Pathology: Is it worth it?

[gbwillner]

I know two unemployed pathologists who are now stay at home moms due to lack of available jobs in their regions. I know two others who are working at cosmetic skin clinincs (they do not have dermatology residency training).


Here is an example of a pathologist doing cosmetic dermatology work
http://www.learncosmetics.com/learncosmetics/bio.html

Here is an example of a pathologist now working as a Vein Doctor. http://www.stlveindoctor.com/

Here is a pathologist working as an ER doc
http://www.ochsner.org/page.cfm?id=1564&action=detail&ref=479

This is older material but it is interesting and not totally irrelevant to the current situation
http://members.tripod.com/runker_room/ap/ap_jobs.htm

I'm perhaps too naive to get into this conversation, but I'm a 4th year about to match into Path. IMHO, I gather from a majority of the posts here that the Path job situation is not optimal. However, Just like in escaping a runaway tiger, I don't have to outrun it- just the slowest applicant. It looks like people are still getting very good, high-paying jobs out there. I even heard of someone going straight CP and then landing a 300K+ job right out of residency.

Outside of these posts, you would tink a career in Path was a safe bet at a great lifestyle and career. Every one of my friends who are now finishing residency in either Medicine or other primary care field think it is an excellent choice, and many wish that they had done path rather than their current field where, although jobs may be readily available, they have go through a hellish residency for a prospect of earning between 90-150K/year.

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[path19]

...To me, the bigger concern than too many residency programs is too many mega lab and pod labs proliferating. Those are the factors that are hurting the field far more.

So, do you not think these 2 things are directly related? IMO, if there wasn't such a surplus of new (and some not so new) pathologists flooding the job market, these crap jobs would not even exist b/c they would have no chance of finding a pathologist willing to do them. These kinds of situations exist solely because there are too many pathologists for the number of cases, and this therefore creates a natural pressure to compete for the cases among pathologists. This point also highlights the fact that everyone, whether from a top program or not, is going to be affected by this surplus. Sure, everyone from a top program may find a job, and a job they currently like, but this pressure still exists. It is very possible that 5 or 10 years down the road (if not sooner) some pod lab (staffed by graduates of "lower tier" programs who could find no other jobs) will steal their business since these lower tier pathologists are willing to do the work for 1/2 the salary given to those from a top program.

And as an aside, I also thought it was interesting that in his USCAP address Fletcher stated that those in academics will not be completely protected from these things as I once kind of assumed.

 

[Psychopathology]

Are people really working full-time making < 100 K after completing their training in pathology or medicine? I keep hearing that here but something just doesn't seem right. Do these people come from money? Have a second income?

Every specialist has an opinion about what life entails as some other kind of specialist. Whether or not those opinions are accurate can be debated ad nauseum. A lot of people would like to think that they would have had it easier in a career other than the one they have chosen, but without actually changing careers, they will never know for certain.

Path is demanding in its own ways. A lot of people who are not going into path or trained in path talk about path residencies as having bankers hours and free weekends. I have heard of some programs like this, but they might not be the best places to train if you are serious about lining up a desirable job in a desirable location. Candidates pursuing combined training in AP/CP may encounter a 9 to 5 schedule from time to time, but that is the exception to the rule. Do a few surgical rotations back to back at a high volume hospital and you'll find yourself dead-tired at the end of long shifts, trying to stay focused enough to read up on your cases. I don't think that third year clinical clerkships give you much insight into what you'll spend the bulk of your time doing as a pathology resident. There's a lot to learn that you may not have had any exposure to in medical school. Someone who is not a pathologist who has never had this sort of exposure is probably not very qualified to give you his or her two cents on how the lifestyles compare.

 

[gbwillner]

Are people really working full-time making < 100 K after completing their training in pathology or medicine? I keep hearing that here but something just doesn't seem right. Do these people come from money? Have a second income?

