of training is a sweet deal. You are typically at the most vulnerable and unsophisticated of your professional life and they know that and therefore they will deign to make you an esteemed assistant instructor responsible for a full work load, some rat-tail research and teach a bunch of subminions gunning for your job.

 

[Drifter76]

I don’t recall anyone implying academia out of training is a sweet deal. You are typically at the most vulnerable and unsophisticated of your professional life and they know that and therefore they will deign to make you an esteemed assistant instructor responsible for a full work load, some rat-tail research and teach a bunch of subminions gunning for your job.

Gbwillner was essentially implying that, if you look at his posts. I think a lot of these low level academic jobs are just a way for people to get some sort of paycheck while they continue to look for a “real” job. At least that’s how I’d look at it if I had to take one of them.

 

[Drifter76]

It seems you are pissing into the wind.

Perhaps.. if my primary objective here is to improve my own situation. But that is not the goal; the goal is to educate others who are earlier in the process, so they won’t make the same mistake I did and ruin their career by choosing pathology.

 

[Drifter76]

The difficulties I mentioned in PP are not hours worked. It's the stress and uncertainty of operating a business, maintaining contracts, and managing professional and administrative staff.

If someone has the opportunity to operate a business, work to maintain contracts, manage staff etc and then finds, after being given that opportunity, that they can’t handle the stress (or someone turns down an opportunity because they don’t want to take on the stress/responsibility), that is a different matter and not really what I am referring to. I am talking about a situation where you never have the opportunity in the first place and you are treated like some kind of peon by default. It doesn’t really matter whether you can handle the stress or not if you never have the opportunity in the first place.

 

[Allegri]

I am not 100% sure. But the start pay is in the 300K's and there is no state income tax.

This is an academic department? That is very high for academics.