Pathology compensation increases are greater than the cost of living for the past 20 years

[BU Pathology]

This information is for medical students considering pathology as a career. You may wonder if compensation (salary plus bonuses) has increased over the past 20 years, given the substantial negativity on this forum. If there has been an increase, has our pay kept up with inflation?

The short answer is that pathologists’ compensation increases have been much greater than the cost of living.

That conclusion is based on the following data. First the compensation for Assistant Professors in Pathology was collected from the AAMC salary survey for each year going back to 1999, using the 25th percentile as the starting salary. Next, the annual cost of living increases were collected from the social security website: http://www.socialsecurity.gov/news/cola/automatic-cola.htm The 1999 compensation and social security were arbitrarily set to 100 to allow comparison of the changes.

The curve shows that pathology compensation increased twice as fast as the cost of living.

While past performance does not guarantee future results, students considering a career in pathology should be reassured that our compensation has exceeded the cost of living over the past 20 years.

Daniel Remick, M.D.
Chair and Professor of Pathology & Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

---

Members don't see this ad.

 

[y2k_free_radical]

This information is for medical students considering pathology as a career. You may wonder if compensation (salary plus bonuses) has increased over the past 20 years, given the substantial negativity on this forum. If there has been an increase, has our pay kept up with inflation?

The short answer is that pathologists’ compensation increases have been much greater than the cost of living.

That conclusion is based on the following data. First the compensation for Assistant Professors in Pathology was collected from the AAMC salary survey for each year going back to 1999, using the 25th percentile as the starting salary. Next, the annual cost of living increases were collected from the social security website: http://www.socialsecurity.gov/news/cola/automatic-cola.htm The 1999 compensation and social security were arbitrarily set to 100 to allow comparison of the changes.

The curve shows that pathology compensation increased twice as fast as the cost of living.

View attachment 276160View attachment 276160

While past performance does not guarantee future results, students considering a career in pathology should be reassured that our compensation has exceeded the cost of living over the past 20 years.

Daniel Remick, M.D.
Chair and Professor of Pathology & Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

What about the incomes of the majority of pathologists,the peon community pathologists ???????????????? Also please reply on private remuneration trends such as ANTHEM's last severe cuts.

 

[Med Director New England]

In New England Family practice, IM and Gen Surg are in such demand that fresh graduates are being offered 25-50 K sign on bonuses and these are in desirable geographic areas. I have not ever heard of a pathology hire getting any more than a relocation package.

Many paths in private practice are making less now than 10 yrs ago or having to sign out significantly more to maintain salary.

Dr. Remick in your opinion how is the job market for recent path grads? How are your recent trainees doing ?

 

[FourCandles]

This information is for medical students considering pathology as a career. You may wonder if compensation (salary plus bonuses) has increased over the past 20 years, given the substantial negativity on this forum. If there has been an increase, has our pay kept up with inflation?

The short answer is that pathologists’ compensation increases have been much greater than the cost of living.

That conclusion is based on the following data. First the compensation for Assistant Professors in Pathology was collected from the AAMC salary survey for each year going back to 1999, using the 25th percentile as the starting salary. Next, the annual cost of living increases were collected from the social security website: http://www.socialsecurity.gov/news/cola/automatic-cola.htm The 1999 compensation and social security were arbitrarily set to 100 to allow comparison of the changes.

The curve shows that pathology compensation increased twice as fast as the cost of living.

View attachment 276160View attachment 276160

While past performance does not guarantee future results, students considering a career in pathology should be reassured that our compensation has exceeded the cost of living over the past 20 years.

Daniel Remick, M.D.
Chair and Professor of Pathology & Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

Thank you for your optimism. But we, the pathologists in community practice, are the canaries in the coal mine!

 

[Unty]

This information is for medical students considering pathology as a career. You may wonder if compensation (salary plus bonuses) has increased over the past 20 years, given the substantial negativity on this forum. If there has been an increase, has our pay kept up with inflation?

The short answer is that pathologists’ compensation increases have been much greater than the cost of living.

That conclusion is based on the following data. First the compensation for Assistant Professors in Pathology was collected from the AAMC salary survey for each year going back to 1999, using the 25th percentile as the starting salary. Next, the annual cost of living increases were collected from the social security website: http://www.socialsecurity.gov/news/cola/automatic-cola.htm The 1999 compensation and social security were arbitrarily set to 100 to allow comparison of the changes.

The curve shows that pathology compensation increased twice as fast as the cost of living.

View attachment 276160View attachment 276160

While past performance does not guarantee future results, students considering a career in pathology should be reassured that our compensation has exceeded the cost of living over the past 20 years.

Daniel Remick, M.D.
Chair and Professor of Pathology & Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

There is substantial negativity but there is some truth to what is being said. Job market is not a robust one. You may have to move in order to secure a job. I’ve been looking at pathoutlines for the past 5-10 years and have only seen a handful of jobs near my hometown (large metropolitan city). Whether these jobs are not advertised and filled by word of mouth I will never know. I think medical students have to be warned.

