Molecular Pathology, THE fellowship for pathology moving forward

[LADoc00]

I have to eat crow when I so poorly read the tea leaves on the pathology job situation for SDN. I am sorry and do feel at some level I have failed you guys.

I have for many years felt since there were very little professional fees to be collected in the CMS mol. path fee schedule that the field was destined to be dud, ruled over by PhDs in high throughput commercial set ups and if you did get a position somewhere you would expect salary well below a starting intern at Google and be forced to move from job to job.

---------------
This is not the case. Not only are mol path fellows commanding the highest salaries out of ALL fellowship trained applicants in 4 of 4 recruiting firms Ive spoken with but I now have real world examples now of mol trained pathologists making the highest incomes the entire field has seen since the 1970s.

I only see this expanding and in fact the mol path fellowship of tomorrow maybe the general surgical path fellowship of today.

---

Members don't see this ad.

 

[Spikebd]

I have to eat crow when I so poorly read the tea leaves on the pathology job situation for SDN. I am sorry and do feel at some level I have failed you guys.

I have for many years felt since there were very little professional fees to be collected in the CMS mol. path fee schedule that the field was destined to be dud, ruled over by PhDs in high throughput commercial set ups and if you did get a position somewhere you would expect salary well below a starting intern at Google and be forced to move from job to job.

---------------
This is not the case. Not only are mol path fellows commanding the highest salaries out of ALL fellowship trained applicants in 4 of 4 recruiting firms Ive spoken with but I now have real world examples now of mol trained pathologists making the highest incomes the entire field has seen since the 1970s.

I only see this expanding and in fact the mol path fellowship of tomorrow maybe the general surgical path fellowship of today.

Wow. I believe you, but am surprised you mention the salaries are so high.

 

[coroner]

...but I now have real world examples now of mol trained pathologists making the highest incomes the entire field has seen since the 1970s.

Is that the top 1-5%, or the median of molecular pathologists making the highest incomes in our field? Sure, there are pathologists who own labs/multiple medical directorships making $1 mil+, but that is not anywhere close to the median or expected income range for a new grad, let alone typical pathologist.

"Highest incomes since the 1970s" sounds like at least $500K+. If such incomes are attainable; is this realistic for the run-of-the-mill molecular trained pathologist working a typical job i.e. who is not in the top wage bracket or own their own lab? This intrigues me, maybe the molecular folks on here can weigh in...

 

[HeyDalaron]

What would the molecular pathologists do in these roles?

I was under the impression that molecular pathology would be primarily an academically oriented field with little direct clinical applicability on a daily basis, lending itself well to unimpressive salaried models.

 

[Guest8]

What would the molecular pathologists do in these roles?

I was under the impression that molecular pathology would be primarily an academically oriented field with little direct clinical applicability on a daily basis, lending itself well to unimpressive salaried models.

They're synthesizing the final report on all the complex genetic and molecular tests we're all ordering now. The machines spit out what mutations are/aren't present and the molecular pathologist writes up the report. Seems similar to writing up a note detailing how all the IHC comes together for a diagnosis.

 

[Thaitanium]

I have to eat crow when I so poorly read the tea leaves on the pathology job situation for SDN. I am sorry and do feel at some level I have failed you guys.

I have for many years felt since there were very little professional fees to be collected in the CMS mol. path fee schedule that the field was destined to be dud, ruled over by PhDs in high throughput commercial set ups and if you did get a position somewhere you would expect salary well below a starting intern at Google and be forced to move from job to job.

---------------
This is not the case. Not only are mol path fellows commanding the highest salaries out of ALL fellowship trained applicants in 4 of 4 recruiting firms Ive spoken with but I now have real world examples now of mol trained pathologists making the highest incomes the entire field has seen since the 1970s.

I only see this expanding and in fact the mol path fellowship of tomorrow maybe the general surgical path fellowship of today.

How about opening a mol path lab. High overhead costs im thinking And you need enough referrals to stay afloat. How about infectious disease mol path like fungal speciation?

Since the 1970s? Pathologists were making 1 mil a year billing for CP labs back then.

 

[KeratinPearls]

I have to eat crow when I so poorly read the tea leaves on the pathology job situation for SDN. I am sorry and do feel at some level I have failed you guys.

