outpatient pathology

[Sertraline]

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http://www.dianon.com/aboutbod.htm

There are several of these outpatient pathology groups backed up by deep pocketed Wall Street investment groups...

They seem to have the market pretty well-figured out and determined to corner the 3 billion dollar market...

For example, many urologists are given with free needles for prostate biopsies....

This may not be a bad future considering lack of frozen sections(=no calls) but the idea of working for the coorporate type does scare me a little... It seems that not many pathologists enjoyed working with these groups(ImPath, LabCorp?, etc) but this perception is based on heresays...

Again, these groups are specifically targeting OUTPATIENT pathology specimens(derm, GI, Gyn, etc). If you like academia, you are actally likely to benefit(more on that later?)

Opinions and comments would be appreciated. And yes, I do like Pathology but refuse to bend over while others take advantage. The operative word I am hoping to use here is MARKET VALUE.(we get ours!) I hate Scott Boras for his strong hold on free agent market(I can't believe the Dodgers paid Drew 55m!!!) but the free agents should be adequatley represented.

I digress.....

 

[pathdawg]

Private labs like Dianon are interesting. I know some people who work there (and other places like Dianon) and there are certainly advantages as well as disadvantages.
Advantages:
1. $$ They generally pay alot more than community hospital practice. Also, many offer incentives.
2. No call
3. No autopsies
4. No communting betwwen hospitals (as is the case in many community hospital situations).

Disadvantages:
1. They can fire you at any time. If they lose an HMO contract and need to downsize, you can be gone quickly.
2. Very high volume expectations. As a pathologist, you have to be careful about being tempted to sign out too many cases per day (and rushing, thus making avoidable mistakes).

btw, I'm a Phillies fan, so I a little sensitive to the whole Boras thing (I'm still bitter about JD Drew, but thats another story).

http://www.dianon.com/aboutbod.htm

There are several of these outpatient pathology groups backed up by deep pocketed Wall Street investment groups...

They seem to have the market pretty well-figured out and determined to corner the 3 billion dollar market...

For example, many urologists are given with free needles for prostate biopsies....

This may not be a bad future considering lack of frozen sections(=no calls) but the idea of working for the coorporate type does scare me a little... It seems that not many pathologists enjoyed working with these groups(ImPath, LabCorp?, etc) but this perception is based on heresays...

Again, these groups are specifically targeting OUTPATIENT pathology specimens(derm, GI, Gyn, etc). If you like academia, you are actally likely to benefit(more on that later?)

Opinions and comments would be appreciated. And yes, I do like Pathology but refuse to bend over while others take advantage. The operative word I am hoping to use here is MARKET VALUE.(we get ours!) I hate Scott Boras for his strong hold on free agent market(I can't believe the Dodgers paid Drew 55m!!!) but the free agents should be adequatley represented.

I digress.....

 

[yaah]

The consolidation and "walmart" approach, for lack of a better term, was inevitable. Anything that saves money will likely proliferate, particularly when it is backed by strong finances and business/advertising contacts.

As for whether I would work there, dunno. Guess it would depend on my life goals and situation at the time. As of now, I would prefer not to.

p.s. Scott Boras sucks!
p.p.s. J.D. Drew sucks!

 

[Sertraline]

Thank you.

If you have any insight regarding the contracts they offer, I would like to hear about it. Is it an annual contract? I have very little understanding of how this works in general.

Another question would be regarding the volume. What kind of efficiency is expected? The attendings in my residency program seem to deal with as few as 10 to 30 cases in a given day.(the figure includes pending cases with IMH) Some are obviously more challenging that others but they seem pretty manageable...(I can't give away where I am but it's not a big academic center)

I have many years left in my residency training but I am hoping to follow the landscape of the market. Just 6 month ago, I used to think that there were two kinds of pathologists. Community hospital vs. Academic center based.(actually only one kinda pathologists, hosptial based)

Should this entity be viewed as a threat like OURSOURCING? It would definitely be easier transition for these cooperations, given possible large volume(some specimens are currently being mailed from one location to the regional labs) and IT(although slides are not being digitized like radiographs, the reports with digital pictures can be) Infrastructure can be set up with overnight shipping to India(most likely) and digitized report can yield 2 to 3 day turn-out.

