Pathologist Glut

[exPCM]

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http://www.nrmp.org/advancedata2007.pdf
Look at the pathology data - 383 spots in the match in 2001 to over 500 spots per year for the past 3 years.
The biggest problem with shortening AP/CP pathology residency is that the residency programs have continued to fill all their slots. This means that we used to have about ~2000 residents spread over five years (thus graduating about 400 residents/yr. to enter the job and fellowship market) and now have ~2000 residents spread over four years (thus graduating about 500 residents/yr. to enter the job and fellowship market). This has made the competition for jobs and fellowships fiercer than ever. The job market can not sustain this increased supply and my contacts with recruiters clearly indicate that the job market is taking a rapid turn for the worse for new grads and for practicing pathologists wanting to change jobs. I see significant unemployment in the future.

 

[djmd]

http://www.nrmp.org/advancedata2007.pdf
Look at the pathology data - 383 spots in the match in 2001 to over 500 spots per year for the past 3 years.
The biggest problem with shortening AP/CP pathology residency is that the residency programs have continued to fill all their slots. This means that we used to have about ~2000 residents spread over five years (thus graduating about 400 residents/yr. to enter the job and fellowship market) and now have ~2000 residents spread over four years (thus graduating about 500 residents/yr. to enter the job and fellowship market). This has made the competition for jobs and fellowships fiercer than ever. The job market can not sustain this increased supply and my contacts with recruiters clearly indicate that the job market is taking a rapid turn for the worse for new grads and for practicing pathologists wanting to change jobs. I see significant unemployment in the future.

The slight change in the rate of number of pathologist graduating every year is not the cause of a pathology glut. The number was too high to begin with..

and if you want to cry thing about the poor bastards smashed in the double class year ending...

 

[malchik]

http://www.nrmp.org/advancedata2007.pdf
Look at the pathology data - 383 spots in the match in 2001 to over 500 spots per year for the past 3 years.
The biggest problem with shortening AP/CP pathology residency is that the residency programs have continued to fill all their slots. This means that we used to have about ~2000 residents spread over five years (thus graduating about 400 residents/yr. to enter the job and fellowship market) and now have ~2000 residents spread over four years (thus graduating about 500 residents/yr. to enter the job and fellowship market). This has made the competition for jobs and fellowships fiercer than ever. The job market can not sustain this increased supply and my contacts with recruiters clearly indicate that the job market is taking a rapid turn for the worse for new grads and for practicing pathologists wanting to change jobs. I see significant unemployment in the future.

I think this part of your analysis is wrong. You can't graduate 500 residents/yr without matching 500 new residents/yr, and there aren't 500 slots per year. However, your point may still be true, but it's not because of shortening training.

 

[exPCM]

I think this part of your analysis is wrong. You can't graduate 500 residents/yr without matching 500 new residents/yr, and there aren't 500 slots per year. However, your point may still be true, but it's not because of shortening training.

Huh? There were 513 slots in the match last year. So exactly what part of my analysis was wrong?

 

[djmd]

I think this part of your analysis is wrong. You can't graduate 500 residents/yr without matching 500 new residents/yr, and there aren't 500 slots per year. However, your point may still be true, but it's not because of shortening training.

Actually that is correct. Programs were slotted for say 20 residents (that is all years combined) so instead of taking 4 residents a year, they take 5 residents a year.
So a relative increase of 20% pathology residents per year.

My issue is that it is not the 20% extra per year, it is the fact that we don't need 300+ new pathologist every year.
It has been a problem before the 5 year to 4 year switch.

 

[exPCM]

In the steady state, the production of pathologists is determined by the input rate (i.e., the number of available slots). The steady state output doesn't depend on the number of years of training. Thus, if the input rate is 513/yr, then 513 newly minted pathologists come off the assembly line every year. This is true whether the training takes 10 minutes or ten years.

There is a general relation between work-in-process(WIP), lead-time(LT) and the production rate (R):

WIP = R*LT

In this context WIP is the number of people in training, LT is the length of training and R is the production rate. Thus if the lead-time is shortened the WIP is decreased. Translating this to the pathology production factory: the decrease in lead time (LT) caused a decrease of the number of people in training (WIP) but, aside from the one-time release of extra inventory, the rate of production (R) remains constant.