I have for many years felt since there were very little professional fees to be collected in the CMS mol. path fee schedule that the field was destined to be dud, ruled over by PhDs in high throughput commercial set ups and if you did get a position somewhere you would expect salary well below a starting intern at Google and be forced to move from job to job.

---------------
This is not the case. Not only are mol path fellows commanding the highest salaries out of ALL fellowship trained applicants in 4 of 4 recruiting firms Ive spoken with but I now have real world examples now of mol trained pathologists making the highest incomes the entire field has seen since the 1970s.

I only see this expanding and in fact the mol path fellowship of tomorrow maybe the general surgical path fellowship of today.

Are you saying there’s actually some glimmer of hope in Pathology?

 

[SetecAstronomy]

Are you saying there’s actually some glimmer of hope in Pathology?

 

[Alteran]

Are you saying there’s actually some glimmer of hope in Pathology?

The capital startup cost for a NGS molecular lab is somewhere in the $500K-1M mark. And that's nothing to say of the personnel costs and IT expenses needed to make it actually function. If molecular pathologists are getting jobs, I can assure you that they are in primarily academia or large private reference style labs as employees (I'm sure the rare exception or two exists, somewhere).

It really is hard to break into molecular pathology on your own because you have to go against the marketing of the players like Foundation Med and Caris who already dominate with an army of business reps who literally, and I do mean literally, bird dog the specimens out of the hospitals to their facilities. You have no chance at the academic markets because those specimens will never leave the system for contractual reasons. That and the academic mentality is they'd rather build their own molecular lab, even at a loss, if it meant not relying on outside private vendors.

 

[doctor313]

For those of us who aren't in the know yet, what does getting board certified in molecular pathology enable you to do that being board-certified in AP/CP does not allow you to do? Are there some things that you can sign out as a molecular pathologist that you cannot sign out as AP/CP?

 

[WEBB PINKERTON]

Are you saying there’s actually some glimmer of hope in Pathology?

Remember Hope is a good thing, maybe the best of things and no good thing ever dies.
Andy, Shawshank redemption

I would definitely recommend molecular fellowship over some others.

 

[harlesmd]

Money aside, molecular genetics pathology is a very exciting field. If making 500k and above is your goal, you're going to the wrong field of medicine.

 

[HeyDalaron]

The capital startup cost for a NGS molecular lab is somewhere in the $500K-1M mark. And that's nothing to say of the personnel costs and IT expenses needed to make it actually function. If molecular pathologists are getting jobs, I can assure you that they are in primarily academia or large private reference style labs as employees (I'm sure the rare exception or two exists, somewhere).

It really is hard to break into molecular pathology on your own because you have to go against the marketing of the players like Foundation Med and Caris who already dominate with an army of business reps who literally, and I do mean literally, bird dog the specimens out of the hospitals to their facilities. You have no chance at the academic markets because those specimens will never leave the system for contractual reasons. That and the academic mentality is they'd rather build their own molecular lab, even at a loss, if it meant not relying on outside private vendors.

This is why I do not think it has long term profitability from a career standpoint. Set up is too costly which means academics or private conglomerates will be the only ones to control it, and neither of those entities want to pay top dollar for expertise.

Someone above mentioned mol paths interpreting results, much like AP interprets IHC. We do IHC every day, and that hasn't made our bottom lines better. If anything, it costs us money. I can't see how mol path is any different. Flow cytometry too.

I'm not keen on the gravy train lasting very long.

 

[Alteran]

This is why I do not think it has long term profitability from a career standpoint. Set up is too costly which means academics or private conglomerates will be the only ones to control it, and neither of those entities want to pay top dollar for expertise.

Someone above mentioned mol paths interpreting results, much like AP interprets IHC. We do IHC every day, and that hasn't made our bottom lines better. If anything, it costs us money. I can't see how mol path is any different. Flow cytometry too.

I'm not keen on the gravy train lasting very long.

Old Japanese proverb: The tallest blade of grass is the first to get cut.

 

[Pollux]

Typical low effort post. The plural of anecdote is not data.

I am a molecular pathologist, so I would of course agree that molecular pathology is the future. But the claim that "molecular pathologists making the highest incomes the entire field has seen since the 1970s" is just absurd.

