Pathologist overworked and burntout?

[octopusprime]

did you mean it’s not worth it?

yes typo

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[Pingu]

It's difficult to estimate without knowing your payor mix, CPT breakdown, and collection percentage but if you are signing out 7000 cases a year you are probably bringing in between 750k to 1 million in revenue. The red flags for me are it not being partnership track and saying the previous partners complained a lot. Have you actually received a bonus yet or is that a carrot they are dangling in front of you?

Is this your first job/first year out of residency/fellowship? Because the first year is rough but your volume to compensation ratio does seem like you might be being taken advantage of.

 

[imgtointern]

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

Getting a lecture. Being told I could get investigated for Medicare fraud! Yikes! I’ve only been in practice 5 months technically since the first month was spent in orientation/observation!

 

[HeyDalaron]

Getting a lecture. Being told I could get investigated for Medicare fraud! Yikes! I’ve only been in practice 5 months technically since the first month was spent in orientation/observation!

You're new. Your license and reputation are on the line at this stage in your career. Ordering a stain is usually better than wishing you had when something bad catches up with you down the line.

From what you are saying about this group, it sounds like they are getting a bargain with you and it does not look like your career will be serviced by staying further. They also sound like jerks, frankly.

If you feel the need to order a stain at this point, I would say go for it as long as you can justify it after the fact.

I'd also look around for new jobs.

 

[imgtointern]

It's difficult to estimate without knowing your payor mix, CPT breakdown, and collection percentage but if you are signing out 7000 cases a year you are probably bringing in between 750k to 1 million in revenue. The red flags for me are it not being partnership track and saying the previous partners complained a lot. Have you actually received a bonus yet or is that a carrot they are dangling in front of you?

Is this your first job/first year out of residency/fellowship? Because the first year is rough but your volume to compensation ratio does seem like you might be being taken advantage of.

Yes first job after two fellowships. Payors are a mix, most cases are 88305. I did receive a quarterly bonus and it was decent, although I don’t know the exact percentage because the tax guy got his share out first! I’m sure the seniors are making close to 500k with bonus. I hope they are, because otherwise, it’s sad.

 

[imgtointern]

You're new. Your license and reputation are on the line at this stage in your career. Ordering a stain is usually better than wishing you had when something bad catches up with you down the line.

From what you are saying about this group, it sounds like they are getting a bargain with you and it does not look like your career will be serviced by staying further. They also sound like jerks, frankly.

If you feel the need to order a stain at this point, I would say go for it as long as you can justify it after the fact.

I'd also look around for new jobs.

Thank you for this. That is how is feel. I haven’t ordered ridiculous amounts of stains. And I agree, I’m new and also some tumors do weird stuff. Maybe I am making them sound worse than they are but the way the boss sugar coats it as if they are trying to help me just has the opposite effect. Biding my time! Serenity now! Every dog has his day!

 

[MetroPath]

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.

You’re in a group with a bunch of jerks. That’s why when you interview make sure the people you work with are like family. You got to see each other everyday and you have to work with each other closely. I’d say look for a new job.

To the young grads out there: Learn to read people during interviews. Interviews are usually 30 mins long and you got to get a sense of the personalities in a group. Are these the types of people you can work with everyday? Day in and day out for years?

 

[HeyDalaron]

Thank you for this. That is how is feel. I haven’t ordered ridiculous amounts of stains. And I agree, I’m new and also some tumors do weird stuff. Maybe I am making them sound worse than they are but the way the boss sugar coats it as if they are trying to help me just has the opposite effect. Biding my time! Serenity now! Every dog has his day!

What kind of $ are you doing there?

 

[imgtointern]

What kind of $ are you doing there?

Like I mentioned before, <300k with 10-40% bonus.

 

[caffeinegirl]

To the OP - what you are describing here is not a well-functioning or supportive group of peers. I would start looking elsewhere, and quick. It's tough to sort out the personalities and red flags when it's your first job out of training. It's easy to overlook things and just be happy that you have a job. But, this underscores just how fragile your tenure is, and also that life is short. You do not want to be toiling away and being taken advantage of (financially and mentally), as well as being put down on a regular basis. You should not be made to feel inferior just because you are junior. Unfortunately this occurs more in the medical field than other fields, both due to antiquated cultural norms as well as lack of HR.
I was in a similar situation as you, OP, and I thought I could "tough it out". It was not worth it at all.

 

[octopusprime]

agree with what others are saying. bottom line: you've been there 6 mos; it doesn't sound good thus far and your coworkers seem like tools.
If your family situation does not necessitate you being there, I'd start looking now--the market is in your favor at this point--and see what else is available in the coming year. Based on what you said the money is not a reason to stay and you're not partnership track; doesn't seem like you have cush hours...doesn't seem like a particularly good arrangement.

(btw you're not going to get audited for doing PIN4s on every prostate; jesus most of the GU pod labs out there do that. Also I think audits are generally not triggered by 1 particular person if you're part of a group unless it's extraordinarily bad..we have a mix of IHC-happy people and anti-IHC people, it probably averages out to be a normal amount. If you think you order a larger-than-average assortment of stains, just document it in your micro your justification for doing so)

 

[shikimate]

The job market is hot in both US and Canada, so if you want to change jobs right now it's the time to do it.

 

[imgtointern]

To the OP - what you are describing here is not a well-functioning or supportive group of peers. I would start looking elsewhere, and quick. It's tough to sort out the personalities and red flags when it's your first job out of training. It's easy to overlook things and just be happy that you have a job. But, this underscores just how fragile your tenure is, and also that life is short. You do not want to be toiling away and being taken advantage of (financially and mentally), as well as being put down on a regular basis. You should not be made to feel inferior just because you are junior. Unfortunately this occurs more in the medical field than other fields, both due to antiquated cultural norms as well as lack of HR.
I was in a similar situation as you, OP, and I thought I could "tough it out". It was not worth it at all.