Huh? The "input rate" is not steady!!! The number of slots was 383 in 2001 and 513 in 2007. This is a greater than 25 percent increase in the "input rate". This IS NOT a one time release of extra inventory.

 

[exPCM]

There are two different things happening:

1) the input rate has increased from 383 to 513

2) there was a one-time extra release of trainees when the training time changed.


So, I agree with you that the rate of production has increased. My point is that it is not due to the decrease in training time.

The decrease in training time is EXACTLY what caused an increase in the rate of production. As eloquently stated by djmd,when the training time decreased from 5 years to 4 years, programs which were ACGME approved for 20 slots were now taking 5 residents per year to fill the 20 slots when they were previously taking 4 residents per year to fill the 20 slots. The decrease in training time has directly increased the rate of production.

 

[yaah]

I see significant unemployment in the future.

There are people who disagree, and who say that positions are being added at a significant rate as well. I don't really know the data. I do know I keep seeing more and more ads for available jobs (although I don't know what kind of jobs they are since I only glance at them) then 2-3 years ago.

All I can say is that I am in a large, good training program. The volume of material you need to be competent is astounding. We get appropriate training and volume, enough to be competent. But our program has more volume and specialized stuff than probably 98% of training programs. I probably would NOT feel very competent training at a program which is significantly smaller unless I had at least one fellowship. But I say that with a bit of ignorance in not knowing how training really works at these programs.

I would also say that for a well trained, competent pathologist with decent communication skills, there should be not much trouble finding a good job now or in the future. The problem will be for those who don't fall into that category.

 

[malchik]

Actually that is correct. Programs were slotted for say 20 residents (that is all years combined) so instead of taking 4 residents a year, they take 5 residents a year.
So a relative increase of 20% pathology residents per year.

My issue is that it is not the 20% extra per year, it is the fact that we don't need 300+ new pathologist every year.
It has been a problem before the 5 year to 4 year switch.

Huh? There were 513 slots in the match last year. So exactly what part of my analysis was wrong?

I get it. Sorry, I was wrong.

 

[Tappat]

If it becomes the norm to do multiple fellowships, and the average number of fellowships-per-trainee increases while funded slots and number of years in the actual residency remain the same, the rate of production would go down. For example, our program does not yet know how many first years it will take next year, as the fellow count is not yet complete.

 

[exPCM]

If it becomes the norm to do multiple fellowships, and the average number of fellowships-per-trainee increases while funded slots and number of years in the actual residency remain the same, the rate of production would go down. For example, our program does not yet know how many first years it will take next year, as the fellow count is not yet complete.

I think you need to review some basic data.
An increased number in the pipeline yields an increased number out of the pipeline. Think about it!
In addition, the ACGME approves the number of resident slots in a pathology residency (see the ACGME website). The number of fellows is a totally separate issue (some fellowships are ACGME accredited and others are not).

 

[trent05]

We should also keep in mind that 513 pgy-1 spots were available in the match/scramble, but there were a significant number of spots that were filled outside the match and were never reported to the NRMP. Many programs still fill some of their pgy-1 positions before the match with applicants switching specialty or IMGs/DOs. So the number is even greater than 513 per year. The oversupply of newly minted pathologists is a real problem, even for those that trained at "top programs".

 

[Tappat]

I think you need to review some basic data.
An increased number in the pipeline yields an increased number out of the pipeline. Think about it!
In addition, the ACGME approves the number of resident slots in a pathology residency (see the ACGME website). The number of fellows is a totally separate issue (some fellowships are ACGME accredited and others are not).

I totally understand and agree with your logic regarding increased numbers in the pipeline, etc. However, what I was implying has to do with the funding available, which is not the same thing as the number of positions for which the ACGME has approved a residency program. There is a really good explanation here:
http://64.233.169.104/search?q=cach...ips&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a

So, in my (limited, I'm sure) understanding, a program may be ACGME-approved for a certain number of resident positions separate from their fellowship positions, but the number of these positions that the department can actually use will depend greatly on the available funding, for which the program will have to consider residents and fellows in one pot. In this way, an increased number of fellows could decrease the number of residents.

 

[djmd]

So, in my (limited, I'm sure) understanding, a program may be ACGME-approved for a certain number of resident positions separate from their fellowship positions,...
In this way, an increased number of fellows could decrease the number of residents.

That is not really how it works, Fellowships must funded differently. That paper you link to is not really a good explanation of the reality.