You may be able to secure a job near your hometown. I know people who have. I know a guy who couldn’t move for family reasons but luckily secured a job. He was stressed.

You also may have to apply to 20-30 jobs and only get a few interviews. That’s what my buddy experienced.

On a positive note, if you aren’t able to secure a job in an area you desire, you can always move for your second job.

I’ve seen people interview at my residency and fellowship who wouldn’t stand a chance if the field was competitive. I’ve seen random foreign grads with 10+ years of internal medicine clinical and research experience in their own country come to the US only to switch to pathology in the US. You wonder why. Pathology is not a competive field, which allows random applicants to match every year.

Residency programs depend on cheap labor to gross their specimens. Even worse is having residents gross biopsies in weekends. It doesn’t get any worse than that. I’ve seen it in programs. I’ve also seen programs rank all 50 positions so that they can fill in the match and don’t have to go through the hell of the Scramble or whatever it’s called now. They wet their pants when they find out they filled. Hell you ranked 50 people!!!!

I know there are weak training programs out there pumping out poor candidates. These programs see less than 10-15,000 surgicals a year. There are programs out there where they only see one gallbladder in a day. That’s just plain ridiculous. They pump subpar graduates out into the workforce. This is where our leadership has failed us...having training programs exist that shouldn’t exist in the first place.

The oversupply of training spots has hurt the field unfortunately in different ways. One derm trained dermpath fellow once mentioned to me “Pathology is a dying field.”

 

[FourCandles]

Pathology is dead as dead could be!

 

[y2k_free_radical]

There is substantial negativity but there is some truth to what is being said. Job market is not a robust one. You may have to move in order to secure a job. I’ve been looking at pathoutlines for the past 5-10 years and have only seen a handful of jobs near my hometown (large metropolitan city). Whether these jobs are not advertised and filled by word of mouth I will never know. I think medical students have to be warned.

You may be able to secure a job near your hometown. I know people who have. I know a guy who couldn’t move for family reasons but luckily secured a job. He was stressed.

You also may have to apply to 20-30 jobs and only get a few interviews. That’s what my buddy experienced.

On a positive note, if you aren’t able to secure a job in an area you desire, you can always move for your second job.

I’ve seen people interview at my residency and fellowship who wouldn’t stand a chance if the field was competitive. I’ve seen random foreign grads with 10+ years of internal medicine clinical and research experience in their own country come to the US only to switch to pathology in the US. You wonder why. Pathology is not a competive field, which allows random applicants to match every year. Every interview season we get a pack of candidates walk in like a United Nations assembly.

Residency programs depend on cheap labor to gross their specimens. Even worse is having residents gross biopsies in weekends. It doesn’t get any worse than that. I’ve seen it in programs. I’ve also seen programs rank all 50 positions so that they can fill in the match and don’t have to go through the hell of the Scramble or whatever it’s called now. They wet their pants when they find out they filled. Hell you ranked 50 people!!!!

I know there are weak training programs out there pumping out poor candidates. These programs see less than 10-15,000 surgicals a year. There are programs out there where they only see one gallbladder in a day. That’s just plain ridiculous. They pump subpar graduates out into the workforce. This is where our leadership has failed us...having training programs exist that shouldn’t exist in the first place.

The oversupply of training spots has hurt the field unfortunately in different ways. One derm trained dermpath fellow once mentioned to me “Pathology is a dying field.”

Perhaps DR. REMICK will inform us how many AMERICAN BORN AND TRAINED RESIDENTS BU HAS.

 

[octopusprime]

There are lies, damned lies, and statistics.

How about a comparison of overall compensation to reimbursement rates and overall volume...

Perhaps those in the 25th percentile/asst professor role are seeing their income rise above COLA, but not sure how that's a glowing endorsement of the field's financial status overall...my income over a 10 year period would not follow some linear trajectory (in relation to COLA or otherwise) for no apparent reason...whether it were proactive or reactionary, I'd have to expand volume, plain and simple.

I love how DR randomly swoops into SDN from his secure position perched in the eaves of academia and drops some shiny sparkly tidbits of encouragement then vanishes into obscurity. Classic.

 

[deleted314957]

Perhaps DR. REMICK will inform us how many AMERICAN BORN AND TRAINED RESIDENTS BU HAS.

I would be stunned if there were more than 20%. And I would wager that it is less.
Academic pathology really needs their own board on SDN.
When I read Dr. Remick’s post it is clear to me that he does not see the train coming, and not just for path. There used to be a massively larger share of our labors going in our pockets. For a few years, long ago, we made >1M/yr in today’s dollars. And non-partner associates did better than most do in today’s dumpster fire.
With rare exception, this does not happen today.

