Lots of new jobs on pathoutlines

[doctor313]

Anyone else notice the uptick in jobs on pathoutlines? Just looking back over the last month, there's been over 80 new job postings. This rate of job openings seems to go back about 2 months.

At that pace there would be around 1000 new jobs this year, way more than the number of graduating residents/fellows. And this is not counting all the jobs that aren't being posted. Is it a positive sign?

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[KeratinPearls]

Maybe some of the groups that delayed their hiring because of covid early in the year are starting their hiring process back up. Maybe all these jobs are from the past few months of hiring freezes that are becoming unfrozen. Good to see more jobs for trainees. I’ve also seen a lot of demand for hemepath.

 

[Allegri]

It seems a lot of jobs are asking for cytopathology training. But I have read multiple opinions on this board that cyto is basically dead. Why the discrepancy?

 

[Vicinal]

There is cyto and then there is cyto. Most negative posters are old school generalists that are lumpers. If groups do nongyn cytology EBUS, EUS, with cell blocks for ancillary testing including molecular then a good fellowship is necessary. The average SP with fellowship trainee will not understand these things. Also it has to be a good cyto fellowship with a great director and service. Many are crap and should be shut down immediately.

 

[KeratinPearls]

It seems a lot of jobs are asking for cytopathology training. But I have read multiple opinions on this board that cyto is basically dead. Why the discrepancy?

There is plenty of Cyto Work at larger community hospitals. Even the smaller hospitals (200-300 bed) need Cyto. Maybe the reimbursement isn’t as good but ppl need Cyto fellowship trained pathologists.

I interviewed for a job and they were busy. They would get all the paps from their huge group. Like at least 20-40 a day. They had no cytotech and wanted the person who will be hired to go do the adequacies lmao (10-15 adequacies a day) and come back to their office to sign out cases as well. GI docs need someone to read their EUS and ERCP FNAs. Sounded like hell. Anyways they were trying to get the hospital to pay for a tech but nada.

Paps aren’t abundant at some hospitals because they dont want to pay for a cytotech considering the small volume. So they just send it out. If you go to a larger comm hospital there will be a lot of Cyto to look at. People on sdn make Cyto look like crap but ppl still need to be competent to read it especially so at larger hospitals where volume will be higher.

 

[coroner]

They would get all the paps from their huge group. Like at least 20-40 a day. They had no cytotech

GYN Pap smears with no cytotech?!? This is almost non-existent today. Private groups (and most definitely academics) almost all have cytotechs. I have yet to encounter a general pathologist or even a cytopathologist who enjoys screening Paps. If the group is that busy, they are probably doing more than ok financially. And, if are too cheap to hire a cytotech themselves, which would make their workload significantly easier, that speaks to a lack of business sense on their part. The professional component reimbursement is not worth the time investment to screen Paps. This is why almost all private groups have either outsourced them to Pap mills, or at the very least hire cytotechs.

On another note, when I was on the interview trail, I met a pathology group who totally did away with intra-op FNA adequacies (ROSE, EBUS, EUS, etc.). Initially it upset the clinicians, but the pathologists stood their ground and basically said if you know where the lesion is, then you should be able to target it yourself without needing a pathologist. If not, then they need to work on their technique and stop treating the patient like a pincushion. Just send it to the lab for permanents.

Also it has to be a good cyto fellowship with a great director and service. Many are crap and should be shut down immediately.

The same can be said about a fair number of residency programs as well...

 

[KeratinPearls]

GYN Pap smears with no cytotech?!? This is almost non-existent today. Private groups (and most definitely academics) almost all have cytotechs. I have yet to encounter a general pathologist or even a cytopathologist who enjoys screening Paps. If the group is that busy, they are probably doing more than ok financially. And, if are too cheap to hire a cytotech themselves, which would make their workload significantly easier, that speaks to a lack of business sense on their part. The professional component reimbursement is not worth the time investment to screen Paps. This is why almost all private groups have either outsourced them to Pap mills, or at the very least hire cytotechs.

On another note, when I was on the interview trail, I met a pathology group who totally did away with intra-op FNA adequacies (ROSE, EBUS, EUS, etc.). Initially it upset the clinicians, but the pathologists stood their ground and basically said if you know where the lesion is, then you should be able to target it yourself without needing a pathologist. If not, then they need to work on their technique and stop treating the patient like a pincushion. Just send it to the lab for permanents.