On thing it does talk about is the fact that hospitals only get paid for X of years per resident. Beyond X they get paid less (50%?).


More likely a hospital will vary the number of people they take because they have their residency+fellows set up for working, so they need say 10 bodies to fill a schedule and they will work to maintain that...

 

[exPCM]

I totally understand and agree with your logic regarding increased numbers in the pipeline, etc. However, what I was implying has to do with the funding available, which is not the same thing as the number of positions for which the ACGME has approved a residency program. There is a really good explanation here:
http://64.233.169.104/search?q=cach...ips&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a

So, in my (limited, I'm sure) understanding, a program may be ACGME-approved for a certain number of resident positions separate from their fellowship positions, but the number of these positions that the department can actually use will depend greatly on the available funding, for which the program will have to consider residents and fellows in one pot. In this way, an increased number of fellows could decrease the number of residents.

I'll play along. If resident positions are in fact being converted to fellowship positions, then how do you explain the large rise in resident positions? In addition, the fellowship and resident positions are not one pot. Many pathology fellowships are not ACGME accredited (i.e surgpath, GI, GU, Breast, GYN, etc.) and thus they are not even eligible for medicare funding - see link http://www.aapmr.org/passor/resources/fellowshiptrain3.htm

 

[LADoc00]

The market CANNOT I repeat CANNOT absorb 500 pathologists/year. It cant absorb 300. I good chunk of people never pass boards, somewhere in the 30%+ range. Of those that do pass boards, probably 20%+ will never have FT jobs for more than a few years.

One saving grace is the fact so many women are going into pathology and likely will exit out of the job market to have kids. If they dont, then all hell will break loose, even for people like me as we will have desperate low bidder wars across the geographic spectrum.

Folks, this is a crisis, no one can question that. There will be a time when nursing pays more on the average than Pathology and we are approaching that point very quickly.

The fault entirely lies with Academia. They MUST be stopped. I would suggest an across the board 50% slash in residency positions ASAP. Anything less would spell disaster on scale we havent seen in medicine in this country for over 100 years...

 

[docbiohazard]

I would also say that for a well trained, competent pathologist with decent communication skills, there should be not much trouble finding a good job now or in the future. The problem will be for those who don't fall into that category.

This is my hope. For all the potential oversupply or undersupply, the fact remains that I want to be a Pathologist. I'd like to have a job where I can work and do some research. I figure I have to fight tooth and nail to do the best job that I can in training to position myself to get the best job that I can when I get finished.

That said, I'm not sure exactly who is in control of the # of positions a year, if the CAP or ACGME could tighten down or eliminate underperforming programs, or if that'd even be adviseable... all I can be certain of is what I want to do, and that in order to do that I need to work to do the best job I possibly can...

BH

 

[LADoc00]

We COULD fill all the available positions needed for pathology by having a mere handful of slots at Harvard/Boston(combined), NYC, Hopkins, Michigan, Chicago combine, St Louis/Mayo/Minn. combine, Stanford/UCSF(combined), UCLA/LA combine and a single combined Texas program. CLOSE everything else. Put 12 or so residents at each location per year. Train 1/4 in derm, 1/4 in heme, 1/4 in cyto and 1/4 in other subs (GI and GU). 5 year training program with an included fellowship that is mandatory. Everyone does AP/CP/Fellowship.

A completely separate research pathology track could be developed that does not lead to board certification for MD/PhD types that is half/part time no stress pathology rotations at a number of institutions.

Another track is for people like Mindy to go fast track into forensics. 2-3 Year board cert in general pathology then a FP cert.

Someone needs to seriously un**** the training programs in Path asap.

 

[pathstudent]

One saving grace is the fact so many women are going into pathology and likely will exit out of the job market to have kids. If they dont, then all hell will break loose, even for people like me as we will have desperate low bidder wars across the geographic spectrum.
.

While in medical school, during rounds, a pulmonologist told us that "women have saved the field of medicine".

 

[exPCM]

The market CANNOT I repeat CANNOT absorb 500 pathologists/year. It cant absorb 300. I good chunk of people never pass boards, somewhere in the 30%+ range. Of those that do pass boards, probably 20%+ will never have FT jobs for more than a few years.

One saving grace is the fact so many women are going into pathology and likely will exit out of the job market to have kids. If they dont, then all hell will break loose, even for people like me as we will have desperate low bidder wars across the geographic spectrum.