 

[Spikebd]

I would be stunned if there were more than 20%. And I would wager that it is less.
Academic pathology really needs their own board on SDN.
When I read Dr. Remick’s post it is clear to me that he does not see the train coming, and not just for path. There used to be a massively larger share of our labors going in our pockets. For a few years, long ago, we made >1M/yr in today’s dollars. And non-partner associates did better than most do in today’s dumpster fire.
With rare exception, this does not happen today.

It’s sad because Pathology is so valuable to patient care. I see no reason we shouldn’t all be paid our full professional component on any specimens we sign out. Academic salaries of $150,000, is a very low sum for current medical school graduates who enter residency with >$200,000 of debt. That’s why it’s tough to see programs full of individuals who graduated medical school in nations where their medical education was fully subsidized. To them, $150,000 is wonderful since they have no debt, and their home nations pay like $60,000 if that.

 

[Granular]

Not sure what to say to BU. Salaries of a subgroup are not that good of a job market or quality of life indicator. There are probably fewer assistant professors because more path trained people are hired as instructors, who are paid less, but hopefully a little more than they were paid as fellows.

Professional athletes and rock stars earn a lot; I am not encouraging my kids to pursue either of those careers. Those salaries BU is citing are for people who got jobs practicing pathology. What about the people who gave up? They went into research, returned to their home countries, trained in something else, or are still doing fellowships and hoping things will improve. I value job indicators like number of posted positions, finding physician recruiters who even know what pathology is, signing bonuses, etc. You should be able to do one fellowship and get 5 offers without struggling in the job search. That is a good job market. Getting offers with signing bonuses a year before finishing training is a great job market.

 

[Med Director New England]

That is a good point about instructors. The position of instructor is a relatively recent phenomenon and an instructor in 2019 is the new entry level position for academia whereas in 2000 most entry level academic paths were appointed as assistant professors.

The original post by DR is misleading and irresponsible and he knows it is not true.

The truth:

- Path salaries are going down and the only way to maintain salary is to increase your volume.

- Employed pathologists are at an extreme disadvantage when negotiating salary b/c there are so damn many of us.

- MD owned path practices are an endangered species.

- Many hospitals including large academic groups are completely outsourcing pathology b/c reimbursement pressure is making lab medicine a money loser for all but the most efficient labs.

- The job market is so saturated that per diem path assistants cost more than new hire pathologists (I.e pathologists struggling to find the first job can become a per diem path assistant and make just as much $)

 

[Unty]

That is a good point about instructors. The position of instructor is a relatively recent phenomenon and an instructor in 2019 is the new entry level position for academia whereas in 2000 most entry level academic paths were appointed as assistant professors.

The original post by DR is misleading and irresponsible and he knows it is not true.

The truth:

- Path salaries are going down and the only way to maintain salary is to increase your volume.

- Employed pathologists are at an extreme disadvantage when negotiating salary b/c there as so damn many of us.

- MD owned path practices are an endangered species.

- Many hospitals including large academic groups are completely outsourcing pathology b/c reimbursement pressure is making lab medicine a money loser for all but the most efficient labs.

- The job market is so saturated that per diem path assistants cost more than new hire pathologists (I.e pathologists struggling to find the first job can become a per diem path assistant and make just as much $)

Thanks for telling us the reality of Pathology, not some sugar coated bs. Only those in the private sector know how it really is.

 

[yaah]

Well all I can say is that a lot of pathologists have no idea about how a private practice pathologist gets paid. Not on these forums necessarily, but in general. We have had applicants for positions who want "guaranteed" income amounts. OK, no, sorry. We're a private group that controls our own finances and we don't have a theoretical maximum pay. We're not going to guarantee your income if the rest of us don't have that! We can guarantee it for the first couple of years until you become a partner though! They also have no idea what actually goes into "income" - do you count benefits? Just salary? Retirement stuff? Clueless! Someone at a different job tells them a number which is almost certainly inflated and includes every ancillary benefit they can find, translated into a cash amount (not as though you could take the cash option). "Can you match that"? What are we trying to match, exactly?

My income has fluctuated fairly wildly, based in part on number of partners in the group, how busy we are, hospital contacts, etc. Because of some unusual circumstances, last year's income was 2x what it had been 3-4 years prior. Since I have been hired, my income on a graph would look like the back of a double-humped camel where we are currently at the top of the second hump. First few years it went up due to becoming a full partner, then fell a lot with reimbursement changes and contract changes and the vaguaries of socialized and capitalist medicine, then started coming back up, then shot up recently when all the boomers retired. It works out well because the extra amounts get paid quarterly, so you can base your regular salary and lifestyle on the regular paychecks, and treat the quarterly stuff as windfalls to save or invest, but not count on.

