Pathologist overworked and burntout?

[KeratinPearls]

CV is not that important.
Hopefully you can spot candidates that are reasonably independent.
This is not something that residency and fellowship teaches these days

Agree. CV is more important in academics. Someone can have a great CV, train at the top institutions, be so arrogant/think so highly of him or herself that it becomes hard to work with that person. Even worse they think they know it all when they don’t.

You don’t need to go to Ivy League to be a good or great pathologist in private practice. As long as you have several of the qualities I mentioned you will do just fine.

Independence comes with confidence and confidence comes with signout experience. The more you push that signout button (while knowing that you can be sued for any mistakes), the more confident and independent you will become. However, most fellowships don’t give you signout experience.

---

Members don't see this ad.

 

[pathslides]

No burnout here. Fun job, easy money.

 

[B***F*****]

No burnout here. Fun job, easy money.

Bingo!

 

[PATHDOCNYCNJ]

Sometimes you are not even treated with respect by your own department. I worked at a place that held you to a strict turn around time like you were making widgets for Ford. The computer clocked your TAT to the second and case had to be put in 3 days seven hours. If you surpassed that you had to write a reason for the delay. This stood for any case other than biopsies and cytos (2 days 7 hours), and held true for a hernia sac or a complex 40 slide GYN oncology exenteration specimen. Time wasters like resident teaching, multiple tumor boards, admin meetings were commonplace to waste even more time. Then at the consensus meetings if you had an a-hole of a colleague who told you to get a stain or an IHC or more levels, you had to do so and delay finalization still more. The boss made you justify in writing every immuno stain. Then at the end of the month your TAT would be shown to entire department and you’d be shamed for being slow. All those PIP and PAP tests from CAP were used for your performance evaluation.

This is the type of toxic place you are forced to end up in after you get booted from your community hospital path job only because it merged with a major academic medical center, and the chief muckety muck of said academic hospital decided they didn’t want community level paths with no sub specialty expertise.

I trained at an academic path department. The training was inadequate where the resident was basically a glorified PA, stenographer or secretary. Even in a surg path rotation you spent the vast majority of your time cutting meat in the gross room, taking photos of specimens and then arranging your slides and schedule to deal with 10 sub specialty attendings. Hopefully you could absorb a pathology Pearl from the attending while you are taking his or her final report dictation like a human Dragon Naturally Speaking program.

I hear that over the last 20 years path departments rather than correcting the training just made it less demanding with all gross work done by PAs and more glass slide time. So why are new pathologists less prepared? The glass slide review time in my training suffered as a result of all the other demands on my time.

 

[KeratinPearls]

No burnout here. Fun job, easy money.

Sounds like you got a good job. Just talked with a friend who is being offered a job in NY for mid 200s. This after 7 years of training. Incredibly crappy considering the high cost of living. The grass isn’t so green for everyone nor is it “easy money” for everyone.

I know of hospitalists in NYC making 400-500k btw

 

[B***F*****]

Sounds like you got a good job. Just talked with a friend who is being offered a job in NY for mid 200s. This after 7 years of training. Incredibly crappy considering the high cost of living. The grass isn’t so green for everyone nor is it “easy money” for everyone.

I know of hospitalists in NYC making 400-500k btw

The key is to NOT work in a place like NYC where earnings to cost of living ratio is suboptimal. Granted, some people love NYC so it's all up to the individual. There are other cities and metropolitan areas, for instance in the midwest, where the salary to cost of living ratio is more optimal and you can have more extra money to play with.

 

[voxveritatisetlucis]

I thought hospitalist in NYC made like 200k

 

[Zarniwoop]

I've seen many examples in medicine where the same-ish job might pay $200K and one place, and $400K literally across the street. This doesn't work with gas prices, but seems to be commonplace with physician salaries.
So, if you want to be optimistic, you can say "Hospitalists in NYC make $400" and if you want to be pessimistic you can say "hospitalists in NYC make $200" and you'd both be right.
I tend to favor the more pessimistic view. Seems more real to me and mirrors my own career trajectory more accurately.