Folks, this is a crisis, no one can question that. There will be a time when nursing pays more on the average than Pathology and we are approaching that point very quickly.

The fault entirely lies with Academia. They MUST be stopped. I would suggest an across the board 50% slash in residency positions ASAP. Anything less would spell disaster on scale we havent seen in medicine in this country for over 100 years...

I agree that the academic institutions continue to fill all their pathology slots based on their own self interest and at the expense of the specialty as a whole. These so-callled bastions of learning really just do not want to give up their free resident labor (since Medicare resident funding averages ~85K per resident, residents are essentially a free source of labor for hospitals).
http://www.amsa.org/pdf/Medicare_GME.pdf
Note: $8,500,000,000 in FY2004 divided by approximately 100,000 total residents yields $85,000 per resident just from Medicare. Of course there are other additional sources of resident funding including state Medicaid and VA funds in many cases.
A recent AMA news showed total GME funding of $11,500,000,000 or approximately 115K per resident http://www.ama-assn.org/amednews/2007/07/09/prse0709.htm

 

[yaah]

I'll play along. If resident positions are in fact being converted to fellowship positions, then how do you explain the large rise in resident positions? In addition, the fellowship and resident positions are not one pot. Many pathology fellowships are not ACGME accredited (i.e surgpath, GI, GU, Breast, GYN, etc.) and thus they are not even eligible for medicare funding - see link http://www.aapmr.org/passor/resources/fellowshiptrain3.htm

I for one don't think resident positions are being converted to fellowship positions. Here at least, the fellowship positions that are ACGME accredited have not increased (two cyto, 2-3 heme, 1 derm, 1 BB). The surg path fellowship, which used to be funded because it was 5th year, is now funded by the department and various endowments. The subspecialty (breast, GI, GU) are funded by research and professorship endowment $$.

Our residency positions have increased maybe from 5/year to 7/year, although there is usually a CP only person who doesn't really count.

I tend to agree with LADoc that path residency should be limited to certain high power institutions, but there does need to be a bit more than that. But the ABP who whoever regulates # positions should seriously evaluate the current situation. They say they are and the current numbers support the need (so said the USCAP guru Dr Silva, among others). But I am not sure what to think.

Part of the reason though that residency positions are increasing is sheer numbers - our specimen volume continues to rise and if there were only 5 residents per year we would get no elective time at all and some surg path services would go uncovered. While it is probable that not all programs are increasing in volume, for the ones that do it is not unreasonable to increase # spots.

 

[exPCM]

I for one don't think resident positions are being converted to fellowship positions. Here at least, the fellowship positions that are ACGME accredited have not increased (two cyto, 2-3 heme, 1 derm, 1 BB). The surg path fellowship, which used to be funded because it was 5th year, is now funded by the department and various endowments. The subspecialty (breast, GI, GU) are funded by research and professorship endowment $$.

Our residency positions have increased maybe from 5/year to 7/year, although there is usually a CP only person who doesn't really count.

I tend to agree with LADoc that path residency should be limited to certain high power institutions, but there does need to be a bit more than that. But the ABP who whoever regulates # positions should seriously evaluate the current situation. They say they are and the current numbers support the need (so said the USCAP guru Dr Silva, among others). But I am not sure what to think.

Part of the reason though that residency positions are increasing is sheer numbers - our specimen volume continues to rise and if there were only 5 residents per year we would get no elective time at all and some surg path services would go uncovered. While it is probable that not all programs are increasing in volume, for the ones that do it is not unreasonable to increase # spots.

For sure the academic institutions may justify increasing their resident complement due to increased surgical volume. After all, academic attendings can not be expected to perform any work which is classified as "RESIDENT WORK" and of course they can not hire PAs when residents are free labor. Yet somehow the pathologists in private institutions are able to cover large volumes of cases without residents. Think about it!
I agree with your idea of limiting path residency to high power institutions.
My recollection from the USCAP resident meeting in February 2006 is hearing Fred Silva state that only about one percent of pathology groups have a track record of hiring new residents and then not making them partners at the end of their initial contract. In my experience, with the glut of pathologists, the percentage of newer hires who are not being offered partnership is much higher than that. I have no idea where or how Fred Silva gets his numbers but I am skeptical. I would be interested to hear LADOC's take on Fred Silva's optimistic assessments.