 

[y2k_free_radical]

Well all I can say is that a lot of pathologists have no idea about how a private practice pathologist gets paid. Not on these forums necessarily, but in general. We have had applicants for positions who want "guaranteed" income amounts. OK, no, sorry. We're a private group that controls our own finances and we don't have a theoretical maximum pay. We're not going to guarantee your income if the rest of us don't have that! We can guarantee it for the first couple of years until you become a partner though! They also have no idea what actually goes into "income" - do you count benefits? Just salary? Retirement stuff? Clueless! Someone at a different job tells them a number which is almost certainly inflated and includes every ancillary benefit they can find, translated into a cash amount (not as though you could take the cash option). "Can you match that"? What are we trying to match, exactly?

My income has fluctuated fairly wildly, based in part on number of partners in the group, how busy we are, hospital contacts, etc. Because of some unusual circumstances, last year's income was 2x what it had been 3-4 years prior. Since I have been hired, my income on a graph would look like the back of a double-humped camel where we are currently at the top of the second hump. First few years it went up due to becoming a full partner, then fell a lot with reimbursement changes and contract changes and the vaguaries of socialized and capitalist medicine, then started coming back up, then shot up recently when all the boomers retired. It works out well because the extra amounts get paid quarterly, so you can base your regular salary and lifestyle on the regular paychecks, and treat the quarterly stuff as windfalls to save or invest, but not count on.

Is the second hump not largely secondary to a larger work load with fewer pathologists than before retirement doing the same volume ?"

 

[yaah]

Is the second hump not largely secondary to a larger work load with fewer pathologists than before retirement doing the same volume ?"

Volume also significantly higher. But it is common sense that if you are in a private group, having fewer people will increase individual compensation. If it doesn't, you're not a true private practice.

 

[StatistPriceControlsFail]

1. What percentage of pathology graduates are offered 2 or more partnership-track private practice jobs? I don't know of one. This is common in other medical specialties.

2. The difficulty of obtaining one such offer is a big source of stress for pathology graduates.

3. The threat of a hospital merger and the common practice of laying off all the pathologists is a big source of anxiety for practicing pathologists.

The above 3 claims are relatively unique to pathology and not controversial. I defy you to present data that disputes any of these 3.

This last point is more technical but just as relevant to cost of living comparisons in general.

4. Short version: The CPI is not an accurate measure of price increases and inflation (i.e. an increase in the money supply thanks to the government central bank). The Social Security site's COLA is based on the CPI (the CPI-W in particular).

Long version: The CPI methodology changed in 1980 and again in 1990 so that now the CPI actually excludes real estate, energy, food, and stocks. So, at best, the CPI today is potentially useful for measuring the prices of everything except what you spend most of your money on.

In addition, they use "hedonic adjustments" to falsely claim that an increase in quality offsets an increase in price. For example, the price of something went up 10%. They can arbitrarily claim that the quality of that item went up 15%, so then they claim the price actually went down by 5%.

A more honest way to measure the CPI using the original method:
Alternate Inflation Charts

A more detailed explanation of how the CPI has changed:

 

[LADoc00]

Perhaps DR. REMICK will inform us how many AMERICAN BORN AND TRAINED RESIDENTS BU HAS.

OH SNAP! Getting right to the point of our current predicament.

But folks of SDN do not worry! The glorious propaganda media outlet known as Medscape has deemed it worthy to publish an article about how we in the US make an average of 300k+ as physicians but Mexican physicians make only 22K. No mention of North Korean doctors though, but Im sure they wanted to include those data points.

Because when your goal is to use propaganda to convince an uneducated populace U.S. physicians are at the root of all evil in the Healthcare system, using data points from countries where it's citizens swim dangerous rivers, jump barbwire and subject themselves and their kids to human traffickers just to escape is valid reasoning.

Everyone take a moment to see where you will be ending up with a Warren or Sanders presidency in 2020. Somewhere between Spain and France. Right in there, somewhere below slinging crack in the southside of Chicago. Dont worry though, everyone will get absolutely free healthcare, so its all for the "Greater Good." You know, just like when they really really needed cotton for clothing and "some people did something."

 

[WEBB PINKERTON]

Quote in new CAP today

Shifting trends test labs’ financial mettle - CAP TODAY

September 2019—There’s nothing new about lab and pathology reimbursement cuts that threaten bottom lines. Over the past three or four decades they’ve become essentially part of the wallpaper in health care.

www.captodayonline.com

“Salaries for most of our pathologists—and we’ve worked with 10 percent of all pathologists in the nation in the last 17 years—have been in a long, steady decline as pathology groups continue to consolidate. The second major trend is a big change in the ability to negotiate with payers.” The major impact of the national surprise billing laws now evolving will be that they take away the ability to negotiate, Raich says. “The truth is, the ability to negotiate is how we stay in business. If a surprise billing law comes into play and you have to cut the rate and you can’t balance bill patients, as an unintended consequence you are going to drive down provider rates considerably.”