 

[gbwillner]

I am also a molecular pathologist. My take on this (note- this is a modern, abbreviated history of the current MGP field):

Most MGPs are in academia and make academic salaries. Until recently, MGP was the most exciting field but there was doom and gloom unlike any other specialty in pathology. That was because the filed was in flux, and most services rendered by MGPs were not covered by insurance. So there was no revenue, ensuring the only way to be a practicing MGP, particularly in cancer testing, was in academia. As a consequence of its novelty and lack of revenue, to date we mint only about 50-60 MGPs every year.

A few companies came out and made commercial tests for cancer. They raised a lot of money, and starting 2013 or so launched commercial NGS tests that were very expensive. They hired MGPs as well as PhD ABMG geneticists to run labs. IMO, there are different use cases for the typical MD vs PhD in this field- in many cases NEITHER has sufficient understanding and expertise to run a commerical NGS lab. Those that were truly qualified were no more than a handful, and plucked form academia. They demanded good salaries and equity. I was one of these.

For reasons I won't cover here, reimbursement for these tests did not come as these companies (most who came out of a technology space and not a the lab testing space) expected. Most folded. A few survived, and clinical labs with existing revenue took more pragmatic steps in the field.

Eventually the tests became accepted medical practice, and insurance started paying for tests. That meant revenue. That meant that new companies started popping up again. MGPs are rare, and now highly prized. Those that worked for companies with equity may have seen large sums of cash as their companies went public.

So we have 2 populations of MGPs- those that went into the commercial space at the right time and have experience running national companies and make serious $$ (although these are very rare and most are still treated as a commodity) and those in academia making academia $$.

 

[doctor313]

I am also a molecular pathologist. My take on this (note- this is a modern, abbreviated history of the current MGP field):

Most MGPs are in academia and make academic salaries. Until recently, MGP was the most exciting field but there was doom and gloom unlike any other specialty in pathology. That was because the filed was in flux, and most services rendered by MGPs were not covered by insurance. So there was no revenue, ensuring the only way to be a practicing MGP, particularly in cancer testing, was in academia. As a consequence of its novelty and lack of revenue, to date we mint only about 50-60 MGPs every year.

A few companies came out and made commercial tests for cancer. They raised a lot of money, and starting 2013 or so launched commercial NGS tests that were very expensive. They hired MGPs as well as PhD ABMG geneticists to run labs. IMO, there are different use cases for the typical MD vs PhD in this field- in many cases NEITHER has sufficient understanding and expertise to run a commerical NGS lab. Those that were truly qualified were no more than a handful, and plucked form academia. They demanded good salaries and equity. I was one of these.

For reasons I won't cover here, reimbursement for these tests did not come as these companies (most who came out of a technology space and not a the lab testing space) expected. Most folded. A few survived, and clinical labs with existing revenue took more pragmatic steps in the field.

Eventually the tests became accepted medical practice, and insurance started paying for tests. That meant revenue. That meant that new companies started popping up again. MGPs are rare, and now highly prized. Those that worked for companies with equity may have seen large sums of cash as their companies went public.

So we have 2 populations of MGPs- those that went into the commercial space at the right time and have experience running national companies and make serious $$ (although these are very rare and most are still treated as a commodity) and those in academia making academia $$.

Thank you for explaining this... that is very valuable insight.

 

[gbwillner]

The capital startup cost for a NGS molecular lab is somewhere in the $500K-1M mark. And that's nothing to say of the personnel costs and IT expenses needed to make it actually function. If molecular pathologists are getting jobs, I can assure you that they are in primarily academia or large private reference style labs as employees (I'm sure the rare exception or two exists, somewhere).

It really is hard to break into molecular pathology on your own because you have to go against the marketing of the players like Foundation Med and Caris who already dominate with an army of business reps who literally, and I do mean literally, bird dog the specimens out of the hospitals to their facilities. You have no chance at the academic markets because those specimens will never leave the system for contractual reasons. That and the academic mentality is they'd rather build their own molecular lab, even at a loss, if it meant not relying on outside private vendors.

Cost of lab setup depends on many factors (like what kind of test you will perform), but in general is considerably higher that 500K-1M. A good QPCR machine alone can cost $150K; NGS machines typically used in clinical testing are around $350-500K, unless you are talking about the low-scale cheap ones that run about $150 but have limited thoroughput and utility (i.e., cannot do comprehensive testing).