 

[pathdoc68]

The market CANNOT I repeat CANNOT absorb 500 pathologists/year. It can't absorb 300. Folks, this is a crisis, no one can question that. There will be a time when nursing pays more on the average than Pathology and we are approaching that point very quickly.

I TOTALLY AGREE WITH LADoc.

 

[Gut Shot]

The word around the campfire from the CAP meeting is that 6,000 pathologists are expected to retire over the next 10 years. Last year Fred Silva said the AP market was growing annually at about 5%. No clue about CP. If this is true, the predictions of gloom and doom might be ill founded.

Any thoughts?

 

[coroner]

No idea about the 5% increase in AP. As far as the retirement thing, this might make sense (although we've been hearing people cry wolf before about the mass retirement of pathologists before) for two reasons: 1. Those who entered path during the end of the "Golden Era" would be entering their early to mid 60's 2. The majority of baby boomers should have retired by then as well. It would be nice if this held true as most of us would like as many options as possible. Then again these predictions could be wrong and we'll be at the mercy of having a job interview with a guy in a bowtie, walking cane, and hearing aid talking about how programs used to require 500 autopsies to graduate. Who knows.

 

[yaah]

Well, our institutional volume for AP goes up by it seems like 5-10% every year, and we are not swallowing other practices, it's just growing volume. And this is in a state that is losing people like crazy. It seems to be spread out too - the volume has gone up in every service except perhaps breast and GYN since I have been here.

I tend to wonder what will happen in the future - a lot of these people who are nearing retirement age are true renaissance pathologists who can sign out anything. As they retire, new graduates are going to be more subspecialized. So either groups hire more people to deal with each subspecialty or they start sending more consults. I think it's going to be a bonanza for people who get lots of consults. That's where the volume really grows exponentially.

 

[Matte Kudesai]

Well, our institutional volume for AP goes up by it seems like 5-10% every year, and we are not swallowing other practices, it's just growing volume. And this is in a state that is losing people like crazy. It seems to be spread out too - the volume has gone up in every service except perhaps breast and GYN since I have been here.

I tend to wonder what will happen in the future - a lot of these people who are nearing retirement age are true renaissance pathologists who can sign out anything. As they retire, new graduates are going to be more subspecialized. So either groups hire more people to deal with each subspecialty or they start sending more consults. I think it's going to be a bonanza for people who get lots of consults. That's where the volume really grows exponentially.

We are seeing the same thing. Our volume is growing in every area. As we batten down a service with the right number of pathologists to sign out another service starts to bust at the seams.

And you are absolutely correct that sub specialization is the rule of the future. When I first started out as a resident, the pathologist that got a GI reg for colon CA with an incidental lymphoma in a LN would work up and sign out the entire case. Now pieces and parts are shuffled to the "lymphoma group" or the "skin group."

 

[yaah]

Yeah, the subspecialization thing bothers me in a sense. But part of the problem is not that the pathologists are necessarily uncomfortable with signing it out, it's the clinicians who think that a non-specialist can't correctly interpret something outside their area. Anything "heme" gets shuttled to heme even if it wasn't originally accessioned as such. Anything "non-heme" gets shuttled back. Every case that overlaps two fields (like a GI lymphoma) gets seen by both and one service signs it out with comments that the other field saw it. This may sound like overkill, but if it doesn't happen, within 30 seconds 10 clinicians have called to ask whether "the heme service" (or whichever is relevant) has seen it and if not, can we show them? And even if you say it's clear cut, etc, they will bring up a case from 5 years ago where we said the same thing but the diagnosis changed. And if you still say no they will call the heme service themselves and the heme service (or whoever) will end up looking at it anyway.

It gets really frustrating when there are difficult cases that don't fit in one area or another, or are mistakenly assumed to be in one. We had a case recently that heme people thought wasn't lymphoma so it was given to one of the other subspecialty services, who thought it was lymphoma so they tried to give it back.