 

[MetroPath]

The key is to NOT work in a place like NYC where earnings to cost of living ratio is suboptimal. Granted, some people love NYC so it's all up to the individual. There are other cities and metropolitan areas, for instance in the midwest, where the salary to cost of living ratio is more optimal and you can have more extra money to play with.

Cost of living is better of course in Midwest than NYC. From talking to other pathologist there are jobs that pay well for pathologists in Midwest, especially farther away from the big cities. I interviewed for a small hospital job in rural Indiana for 220 K starting. Lower cost of living for sure but that salary is low considering how much some internists can make in rural Midwest.

I’ve also been told by other pathologists they’ve been offered low starting salaries as well in Midwest. There are high paying jobs though, like I said, farther out from big cities (300K+).

Seems like there’s a mix of good and bad jobs out there. It just depends on location and luck.

 

[k_sheep]

Australia and NZ have critical shortages - just look at our jobs page RCPA - Job Listings .... and this is only advertised jobs. Almost every lab has vacancies. A LOT of people are burning out.

Funny thing is everyone is desperate for locums, but no one is offering more than 2k/day, which is less than most medical registrars (resident equivalent) get.

 

[shikimate]

Do you know what compensation is like in Australia? I was told in 400K AUD range. I contemplated moving there before but it seems cost of living is high in most cities and AUD is relative weak. After the FX conversion it seems hard to exceed compensation in north America. Thanks for any info.

 

[B***F*****]

Cost of living is better of course in Midwest than NYC. From talking to other pathologist there are jobs that pay well for pathologists in Midwest, especially farther away from the big cities. I interviewed for a small hospital job in rural Indiana for 220 K starting. Lower cost of living for sure but that salary is low considering how much some internists can make in rural Midwest.

I’ve also been told by other pathologists they’ve been offered low starting salaries as well in Midwest. There are high paying jobs though, like I said, farther out from big cities (300K+).

Seems like there’s a mix of good and bad jobs out there. It just depends on location and luck.

Agree. Location, luck, and experience matters. 200K starting is on the low side for sure. Starting salary above 300K, you're starting out ahead. 400K+...probably get there with more experience. Important thing is what you do with the money. Creating more than one income stream can set you up to compound your salary if you do it right...comes with risk though of course. Do you want to be rich? Or do you want to be wealthy (ability to use money to make more money)?

 

[k_sheep]

Do you know what compensation is like in Australia? I was told in 400K AUD range. I contemplated moving there before but it seems cost of living is high in most cities and AUD is relative weak. After the FX conversion it seems hard to exceed compensation in north America. Thanks for any info.

About 330-350k for new grads, 400 about 5 years out, then seems to cap out at 600 (unless you start your own lab).

 

[KeratinPearls]

About 330-350k for new grads, 400 about 5 years out, then seems to cap out at 600 (unless you start your own lab).

That’s pretty good salary for outside the US. That’s 200-260,000 usd comparable to US. I know US private practice pathologists who make that range (employee salary), which is low compared to most other fields except for internal medicine and family medicine. I always thought America had the highest average salaries in the world.

How’s the cost of living? I’m assuming it’s pretty high?

 

[k_sheep]

Depends where you live - in Sydney, it's ridiculous (mainly because of the real estate prices). Regional areas real estate is much cheaper, but food is more expensive (and no public transport so have to rely on cars).

Very broad strokes but $1m will get you a 1 bedroom unit in Sydney, a 3 bed house 20 min drive to Brisbane, or a nice big house and yard in small towns. A barista coffee is $4-6. Avo on toast breakfast about $15 with an egg. A dozen eggs $5. 1kg of chicken $16-20. Petrol is $2/litre. Cheap new car is $16k. Mid size SUV $40k.

Taxes are higher (49% once over 180k per year) but universal health so don't need to pay for insurance.

 

[coroner]

A pathologist still comes out notably better in the US income-wise, mainly due to taxes.

About 330-350k for new grads, 400 about 5 years out, then seems to cap out at 600 (unless you start your own lab).

Taxes are higher (49% once over 180k per year) but universal health so don't need to pay for insurance.

So, an average of $400K AUD would be in the middle of a new grad and the high end. $400K AUD = $258K USD. After paying taxes at a rate of 49% which is roughly half of their gross income, an average pathologist winds up with roughly $126K USD per year.