The same can be said about a fair number of residency programs as well...

Pap smears are screened at a central lab for the group. On site in the hospital they had no cytotechs to do adequacies.

 

[Vicinal]

Judge a cyto fellowship IMHO by whether fellow does lots of pathology driven actual palpation or US guided FNAs. This is a nice metric as it demonstrates the level of respect all clinicians have for the pathologists as members of the clinical team. When a cyto fellowship has been able to set up a clinically respected patient centered (actual patient contact) service, this is a metric for the quality of the program. There are lots of programs which are a waste of time and should be shut down. The fellowship directors have no vision and leadership and are place holders jockeying for academic (pseudo academic) positions and power. Many private practice groups get EUS, EBUS, thyroid etc specimen and need pathologists from fellowship with an understanding of team work, clinical contact, ancillary testing etc. this is very difficult to learn on the job especially if a group is old school grand fathered in generalist entrenched.

 

[Iceman24]

Anyone else notice the uptick in jobs on pathoutlines? Just looking back over the last month, there's been over 80 new job postings. This rate of job openings seems to go back about 2 months.

At that pace there would be around 1000 new jobs this year, way more than the number of graduating residents/fellows. And this is not counting all the jobs that aren't being posted. Is it a positive sign?

Right now it is 320 jobs on pathoutlines, and the number of graduating residents is roughly 600 plus fellows.
In February there were approximately 420 jobs.
I hardly see where your assumption about "1000 jobs" is coming from.
Obviously, closer look at ads confirms that a lot of them are for administrative positions and some do require previous experience excluding fresh graduates.

 

[WEBB PINKERTON]

YOU DO NOT NEED TO DO A CYTO FELLOWSHIP

You should be good to go if you went to a decent program and showed some initiative.

There are plenty of crutches to use that make you just as smart as the "experts" in cytopath.

The field is definitely contracting as cores and molecular take over.

 

[Alteran]

Right now it is 320 jobs on pathoutlines, and the number of graduating residents is roughly 600 plus fellows.
In February there were approximately 420 jobs.
I hardly see where your assumption about "1000 jobs" is coming from.
Obviously, closer look at ads confirms that a lot of them are for administrative positions and some do require previous experience excluding fresh graduates.

Perhaps there are more jobs posted now than historically have been. Reality is that the best jobs on path outlines are going to go to seasoned pathologists who are going to leverage their current experience to get a better position and the left overs, should there be any, will go to the best name brand grads. There will still be a deficit of "advertised" or recruited jobs in pathology.

 

[doctor313]

Right now it is 320 jobs on pathoutlines, and the number of graduating residents is roughly 600 plus fellows.
In February there were approximately 420 jobs.
I hardly see where your assumption about "1000 jobs" is coming from.
Obviously, closer look at ads confirms that a lot of them are for administrative positions and some do require previous experience excluding fresh graduates.

"Around 1000" comes from simple math. 80 jobs / month x 12 months = 980. That would be if the current pace holds.

Keep in mind that job postings are removed as they are filled, so 320 jobs right now is not reflective of the total number of jobs being posted per year. It's just a snapshot of what is available now (minus the outdated posts that haven't been taken down). Pathoutlines has reports of numbers of new jobs posted per quarter, and in the last couple pre-COVID quarters, there were around 200 jobs / quarter, which is in the vicinity of 800 jobs / year - not bad at all.

 

[Vicinal]

YOU DO NOT NEED TO DO A CYTO FELLOWSHIP

You should be good to go if you went to a decent program and showed some initiative.

There are plenty of crutches to use that make you just as smart as the "experts" in cytopath.

The field is definitely contracting as cores and molecular take over.

Can’t disagree. Sometimes the needle gauge for cores is too big and a cell block is more amenable and it depends on where you are working but you may be right that it is program and resident dependent on how adept you become without a fellowship. Going to tumor boards and discussing cases with clinicians and managing cases in a busy cyto fellowship is a great experience. You can cover lots of depth and breadth.

 

[cmz]

We have lots of EBUS and EUS procedures. It is invaluable to have boarded cytopaths who came from excellent training programs that had these types of specimens in their routine case mix.