Just thinking outside of box... while drinking Asahi beers...

BTW Scott Boras is representing JD's brother, Stephen Drew who played shortstop for FSU. "Boras" effect drives UP the price while "Wal-mart" effect driving prices down. The awesome power of near-monopoly....

Private labs like Dianon are interesting. I know some people who work there (and other places like Dianon) and there are certainly advantages as well as disadvantages.
Advantages:
1. $$ They generally pay alot more than community hospital practice. Also, many offer incentives.
2. No call
3. No autopsies
4. No communting betwwen hospitals (as is the case in many community hospital situations).

Disadvantages:
1. They can fire you at any time. If they lose an HMO contract and need to downsize, you can be gone quickly.
2. Very high volume expectations. As a pathologist, you have to be careful about being tempted to sign out too many cases per day (and rushing, thus making avoidable mistakes).

btw, I'm a Phillies fan, so I a little sensitive to the whole Boras thing (I'm still bitter about JD Drew, but thats another story).

 

[tsj]

http://www.dianon.com/aboutbod.htm

There are several of these outpatient pathology groups backed up by deep pocketed Wall Street investment groups...

They seem to have the market pretty well-figured out and determined to corner the 3 billion dollar market...

For example, many urologists are given with free needles for prostate biopsies....

This may not be a bad future considering lack of frozen sections(=no calls) but the idea of working for the coorporate type does scare me a little... It seems that not many pathologists enjoyed working with these groups(ImPath, LabCorp?, etc) but this perception is based on heresays...

Again, these groups are specifically targeting OUTPATIENT pathology specimens(derm, GI, Gyn, etc). If you like academia, you are actally likely to benefit(more on that later?)

Opinions and comments would be appreciated. And yes, I do like Pathology but refuse to bend over while others take advantage. The operative word I am hoping to use here is MARKET VALUE.(we get ours!) I hate Scott Boras for his strong hold on free agent market(I can't believe the Dodgers paid Drew 55m!!!) but the free agents should be adequatley represented.

I digress.....

I didn't go into medicine to work in a cubicle making money for some MBA. Plus no way can you make more working for one of these companies. Think about it. They are taking a cut of your reimbursement. Yes, they might offer a better starting salary than private practice, but no it is impossible for you to make more than one who bills for his/her services. I guess the only way they can help is by providing a good health ins/retirement/malpractice insurance package, better than you can get for yourself. Hopefully, it will be worth them taking a 10-20% cut out of money that is meant for you.

We really need the government to take over medicine. It seems like med students fret over that, but think about it. All insurance companies pay plus of minus 10% of what the government reimburses for services. And 40 million Americans will then have insurance and we would be able to get reimbursed for taking care of their emergent and elective surgical specimens rather than taking care of them for free (unless your heartless enough to sic the collection agency on some single working class unisured mom with two kids, making 20 K a year, to get your $150 for reading her breast biopsy). Plus medicare is able to put 96cents on the dollar into health care, while private companies end up putting less than 70cents as the shareholders need their cut. But that's another issue. No matter, there would be a lot more money and a lot more specimens for pathologists to split up if the government took over medicine.

As far as corporations targeting the outpatient market, I think the fate of pathologists is in their own hands. If they have good relationships with clinicians, no way are the clinicians going to send their specimens to a faceless corporation over their colleagues who they know and trust and have been working with for years. Moreover, the clinicians have no incentive to send them to outside people as they don't make money off it. And if the corporations offer them "incentives" in the way of cash or goods, that would be so unethical (i.e. fee splitting) and would be put to a stop instantly once reported to a regulatory agency.

It's not like blood samples where it totally makes sense for outpatient samples to go to an outside lab where there is no rush and the specimens can be batched. The in hospital lab is much more complex and needs to provide 24 hour a day service.