In the US, a reasonable income for a pathologist in between a new grad and high end would be $300K. Yes, we all know of non-partners, academia, and Quest employees earning in the 180-250 range. But, that's the lower end for the field as a whole. There's also employed pathologists of health care networks who are earning at MGMA ranges in between 300-400K, as well as pp groups earning more.

So, at a very attainable $300K/yr in the US and at an average tax rate at 37% (varies from state-to-state, marital status, and how good your accountant is, etc.) that equals $111K/yr in taxes. Your net would then be 300K - 111K = $189K USD per year.

That's a gross of $189K/yr in the US. Subtract the difference of 126K/yr in Australia = 63K more per year in the US. 63K/126K = 50% higher gross income in the US for the average pathologist.

That's not to speak of cost of living, quality of life, or what one's personal preferences are. This is just going over some numbers.

 

[shikimate]

Appreciate the answers above.
Sometimes we forget that the standard of living in North America is amongst some of the highest in the world. So yes, pathology remuneration has stagnated and declined in real dollar values, but it is not easy to find "greener grass" elsewhere in the world either.

I think this is a global trend, as my research about pathology jobs in Australia, Canada, EU and various other places does not necessarily yield better options. For example, consultant autopsy pathologist in Ireland (employee position) with a salary of 168 EUR is no better than what US/Canadian forensic pathologists are paid, not to mention taxes and COL in Ireland isn't cheap either.

Jobs in Canada will yield between 350K and 450K CAD, which again is no better than the US. As a field, our remuneration probably has a "glass ceiling" of the USD pathologist rate.

 

[KeratinPearls]

Appreciate the answers above.
Sometimes we forget that the standard of living in North America is amongst some of the highest in the world. So yes, pathology remuneration has stagnated and declined in real dollar values, but it is not easy to find "greener grass" elsewhere in the world either.

I think this is a global trend, as my research about pathology jobs in Australia, Canada, EU and various other places does not necessarily yield better options. For example, consultant autopsy pathologist in Ireland (employee position) with a salary of 168 EUR is no better than what US/Canadian forensic pathologists are paid, not to mention taxes and COL in Ireland isn't cheap either.

Jobs in Canada will yield between 350K and 450K CAD, which again is no better than the US. As a field, our remuneration probably has a "glass ceiling" of the USD pathologist rate.

Aren’t Canadian taxes like 50%? If so, there goes all of your income.

 

[shikimate]

your question is too broad to answer. It depends on jurisdiction and which "tax" you are referring to.
Marginal tax rate on personal income can be as high as 53%. This is not the same as the "average tax rate".
Professional corporation tax depends on revenue, there is a lower rate of around 16% for corporations with <500k in revenue. Also depends on if you take $ out of corporation as salary or dividend, the tax rate would differ as well.

 

[CDX-2]

Do you know what compensation is like in Australia? I was told in 400K AUD range. I contemplated moving there before but it seems cost of living is high in most cities and AUD is relative weak. After the FX conversion it seems hard to exceed compensation in north America. Thanks for any info.

It depends on whether you're working in a public lab or a private lab.

For a consultant (attending) working in a public lab, the salary is as per the health department EBA for that state/territory, which is HIGHLY variable.

The latest 1st year PUBLIC consultant (attending) BASE salaries:

Western Australia - $AU 337,820.

Victoria - $AU 249,470 ($4797.50 x 52 weeks)

South Australia - $AU 220,914 (Consultant Step 1)

Northern Territory - $AU 189,585 (Staff Specialist Year 1)

Queensland - $AU 188,800 (Staff Specialist - Level 18)

Australian Capital Territory - $AU 188,151 (Specialist Band 1)

Tasmania - $AU 163,005 (Specialist Medical Practitioner - Level 1)

I'm unable to find the relevant EBA for public consultants (attendings) in New South Wales.

Within the public sector, there are also additional things like CPD allowance, travel allowances / free petrol, and salary packaging/sacrificing (pre-tax deductions of up to $AU 9009/year).

I've also been told there's a separate optional Commonwealth agreement where you report private cases in addition to the public cases in a public lab, with an extra 30% loading on top of the base salary.