 

[Alteran]

OH SNAP! Getting right to the point of our current predicament.

But folks of SDN do not worry! The glorious propaganda media outlet known as Medscape has deemed it worthy to publish an article about how we in the US make an average of 300k+ as physicians but Mexican physicians make only 22K. No mention of North Korean doctors though, but Im sure they wanted to include those data points.

Because when your goal is to use propaganda to convince an uneducated populace U.S. physicians are at the root of all evil in the Healthcare system, using data points from countries where it's citizens swim dangerous rivers, jump barbwire and subject themselves and their kids to human traffickers just to escape is valid reasoning.

View attachment 280530

Everyone take a moment to see where you will be ending up with a Warren or Sanders presidency in 2020. Somewhere between Spain and France. Right in there, somewhere below slinging crack in the southside of Chicago. Dont worry though, everyone will get absolutely free healthcare, so its all for the "Greater Good." You know, just like when they really really needed cotton for clothing and "some people did something."

I grew up in a border town next to Mexico. We call the doctors across the border “los carniseros de Mexico” - The butchers of Mexico. It’s not hard to see why everyone who comes to the US from over the border is diagnosed with SLE. For a salary of $22K/year in medicine, I can’t imagine anyone doing anything other than just calling it SLE (or some other nebulous vague systemic disorder), telling them they’re SOL, and to GTFO.

 

[yaah]

Everyone take a moment to see where you will be ending up with a Warren or Sanders presidency in 2020. Somewhere between Spain and France. Right in there, somewhere below slinging crack in the southside of Chicago. Dont worry though, everyone will get absolutely free healthcare, so its all for the "Greater Good." You know, just like when they really really needed cotton for clothing and "some people did something."

You know to be honest if it meant everyone who works in healthcare, including all the administrators and presidents and influences and whatever also got their pay cut by that amount, I might actually welcome it. That's where the graft really is and where it is likely to continue to fester. That and "medical devices".

 

[yaah]

1. What percentage of pathology graduates are offered 2 or more partnership-track private practice jobs? I don't know of one. This is common in other medical specialties.

Essentially everyone in my group had multiple offers, and most of the candidates we interview have had multiple offers, many with 3 or more. Many of us have also been contacted about potential new positions should we ever want to leave. I do not know where you all exist in the world, but this disconnect has been one of the most massively confusing things from my visits to these forums.

 

[LADoc00]

You know to be honest if it meant everyone who works in healthcare, including all the administrators and presidents and influences and whatever also got their pay cut by that amount, I might actually welcome it. That's where the graft really is and where it is likely to continue to fester. That and "medical devices".

Yaah for even the briefest millisecond of axons firing in your cerebral cortex, do you actually believe THAT would happen?

I would work for free if I could just live like Dan Blizerian. No bending my arm or anything.

Yaah we both know the power brokers in healthcare will just point to us and say "That cotton isnt going to pick itself boy!"

 

[MetroPath]

Essentially everyone in my group had multiple offers, and most of the candidates we interview have had multiple offers, many with 3 or more. Many of us have also been contacted about potential new positions should we ever want to leave. I do not know where you all exist in the world, but this disconnect has been one of the most massively confusing things from my visits to these forums.

Might be because you went to a well respected training program. I wonder about those graduates who went to lesser known programs. Do the people you mention who contacted you post their jobs on pathoutlines. Might also support the fact that some jobs (maybe the best jobs) are via word of mouth?

I have a feeling those who go to good strong training programs and who are US grads get the offers you allude to. I may be wrong but I have friends who weren’t as fortunate as you who had three fellowships (Surgpath, GI and cyto) and only ONE offer after applying to 20-30 jobs. He had only THREE interviews with no geographic restrictions. Most of the jobs he applied to never replied or emailed him back.

That’s why I would recommend everyone to go to the best brand name, well respected program they can get in. If you can’t get into a great residency you better go to a well known well respected surgpath fellowship as it’s not hard to get into. It’s somewhat more competitive to get a job in a limited job market if you come from a lesser known program is my feeling.

It’s a buyers market. Employers can pick and choose. They will look at the person with the best pedigree in their stack of CVs.

 

[Med Director New England]

Quote in new CAP today

Shifting trends test labs’ financial mettle - CAP TODAY

September 2019—There’s nothing new about lab and pathology reimbursement cuts that threaten bottom lines. Over the past three or four decades they’ve become essentially part of the wallpaper in health care.

www.captodayonline.com

“Salaries for most of our pathologists—and we’ve worked with 10 percent of all pathologists in the nation in the last 17 years—have been in a long, steady decline as pathology groups continue to consolidate. The second major trend is a big change in the ability to negotiate with payers.” The major impact of the national surprise billing laws now evolving will be that they take away the ability to negotiate, Raich says. “The truth is, the ability to negotiate is how we stay in business. If a surprise billing law comes into play and you have to cut the rate and you can’t balance bill patients, as an unintended consequence you are going to drive down provider rates considerably.”