 

[pathdawg]

I didn't go into medicine to work in a cubicle making money for some MBA. Plus no way can you make more working for one of these companies. Think about it. They are taking a cut of your reimbursement. Yes, they might offer a better starting salary than private practice, but no it is impossible for you to make more than one who bills for his/her services. I guess the only way they can help is by providing a good health ins/retirement/malpractice insurance package, better than you can get for yourself. Hopefully, it will be worth them taking a 10-20% cut out of money that is meant for you.

Truth be told, they generally do indeed pay better (often, much better) than community hospital practice. How do they do it? Volume, volume, volume. Why else would one want to work at one of these mills ? I know a few people who work for companies like these who make >300k. On the other hand, I have heard stories of how pathologists working at places like this came into work on a Tues morning, only to be gone by Tues afternoon. So, its not without risk. But really, when you think about it, making more money without the hassle of frozens and call isn't a bad gig.
For those of you in residency, these companies usually want those with a least 5 years experience, board certification, and fellowships in cyto, heme, or dermpath.

 

[pathdawg]

As far as corporations targeting the outpatient market, I think the fate of pathologists is in their own hands. If they have good relationships with clinicians, no way are the clinicians going to send their specimens to a faceless corporation over their colleagues who they know and trust and have been working with for years. Moreover, the clinicians have no incentive to send them to outside people as they don't make money off it. And if the corporations offer them "incentives" in the way of cash or goods, that would be so unethical (i.e. fee splitting) and would be put to a stop instantly once reported to a regulatory agency.

It's not like blood samples where it totally makes sense for outpatient samples to go to an outside lab where there is no rush and the specimens can be batched. The in hospital lab is much more complex and needs to provide 24 hour a day service.

Clinicians are often handcuffed over where they can send specimens due to managed care contracts. It really isn't so simple.

 

[tsj]

Truth be told, they generally do indeed pay better (often, much better) than community hospital practice. How do they do it? Volume, volume, volume. Why else would one want to work at one of these mills ? I know a few people who work for companies like these who make >300k. On the other hand, I have heard stories of how pathologists working at places like this came into work on a Tues morning, only to be gone by Tues afternoon. So, its not without risk. But really, when you think about it, making more money without the hassle of frozens and call isn't a bad gig.
For those of you in residency, these companies usually want those with a least 5 years experience, board certification, and fellowships in cyto, heme, or dermpath.

No matter what, they are getting their 15% cut, which means you have to work 15% harder to make the same amount of money as if you were working for yourself. It just doesn't add up.

 

[LADoc00]

These jobs suck, take it from me or learn the hard way. Personally Im not fond of being the b!tch of some guy who got a business degree online, leaves smartly at 5pm and takes 2 hour lunches chatting it up with the wives of the poor slobs hunched over microscopes signing out 120 cases/day and making half his salary....or maybe your into that....

 

[Sertraline]

Won't these labs encroach into community hospital based practices? pathdawg brought up a good point of the contracts issue between clinicians and HMOs.

I am thinking we may not have too many choices in the future if these things were to proliferate. I too share the reluctance to work for them...

It is a free market and there seems to be very little to be done. or is there? I dunno.

Medicare looks like it's heading for the cliff and appears that something drastic will happen in my lifetime... I am not suggesting that we are gonna be out on the street but....

p.s. Is there a lobbyist working for us? Freaking lawyers(American Bar Association) contributed like 100m in 2000...

and it appears that nobody believes that the outsourcing will happen???

These jobs suck, take it from me or learn the hard way. Personally Im not fond of being the b!tch of some guy who got a business degree online, leaves smartly at 5pm and takes 2 hour lunches chatting it up with the wives of the poor slobs hunched over microscopes signing out 120 cases/day and making half his salary....or maybe your into that....

 

[tsj]

These jobs suck, take it from me or learn the hard way. Personally Im not fond of being the b!tch of some guy who got a business degree online, leaves smartly at 5pm and takes 2 hour lunches chatting it up with the wives of the poor slobs hunched over microscopes signing out 120 cases/day and making half his salary....or maybe your into that....

No doubt! Who in their right mind would be willing to work 30% harder to make 15% more?

 

[pathdawg]

These jobs suck, take it from me or learn the hard way. Personally Im not fond of being the b!tch of some guy who got a business degree online, leaves smartly at 5pm and takes 2 hour lunches chatting it up with the wives of the poor slobs hunched over microscopes signing out 120 cases/day and making half his salary....or maybe your into that....