Every specialist has an opinion about what life entails as some other kind of specialist. Whether or not those opinions are accurate can be debated ad nauseum. A lot of people would like to think that they would have had it easier in a career other than the one they have chosen, but without actually changing careers, they will never know for certain.

Path is demanding in its own ways. A lot of people who are not going into path or trained in path talk about path residencies as having bankers hours and free weekends. I have heard of some programs like this, but they might not be the best places to train if you are serious about lining up a desirable job in a desirable location. Candidates pursuing combined training in AP/CP may encounter a 9 to 5 schedule from time to time, but that is the exception to the rule. Do a few surgical rotations back to back at a high volume hospital and you'll find yourself dead-tired at the end of long shifts, trying to stay focused enough to read up on your cases. I don't think that third year clinical clerkships give you much insight into what you'll spend the bulk of your time doing as a pathology resident. There's a lot to learn that you may not have had any exposure to in medical school. Someone who is not a pathologist who has never had this sort of exposure is probably not very qualified to give you his or her two cents on how the lifestyles compare.

Perhaps my point was not clear- I agree with your sentiments, but used the example of people in other fields wishing they had gone into path as a parallel to comments in this thread that you should go into another field of medicine because the opportunities are bleak.

I'm sure as many Medicine residents feel like our lifestyle in residency is cushy (and maybe relatively it is- let's face it, no matter how hard you work, you probably don't have to sleep in the hospital every 4 days), path residents/attendings seem to think that other specialties are better to our own with seemingly equal poor insight.

Regarding bad incomes in promary care... I doubt many starting positions in Peds are more that 90K/year. I'm not an expert but I know several residents in the field who are in PP and start at that low level.

 

[Psychopathology]

path residents/attendings seem to think that other specialties are better to our own with seemingly equal poor insight.

Regarding bad incomes in promary care... I doubt many starting positions in Peds are more that 90K/year. I'm not an expert but I know several residents in the field who are in PP and start at that low level.

The average path resident has decent insight into what a good portion of the med, surg, or peds residency entails after having spent a chunk of his or her medical school training rounding and taking call with those people. Difficult to say the opposite is true unless those clinical residents have rotated through pathology services. Same could be said about radiology, physiatry, and other fields that are not associated with a core rotation. Rumors abound

I agree with you about the call schedule in path being particularly sweet and I know some people who were happy to switch into pathology from other fields. My instinct is that residents work hard in every field and the trick is to find a good personal match. People who enter pathology because they want it easy will be unsuccessful and unhappy. People who decide against pathology because of an unpredicatable job market will never know what they're missing.

 

[gbwillner]

My instinct is that residents work hard in every field and the trick is to find a good personal match. People who enter pathology because they want it easy will be unsuccessful and unhappy. People who decide against pathology because of an unpredicatable job market will never know what they're missing.

In my limited Path experience, I ran across more than a few residents who were miserable because they expected an easy road at a top-notch place. Personally, I'm looking forward to working apprx 14 hr days if I match at my top place or 12 hrs/ day if I don't. There are certainly easier residencies out there. I'm bracing for some serious pain the next few years...

 

[Gyric]

I would advise MS3’s who are scared of risk and want a guaranteed “median” salary/lifestyle to choose something involving Botox. If on the other hand you are comfortable with your head out of your ***, then you will do fine in path. The anatomic pathology market rose to $12.4 billion last year ($11.3 in 2006) and Wall Street now knows that diagnostics beats pharma and are pouring in tons of venture capital. This will change our profession dramatically and those who adapt will have great economic opportunities.

 

[yaah]

So, do you not think these 2 things are directly related? IMO, if there wasn't such a surplus of new (and some not so new) pathologists flooding the job market, these crap jobs would not even exist b/c they would have no chance of finding a pathologist willing to do them.

Yes, that was my implication.

As far as it encroaching on academics, that has happened in some areas. Some smaller academic programs lose a lot of (outpatient) biopsy business to large labs - derm cases are farmed out, prostate cores, GI biopsies.

