# of graduating pathologists

Discussion in 'Pathology' started by Path2009, Jul 25, 2011.

  1. Path2009

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    It seems like pathology programs graduate a high number of graduates and that our supply exceeds the demand (I have no data for this - just anecdotal). Even if this is not true, does any governing body lobby the ACGME to keep the number of residency spots low (a la dermatology). I don't think CAP, ASCP or anyone else really addresses this. When Jared Schwartz (former CAP president) visited our institution, he basically brushed off the question and didn't take this seriously.

    Perhaps this has been previously addressed, I am hit and miss on this website.

    Thanks. Thoughts?
     
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  3. sbp

    sbp
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    I have posted about this before... I agree that we have to many graduating pathologists...

    I think that since residency became 4 years we have been graduating 1/5 more pathologists/year... programs did not cut the spots by 1/5....not only that, that year twice the number graduated (that is likely spread out over 1-3 years because of fellowships etc...)

    bottom line we should cut some spots... we need to cut like 50 spots... there are plenty of lousy programs out there that can be cut...
     
  4. Path2009

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    Does anyone know if there is a governing body that has shown any interest in this issue who could potentially lean on ACGME to improve the situation?
     
  5. Sulfinator

    Sulfinator Pathology
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    There are a couple of programs that closed down this year, I think.
     
  6. sbp

    sbp
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    the few programs that closed just droped the number/year by I am guessing like 5 spots.

    and at the same time other programs gained some spots because they took those residents mid residency and received emergency approval for the extrat spots. and now that the programs have the extra spots they wont loose them..

    also there are program that are applying for expanded spots and hospitals that are applying for new residencies...

    bottom line the net is likely a very small decrease in spots/year.. we need like a decrease of 50/year (estimate)

    another problem with this is that the acgme made new rules regarding work hours that make it very difficult for some path programs.. especially the small ones.. so they are all requesting more spots..
     
  7. Path2009

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    The thing that is most concerning is that it doesn't seem to be on anyone's radar. However, there are several disruptive forces at play here which could change this: increasing # of PA's who do work traditionally done by pathologists, digital pathology which is finally coming into its own, etc. I am not saying that the sky is falling, but the specialties who have their stuff together are very controlling of the number of residency slots. We just don't have it together in this regard right now.
     
  8. cjw0918

    cjw0918 Senior Member
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    I was very lucky to find a job after 2 fellowships, but I was geographically restricted. I did have an in town private practice offer which I seriously considered, but I ultimately decided that I did not want to work that many hours with such little flexibility, such is the way this group is structured.

    I got my current job the last week of May. In May I was going to have responsibility in an area which would have required more training, but as luck would have it, by July the needs of the department had shifted. Now I am working in my two fellowship trained areas.

    While I am happy at my job, the whole experience of job-seeking made me feel very bitter toward this field. It just shouldn't be this hard for new grads to find decent employment in huge metropolitan markets. This business of "everyone gets a job" is so out of touch. Maybe everyone does get a job, but many of the jobs suck and you get what is available, which may be a far cry from what or where you want. That is disappointing to say the least after years of training.

    The other point I would make is that so many things are unpredictable. I never would have predicted that in July my job responsibilities would change allowing me to work exclusively in fields I enjoy. My point is this: If waiting for the right job is an option for you, consider it. I know it is a luxury, but to me it's better than taking something totally miserable. Best of luck to all.
     
  9. KCShaw

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    I can't immediately lay my hands on the link to the post, but I thought zao recently posted that the stately bigs of ?CAP/?ASCP were talking about -undersupply- of new pathologists as far as their projections were concerned. Maybe someone can find that reference before I do and correct me.
     
  10. scienceguy19

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    I wonder if older pathologists encourage their children to go into pathology or do they encourage them to go into other medical fields.
     
  11. mikesheree

    Physician Lifetime Donor Gold Donor Classifieds Approved 7+ Year Member

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    We (I) didn't even consider encouraging them to go into ANY medical field with the exceptions of nursing ( and pursuing CRNA or similar status) or PA training if they were hell-bent on a medical career. I actively discouraged it. NO WAY they would have had the opportunities I had. My kids have found successful careers outside of this zoo. 30 years ago I would have supported/encouraged it but not today with the other opportunities out there.
     