My ex-colleague who is now a 1st year consultant (attending) pathologist in Tasmania is earning ~$AU 250K once the FULL package is included
( [ $AU 163,005 x 1.30 ] + CPD allowance + travel allowance + salary packaging).

 

[shikimate]

Many thanks for the info.
Relative to Canada, the consultant salary in Australia seems low. It seems less financially attractive to move there. I've heard the cost of living is equally high in many larger areas (houses > 1 million AUD), which is similar to major cities in Canada.
For reference, in Canada salary averages from $370K CAD to >450 CAD. As of writing 1 CAD = 1.08 AUD.
I've seen some pathologists move from Australia to Canada but not the reverse.
If you are ever interested in moving here, our health authority is still hiring multiple pathologists.

 

[coroner]

I'm guessing the salaries in Australia and New Zealand are similar? Interestingly, I've seen a few ads on pathoutlines pop up for New Zealand over the years, but hardly ever for Australia.

 

[k_sheep]

I've seen some pathologists move from Australia to Canada but not the reverse.
If you are ever interested in moving here, our health authority is still hiring multiple pathologists.

I'm actually in the process of doing just that - but I expect my pay to go down. I have a rather high salary in Australia due to a couple of factors, mainly my speed and reputation. I won't be able to get to the same level without starting off as an 'unknown' again. I'm looking to move for lifestyle rather than financial reasons.

My stumbling block is they seem to want to make me do the MCCQE1 which seems ridiculous because we give Canadians reciprocity so they don't have to resit exams. Especially a med school level exam - I'm WAY too far off med school to do that! Why do I have to sit a med school exam when they accept all my fellowship exams?! Crazy.

NZ salary is a fair bit lower than australia, and cost of living is much higher - there's a reason most of them end up over here.

Australia doesn't really bother with pathoutlines ads, they just go on our college website. But the majority of positions are filled by people phoning their preferred paths.

 

[shikimate]

Each province has different rules, some province like Ontario and BC are particularly onerous, whereas others with acute shortage of physicians will be more lax.

I would say speed is not a factor in 95% of practices in Canada. Most places probably sign out at a snail's pace compared to US and other private places. I know pathologists who "struggle" with a 2K annual case load. Consults don't pay that well either compared to say big names in US. Speed is slow too, sometimes I send out a consult and get a report back 6 weeks later.

It's hard to up your $ in many places in Canada. As a real world example recently I asked if I could work as locum on weekends at a hospital in a city 1.5 hours away as they were short-staffed and cases were piling up. Turn out provincial regulation says I cannot because I hold a full time position in my own city and that hospital belongs to the same health authority, therefore I am not allowed to double dip another position within the same health authority.

 

[k_sheep]

Oh that helps explain it, I was looking at BC and Ontario ... maybe I should cast my net wider.

Ideally I'd love to locum to try out different places but the thought of registering with several states is a little overwhelming right now.

 

[HeyDalaron]

Each province has different rules, some province like Ontario and BC are particularly onerous, whereas others with acute shortage of physicians will be more lax.

I would say speed is not a factor in 95% of practices in Canada. Most places probably sign out at a snail's pace compared to US and other private places. I know pathologists who "struggle" with a 2K annual case load. Consults don't pay that well either compared to say big names in US. Speed is slow too, sometimes I send out a consult and get a report back 6 weeks later.

It's hard to up your $ in many places in Canada. As a real world example recently I asked if I could work as locum on weekends at a hospital in a city 1.5 hours away as they were short-staffed and cases were piling up. Turn out provincial regulation says I cannot because I hold a full time position in my own city and that hospital belongs to the same health authority, therefore I am not allowed to double dip another position within the same health authority.

That final point is alarming. In essence they are accepting that patients don't get seen rather than pay for a doctor to see them. Imagine if that was a front facing clinical scenario: "We have a surgeon willing to do weekend cases but because he works for the same health system we can't pay him for those"

Inanity!

 

[shikimate]

There are many scenarios in Canada that doesn't pass the common sense test, some are intentional, some are historical. See below:

https://www.cbc.ca/news/canada/newfoundland-labrador/dr-paul-hart-fogo-island-1.6577101

 

[CDX-2]

Each province has different rules, some province like Ontario and BC are particularly onerous, whereas others with acute shortage of physicians will be more lax.