I often wonder if it ends up costing the patient more in the long run - patients get billed when a case gets sent out in consult, or reviewed as a "transfer" case. Lots of person-hours are spent coordinating outside results into tumor boards, etc. But since it doesn't end up costing clinicians more, it doesn't matter to them.

 

[LADoc00]

I hate to sound like a broken record but the path job market IS NOT good.

QFE.

Anyone who disagrees with this is smoking CRACK. I cant even believe there intelligent people here arguing about this. This is no longer an issue of what went wrong, it is an issue of how many academic pathologists who created this mess need to be strung up.

The whole speciality is in tatters and the situation isnt improving. If the now retiring generation of pathologists have a legacy they have left it is this cluster fck we have inherited, one of unbridled greed and contempt of basic economics.

Yeah dermies can be squishy and often perceived of as lazy but at least they dont eat the young like pathology has done for now going on 10+ years.

CLOSE 50% of ALL TRAINING SLOT NOW, not tommorrow, not after a committee looks into it, NOW. You want to do something for the field, do that. Everyone at the ABP needs to be FIRED, the entire board of trustees has managed this field on par with Enron and Worldcom. Im sure the Bear Stearns CEO and CFO are next of the list of hires in Tampa to only add to our worries...

 

[LADoc00]

Are people really working full-time making < 100 K after completing their training in pathology or medicine? I keep hearing that here but something just doesn't seem right. Do these people come from money? Have a second income?

Every specialist has an opinion about what life entails as some other kind of specialist. Whether or not those opinions are accurate can be debated ad nauseum. A lot of people would like to think that they would have had it easier in a career other than the one they have chosen, but without actually changing careers, they will never know for certain.

Path is demanding in its own ways. A lot of people who are not going into path or trained in path talk about path residencies as having bankers hours and free weekends. I have heard of some programs like this, but they might not be the best places to train if you are serious about lining up a desirable job in a desirable location. Candidates pursuing combined training in AP/CP may encounter a 9 to 5 schedule from time to time, but that is the exception to the rule. Do a few surgical rotations back to back at a high volume hospital and you'll find yourself dead-tired at the end of long shifts, trying to stay focused enough to read up on your cases. I don't think that third year clinical clerkships give you much insight into what you'll spend the bulk of your time doing as a pathology resident. There's a lot to learn that you may not have had any exposure to in medical school. Someone who is not a pathologist who has never had this sort of exposure is probably not very qualified to give you his or her two cents on how the lifestyles compare.

I know several pathologists who make 80-90 and only after several years have attained ~150K, which is what my 70 year old flipping realtor makes and 1/3 of what attorney makes..buwhahahahahahaa

you could not buy a home on that money where I am, even now.

 

[Nilf]

QFE.

Anyone who disagrees with this is smoking CRACK. I cant even believe there intelligent people here arguing about this. This is no longer an issue of what went wrong, it is an issue of how many academic pathologists who created this mess need to be strung up.

The whole speciality is in tatters and the situation isnt improving. If the now retiring generation of pathologists have a legacy they have left it is this cluster fck we have inherited, one of unbridled greed and contempt of basic economics.

Yeah dermies can be squishy and often perceived of as lazy but at least they dont eat the young like pathology has done for now going on 10+ years.

CLOSE 50% of ALL TRAINING SLOT NOW, not tommorrow, not after a committee looks into it, NOW. You want to do something for the field, do that. Everyone at the ABP needs to be FIRED, the entire board of trustees has managed this field on par with Enron and Worldcom. Im sure the Bear Stearns CEO and CFO are next of the list of hires in Tampa to only add to our worries...

Roma locuta, causa finita.

Let's not argue WHETHER the market is bad. Let's talk what we can do to remedy it.

Email the USCAP, CAP, ASCP today. I'm doing it as soon as I finish my signout.