  12. yaah

    yaah Boring
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    I think the problem is that everyone's "real" data and statistical models are consistent with a future shortage. If you follow the curve of healthcare expenditures and procedure volume, as well as the increasing number of tests being performed and developed, it seems like the workload for pathologists has been and will be increasing exponentially. And everyone who works in pathology knows that pathologists have been taking on more and more work with every passing year. Places that had 10,000 surgicals and 15 pathologists 15 years ago now have 40,000 surgicals and still have 15 pathologists. And now they do more tests they didn't do before. Plus, as said many times, the average age of pathologists is quite high, and if you follow actuarial data and trends it seems like the pace of training is not sufficient to keep up.

    But there are problems with assuming that trends continue to have the same effects. Pathologists have been doing more. They are more efficient. Subspecialization means pathologists get quicker and do more cases. The predictions don't have a good way of figuring out where the limits are on that. And some tests and methods make diagnosing things more efficient. You don't need to spend as much time on certain cases with new technologies added to the mix. But again, it's hard to quantify that. Another factor is that practice environments are changing. Pathologists are working for clinicians or reference labs, which removes specimens from other areas and presumably also increases efficiency, but yet may also increase total specimen numbers. So how do you predict how that trend will effect supply and demand? It's not like a baseball team which every year has a 25 man roster which needs to be filled.

    Obviously, the current job market seems oversaturated, which means the prediction abilities of the authorities have failed. Seems to also be happening in radiology now. To me, it seems as though estimates of pathologist need 10-20 years ago were off, which if you look back at the trends and developments that have happened, is very understandable.

    How many cases can a pathologist sign out? It's radically different if you talk about some who does purely derm (which can be 25-30,000 cases per pathologist per year) as compared to someone who only does bone marrows (could be only 1-2,000 per year). And most pathologists don't do just one thing. And what about non-surgical tests?

    It's hard to predict. I know many people on here would have you believe that it is a simple thing. Too many pathologists. Too few jobs. Cut training spots. But things are only that simple if you don't think about it very hard. Fortunately for a lot of hot heads they don't have to think about it very hard - it's easy to come up with solutions when you don't personally have to deal with it.

    What are the consequences if training slots are cut and we end up with a shortage? I know some people would say no big deal, it works out fine. Does it? If you cut too far, it takes years to even start to increase supply. I realize the internet is a great place to just make wild extreme pronouncements and be totally confident in one's certitude, but real life simply does not work like that unless you are a politician or a talk radio host.

    Step 1: Cut training slots
    Step 2: ....
    Step 3: Profit.
     
  13. Entgegen

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    Reminds me of a post on AuntMinnie.com (radiology forum) by one of the more veteran posters/radiologists which was in response to a lot of current rads residents saying how they need to cut their training spots (>1,000 graduates/year) due to their current crappy job market. Copied/pasted below...some seems like it might be applicable to path, some not (brackets/bolded text is mine):

    "I have often heard this foolish idea, that there should be an artificial shortage of radiologists created. This idea is usually propagated by residents who primarily care about a good job market for them.

    If there is a true shortage of radiologists, the excess work can be addressed in a variety of ways. Hospitals can give clinicians privileges to interpret images. [I doubt there'd be too many clinicians jumping at the opportunity to try to read their own specimens and make heads or tails of the pink and purple blobs, though some have mentioned that it doesn't take much to learn to identify a TA or HP on GI biopsy] Radiology PAs can be used to interpret images while being supervised by overworked radiologists. [Again, seems like it would take a lot to be able to sufficiently train a mid-level provider to be able to handle pathology, unlike the current mid-level encroachment/invasion/takeover of primary care...but there may be those who could learn to read simple things] Foreign-trained radiologists can be brought in (as long as they get a medical license they can work) with the promise of being able to sit for the ABR boards after helping out for several years. [Reasonable enough threat, I suppose. Radiology already has the problem of foreign-trained radiologists being able to come to the US, do a few US fellowships and qualify to sit for boards and bypass a US rads residency...this happens and hurts the US rads job market. Bad move on radiology's part] Or the work can simply be outsourced overseas. [Seems more likely to happen to rads before path, but it might be a threat once the technology for wide-spread telepathology becomes available, but that's another discussion] Current radiologists if overworked secondary to the shortage, will make more mistakes and decrease the perceived value of the specialty. Far from increasing the value of radiologists, an artificial shortage would decrease the value substantially. -MDCT"

    I don't post this in order to say that the current oversupply of pathologists is less harmful to the profession than a potential shortage, or to downplay the effect that the oversupply is having on the profession...just a different discussion point on the same monotonous topic.
     
    #12 Entgegen, Jul 26, 2011
    Last edited: Jul 26, 2011
  14. Path2009

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    I really appreciate the thoughtful posts by yaah and others. I agree that this is a nuanced problem. Profit is certainly not the only issue - for me the issue is effectively maintaining the most beneficial working conditions for pathologists which (which, in the end, also includes profit).