I would say speed is not a factor in 95% of practices in Canada. Most places probably sign out at a snail's pace compared to US and other private places. I know pathologists who "struggle" with a 2K annual case load. Consults don't pay that well either compared to say big names in US. Speed is slow too, sometimes I send out a consult and get a report back 6 weeks later.

It's hard to up your $ in many places in Canada. As a real world example recently I asked if I could work as locum on weekends at a hospital in a city 1.5 hours away as they were short-staffed and cases were piling up. Turn out provincial regulation says I cannot because I hold a full time position in my own city and that hospital belongs to the same health authority, therefore I am not allowed to double dip another position within the same health authority.

Re: the provincial regulation, there's a similar rule in Tasmania where medical staff (both clinical and non-clinical) who are already working within the state public health system (THS - Tasmanian Health Service) are prohibited from working locum shifts elsewhere within THS during their time off (eg weekends or annual leave). This includes full-time staff and quite possibly part-time staff as well?!?!?!?!?!?!?!?!?!?!?!?!?!

I've been told that the locum medical registrars ("senior medical residents") in THS are getting paid ~$AU 140-160/hour. I've also been told that the offered locum consultant (attending) pathologist rate for Tasmania (both public and private) is $AU 2000/day. The (public) lab that I'm currently working in has been very short-staffed at the consultant (attending) level for much of 2022 due to COVID-19 and other unforeseen circumstances. To date, there's been relatively patchy locum consultant (attending) pathologist coverage with the ongoing locum offer of $AU 2000/day.

IIRC for the ~6 month period in which locum pathologists were advertized for, locum coverage was/will be provided for a total of ~?10 weeks (~5 weeks by one pathologist last year, and ~5 weeks by another pathologist who's going to start next month). Both of the locum pathologists are from interstate.

I've read that the locum consultants (attendings) for clinical medicine were getting paid up to $AU 3500/day, so I'm surprised the offered locum pathologist rate hasn't been increased given the severe short-staffing (at the consultant/attending level) in the lab.

The "internal" locum prohibition rule doesn't apply to Victoria. I can't comment on the other Australian states/territories.

 

[CDX-2]

There are many scenarios in Canada that doesn't pass the common sense test, some are intentional, some are historical. See below:

https://www.cbc.ca/news/canada/newfoundland-labrador/dr-paul-hart-fogo-island-1.6577101

Wow that sounds really bureaucratic...................

 

[shikimate]

The locum rates in Canada isn't worth my time, I've heard offers from 1000 a day to 1600 a day, but free hotel/meal.
I was hoping to find fee for service opportunities but those are far and few between, so I gave up. Instead booked some vacation to Carribean lol.
For the record, ICU locum coverage for weekend is 10K. Tough shift but 5K a day is pretty sweet.

 

[HeyDalaron]

The locum rates in Canada isn't worth my time, I've heard offers from 1000 a day to 1600 a day, but free hotel/meal.
I was hoping to find fee for service opportunities but those are far and few between, so I gave up. Instead booked some vacation to Carribean lol.
For the record, ICU locum coverage for weekend is 10K. Tough shift but 5K a day is pretty sweet.

The lowest Canadian locum rate that is acceptable is 2000/day all expenses paid.

Southern Ontario has abysmal rates because of the lack of self respect pathologists have there. I've seen 1200/day full case load and no covered expenses. It's better to not work than to assume liability at that paltry rate.

 

[canadapath]

The lowest Canadian locum rate that is acceptable is 2000/day all expenses paid.

Southern Ontario has abysmal rates because of the lack of self respect pathologists have there. I've seen 1200/day full case load and no covered expenses. It's better to not work than to assume liability at that paltry rate.

Which provinces do you know of that offer 2000+/day?

 

[shikimate]

Southern ON offered my friend 900 a day few years back.
Thunder bay offers 1600 a day and can include flight and hotel. I contemplated the offer but in the end it's not more than what I already could make so why bother sacrificing vacation time for it. So I will go to Caribbean and enjoy myself instead.
But I am not aware of anywhere that offers 2000 a day.