Add knowledgeable staff, infrastructure, bioinformatics... The first large scale NGS lab I set up in TX cost $3M. You can do it for less now for sure, but if you start from nothing, your costs are substantial.

 

[LADoc00]

What would the molecular pathologists do in these roles?

I was under the impression that molecular pathology would be primarily an academically oriented field with little direct clinical applicability on a daily basis, lending itself well to unimpressive salaried models.

Full disclosure: I am not a molecular pathologist. The ones I have known were basically managers who could intelligently answer clinical questions on the results and brought up new assays as needed, but obviously the real money is in owning the lab and scaling it up to high throughput.

 

[LADoc00]

Cost of lab setup depends on many factors (like what kind of test you will perform), but in general is considerably higher that 500K-1M. A good QPCR machine alone can cost $150K; NGS machines typically used in clinical testing are around $350-500K, unless you are talking about the low-scale cheap ones that run about $150 but have limited thoroughput and utility (i.e., cannot do comprehensive testing).

Add knowledgeable staff, infrastructure, bioinformatics... The first large scale NGS lab I set up in TX cost $3M. You can do it for less now for sure, but if you start from nothing, your costs are substantial.

I never even imagined building one until like 5 months ago. I called only 2 people and had Fintech folks offer me 3.2m to get going based on just 8 power point slides I did drinking coffee on single Saturday morning.

IF your ideas are good, then money will find you. From there its about building a path to profit that skirts insurance as much as possible.

As an aside, I spoke to guy I hadnt seen for over 15 years yesterday. He was with a group I interviewed with literally around the time I joined this forum. He was the guy that dissuaded me from taking the offer. He said the group imploded and went to a mol path start up after feeling like the wasted 10 years in private prac path, got stock options and the company was then sold to Novartis cashing him out at 8 figures......I never player hate and am really proud of those of us who do escape the grind.

 

[KeratinPearls]

Cost of lab setup depends on many factors (like what kind of test you will perform), but in general is considerably higher that 500K-1M. A good QPCR machine alone can cost $150K; NGS machines typically used in clinical testing are around $350-500K, unless you are talking about the low-scale cheap ones that run about $150 but have limited thoroughput and utility (i.e., cannot do comprehensive testing).

Add knowledgeable staff, infrastructure, bioinformatics... The first large scale NGS lab I set up in TX cost $3M. You can do it for less now for sure, but if you start from nothing, your costs are substantial.

Damn where did you find 3M bro straight outta fellowship? Investors? Drinks on you at the next CAP post Covid meeting?

 

[KeratinPearls]

I never even imagined building one until like 5 months ago. I called only 2 people and had Fintech folks offer me 3.2m to get going based on just 8 power point slides I did drinking coffee on single Saturday morning.

IF your ideas are good, then money will find you. From there its about building a path to profit that skirts insurance as much as possible.

As an aside, I spoke to guy I hadnt seen for over 15 years yesterday. He was with a group I interviewed with literally around the time I joined this forum. He was the guy that dissuaded me from taking the offer. He said the group imploded and went to a mol path start up after feeling like the wasted 10 years in private prac path, got stock options and the company was then sold to Novartis cashing him out at 8 figures......I never player hate and am really proud of those of us who do escape the grind.

Damn just went to a mol path startup and cashed out like that? Talk about making the right move at the right time. Luck?

 

[LADoc00]

Damn where did you find 3M bro straight outta fellowship? Investors? Drinks on you at the next CAP post Covid meeting?

Not many know this, but GB is actually a very personable and attractive blonde who somehow also manages to pull off a killer Australian accent.

Such feats are not for mere mortals.

 

[gbwillner]

I never even imagined building one until like 5 months ago. I called only 2 people and had Fintech folks offer me 3.2m to get going based on just 8 power point slides I did drinking coffee on single Saturday morning.

IF your ideas are good, then money will find you. From there its about building a path to profit that skirts insurance as much as possible.

As an aside, I spoke to guy I hadnt seen for over 15 years yesterday. He was with a group I interviewed with literally around the time I joined this forum. He was the guy that dissuaded me from taking the offer. He said the group imploded and went to a mol path start up after feeling like the wasted 10 years in private prac path, got stock options and the company was then sold to Novartis cashing him out at 8 figures......I never player hate and am really proud of those of us who do escape the grind.