    My main concern is that the ACGME is the body who assigns how many residency slots are allocated to pathology and that they have no vested interest in the future of our profession. I am uncertain how they determine this number. And I am unconvinced that any professional associations are really interested in this issue. I would be very interested in hearing whatever insight is out there as to how this process works.

    So, perhaps the issue is not whether there is a shortage (clearly this is a matter of debate), but whether anyone in pathology is actively involved in how many residency slots are assigned. My experience with CAP, USCAP and ASCP tells me no.
     
  15. sbp

    sbp
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    at the most recent program director meeting (i think at USCAP) the talk was about the upcoming shortage of pathologists etc...

    the reality is no program wants to cut residency spots because they need the residents for grossing and the like and for the funding they get from medicare... otherwise they would have to hire PA's and techs to cever the work so it is a substancial financial shift..

    It is possible that we may have a higher rate of retirement in the next few years but right now it is a tough market... I am fortunate and I just started a job straight out of fellowship, and so far so good.. but who knows what I could have had..

    Another topic that people fail to discuss is that to me it seems the job market is tight for recent graduates, the majority of postings want experienced pathologists so as not to have to babysit for the first few years.... the market for the experienced pathologists seems much better.. so overal the market may not be that bad...

    anyway... I still think there should be some sort of cut in spots..

    good luck to all that are looking for jobs
     
  16. KCShaw

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    It still comes back to money. Specimen numbers may go up, but how much does recovery & reimbursement from billing go up? If the same number of pathologists at any given practice are managing the increased workload, did they not hire on more pathologists because they didn't really need to (implying they were grossly overpaid to begin with, depending on one's take on "new" methods improving efficiency) or because they still couldn't afford to? If the latter, why didn't the increased specimen load allow for more positions? Is it primarily because any increased pathology income is subsidizing something/someone else (which seems to be a big fear)? Or because costs have gone up? Something else?

    Webs of cause & effect are often more complicated than sometimes they appear, though at the same time doing nothing about an apparent problem suffices only in doing nothing about it.
     
  17. WEBB PINKERTON

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    When you are engaging in client billing and other kickbacks, your profit margins take a hell of a hit and you are forced to sign out more cases just to keep the doors open. There is one sweatshop lab in my area that stole a huge derm account from me because they were willing to go 5 dollars for the TC component.

    I saw in Florida that a pathologist got arrested recently for doing client billing on Medicare patients with a derm. Maybe pathologists going to prison could help fix the saturated market. Another pathologist turned him in. Remember to whistleblow when you see illegal stuff going on. :smuggrin:
     
  18. Euchromatin

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    Glad to see at least a few people are getting in trouble for this bullsh*t. Was this written up/covered by any news agencies? A quick Google search involving combos of "Florida, pathologist, arrested, client billing, Medicare" didn't result in much other than an amusing PowerPoint from the 2009 USCAP meeting about POD labs:

    www.uscap.org/site~/98th/pdf/companion23h01.pdf
     
  19. KeratinPearls

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    Ouch if 3.5 million dollars was not enough. If convicted, millions of dollars in fines and loss of license. OUCH.

    http://labpathconsulting.com/component/content/article/60?format=pdf
    http://scholar.google.com/scholar_case?case=3404570132046682877&q=Freedman+v.+Suarez-hoyos&hl=en&as_sdt=2,21
     
    #18 KeratinPearls, Jul 27, 2011
    Last edited: Jul 27, 2011
  20. Euchromatin

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    Thanks for the links - lots of interesting additional information. I love that they could clearly see that the dermatologist was fraudulently billing just by calculating that the amount of time he claimed to be counseling patients and performing procedures was impossible.
     
  21. WEBB PINKERTON

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    I am familiar with the story because the derm practice was in Venice florida which is where my parents live. The story was all over the paper. There are MANY crooked derms down there. Who can forget Michael Rosin who signed out his own cases and called everything Squamous Cell CA. LOL. I saw some of the "slides" from the Rosin case and I cant for the life of me figure out how they ever passed an inspection. The slides were unreadable. Very sad.
     
  22. pathdoc68

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    In another post someone accused me of being bitter or something - but the post above summarizes exactly how I feel, and I had to suffer through working with some very evil groups before I found my current position which I enjoy, though it pays rather poorly.
     
  23. Path2009

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    It seems like the best we can hope for is that someone petitions ACGME to set a moratorium on new residency slots.
     

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