Webb- you should post this article as a new thread.
This is my experience about reimbursements and trend in paths salaries. The original post is so far off the truth.

 

[yaah]

Yaah for even the briefest millisecond of axons firing in your cerebral cortex, do you actually believe THAT would happen?

I would work for free if I could just live like Dan Blizerian. No bending my arm or anything.

Yaah we both know the power brokers in healthcare will just point to us and say "That cotton isnt going to pick itself boy!"

That cotton isn't going to pick itself, but by the way you need to cut your med tech FTE budget by 5.

 

[yaah]

Might be because you went to a well respected training program. I wonder about those graduates who went to lesser known programs. Do the people you mention who contacted you post their jobs on pathoutlines. Might also support the fact that some jobs (maybe the best jobs) are via word of mouth?

I have a feeling those who go to good strong training programs and who are US grads get the offers you allude to. I may be wrong but I have friends who weren’t as fortunate as you who had three fellowships (Surgpath, GI and cyto) and only ONE offer after applying to 20-30 jobs. He had only THREE interviews with no geographic restrictions. Most of the jobs he applied to never replied or emailed him back.

That’s why I would recommend everyone to go to the best brand name, well respected program they can get in. If you can’t get into a great residency you better go to a well known well respected surgpath fellowship as it’s not hard to get into. It’s somewhat more competitive to get a job in a limited job market if you come from a lesser known program is my feeling.

It’s a buyers market. Employers can pick and choose. They will look at the person with the best pedigree in their stack of CVs.

See, I don't really think it's a buyer's market, unless the buyer doesn't care about who they get as long as it's a body.

I have always said here, consistently for 15 years, that there are too many path programs that should not have residency programs (or at the very least should have fewer residents). Not enough volume, not enough expertise. Even good programs may have too many residents and spread things too thin with all the subspecialization of resident signout. Subspecialization is great for attendings and fellows, but can be a determinent to resident education if not handled well.

 

[HeyDalaron]

See, I don't really think it's a buyer's market, unless the buyer doesn't care about who they get as long as it's a body.

I have always said here, consistently for 15 years, that there are too many path programs that should not have residency programs (or at the very least should have fewer residents). Not enough volume, not enough expertise. Even good programs may have too many residents and spread things too thin with all the subspecialization of resident signout. Subspecialization is great for attendings and fellows, but can be a determinent to resident education if not handled well.

The above bolded is precisely the problem I have noticed.

 

[yaah]

Yeah, that's always been a problem. To varying degrees over the years. Not sure if it's worse now than in the past.

 

[gbwillner]

I'm glad I avoided this thread for as long as I have. It's funny but I think I disagree with basically everything anyone has said to some degree. Don't let it be said there are only 2 sides to this discussion!

Re: Dr. Remick's post: First, it's nice to see actual data, and it's sad to see so many fire off tired and unsubstantiated criticisms of that data. I would argue that everyone has a valid point, and these are not mutually exclusive of each other. From what I've seen, I have no reason to doubt the data in the first post. I think Assistant Professor salaries HAVE been going up over the last 20 years, in some cases pretty dramatically. I also disagree with some statements from Granular that state that the new bottom tier academic job is Instructor. This position is not really new, and is fairly limited to the top academic departments. Most academic jobs still start with Asst. Prof; and I do think these are going up.

However, IMHO it is a double-edged sword that these academic salaries are going up. One should ask WHY they are going up and what that means. From my experience, they are going up because they have to to attract good applicants, but departments can afford it because these new employees are not necessarily having the same job that academic pathologists used to have in general- molded around research and teaching- and they are being used more as warm bodies to sign out clinical cases as "clinical track" employees. These jobs are more akin to private practice jobs than academic ones, with academic pay. This has both strengths and weaknesses. On one hand, you don't directly have to care or worry about coverage/reimbursement/contracts and can focus on the cases and your schedule. On the other, you are in a way taking in a smaller fraction of the revenue you generate, and are having to work more and more hours, just like everyone else. In the end, market forces are still present in academia, even if they are hidden under layers of other departments and policies.

Secondly, the underling false impression that can be derived from the chart is that if salaries are going up at a steady rate, your salary as an assistant professor will continue to increase at that same rate. In general, this is NOT how academic salaries are structured. You are hired at a certain rate (and according to this chart that figure goes up every year), but then you are stuck at that rate any may receive a Cost of Living adjustment (if you are lucky). you don't really get any real increase in salary until you are promoted, and this doesn't happen until years 5-7, if at all.

