Partnership tracks becoming less common?

[Unty]

For anyone in private practice. Are partnership tracks becoming less common in pathology nowadays. Are we seeing more employee type positions with a flat salary?
Any comments?

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[Tissue issue]

Yes.

Comment:
http://healthleadersmedia.com/page-...nts-May-Extend-to-Other-Services-Other-Payers

 

[path24]

A pathology job can get 100+ applicants. Why offer partnership to someone so easily replaced with cheaper labor?

 

[jp123ok]

Yes, partnership tracks are becoming less common and this trend is likely to continue in the future.

 

[LADoc00]

1.) Alot of private groups are set to disappear from the landscape in the next decade. Path has been protected for a bit, but Surgery, Oncology, GI and other supposed "high fliers" have been gobbled up with increasing speed by hospital systems when they stumble on the business front. In my area alone, Cards, Oncology, OB/Gyn, ENT, Surgery and a few others all surrendered to the local hospital's medical group where they are merely members.

2.) As private groups die, "partnership" in the traditional sense will go away. You will become a salaried W2 employee or 1099 contractor with medical group or hospital entity.

3.) For some of the lower tier pathologists, this may actually be a good thing as larger entities offer weaker pathologists more employment protection.

4.) The ceiling on income potential will be drastically less in the next decade. There will be a few dinosaurs making a good stack like me but even I dont think my realm will last more than a decade. Im already gearing the exit strat.

I think the take away from my post is this: alot of our SDN pathologists are the not the sharks who would be have been bringing home 800-1.8m+ anyway. Most of our trusty readers will be perma junior staff status at different positions making at most 250 and for those folks I think things will actually improve marginally in the next 10 years.

 

[caffeinegirl]

Agree with LADoc..

There are lot of market pressures now in the private practice landscape that will end up with decreased reimbursement and volume in the near future (ie. less than 10 years). What this means is less $$ in the current partner's wallet, less profit margin and therefore an increased tenacity to "keep the $$ we got". This adds up to groups hiring future pathologists as employees/contractors without partnership opportunities, and with increased workload/schedules compared to the current partners.

As I have mentioned earlier, job stability in this volatile market will only be present in positions in large health systems (Kaiser, academic centers) or conglomerates that have a high market share and economies of scale. The small hospital based pathology groups in rural locations will likely be buffeted from much change just due to location...but in larger cities there will be a major shift coming...

 

[pathstudent]

I work in a major metropolitan area and we are one of the last private groups left. Yes there are non-academic groups, but they all sold to ameriapth or some other entity over the last decade and are all just salaried employees. Our small private group is totally stable but I have a hard time seeing how we can exist over a period of decades. It is getting more and more difficult to run things ourselves for a number of reasons. In short the MBAs and governmental agencies won.

 

[LADoc00]

Well major metro areas were the first to lose private practice medicine, it is when the small private groups in Redding CA, Bend OR, Salinas KS and St. Joseph's MO get gobbled up that the fight is truly at the Seelow Heights.

 

[coroner]

For anyone in private practice. Are partnership tracks becoming less common in pathology nowadays. Are we seeing more employee type positions with a flat salary?
Any comments?

Essentially, yes. To echo what has been said by previous posters. This is not unique to pathology but medicine in general. At my hospital, there are private practice physicians who have been there for the past 30+ years and mentioned that when they started their careers, they were the majority. Now, the tables have turned and they are the minority compared to the employed physicians who are currently the majority. Also, I was talking to a plastic surgeon colleague awhile back who summed it up well and said, "Private practice physicians are like dinosaurs waiting for the meteor to hit…"

...alot of our SDN pathologists are the not the sharks who would be have been bringing home 800-1.8m+ anyway.

There are few pathologists in this strata period, not just “a lot of our SDN pathologists”. This would put somebody in our field in the top 1-2% income-wise.

The small hospital based pathology groups in rural locations will likely be buffeted from much change just due to location...