You are right. It’s just attitude of not wanting to complain too much coz pathology world is small, etc etc. I was happy to have a job! So true! But I am very close to being done with the sort of attitude you are describing. It’s everywhere though is what I’m told. Hopefully the next generation does better.

 

[imgtointern]

Thank you for your thoughts. I do feel better.

 

[IMGDocPK]

Thank you for your thoughts. I do feel better.

What's your working schedule? How many hours/week do you work?

 

[imgtointern]

What's your working schedule? How many hours/week do you work?

Are you an img applying to path? I can tell you my hours but I don’t want to discourage you from pathology. My hours are not the norm. With commute time, I’m out of the house 12hrs. No call on the weekends or after hours.

 

[caffeinegirl]

(btw you're not going to get audited for doing PIN4s on every prostate; jesus most of the GU pod labs out there do that. Also I think audits are generally not triggered by 1 particular person if you're part of a group unless it's extraordinarily bad..we have a mix of IHC-happy people and anti-IHC people, it probably averages out to be a normal amount. If you think you order a larger-than-average assortment of stains, just document it in your micro your justification for doing so)

Completely agree with the above statement. You will not be audited for ordering too many stains such as what the OP described. The audits happen mostly in pod labs that order stains on every single case (ie. CD3 for every duodenal biopsy to look for IELs). And it's lab-wide, not provider centric. If you justify in the micro description then it's all good. You will order more stains as a junior than a senior pathologist...but there are those that order stains all the time (the IHC-happy people). The fact that your boss is trying to scare you, rather than trying to give you strategies to boost your confidence says it all.

 

[shikimate]

I thought it's standard to order PIN on all prostate bx? Like other people here order HMWCK in addition to PIN on all of them and I'm trying to save $ by just ordering PIN lol.

 

[coroner]

I thought it's standard to order PIN on all prostate bx?

No, it is not standard if someone is a halfway decent morphologist. Maybe it's standard for POD labs or pp groups trying to milk the cow.

Like other people here order HMWCK in addition to PIN on all of them and I'm trying to save $ by just ordering PIN lol.

PIN-4 cocktail already includes HMWCK. You're not saving money (for the patient) by just ordering a PIN-4. Those other people are double-dipping.

 

[IMGDocPK]

Are you an img applying to path? I can tell you my hours but I don’t want to discourage you from pathology. My hours are not the norm. With commute time, I’m out of the house 12hrs. No call on the weekends or after hours.

Yes, I'm IMG thinking about applying to pathology. The reason being I'm introvert and don't like patient interaction, so I can't see myself doing other speciality.

60 hrs/week seems hectic for the salary they are paying, I wish you find better opportunity in the future. 👍

 

[octopusprime]

No, it is not standard if someone is a halfway decent morphologist. Maybe it's standard for POD labs or pp groups trying to milk the cow.


PIN-4 cocktail already includes HMWCK. You're not saving money (for the patient) by just ordering a PIN-4. Those other people are double-dipping.

Yeah can't (or no point to) order a PIN4 and keratin on same block, and if you order PIN on block A1 you can't order another PIN on A2, etc, if multiple blocks in one part, but you can order a different keratin on A2. If you NEED to order a second basal cell stain, you either eat the cost by multiple orders on 1 part or order a second stain. (though this is more often likely in , say, a breast cancer case than a prostate bx)

 

[shikimate]

I don't know what you guys are using but the PIN here is AMACR+P63, have never used in residency or practice a PIN that includes HMWCK.

 

[path19]

I don't know what you guys are using but the PIN here is AMACR+P63, have never used in residency or practice a PIN that includes HMWCK.

It's a triple stain with both p63 (brown nuclear) and HMWCK (brown cytoplasmic).

PIN4 triple stain | cellnetix

CellNetix Pathology and Laboratories is an anatomic pathology group located in Washington serving communities and hospitals in the Pacific Northwest and Alaska.

cellnetix.com

 

[mike-sheree]

I don't know what you guys are using but the PIN here is AMACR+P63, have never used in residency or practice a PIN that includes HMWCK.

That is surprising. Are you in the US? The triple stain with HMWCK was the “routine” immuno even before I retired 10 yrs ago. I thought the HMWCK was perhaps the most useful of the 3.

 

[ScubaV]

I get IHC on maybe 20-25% of my prostate bx cases. Mostly it's to confirm small foci of 3+3 vs. no cancer or intraductal carcinoma vs. invasive pattern 4/5. But if the patient has Gleason 5 in one area, I'm not going to stress about some low-grade stuff elsewhere.

Edit: Thinking about this some more. The amount of IHC ordering could also vary with histo quality. I've seen places with really crappy H&E staining or poor cuts that might incentivize more CYA IHC.

 

[mike-sheree]

I get IHC on maybe 20-25% of my prostate bx cases. Mostly it's to confirm small foci of 3+3 vs. no cancer or intraductal carcinoma vs. invasive pattern 4/5. But if the patient has Gleason 5 in one area, I'm not going to stress about some low-grade stuff elsewhere.

Edit: Thinking about this some more. The amount of IHC ordering could also vary with histo quality. I've seen places with really crappy H&E staining or poor cuts that might incentivize more CYA IHC.

Excellent point about the H&E, a great “special stain” for nuclear and cytoplasmic detail!