 

[CDX-2]

The locum rates in Canada isn't worth my time, I've heard offers from 1000 a day to 1600 a day, but free hotel/meal.
I was hoping to find fee for service opportunities but those are far and few between, so I gave up. Instead booked some vacation to Carribean lol.
For the record, ICU locum coverage for weekend is 10K. Tough shift but 5K a day is pretty sweet.

Apparently Darwin Hospital (Northern Territory, Australia) is offering $AU 2500/day for a locum pathologist, which is more than the $AU 2000/day being offered in my current hospital.

I also found out that the locum pathologist (a General Pathologist from interstate) that's going to start on coming Monday has reduced coverage from 5 weeks down to 2 weeks.

So the total locum coverage will be ~7 weeks (2 locums) out of 6 months...

I've been informed that the hospital already has 2 permanent General Pathologists (both have previously done AP), but for some reason they weren't requested to cover AP during the current staffing shortage?!?!?!

I'm not sure what's going on....

 

[shikimate]

Apparently Darwin Hospital (Northern Territory, Australia) is offering $AU 2500/day for a locum pathologist, which is more than the $AU 2000/day being offered in my current hospital.

I also found out that the locum pathologist (a General Pathologist from interstate) that's going to start on coming Monday has reduced coverage from 5 weeks down to 2 weeks.

So the total locum coverage will be ~7 weeks (2 locums) out of 6 months...

I've been informed that the hospital already has 2 permanent General Pathologists (both have previously done AP), but for some reason they weren't requested to cover AP during the current staffing shortage?!?!?!

I'm not sure what's going on....

That's pretty good rate mate, I was offered locum this summer for 1700 CAD a day (in a nice seaside place) and couldn't find anything higher so I might do a couple of weeks. Too bad you are still a trainee otherwise hustle a bit and take some high paying locum wouldn't be too bad of a thing at the beginning of your career.

 

[k_sheep]

Unfortunately in Australia locum is not high paying in general - it's a pay cut in real terms. Not surprising they are struggling to find someone for 2k/day. There's about 200 working days a year (taking out public holidays, rec leave, sick leave, weekends) so that's 400k pa. Take out at least 40k for superannuation (like the USA 401k) then you've got 360pa which is a rather ordinary rate for a junior consultant. Why would you bother?

 

[CDX-2]

Unfortunately in Australia locum is not high paying in general - it's a pay cut in real terms. Not surprising they are struggling to find someone for 2k/day. There's about 200 working days a year (taking out public holidays, rec leave, sick leave, weekends) so that's 400k pa. Take out at least 40k for superannuation (like the USA 401k) then you've got 360pa which is a rather ordinary rate for a junior consultant. Why would you bother?

I've just been informed that all of the AP consultants have resigned from RDH (Royal Darwin Hospital), and that they need locum cover for now, while they're recruiting a long-term AP consultant (as per the current RCPA jobs listing page on 26/2/2023).

I've been told that the locum rate for RDH (Royal Darwin Hospital) should be $2500/day, which is more than RHH (Royal Hobart Hospital) of $2000/day.

If you're interested, perhaps you could contact RDH and negotiate to ask for ???$3000/day, seeing that they used to have up to 4 AP consultants...............

 

[shikimate]

I've just been informed that all of the AP consultants have resigned from RDH (Royal Darwin Hospital), and that they need locum cover for now, while they're recruiting a long-term AP consultant (as per the current RCPA jobs listing page on 26/2/2023).

I've been told that the locum rate for RDH (Royal Darwin Hospital) should be $2500/day, which is more than RHH (Royal Hobart Hospital) of $2000/day.