One area in cytopath that I do not have much practice with are thyroid FNA interpreted with ThinPrep alone. I am too used to FNA smears. I like to see colloid. In routine practice, how easy is it to interpret thyroid with his modality?

 

[Vicinal]

It is better to have DQ and PAP stained smears and liquid based (TP/SP) to catch low cellularity specimen. I guess you can get used to TP alone but suboptimal IMHO. I’m sure groups have optimized work arounds but DQ is excellent for extra cellular material and SP/TP for nuclear features etc. you can pick up a PTC on liquid based preparations I guess but I think having all three is optimal. Sometimes you can even make a nice cell block.

 

[WEBB PINKERTON]

ThinPrep alone is insane for thyroid FNAs. They should at least be doing a cell block. ThinPrep filters get clogged up by even the smallest amount of ultrasound gel.

Some radiologists are fine doing cores of the thyroid I have noticed. I am surprised that hasn't taken off more for many lesions. I have seen quite a few in recent years and they are nice specimens. So refreshing to not have a bunch of slides of blood to screen. A few institutions are doing them after unsat attempts at needles.

 

[deleted314957]

There is cyto and then there is cyto. Most negative posters are old school generalists that are lumpers. If groups do nongyn cytology EBUS, EUS, with cell blocks for ancillary testing including molecular then a good fellowship is necessary. The average SP with fellowship trainee will not understand these things. Also it has to be a good cyto fellowship with a great director and service. Many are crap and should be shut down immediately.

Your opinion that a good cyto fellowship is necessary under your stated circumstances is, in my opinion, false. I did it for years with zero problems. Maybe I was an outlier. I believe there is too much “mystery” about cyto.

 

[Spikebd]

There does seem to be more on-line job posting, but are they good jobs? Would be nice for path if this trend is real. Maybe the field would become more competitive, if it’s true.

 

[Vicinal]

Your opinion that a good cyto fellowship is necessary under your stated circumstances is, in my opinion, false. I did it for years with zero problems. Maybe I was an outlier. I believe there is too much “mystery” about cyto.

I guess I would argue that if your choices are doing cyto with no fellowship, a crappy fellowship, or a great fellowship... I suggest choosing a great fellowship and if you can’t get one just going t work. OTJ May work... Some old school generalists just hate cyto and disparage it. It is rarer for well trained with fellowship cytopathologists to disparage the field.

 

[Vicinal]

ThinPrep alone is insane for thyroid FNAs. They should at least be doing a cell block. ThinPrep filters get clogged up by even the smallest amount of ultrasound gel.

Some radiologists are fine doing cores of the thyroid I have noticed. I am surprised that hasn't taken off more for many lesions. I have seen quite a few in recent years and they are nice specimens. So refreshing to not have a bunch of slides of blood to screen. A few institutions are doing them after unsat attempts at needles.

Yeah we are getting cores from IR as well but endocrine and Head and neck send smears and they are decent. Agree that most often cores are best if possible.

 

[KeratinPearls]

YOU DO NOT NEED TO DO A CYTO FELLOWSHIP

You should be good to go if you went to a decent program and showed some initiative.

There are plenty of crutches to use that make you just as smart as the "experts" in cytopath.

The field is definitely contracting as cores and molecular take over.

Not sure about that. Busy hospitals with a lot of Cyto work hire fellowship trained pathologists for a reason. I would not trust any Regular grad over a Fellowship trained pathologist from a good institution to handle a busy Cyto workload. That’s just my opinion.

if employers could just hire any path grad, they would, to look at Cyto. However that’s not the case. There are plenty of grads who don’t know how to signout competently once they grad residency sadly. I wonder how many new grads can competently go on an adequacy and give a diagnosis Of adeno to the GI docs? I wonder how many grads can sign out paps at a busy pap service (confidently). Some grads are clueless when it comes to basic Cyto and thus this is why employers look for cyto fellowship trained candidates because they don’t trust a regular grad to do it.

 

[coroner]

I wonder how many new grads can competently go on an adequacy and give a diagnosis Of adeno to the GI docs?

That defeats the purpose of an "adequacy" in the first place. Going on an adequacy is strictly that: telling the clinician if they have enough cells or not.
Pathologists need to stop giving diagnoses on these procedures regardless if the clinician pushes them. It sets unrealistic expectations for clinicians and affects other pathologists if these clinicians cover other hospitals or move to another state and expect the same results.

