Path Residency Regulation - Supply and Demand

[SomeDoc]

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I've been perusing threads in this forum for a few months- is there any reason why path regulatory organization(s) are not prudently controlling residency numbers (i.e. reducing them)? Is the reality to the contrary (i.e. is it possible that there an actual shortage of pathologists in the nation)? I ask because I don't know, and am curious.

 

[exPCM]

I've been perusing threads in this forum for a few months- is there any reason why path regulatory organization(s) are not prudently controlling residency numbers (i.e. reducing them)? Is the reality to the contrary (i.e. is it possible that there an actual shortage of pathologists in the nation)? I ask because I don't know, and am curious.

This is from an old site but the logic presented still applies today:
http://philgmh.tripod.com/pjm3.htm
One of the main reasons for the terrible Pathology Job Market has been the Pathology training programs. These programs have continued to train the same number of residents even though the job market has deteriorated badly. The Residency Program Directors should have known about the problem as far back as 1993, when the job market started deteriorating, but the decreases in residency positions have not kept up with the deteriorating job market.

So why train people who may never find jobs? BECAUSE OF THE TREMENDOUS AMOUNT OF MONEY INVOLVED. Keep in mind that Medicare provides Indirect Medical Education (IME) and Direct Medical Education (DME) reimbursements to hospitals that train residents regardless of what the job market is like. This is a considerable amount of money. There is an example available on the internet at the following address:

http://hsc.virginia.edu/medicine/clinical/radiology/FinancingGME.html

In the example given the DME is US $1,280,000/yr. and the IME is US $5,250,000/yr. Reimbursements are proportional to the number of residents. As a result, if the program substantially reduces the number of residents they have, there will be a proportionate decrease in reimbursements. The residency program in this example is much larger than any Pathology residency program - 80 Residents and 20 Fellows in the program; but it gives you some kind of idea of the amount of money involved. Medicare is paying this program US$65,300/resident/yr. However, the residency programs only pay each resident about US $25,000-35,000/yr. yet residents sometimes work 60 hours per week doing work that otherwise would have to be done by a Pathology Assistant making around US $65,000-85,000/yr. SO THERE IS A TREMENDOUS AMOUNT OF MONEY BEING MADE IN TRAINING PEOPLE TO BE PATHOLOGISTS EVEN THOUGH THERE IS NO CHANCE THAT THEY WILL ALL FIND JOBS IN THE FIELD.

If our math is correct the residency programs are making about US $80,000-$100,000/resident/yr.

The Balanced Budget Act of 1997 reduced some of these reimbursements but did not completely eliminate them. In our opinion Pathologists will be in oversupply until these reimbursements are completely eliminated. Here are a few more links on Medicare DMEs, IMEs, etc:

http://www.aha.org/kit/GME.html
http://www.hanys.org/newsview/issues/med4.htm

 

[yaah]

I've been perusing threads in this forum for a few months- is there any reason why path regulatory organization(s) are not prudently controlling residency numbers (i.e. reducing them)? Is the reality to the contrary (i.e. is it possible that there an actual shortage of pathologists in the nation)? I ask because I don't know, and am curious.

In brief, it is probably (at least in part) because pathology organizations do not see things the same way as some people on this forum (shocking but true! 😉 ). You can choose to believe who you want to - but I would advise looking into things more for yourself, and be very cautious of putting too much stock in anonymous internet posts. Of course, you should also be cautious about blanket statements that anyone puts out (including regulatory agencies and groups) that are not backed up by evidence.

exPCM - the virginia link you provided doesn't work. And residency programs don't pay residents $25,000 per year. They pay generally 40k (for first years) -60k (for fellows) per year. And the arguments about PAs do not hold water. Because PAs can work full days doing nothing but grossing (basically the work of several residents), they do not have to be provided for like residents with regards to education, conferences, CME funds, etc. So it would probably be far far cheaper to hire several good PAs.

 

[LADoc00]

The long and short of it is many residency programs in Path make money off trainees. This is NOT the case in say Derm, ENT or Neurosurgery. I just had a long discussion with some veteran surgeons in my hospital and they actually were astute enough to bring this up in our morning conversation.

Combining this with the movement towards the "Commodization" of Pathology and Lab services and you have massive overtraining.

But there are plenty of threads on this already..do a search.

As an aside it is nowhere near "far cheaper" to hire good PAs vs. adding more residents. That's simply false, were talking the "1+1=3" level of falseness LOL.

Ive been at places where they really struggled with getting any PAs (and had been simply bumping up trainee slots) because of the huge added costs involved.

So I would agree with Yaah on anon internet posters here though, there is a lot of random non sequitor comments flying about these days.

 

[Pathwrath]

I've been perusing threads in this forum for a few months- is there any reason why path regulatory organization(s) are not prudently controlling residency numbers (i.e. reducing them)? Is the reality to the contrary (i.e. is it possible that there an actual shortage of pathologists in the nation)? I ask because I don't know, and am curious.

Specialties differ in their responsiveness to market pressure. Pathology is clearly among the worst. I think it is the worst.

Why that is exactly, I can only guess. Radiologists, for example, strike me as a group that knows it's got a good thing going and is willing to work together to keep it that way. Pathologists are a herd of cats.

 

[malchik]

The College of American Pathologists apparently does not accept the premise that there is an oversupply of pathologists. In fact, they think there is a future shortage. They also explicitly advocate more GME residency slots because residents are doing less work now with duty hour restrictions:

May 18, 2009
CAP Letter to Senate Finance Committee

"The CAP advocates full funding of GME positions and removal of the limit on Medicare-supported GME slots to address reductions in resident duty hour shifts to ensure patient safety and meet the needs of anticipated workforce shortages in the future."

 

[MOHS_01]

The AAD says the very same thing about derm, ignoring the fact that every major non-AAD Workforce Task Force survey has shown, time and again, that dermatology wait times are mid-pack when compared to other specialties.

Believe it or not, the culpable reasons are the same for derm -- the money makers (read those with the say) are quite often subspecialists and referral driven. There simply exists no better construct for a feeder program than a residency.

Any specialty open to such negative influence will eventually be adversely impacted. In fact, the number of derm slots have increased rather significantly on a percentage basis over the past decade.