 

[MasterThespian]

Actually, on the interview trail, 3 or 4 of the 9 programs I interviewed at said they had already received approval to INCREASE the number of trainee slots either because their volume was going up or they were expanding their OR capacity, building a new hospital, etc. Yes, INCREASE! At one of the programs, the chair said that some people in administration thought they should hire more PAs to deal with the increasing volume, but that the pathology attendings had felt very strongly that more residents slots was the answer, so lucky for us, there would be 2 more PGY1 slots available this year! Everybody at these programs presented it as a good thing for us that they were expanding the number of spots available! Of course, as an interviewee, I couldn't very well laugh in their faces.

 

[yaah]

Problem is, it probably is good for the better programs to increase their residents. But it shouldn't be done without at least removing spots from poorer performing residencies.

Maybe they should just make the boards harder to pass

 

[cytoborg]

Would you or would you not advise students who most like pathology to pursue it?

Yes. Do what you love! (Path or otherwise.) Life is too long to be stuck doing something "you could just live with." If you're a competetive applicant, make sure to choose a strong academic program that has connections in the area that you're hoping to eventually practice, and you'll set yourself up to be competetive in the job hunt.

 

[cytoborg]

In my limited Path experience, I ran across more than a few residents who were miserable because they expected an easy road at a top-notch place. Personally, I'm looking forward to working apprx 14 hr days if I match at my top place or 12 hrs/ day if I don't. There are certainly easier residencies out there. I'm bracing for some serious pain the next few years...

Yep you've got the right attitude. If you want to train at a large center where you are going to see a lot and do a lot, you've got to expect it to be tough, or it will be an unpleasant surprise. It's hard to warn people though...they really don't seem to believe it until they are living it.

 

[LADoc00]

Problem is, it probably is good for the better programs to increase their residents. But it shouldn't be done without at least removing spots from poorer performing residencies.

Maybe they should just make the boards harder to pass

Umm Yeah about that...No..Gonna have to disagree. Making the board passing the choke point is a flipping disaster for everyone.

Making any aspect of residency the choke point is dangerously foolhardy as we have witnessed in the Seattle Assassination.

That type of crap has no place in medical training IMO. We need to end the pyramid training schemes where 50% of the people wash out, we simply dont have the $$$ to do that anymore.

This needs to be done pre-residents, all programs most importantly big ones in large urban areas need to seriously clamp down on spots they offer.

FFS What are the job opportunities in the state of Michigan? I thought houses in Detroit were going for 2 dollars now, how are people going to pay bills on 5x88305s??

Overtraining has a huge negative impact on pretty much all aspects of pathology aside from large corporations/academic centers that rely on the cheap manpower to churn big profit.

 

[trent05]

I think we will continue to see a steady increase in the number of pathology positions offered.

 

[polly]

YES!
it is worth it. to spend my days looking at the pink and purple wonderland that is histology is bliss.
in my opinion, you have to do what you love. i am lucky that what i love tends to pay well, if you network and find a job.
i tried to use the username pollyanna, but it was not available.

 

[Path or bust]

They would rather hire cheap labor with "inferior" training, because they can pay them less, work them harder, and thus make more $ off them.

Yes, but only until they get sued.

 

[nvshelat]

Hi guys,

1st time poster in this forum. Figured my question would be somewhat appropriate here - Are most pathology gigs like anesthesiology or radiology gigs, where if you do more, you make more? Staying longer = paying off my loans quicker?

 

[mcfaddens]

Hi guys,

1st time poster in this forum. Figured my question would be somewhat appropriate here - Are most pathology gigs like anesthesiology or radiology gigs, where if you do more, you make more? Staying longer = paying off my loans quicker?

No and No, You do the work you get (if you get paid or not for it) extra hrs dosent mean anything here. sorry

 

[exPCM]

error

 

[yaah]

No and No, You do the work you get (if you get paid or not for it) extra hrs dosent mean anything here. sorry

Not necessarily. Lots of private labs (megalabs) pay you by output. I don't really know the specifics or whether you have the option to do less, or whatever, but you are compensated more for being more productive in terms of signing out more cases. Whether it takes you more time to do is irrelevant.