 

[WEBB PINKERTON]

NEVER give a specific diagnosis on adequacy assessments. Only document adequate or inadequate. I've seen some sites get cited because the inspectors said they should have recorded workload when they documented a specific diagnosis. You can't make this crap up. The cytopath regs make many cytopaths disenchanted with the field, along with physicians expecting magic off of paucicellular specimens.

 

[Alteran]

NEVER give a specific diagnosis on adequacy assessments. Only document adequate or inadequate. I've seen some sites get cited because the inspectors said they should have recorded workload when they documented a specific diagnosis. You can't make this crap up. The cytopath regs make many cytopaths disenchanted with the field, along with physicians expecting magic off of paucicellular specimens.

This is overwhelmingly the primary reason in my experience why hospital based specialists demand cytopathology coverage. They simply think that a cytopathologist can whitewash their poor skills/technique and give a diagnosis so they don't look inept.

 

[Vicinal]

This is overwhelmingly the primary reason in my experience why hospital based specialists demand cytopathology coverage. They simply think that a cytopathologist can whitewash their poor skills/technique and give a diagnosis so they don't look inept.

Can not disagree with this. But if clinicians doing a procedures based fellowships (IR, Pulm, GI, endocrine) are at a program that has a great cyto fellowship with excellent interdepartmental relationships and feedback then it’s a win win for training. Often the reason for frustrating interactions in these situations is the blind leading the blind scenario and passing the buck to the other service . This is not good for anyone including the patient. Obviously a level of basic standardization and shared team training is necessary for optimization of tissue procurement and characterization. I get it that there are excellent pathologists that can SO everything and have learned OTJ. But the way pathology residency training has developed as well as the expectation of residents ( how hard they are willing to work) makes it unlikely for non fellowship trained residents to SO without major issues. There are outliers but you want to avoid services becoming a passive aggressive blaming each other situation. Cyto fellowship is a great opportunity to practice better communication strategies, participate in teaching EBUS, EUS fellows how to get satisfactory diagnostic yields and best practices for ancillary techniques.

 

[WEBB PINKERTON]

This is overwhelmingly the primary reason in my experience why hospital based specialists demand cytopathology coverage. They simply think that a cytopathologist can whitewash their poor skills/technique and give a diagnosis so they don't look inept.

They may not be inept. Some lesions are just difficult to sample using these less invasive techniques. Less invasive sounds great but in practice has many issues.

There seems to be a hell of a lot of luck involved with cytopathology. You can have smears loaded with tumor on adequacy assessment. Then you place some passes into formalin for blocks only to find out in the lab you have necrosis with rare tumor cells in your block for immunos, molecular. Maybe Guardant360 will fix this problem anyways.

 

[LADoc00]

why are people in the age of molecular path even doing cyto??

Everyone needs to just accept cyto is dead. Standing around a procedure room while a patient is prepped and you do 5 sec adequacy assessement or a ROSE that bills a single 30 buck code for an 30-45 of work is best way to end up bankrupt.

Im already trying to save too many private practices where I am with my mad biz skillz, I dont have time to save more. Please stop doing cyto.

 

[KeratinPearls]

Cyto may be a dying field from a biz perspective but ppl still need to do it if you get a general path job. If your skills aren’t up to par (no fellowship) you can just learn from the senior people in your group or the cytopath fellowship trained person in the group. If someone gives you a tray of Cyto you can’t say “sorry I don’t want to sign it out” or “I don’t feel comfortable signing it out.”

 

[cmz]

why are people in the age of molecular path even doing cyto??

Everyone needs to just accept cyto is dead. Standing around a procedure room while a patient is prepped and you do 5 sec adequacy assessement or a ROSE that bills a single 30 buck code for an 30-45 of work is best way to end up bankrupt.

Im already trying to save too many private practices where I am with my mad biz skillz, I dont have time to save more. Please stop doing cyto.

I so want to agree with you, but when one of your client hospitals requests this service, what choice do you have? Yes, you can fight back and say no, but the other guy did that and I took his millions.

 

[cmz]

Yeah we are getting cores from IR as well but endocrine and Head and neck send smears and they are decent. Agree that most often cores are best if possible.