If you're interested, perhaps you could contact RDH and negotiate to ask for ???$3000/day, seeing that they used to have up to 4 AP consultants...............

lol if 1 consultant does the work of 4 consultants I'd expect 8K to 10K a day. Now we are talking baby. 🚀🚀🚀

 

[imgtointern]

I feel like I only ever post here to ask for help and never offer help. I feel selfish. But here I am again asking for advice. I’ve been at work about 6 months. I feel overworked. I have about 3500 cases so far in 6 months, so the year end average will be around 7000. Is that normal? Plus I’m grossing and doing off site frozens. I don’t feel happy. Plus I’m getting dinged for ordering too many stains on prostates. I’m new so ordering more than the others for sure. Do you all order a lot of stains on prostates? I feel pretty soon they will notice that I don’t like being here and kick me out. I dunno, please tell me to buck up and suck it up. I feel this feeling of not making too much noise and just accepting everything is never ending. Accept everything in residency to get a good fellowship, in fellowship to get a good job, at first job to get another one, etc. Please tell me I’m wrong and to stick it out because right now I want to stick it to everyone and just quit.

 

[DoctorInQuotations]

I feel like I only ever post here to ask for help and never offer help. I feel selfish. But here I am again asking for advice. I’ve been at work about 6 months. I feel overworked. I have about 3500 cases so far in 6 months, so the year end average will be around 7000. Is that normal? Plus I’m grossing and doing off site frozens. I don’t feel happy. Plus I’m getting dinged for ordering too many stains on prostates. I’m new so ordering more than the others for sure. Do you all order a lot of stains on prostates? I feel pretty soon they will notice that I don’t like being here and kick me out. I dunno, please tell me to buck up and suck it up. I feel this feeling of not making too much noise and just accepting everything is never ending. Accept everything in residency to get a good fellowship, in fellowship to get a good job, at first job to get another one, etc. Please tell me I’m wrong and to stick it out because right now I want to stick it to everyone and just quit.

New in practice here too. I have similar case numbers after 6 months, but I'm not grossing and only do infrequent frozens/ROSEs (a couple per week). I maybe average one PIN4 per prostate needle biopsy case, sometimes none and sometimes on a few blocks when there's multiple foci of ASAP. I'm normally done by 5PM.

I think that's a decent enough caseload to justify a PA or grossing tech to limit your grossing. If I was doing my current caseload plus grossing and doing multiple frozens and ROSEs a day, I'd be burned out too. Depends on your group dynamic, but I'm in one where I would feel comfortable speaking up if I felt things were unmanageable or unfair. If you think people would listen, you should say something; reasonable people will respect reasonable complaints.

 

[cmz]

I feel like I only ever post here to ask for help and never offer help. I feel selfish. But here I am again asking for advice. I’ve been at work about 6 months. I feel overworked. I have about 3500 cases so far in 6 months, so the year end average will be around 7000. Is that normal? Plus I’m grossing and doing off site frozens. I don’t feel happy. Plus I’m getting dinged for ordering too many stains on prostates. I’m new so ordering more than the others for sure. Do you all order a lot of stains on prostates? I feel pretty soon they will notice that I don’t like being here and kick me out. I dunno, please tell me to buck up and suck it up. I feel this feeling of not making too much noise and just accepting everything is never ending. Accept everything in residency to get a good fellowship, in fellowship to get a good job, at first job to get another one, etc. Please tell me I’m wrong and to stick it out because right now I want to stick it to everyone and just quit.

3500 cases with multiple parts? Do you have a reference of how many 88302/304/305/307/309s you're looking at? What is the case mix like?

Regarding ordering "too many" IHCs -- this is a real thing. There needs to be medical necessity. Sometimes, certain payers may not reimburse the group for going over the MUE limit. Sometimes this cannot be avoided. However, you should document why you're ordering what you're ordering as standard good practice anyway. It will help the billers/coders provide justification in case something needs to be appealed. Plus it will show your group why you're doing what you're doing. This could be reviewed via QA and there may be some things your eye isn't used to seeing (after all, you're in a new group with a different H&E than what you trained with and you're also fairly young into your practice).

Regarding moving practices, that is entirely up to you and what you feel is the best move. Everyone always thinks the grass is greener elsewhere. I don't know if this is exactly true, but you have to figure out why you're not happy. Is it because of the job or other factors? I've seen people jump ship many times and they always complain about the same things. I am not saying that this might be you, but it is helpful to make a list of what you like and don't like about your current situation. There are certainly a lot of groups out there with less than ideal working environments, and the last thing you want to do is go from a not-so-bad situation to a profoundly worse situation.