My overall view of what is happening here is that, as some in PP are complaining, CONSOLIDATION is a major factor in pathologist pay, and academia is no exception. In fact, academia is participating in this model, and large academic powerhouses are buying out smaller groups or just taking over their regional contracts. They then need more warm bodies to do the work. These become "clinical track" pathologists for the most part, and fulfill much of the same tasks and roles as other employee pathologists. As a result, these jobs pay more than a typical academic job, since it is a full-time revenue generating role, not a research and teaching-heavy role. Expect this trend to continue.

 

[MetroPath]

See, I don't really think it's a buyer's market, unless the buyer doesn't care about who they get as long as it's a body.

I have always said here, consistently for 15 years, that there are too many path programs that should not have residency programs (or at the very least should have fewer residents). Not enough volume, not enough expertise. Even good programs may have too many residents and spread things too thin with all the subspecialization of resident signout. Subspecialization is great for attendings and fellows, but can be a determinent to resident education if not handled well.

Yes I agree that there are programs that should not have residency programs. Such as Howard University with a surgical volume of less than 10,000. A program in Ohio whose only specimen on some days is a gallbladder.

There are candidates who come from such programs which I would recommend go to a high volume surgical pathology fellowship training program to compensate for the lack of surgical Path exposure in residency.

You can make up for the lack of volume in your residency by doing fellowships. It does not make you a “marginal candidate” to do two boarded fellowships so you can get specialty expertise and certification.

Do I think you need to do a Cytopathology fellowship to be comfortable at it. No I don’t think so. I think you can get comfortable at Cytopathology by working hard and looking at all the cases you possibly can over your 2-3 months of cyto in residency or even spend more time outside of your rotations.

What I’ve noticed is that some residents do the minimum. Just look at Paps and neglect everything else. Just sit passively at signout without previewing the cases beforehand when cases are sitting there for you to look at them.

What I meant by buyers market is that I get a feeling employers get a bunch of CVs from applicants looking for a job. Employers will have no issue finding candidates to fill a position. Whether those candidates are good or not, who knows. The thing is with two additional fellowships under your belt I think most are competent to do the job.

I don’t have any data on this of course. Why do I say so? There are jobs. Everyone I know who is board certified has jobs but you may have to move to get a job. You may have to apply to many jobs before you get a single offer.

You mentioned you got a few offers? Congratulations. I know some who only got one like I mentioned. He did the two fellowships (surgpath, cyto). I know a bunch of people who did two fellowships. They all have jobs. Are they marginal candidates just because they did two fellowships? I don’t think so.

Most everyone I know does two fellowships. I don’t see anything wrong with someone who wants to do an additional year to get more experience. Some jobs require or at least look for it.

I have been applying to jobs haven’t gotten any replies. There are no jobs I’ve seen online near my hometown city in the Midwest. As a matter of fact, there have not been many (only a handful) jobs posted within the past 5-10 years near my hometown.

You went to a good well respected training program. I think with that you have leverage in this job market and employers most likely look at trainees from strong training institutions for jobs/offers. If you are an employer in a particular state,would you rather offer the job to someone from a well recognized program or a lesser known program? If I was the employer I would offer the job to the former applicant considering there are no personality issues.

I would recommend everyone to go into the best training program they can possibly get in. A big name programfors not always mean a good training program however. If they can’t get into a good training program you can definitely get into a strong fellowship program for surgical pathology. You need all the leverage you can get in this market.

 

[y2k_free_radical]

You know to be honest if it meant everyone who works in healthcare, including all the administrators and presidents and influences and whatever also got their pay cut by that amount, I might actually welcome it. That's where the graft really is and where it is likely to continue to fester. That and "medical devices".

Don't forget pharmaceutical companies

 

[deleted941485]

What the hell kind of nonsense post is this. A subgroup has exceeded cola which is currently a joke of a metric given how it’s changed over the years. And why look at 20 year data?

 

[Euchromatin]

You can make up for the lack of volume in your residency by doing fellowships. It does not make you a “marginal candidate” to do two boarded fellowships so you can get specialty expertise and certification.

The thing is with two additional fellowships under your belt I think most are competent to do the job.

You went to a good well respected training program. I think with that you have leverage in this job market and employers most likely look at trainees from strong training institutions for jobs/offers. If you are an employer in a particular state,would you rather offer the job to someone from a well recognized program or a lesser known program? If I was the employer I would offer the job to the former applicant considering there are no personality issues.

I would recommend everyone to go into the best training program they can possibly get in. A big name programfors not always mean a good training program however. If they can’t get into a good training program you can definitely get into a strong fellowship program for surgical pathology. You need all the leverage you can get in this market.

For med students applying to path residencies, I would not recommend ranking purely based on prestige.