What good does a thyroid core do other than say, rule out PTC? The Bethesda system is based off of thyroid cytopathology. Core biopsies seem to have more limitations than reading the DQ and PAP smears from an FNA.

 

[deleted314957]

Aren’t residents today required/strongly encouraged to do frequent touch preps and fna’s at the grossing bench and autopsies( but i was from the days when autopsies were plentiful for a resident’s 50 requirement), This way, you started to become comfortable with cyto from day one of a four year program. When you signed out the case you reviewed the touch or needle from the lung ca you grossed.

Is this not the norm?

 

[cmz]

Aren’t residents today required/strongly encouraged to do frequent touch preps and fna’s at the grossing bench and autopsies( but i was from the days when autopsies were plentiful for a resident’s 50 requirement), This way, you started to become comfortable with cyto from day one of a four year program. When you signed out the case you reviewed the touch or needle from the lung ca you grossed.

Is this not the norm?

I trained at UTSW in the mid-2000s. Our cyto rotation involved us with a good mix of gyn and non-gyn cyto. We had FNA clinic once a week where the resident pathologist performed FNAs and did adequacy checks. We went to multiple CT-guided and US-guided procedures for adequacy as well. I was very comfortable reading DQ slides with just one cyto rotation, especially thyroid FNAs. Surgical pathology was sequestered, so any biopsies performed went directly to them. Cytology just received the smears and cell block if FNA was performed and only smears/touch imprints if a needle bx was taken. We would inevitably meet up with the surgical pathologist assigned to the case to review the findings and do our cyto-surg correlation.

One thing that wasn't the norm at the time were EUS-FNA and EBUS-FNA procedures. Either they didn't involve the resident or it just wasn't common place. When I did my VA rotation 4th year, I began to see a lot of EUS-FNA. It is operator dependent and I came away with a bad feeling in my mouth because we never escaped an EUS-FNA without receiving 40 slides of crap. Right now I work with excellent GI docs who can nail the lesion in just a few passes, so things have become more tolerable. We only go to procedures that are initially non-diagnostic, which are few and far between.

At least where I practice, I am seeing more and more requests for EUS-FNA and EBUS-FNA. I am sure a seasoned pathologist can offer good insight for diagnosis, but the docs doing these procedures need a pathologist's eyes on hand for specimen adequacy. Right now, especially with molecular testing available, it isn't enough to just say "adequate specimen" if you're just looking at the slide. You need to make sure you have enough specimen for all of the ancillary studies that the oncologist is going to want. I do NOT think you need a cytopath fellowship to learn all of this, but it is very helpful if you've trained at a place that offered this kind of expertise. I had a solid foundation from residency and just expanded on it more with on the job training. That's kind of how ALL programs should be training their residents to begin with.

 

[WEBB PINKERTON]

There is still a lot of luck involved for making sure you have enough for foundation one and all the other crap they want nowadays. Slides, brushings can be loaded and then the block sucks. The big boys want formalin fixed paraffin embedded specimens. And it seems like the wild west with some labs out their using alcohol and cytolyt fixed slides. I have no clue how good their validation studies are. The results may be complete garbage.

Our oncologists seem happy ordering Guardant360 on all their patients. I keep wondering how much longer it will matter if you have enough material for some of this ancillary testing.

 

[Vicinal]

What good does a thyroid core do other than say, rule out PTC? The Bethesda system is based off of thyroid cytopathology. Core biopsies seem to have more limitations than reading the DQ and PAP smears from an FNA.

Agree and it depends on where you work. Would rather get an adequate core than fields of blood contaminated with US gel. At least you can stain a core as well (medullary etc.). Obviously smears are better for the patient in terms of less damage to a vascular organ with a higher gauge needle. If IR does it and sends it to the lab with a nice core at least you can get a diagnosis and not an UNSAT or atypical read.

 

[Vicinal]

Aren’t residents today required/strongly encouraged to do frequent touch preps and fna’s at the grossing bench and autopsies( but i was from the days when autopsies were plentiful for a resident’s 50 requirement), This way, you started to become comfortable with cyto from day one of a four year program. When you signed out the case you reviewed the touch or needle from the lung ca you grossed.

Is this not the norm?