In general yes, but even some of them have been forced into the employed model due to administrative decrees or mergers with larger health care networks. This happened at one of our hub and spoke hospitals i.e. rural that was 1.5 hrs away from the main metropolitan area. Is this ideal? Most including myself would say not; however, this is not as horrible as it may seem. I know of salaried hospital employees who comfortably sign out between 3-4,000 surgicals/yr, with lite grossing duties, minimal call and earn between 300-400K and are content. They may have a lower income ceiling; but, for some it’s worth not having to worry about monthly revenues, declining reimbursements, and losing business.

it is when the small private groups in Redding CA, Bend OR, Salinas KS and St. Joseph's MO get gobbled up that the fight is truly at the Seelow Heights

Redding, CA >>> Bend, OR , Salina, KS, St. Joseph, MO, or Texarkana, AR (throwing that in) for Lake/Mt. Shasta alone…

 

[caffeinegirl]

In general yes, but even some of them have been forced into the employed model due to administrative decrees or mergers with larger health care networks. This happened at one of our hub and spoke hospitals i.e. rural that was 1.5 hrs away from the main metropolitan area. Is this ideal? Most including myself would say not; however, this is not as horrible as it may seem. I know of salaried hospital employees who comfortably sign out between 3-4,000 surgicals/yr, with lite grossing duties, minimal call and earn between 300-400K and are content. They may have a lower income ceiling; but, for some it’s worth not having to worry about monthly revenues, declining reimbursements, and losing business.

Agree with your coroner. There's a trade off between stability with a lower income ceiling and having to manage the business side of things. This is true for other specialties as well. However, the practice model of pathology is very different than other clinical specialties. I attended a medical entrepreneurship panel a few months ago, and those panelists were in ER, derm, and IM and all said that it was worth taking risks because they always had their clinical practice to fall back on (ie. patients are their customers, and they will always have that client base). However, in our practice model of pathology, clinicians, surgical centers, and medical practices are our clients which is risky onto itself...and loyalty usually follows other factors other than quality such as EMR interfaces, client support, insurance/HMO coverage, etc.
Those of us in private practice are dinosaurs waiting for the meteor to hit...and I do think that pathology is more vulnerable to these changes than other fields.

 

[pathstudent]

Agree with your coroner. There's a trade off between stability with a lower income ceiling and having to manage the business side of things. This is true for other specialties as well. However, the practice model of pathology is very different than other clinical specialties. I attended a medical entrepreneurship panel a few months ago, and those panelists were in ER, derm, and IM and all said that it was worth taking risks because they always had their clinical practice to fall back on (ie. patients are their customers, and they will always have that client base). However, in our practice model of pathology, clinicians, surgical centers, and medical practices are our clients which is risky onto itself...and loyalty usually follows other factors other than quality such as EMR interfaces, client support, insurance/HMO coverage, etc.
Those of us in private practice are dinosaurs waiting for the meteor to hit...and I do think that pathology is more vulnerable to these changes than other fields.

Yes. Agree. A busy orthopedic surgeon is worth 5 million in revenue to a hospital via admits, or time, imaging etc. a back surgeon is worth even more. I have witnessed a group of neurosurgeons go from private to employed back to private after their five year contract expired. They have so much more leverage as they control the patients. All hospital based specialties have little leverage. Radiologists have a bit more than pathologists as they do high level procedures in addition to reading films.

 

[caffeinegirl]

Even though employed hospital pathologists may have increased stability, this is not absolute. There have been several instances of health care systems shutting down their pathology labs and letting go of their pathologists for outsourced and cheaper options. There is an argument to having an increased presence in the administration/medical staff, etc. However, the bottom line is $$, and labs are traditionally viewed as cost centers rather than revenue generators by the bean counters.

 

[WEBB PINKERTON]

There is NO job security in this field period.

Our lab in the suppossedly stable "sticks" feels like Cloud City from The Empire Strikes back. It's just a matter of time till one day I am lead into a room with Darth Vader sitting across the table taking over the place.