My private practice group has been trying to hire for the past few years and we encounter similar issues that yaah has brought up - many candidates seem incompetent/unprepared for practice, only want to sign out their particular specialty area and/or have a personality issue. The better candidates often have several offers and seem to make their selection based more on geographic preference than anything else. Since there are not usually an abundance of candidates with 1) the specific specialty training/expertise we are asking for as well as 2) willingness to do more than that one area (e.g. general surgical pathology, CP/lab management, etc.), we don't really need to screen candidates based on where they did their residency/fellowship training. We have found that candidates from "big name" programs do not necessarily perform any better on our slide test or overall interview and often actually do worse. I also think another argument that I have heard some people make that attendings from big name academic centers have more "connections" to help their residents/fellows get jobs is kind of misleading, as most of their "connections" are with others in academia, not private practice, so that is really only helpful if you are looking for an academic job.

Yes, there are some smaller programs that should probably close, but the subspecialty model that many of the biggest academic centers use may also not be ideal - especially if a lot of the work and more interesting cases are taken by fellows and/or if certain specialty areas aren't taught well. I think one could still get excellent training from many mid-tier/mid-size residency programs that have a large volume and variety of cases, give the residents a lot of responsibility for previewing slides, ordering stains and generating reports (not just scutting them out to gross small biopsies and ditzels all day), are well organized, and/or are still doing general surg path sign out instead of subspecialty model. I, personally, would prioritize ranking a residency program that you think will be a good fit for your learning style and will provide good enough training that a general "surg path" fellowship would not be necessary afterward (bonus if you also feel prepared to do basic cyto and/or CP coverage without a fellowship) over one that has a bigger name.

In terms of number of fellowships, 2 is fine in some situations. If they are at least sort of related (e.g. hemepath and molecular) or, as MetroPath describes, someone felt their residency training was inadequate, so they did surg path followed by some subspecialty area, that generally seems reasonable. However, when candidates have 2 fellowships in completely unrelated areas, it starts to raise questions/red flags - did they only do the second fellowship because they couldn't get a job? did they only do the first one in order to get into the second one? And 3 fellowships is even more like to be questionable in my opinion.

 

[LADoc00]

The "I will only sign out subspeciality X" is my biggest problem. I have no clue who is teaching these kids to do or say this but they need to FULLY DRIVEN OUT of academia. This is actually not just limited to Pathology, it is happening to all fields and is having an incredible effect on recruitment.

 

[yaah]

There are a lot of academics out there who think the only people qualified to sign out most cases within their subspecialty are those who have completed subspecialty training, hopefully at a good institution. I've talked to some who say that.

Q: "Do you think candidate X is a good candidate for a general path job which is focused on his/her subspecialty training?"
A: I wouldn't want someone signing out things outside of their subspecialty training without at least a surgical path fellowship.

To me, that's crazy! It's good for groups to have at least one person with subspecialty training in high volume areas or areas where there is significant outreach. But it isn't required in order to sign most stuff out.

 

[LADoc00]

I locums doctor just told me a crazy story of some new Oncologist who was hired in a rural area somewhere who was so "micro-specialized" that in the entire field of Hematology-Oncology she would only see breast cancers cases!...that's it. But apparently that didnt come out until she actually got to said rural location and I assume relocation expenses paid etc. Then the first few patients were run of the mill stuff: bleeding disorder, a recurrent sarcoma, prostate case and she was like nope..cant do that and everyone there was dumbfounded...I cant believe what is happening, it is practically surreal.

 

[chooks]

If you think the push for sub-specialty only is a pathology only thing, or a millennial effect, you are not paying attention. It is hitting oncology and surgery as well. If you have a surgeon who all they do is breast surgery, and an oncologist who only sees breast patients, it doesn't take a great deductive leap to see that they will want a pathologist that only looks at breasts as well.

In other words, it's turtles all the way down.

 

[yaah]

Yeah, well, if you can do multiple things it makes you more valuable. We aren't hiring anyone who does one thing (dermpath is kind of an exception). In my experience most clinicians don't care if you do more than one thing, they just want someone with enough experience or expertise in their area. But they don't care if you do other things too, and they usually don't care if you're fellowship trained if you're still good at it (Note: I'm sure there are some who care - there always are - but these are not always good doctors).

 

[LADoc00]

If you think the push for sub-specialty only is a pathology only thing, or a millennial effect, you are not paying attention. It is hitting oncology and surgery as well. If you have a surgeon who all they do is breast surgery, and an oncologist who only sees breast patients, it doesn't take a great deductive leap to see that they will want a pathologist that only looks at breasts as well.

In other words, it's turtles all the way down.

Well then the end is nigh.

Good luck, I am REALLY REALLY glad Im not a med student looking towards this with a massive debt death ball on my back.

 

[Spikebd]

Well then the end is nigh.

Good luck, I am REALLY REALLY glad Im not a med student looking towards this with a massive debt death ball on my back.

 

[path24]

BU path should add his salary progression to the chart.