Should be the norm. It was the norm for me when I trained. I actually had/have some smears and H/Es from cases I grossed that were great examples of an entity. We were encouraged to collect cases and review cyto morphology and histology. Our director was old school. But I have heard residents gross less and increasingly specimen are sent to the lab in formalin so smears and touch preps are suboptimal in that setting.

 

[Vicinal]

why are people in the age of molecular path even doing cyto??

Everyone needs to just accept cyto is dead. Standing around a procedure room while a patient is prepped and you do 5 sec adequacy assessement or a ROSE that bills a single 30 buck code for an 30-45 of work is best way to end up bankrupt.

Im already trying to save too many private practices where I am with my mad biz skillz, I dont have time to save more. Please stop doing cyto.

Seems like your cyto experience has been suboptimal in the clinical setting in which you work. Surprisingly because UCSF and Sacramento traditionally were considered centers training and excellence

 

[deleted314957]

Should be the norm. It was the norm for me when I trained. I actually had/have some smears and H/Es from cases I grossed that were great examples of an entity. We were encouraged to collect cases and review cyto morphology and histology. Our director was old school. But I have heard residents gross less and increasingly specimen are sent to the lab in formalin so smears and touch preps are suboptimal in that setting.

Bravo for your program. That type of training really demystifies cyto. Not to pat myself on the back but our IR’s thought I was the best cytopath in the mega hospital system they were part of. That is what happens when you don’t treat it like a mysterious black box.

p.s. i am well aware that mega changes have taken place since i retired in 2013 but much is still the same

 

[LADoc00]

I so want to agree with you, but when one of your client hospitals requests this service, what choice do you have? Yes, you can fight back and say no, but the other guy did that and I took his millions.

your choice is tell them that cyto with no molecular follow on is not the current standard of care. And is it the hospitals requesting this OR is the GI groups or Rads groups that want to make more money for their group at your group's expense?

What about patient care? if you do a FNA and then have to follow it up with another procedure to get core sample for NGS and PDL-1 you have taken part in an unnecessary medical procedure.

I think its even unethical to be standing around doing adequacy checks for radiology let alone financially foolish.

 

[Smoothbrain]

Thats great news for us PGY-1s. Reading these forums I got the impression I would be cooking beans and living under a bridge after residency )

 

[octopusprime]

Thats great news for us PGY-1s. Reading these forums I got the impression I would be cooking beans and living under a bridge after residency )

no that's still a few years off, you'll get settled into practice first and have your career slowly whittled away, but you'll essentially be working for peanuts from the start.

 

[KeratinPearls]

Thats great news for us PGY-1s. Reading these forums I got the impression I would be cooking beans and living under a bridge after residency )

You won’t have any issues finding a job if you aren’t geographically restricted. You may even get a job where you’d like to live. In my own experience, jobs are limited in certain regions so you have to take what you can get for the first job. That may not be the case for everyone and some may have more than one choice in the area they want to live.

I’d say go train where you want to live for your future job and network to put yourself in the best position.

 

[WEBB PINKERTON]

CAP president worried about the cuts. Hope there is enough room under the bridge for all you guys.

From the President’s Desk: Painful cuts ahead - CAP TODAY

September 2020—Pathologists have been feeling the pain for months. The COVID-19 pandemic triggered furloughs and layoffs even as we ran a grueling race to implement and scale high-quality testing. And now looming cuts to pathologist physician payments threaten to make our situation even worse.

www.captodayonline.com

 

[LADoc00]

CAP president worried about the cuts. Hope there is enough room under the bridge for all you guys.

From the President’s Desk: Painful cuts ahead - CAP TODAY

September 2020—Pathologists have been feeling the pain for months. The COVID-19 pandemic triggered furloughs and layoffs even as we ran a grueling race to implement and scale high-quality testing. And now looming cuts to pathologist physician payments threaten to make our situation even worse.

www.captodayonline.com

Yup, lots of groups were on the financial edge just due to covid itself, this will be fine straw for sure. I stand by my March predictions of a massive collapse of private practice pathology groups especially larger ones with big overhead from large TC side operations.

 

[Thr0mbus]

CAP president worried about the cuts. Hope there is enough room under the bridge for all you guys.