 

[mlw03]

i wonder if the uber-specialization you guys are speaking of is seen in private practice, where the pathologist and the clinician may not even be in the same building and never see each other. are those clinicians more inclined to just believe whatever the report comes back saying? from all the talk about fellowships it makes me think that in a lot of private groups there may be a fellowship trained pathologist(s) in most major areas like GI, GU, derm, heme, cytology, etc. i would think such a high level of specialization would require more pathologists.

yaah makes an interesting point about clinicans wanting the expert service to review a particular case if it falls under that domain.. as a student i've seen similar stuff from the clinical perspective. for example, working with a family practice doc we had a patient with a history of uncomplicated COPD and instead of managing herself, she chose to refer the patient to a pulmonoligist. i'm seen similar things with rheumatoid arthritis, thyroid disease, and other things that seem fairly straightforward. my point is that in every field people are having the uber-niche practices, and while that likely drives up the overall cost of healthcare, it also means plenty of job security. i don't see why pathology would be any different in that regard.

 

[Sulfinator]

As far as the retirement thing, this might make sense . . .

I recently spoke with a pathologist who was going back to do a fellowship in Molecular at my institution. She mentioned that the ABP will almost certainly require all pathologists to re-certify every 10 years, even the ones who have hitherto been grandfathered in. She thinks this will provide major incentive for some older pathologists to retire en mass. The only thing is, this mandate may come who knows how many years from now or it may happen sooner. But, according to her, it is a matter of "when" and not "if."

 

[djmd]

I recently spoke with a pathologist who was going back to do a fellowship in Molecular at my institution. She mentioned that the ABP will almost certainly require all pathologists to re-certify every 10 years, even the ones who have hitherto been grandfathered in. She thinks this will provide major incentive for some older pathologists to retire en mass. The only thing is, this mandate may come who knows how many years from now or it may happen sooner. But, according to her, it is a matter of "when" and not "if."

The ABP will not do that.
However, insurance companies can and may very well raise their rates on pathologist who are not re-certifying. This has happened in other fields so there is some president and reason to expect that it might happen in pathology.

This will not likely take affect until a sizable percentage of pathology have begun re-certifying, so 15+ years...

 

[Sulfinator]

The ABP will not do that.
However, insurance companies can and may very well raise their rates on pathologist who are not re-certifying.

Come to think of it, I think that was what she said. I was remembering wrong.

 

[LADoc00]

I recently spoke with a pathologist who was going back to do a fellowship in Molecular (hahaha) at my institution. She mentioned that the ABP will almost certainly require all pathologists to re-certify every 10 years, even the ones who have hitherto been grandfathered in. She thinks this will provide major incentive for some older pathologists to retire en mass. The only thing is, this mandate may come who knows how many years from now or it may happen sooner. But, according to her, it is a matter of "when" and not "if."

This has been talked about but it is on very shakey legal grounds(similar thing was done with teaching credentials). IF they did require those with time unlimited certificates to recertify then they would have bear the ENTIRE cost of it, including airfare, accomodations AND cost of covering people's practice. That could stretch into the 10K+ per pathologist, where would they get the money??

If they should decide to mandate without offering to cover costs, then it is a simple breach/person-professional injury suit in Florida. I could make a call today and have a class action legal team in place in a mere week. I would also personally litigate against the ABP leadership, there is nothing better to change someone's mind than being served by a law firm.

The other option is to simply allow people to take an abbreviated test online. Dunno if that would cause the same mass exodus of old timers.

Then you get to the whole board certification issue. BC is not neccessary actually, not for reimbursements. And once someone has a contract with a hospital and is on staff, it is unlikely any action the ABP puts forth will change that.

Lastly, if someone is leaving private prac to get a mol certificate, then in my book they are immediately suspect and I would disregard most things they say. Utter waste of time.

 

[LADoc00]

The ABP will not do that.
However, insurance companies can and may very well raise their rates on pathologist who are not re-certifying. This has happened in other fields so there is some president and reason to expect that it might happen in pathology.

This will not likely take affect until a sizable percentage of pathology have begun re-certifying, so 15+ years...

I think the word is "precedent"...but you are right. Also realize that pathology insurance premiums are already rock bottom and they ALREADY stratify you into the risk categories based on your training (meaning someone from Harvard/Stanford with AP/CP+fellowship blah blah is paying less than an IMG from a small program) so not much would really change. I pay nearly nothing for malprac insurance, its crazy.

 

[djmd]

I think the word is "precedent"...but you are right. Also realize that pathology insurance premiums are already rock bottom and they ALREADY stratify you into the risk categories based on your training (meaning someone from Harvard/Stanford with AP/CP+fellowship blah blah is paying less than an IMG from a small program) so not much would really change. I pay nearly nothing for malprac insurance, its crazy.

That what happens when you spell check and aren't watching the results.. ah well.