 

[imgtointern]

We have grossing techs but they don’t gross everything and I spend about an hour on average grossing, sometimes more on cancer cases and sometimes less. Frozens are 0 to upto 3 a week which takes away 2-3 hrs from the day and I still have to gross on those days. I am ordering more pin4 than you for sure. I haven’t done prostates since residency so need readjusting. Maybe I will talk to them. I still don’t know how the group will take it. They talk about how previous partners complained a lot so I don’t know. I also feel like I don’t want to be seen as incompetent or incapable if I ask for help.

 

[imgtointern]

3500 cases with multiple parts? Do you have a reference of how many 88302/304/305/307/309s you're looking at? What is the case mix like?

Regarding ordering "too many" IHCs -- this is a real thing. There needs to be medical necessity. Sometimes, certain payers may not reimburse the group for going over the MUE limit. Sometimes this cannot be avoided. However, you should document why you're ordering what you're ordering as standard good practice anyway. It will help the billers/coders provide justification in case something needs to be appealed. Plus it will show your group why you're doing what you're doing. This could be reviewed via QA and there may be some things your eye isn't used to seeing (after all, you're in a new group with a different H&E than what you trained with and you're also fairly young into your practice).

Regarding moving practices, that is entirely up to you and what you feel is the best move. Everyone always thinks the grass is greener elsewhere. I don't know if this is exactly true, but you have to figure out why you're not happy. Is it because of the job or other factors? I've seen people jump ship many times and they always complain about the same things. I am not saying that this might be you, but it is helpful to make a list of what you like and don't like about your current situation. There are certainly a lot of groups out there with less than ideal working environments, and the last thing you want to do is go from a not-so-bad situation to a profoundly worse situation.

Most cases are 305 with multiple parts (GI, prostate, endometrium, heme etc). It’s only prostate that I order a lot of stains for. The rest are standard stains as and when needed. I understand what your are saying about moving. I also don’t want to move too soon and gain a “reputation”.

 

[octopusprime]

Would definitely try to stick it out for a while...only being 6 months in, you will learn where to be more efficient, increase your speed and adjust your settings. The first year is definitely the steepest in terms of learning curve and time management.
It definitely helps to be able to QC things without feeling like you're needing constant hand holding. Hopefully there's 1 or 2 people that you can relate to that can sympathize with being 'green' and not mind you showing them cases every now and then.
Also, is this an employed-only position? Partnership track? Do you see the lifestyle/workload of the partners being better?

 

[shikimate]

That's crazy workload. In my residency most attendings do <3000 a year and have long forgotten how to gross. They have a 120 slide per day cap. Yet they complain there's too much work!
How much are you making doing 7000 a year? Like at that rate if you were fee for service (in theory), you'd be making like 1million+ lol.

 

[octopusprime]

That's crazy workload. In my residency most attendings do <3000 a year and have long forgotten how to gross. They have a 120 slide per day cap. Yet they complain there's too much work!
How much are you making doing 7000 a year? Like at that rate if you were fee for service (in theory), you'd be making like 1million+ lol.

yea i too would be curious about the income vs volume...if you're employed and making $250k and no partnership track, that's not worth it.
If you're paying dues and will be a partner soon, different story.

 

[imgtointern]

it’s a busy practice. Even with some specimens being toenails, it adds up. The people are nice and help with cases, but if you have 2-3 prostates, it’s tough to bug someone with looking at it so I order stains. But I will show more now since they want to ding me for it. I won’t be specific, but salary is <300k and bonus is extra, which can be 10-40%, it’s not a partnership track. Those that have been here longer do have better hours due to being faster I guess. I tried counting my slides one day but soon lost track!

 

[imgtointern]

...if you're employed and making $250k and no partnership track, that's worth it.

did you mean it’s not worth it?

 

[Sawback3]

It does sound like a large volume of work for not too much pay (even with a 40% bonus). I would not stay at this job for more than a year or two unless there is opportunity to make at least 400k. I do agree with some of the above about sticking it out, you'll get faster, etc. By the time that happens, it's time to take those skills elsewhere.

 

[HeyDalaron]

How do you get 'dinged' for ordering stains? What are the concerns and what are the consequences?