From the President’s Desk: Painful cuts ahead - CAP TODAY

September 2020—Pathologists have been feeling the pain for months. The COVID-19 pandemic triggered furloughs and layoffs even as we ran a grueling race to implement and scale high-quality testing. And now looming cuts to pathologist physician payments threaten to make our situation even worse.

www.captodayonline.com

THIS CHARLATAN NEEDS TO STOP THE OVERTRAINING AND MAKE OUR WORK IN HIGH DEMAND. THEN AND ONLY THEN WILL WE BE ABLE TO NAME OUR PRICE!!

NOWHERE IN HIS DAMN ARTICLE DOES HE MENTION THIS.

FLEE PATHOLOGY NOW!!!

 

[cmz]

your choice is tell them that cyto with no molecular follow on is not the current standard of care. And is it the hospitals requesting this OR is the GI groups or Rads groups that want to make more money for their group at your group's expense?

What about patient care? if you do a FNA and then have to follow it up with another procedure to get core sample for NGS and PDL-1 you have taken part in an unnecessary medical procedure.

I think its even unethical to be standing around doing adequacy checks for radiology let alone financially foolish.

I think these procedures are money losers for the radiologists (more so because I might be slowing them down between procedures), GI docs, Pulmonary/Critical Care docs AND pathologists. The GI docs and Pulm docs can be in their clinic pumping out 60-80 patients/day and rounding in the ICU collecting $$$$ and the radiologists could be moving from procedure to procedure or sitting back reading films all day uninterrupted so they can be on the golf course by 2. These procedures, though necessary, are very time consuming. The hospital probably makes the most out of all of this since OR time is being used.

Regarding patient care, at least how we practice, you can look at this in many different ways depending on procedure. Almost always you're not going to repeat a procedure for more tissue. Do repeats happen? Yes, this isn't a perfect world. Things like EBUS FNA is used for staging. That provides more cost savings and less patient mortality/morbidity than having your chest cracked open by a surgeon. It can also be diagnostic as well as guide oncologists for therapy-related decisions (e.g. NGS, PD-L1, etc). Thyroid FNA use molecular with AFIRMA (if you believe in this) and provide for more precise diagnoses with a six-tiered system. This also helps guide surgeons on whether to operate or not.

The main purpose of these adequacy checks is to help ensure that repeats aren't necessary. I look at performing these functions in order to keep my client happy. So far it has worked.

 

[LADoc00]

Im seeing over 2/3 of oncology decisions now being driven by NGS data or other molecular testing, maybe more.

Something we never had seen before is the huge number of repeat biopsies for tissue to perform these tests.

I do not see a cell block from a FNA procedure able to satisfy this demand given we have routine rejections even for core biopsy material.

 

[cmz]

Im seeing over 2/3 of oncology decisions now being driven by NGS data or other molecular testing, maybe more.

Something we never had seen before is the huge number of repeat biopsies for tissue to perform these tests.

I do not see a cell block from a FNA procedure able to satisfy this demand given we have routine rejections even for core biopsy material.

I work with four different hospitals and several oncology clinics right now and the number of test requests I get for NGS aren't that high (yet). While I have noticed a significant increase, it doesn't seem to be anywhere near the volume you're talking about. You seem to be ahead of the curve. I am very interested in getting into NGS myself but I need the case volume to warrant such expansion.

What's wrong with repeat sampling for a tumor that has already been treated? The tumor biology has likely changed. Or are you talking about repeat biopsy soon after a diagnosis is made and treatment decisions haven't been flesh out? It is better to have a one-stop shop and get all the answers than have to repeat the same song and dance again for the patient.

 

[WEBB PINKERTON]

There won't be too many repeat biopsies much longer if Guardant realizes its potential. That stock made me a ton so I gotta keep saying good things about them.

 

[y2k_free_radical]

THIS CHARLATAN NEEDS TO STOP THE OVERTRAINING AND MAKE OUR WORK IN HIGH DEMAND. THEN AND ONLY THEN WILL WE BE ABLE TO NAME OUR PRICE!!

NOWHERE IN HIS DAMN ARTICLE DOES HE MENTION THIS.

FLEE PATHOLOGY NOW!!!

You are correct.Furthermore,perhaps the CAP could have a suggestion box or blawg so us little community pathologists could be heard.Less supply is the best answer to this problem.

 

[Allegri]

How does reducing trainees affect the ability of CMS to dictate their reimbursement? This is not exactly a free market situation.