I think LA you will agree that good ideas alone will not produce anything. It is a combination of good ideas, good timing, experience, luck, and networking skills that can get you anywhere near investment capital. I don't think my ideas are really any different today than they were 6-7 years ago... the main difference are all those other things.

 

[LADoc00]

I think LA you will agree that good ideas alone will not produce anything. It is a combination of good ideas, good timing, experience, luck, and networking skills that can get you anywhere near investment capital. I don't think my ideas are really any different today than they were 6-7 years ago... the main difference are all those other things.

networking. Im lucky in that I have enough relatives and friends from "Palo Alto and Cambridge" that I can make things happen.

I really feel for the masses of people far smarter than I that merely for want of better connections will never reach anything close to their fullest potential.

That isnt being an SJW, just the honest truth, there are ton of good people with great ideas that die shivering in the dark. I wake up every morning and thank baby Jesus for my "privilege" from private preppy high school to the Ivy leagues, it is very good to be connected regardless of your industry.

Be social. Might be hard to imagine but I was treated as a child for social disorder as were some of my siblings as was my son. Through hard work, steely determination, an utter fear of amounting to nothing other than reaching level 15 as a wizard in Dungeons and Dragons, I was able to overcome my social awkwardness and you can too!

 

[KeratinPearls]

​

Dear Lab Industry Professional, Medicare claims paid for molecular and genetic testing rose by how much from 2018 to 2019? If the astounding answer of 500-700% gets your attention, imagine how Medicare feels about it. The Dark Report is the first to report this finding from an analyst who crunched the numbers. And you can bet that Medicare officials will be taking note of these numbers themselves—which is where things get complicated for the entire laboratory industry. There are two major ramifications of this development for labs like yours. The first is that both Medicare and private payers are sure to become more aggressive in in their efforts to control utilization of tests they believe physicians are ordering inappropriately for their patients. The second is that such numbers could prompt federal healthcare investigators to look more closely at why such an increase took place, seeking out labs that commit fraud using these tests to bring in massive profits.

 

[Alteran]

​

​

​

Dear Lab Industry Professional, Medicare claims paid for molecular and genetic testing rose by how much from 2018 to 2019? If the astounding answer of 500-700% gets your attention, imagine how Medicare feels about it. The Dark Report is the first to report this finding from an analyst who crunched the numbers. And you can bet that Medicare officials will be taking note of these numbers themselves—which is where things get complicated for the entire laboratory industry. There are two major ramifications of this development for labs like yours. The first is that both Medicare and private payers are sure to become more aggressive in in their efforts to control utilization of tests they believe physicians are ordering inappropriately for their patients. The second is that such numbers could prompt federal healthcare investigators to look more closely at why such an increase took place, seeking out labs that commit fraud using these tests to bring in massive profits.

Its only inevitable that the party will end for molecular in the next couple of years, but the line in the sand may be drawn there. I can see groups/labs separating their molecular business from their classic AP/CP business and negotiating contracts separately. That way, they don’t have to take whatever garbage CMS wants to pay for molecular and not risk preexisting CMS contract obligations. So, if you’re on Medicare and you want “personalized medicine” through molecular, be prepared to pay cash.

 

[ygdrasil]

The hospital lab that we contract with is looking at bringing in the Agena Massarray for Covid testing (we have PCR and NAAT testing running, but can only get reagents for 60-70 tests per day), which can also be used for some tumor testing. It's not NGS, but would it reimburse as NGS? Anyone have experience with the Agena platform?

 

[LADoc00]

The hospital lab that we contract with is looking at bringing in the Agena Massarray for Covid testing (we have PCR and NAAT testing running, but can only get reagents for 60-70 tests per day), which can also be used for some tumor testing. It's not NGS, but would it reimburse as NGS? Anyone have experience with the Agena platform?

Nah COVID tests specifically are locked into reimbursement silos. If your cost per test for the Agena thingy (no clue what that is) is high, your lab will lose their shirt.

PS- GUYS why are you letting "hospital labs" build COVID testing sections, why do you put one up in your area in one of the 1000s of empty commercial building spaces, get a full kit contract and just source an alcoholic CLS who got fired from your local hospital and will work for cheap??