Do you (or did you) work for one of these outfits? You imply that you have first hand experience in the private lab sector.
I ask because, frankly, never-ending (and mostly unnecessay) frozen sections and call are getting kinda old. Private labs seem to offer an interesting alternative.

 

[pathdawg]

No doubt! Who in their right mind would be willing to work 30% harder to make 15% more?

I know several people who are making more than double what I make as a community hospital pathologist. If you're keeping score at home, thats significantly more than 15%.
I don't think your reasoning accurately reflects the reality.

 

[RyMcQ]

Won't these labs encroach into community hospital based practices?

These labs are most certainly encroaching on community practices. They dangle a huge payout to current owners of community practices, who make out okay. The pathologist who hasn't made partner yet and the pathologists who want to stay in that particular community are screwed.

Anyone who is looking for long-term security with these companies is dreaming. Think about it. The goal of every business type is to increase productivity (i.e., extra hours you work without extra compensation or less time per case) while cutting costs (i.e., your salary). They will always hit a point where they say, "Revenues are down, so we can't give you a cost of living increase this year." or "We have to cut benefits." As Yaah alluded to, this is the classic Walmart "race to the bottom". Everyone gets screwed except for the executives and maybe the shareholders. Watch the business news. What happens when a corporation lays off employees? The stock price immediately spikes. So when your practice is managed with quarterly earnings in mind, your quality of life will suffer and you will always have to wonder whether you will have to uproot your family to find another job in a year.

It is a free market and there seems to be very little to be done. or is there? I dunno.

There are things we can do. First of all, resist the temptation to join such groups, if you can. I know this might be difficult depending on where you live.

Secondly, be careful joining a group where the top partners are near retirement. Selling out to the corporate lab might be a phenomenal boost to the retirement accounts of senior partners. (I should say that many older pathologists would sooner sell their grandchildren into slavery than sell out to the corporations. This won't be the case forever, though.)

Thirdly, make sure you provide the best customer service. Don't complain about late night frozen sections. Learn how to communicate well with the clinicians. In other words, make it so that the clinicians won't want to work with anyone else.

p.s. Is there a lobbyist working for us? Freaking lawyers(American Bar Association) contributed like 100m in 2000...

Pathologists spend a lot less per pathologist than many other medical specialties. (I think we spend half of what the radiologists spend, and we all know how much money they are making.) I'm positive that we spend way less than lawyers. The CAP and ASCP do lobby the government and the CAP has PathPAC to support pathology-friendly politicians. Occasionally, they have a victory like doubling the Pap smear reimbursement. I'm sure they would lobby harder if we gave them more money.

By the way, I don't mean to sound fatherly or like a know-it-all. These are just my opinions. I'm probably wrong.

 

[pathdawg]

Won't these labs encroach into community hospital based practices? pathdawg brought up a good point of the contracts issue between clinicians and HMOs.

I am thinking we may not have too many choices in the future if these things were to proliferate. I too share the reluctance to work for them...

It is a free market and there seems to be very little to be done. or is there? I dunno.

They already are encroaching into community hospital practice. They can undercut you on contracts because of their volume. Is it necessarily better quality of service? No, but its not about the quality, its about the cost.

btw, did anyone notice how Labcorp just bought USLabs? They also bought out Dianon a couple of years back. We are going to end up with two or three gigantic global companies running everything.

And no, I don't think thats a good thing.

 

[LADoc00]

I know several people who are making more than double what I make as a community hospital pathologist. If you're keeping score at home, thats significantly more than 15%.
I don't think your reasoning accurately reflects the reality.

No idea what numbers your speaking of but let me throw out my own:

A crappy private group in the Western US will pay people after they have been around for 2-3 years about 250 grand, commercial flow labs wanted to pay me 175.

Good private groups make 400+ per, there is no commercial lab that pay anywhere close to that unless you are management. And if you are in management and have an MBA, go work for Alcoa Steel and be a millionare! Why the heck would you do pathology? If you are making half of 175, you need to look around for a new gig, asap.