 

[nvshelat]

Not necessarily. Lots of private labs (megalabs) pay you by output. I don't really know the specifics or whether you have the option to do less, or whatever, but you are compensated more for being more productive in terms of signing out more cases. Whether it takes you more time to do is irrelevant.

Sounds a lot more reasonable.

 

[Ale]

This is my take on all of this. There are too many of us for too few jobs. Residencies are not training us adequately and subspecialties are overrated. Doing a surg path fellowship is a waste of time (unless you are one of the lucky ones that gets to go to the fancy places in NY or Houston).

Was it worth it? Definitively. Do I regret not making 100K since I was 25 like all my friends? No. I live well with my intern/fellow salary. Am I concerned to find a job? No. The jobs in path are by word of mouth. If you suck everyone knows. If you are good same thing. Concerned that you are in a small program and think it’s not fair, move around talk to people. You think your program sucks because they don’t “teach” or don’t have 10 pancreatectomies a day, open the freaking book and read it. You will be amazed how many things are in it. Pay for the CTTR it’s worth it, look at the CAP PIP and teaching sets, don’t have one start one.

 

[Ale]

Fair enough, but why had only 50% formally applied for a job? That's bizarre and calls into question the whole survey! Are they actually measuring and reporting what they intend to? Who are these 50% who haven't applied for a job yet want one?

I am sure what happened there was that you clicked the wrong button and it kicked you out of the survey (like it did to all the seniors in my program that year)

When we answered one of the questions it read: Are you looking for a job (or something like that), yes. Did you apply for a job? no (because I was doing a fellowship) I was expecting a second question like what are you planning on doing it etc. Instead I got the thank you very much for answering this useless survey that we are going to interpret however we like etc etc.
I tried to go back but could not fix it.

There is my skewed, biased answer

 

[exPCM]

Are you not a Dermatopathologist? So, even then, with all this hype about Dermpath being so great, you still think that Pathology should be pursued only if there is no other option available to one who is deciding which specialty to get into?

I am a dermatopathologist and I hate to see the reckless overproduction of pathologists. I do not see any effort by the residency programs to look into workforce planning issues. I completely agree with the posts above by Trent05 and LADOC. I think pathology should only be pursued by those who really know what they are getting themselves into.

 

[yaah]

I am sure what happened there was that you clicked the wrong button and it kicked you out of the survey (like it did to all the seniors in my program that year)

When we answered one of the questions it read: Are you looking for a job (or something like that), yes. Did you apply for a job? no (because I was doing a fellowship) I was expecting a second question like what are you planning on doing it etc. Instead I got the thank you very much for answering this useless survey that we are going to interpret however we like etc etc.
I tried to go back but could not fix it.

There is my skewed, biased answer

Fair enough, that makes sense. However, it further calls into question the survey itself and indicates poor design rather than intepretable results. You can skew bad data in any which way you want, good or bad. But it's still bad data.

 

[LADoc00]

Hi guys,

1st time poster in this forum. Figured my question would be somewhat appropriate here - Are most pathology gigs like anesthesiology or radiology gigs, where if you do more, you make more? Staying longer = paying off my loans quicker?

No and there is very little if any time/ability to moonlight in pathology aside from burning serious vacation time. So if that is your concern (paying off loans the quickest), Pathology isnt the answer as your income tends to build slowly if you dont land a quick partnership/sole prop. position.

 

[trent05]

The path job market isn't great like rads, but it's not crap. However, I wouldn't read much into the examples you bring up above.

Born in New York City, Dr. XXX graduated from Duke Medical School in 1964.
He completed 5 years of training in anatomic, clinical pathology and hematopathology. After serving 2 years as a Major in the armed forces, Dr. XXX located to Florida where he has been in practice ever since. In his practice he specialized in cancer diagnosis for 25 years. He also headed an 11 physician group, ran business affairs, and was president elect of the AM Foundation of Pathology, a national medical organization.
"Dr. XXX saw the tremendous potential
in medical aesthetics"

After a successful retirement of 3 years, Dr. XX saw the tremendous potential in medical aesthetics and retrained, starting an entire new career. His training included the use of dermal fillers such as Cosmoplast/derm; Restylane and Radiance™ as well as Mesotherapy.
Dr. XXX has now been doing facial aesthetics specializing in BOTOX® and facial fillers for over 4 years. He is an active member of the BOTOX® Cosmetic Physician's Network and he also teaches other physicians in all of these areas.
Dr. XX currently practices in Jupiter, Wellington and Boca Raton.
------------------
C'mon, the guy was in pathology for 25 years! Plus, he probably saw the opportunities in aesthetics and decided to go into it, not because he was unemployed (btw, he is retired). He saw a business opportunity and took advantage of it. Probably still made a good living in retirement.

OK, here's one of a dermatopathologist who is doing hair transplants!http://www.medicalhairrestoration.com/credentials_katona.aspx

 

[KeratinPearls]

OK, here's one of a dermatopathologist who is doing hair transplants!http://www.medicalhairrestoration.com/credentials_katona.aspx

• Hair Transplantation Fellowship, Medical Hair Restoration, Orlando, FL
• Dermatopathology Fellowship, Ackerman Academy of Dermatopathology, New York, NY
• General Surgery Residency, Jackson Memorial Hospital, Miami, FL
• Surgical Pathology Residency, Jackson Memorial Hospital, Miami, FL
• Doctorate of Medicine, Ross University School of Medicine, New York, NY
• Bachelor of Science, University of Minnesota, Minneapolis

That is hardcore. 10 years in training.

 

[mcfaddens]

• Hair Transplantation Fellowship, Medical Hair Restoration, Orlando, FL
• Dermatopathology Fellowship, Ackerman Academy of Dermatopathology, New York, NY
• General Surgery Residency, Jackson Memorial Hospital, Miami, FL
• Surgical Pathology Residency, Jackson Memorial Hospital, Miami, FL
• Doctorate of Medicine, Ross University School of Medicine, New York, NY
• Bachelor of Science, University of Minnesota, Minneapolis

That is hardcore. 10 years in training.

Interesting, Ross is in the carribean, surgical pathology residency? what is that AP only? Isnt the Dermpath fellowship at Ackerman not accredited and you pay cash to get in? How come he only has a board cert in hair replacement?

 

[trent05]

Interesting, Ross is in the caribbean, surgical pathology residency? what is that AP only? Isnt the Dermpath fellowship at Ackerman not accredited and you pay cash to get in? How come he only has a board cert in hair replacement?

According to the website Ross is in NYC?

 

[yaah]

Yeah that's weird about Ross. I have seen other people who have gone there who list it as either in NY or NJ, not sure how they can get away with that.

 

[Thaitanium]

Ross headquarters are in Edison, NJ. However, the campus itself is in Dominica, West Indies. Most students do their rotations in NYC. They are one of the Carribean medical schools that have been around for years along with St. George. Just a FYI.

 

[microdot]

There is a another Caribbean school called AUC. Some guy went to Brown from there to do a residency. Rumor has it he will be a GI pod-labber. These carabeeners have to be stopped. They are removing positions/jobs from USGRAD.

 

[gbwillner]

There is a another Caribbean school called AUC. Some guy went to Brown from there to do a residency. Rumor has it he will be a GI pod-labber. These carabeeners have to be stopped. They are removing positions/jobs from USGRAD.

THey took R Jerbs!!!!!!11!!

 

[Pingu]

Where I'm at we receive a decent number of outside consults from megalabs and one thing I often notice is a significant number of immunostains/extra studies which were ordered on the case. Frequently, they are straightforward biopsy cases that our surgeons want us to review prior to surgery being done at our hospital but they'll have anywhere from 4 to 12 stains on a case that could have been diagnosed on the H&E. I've seen soft tissue consults with 20+ stains from someone who clearly didn't know what they were looking at and decided to throw the kitchen sink at it.

It was explained to me as the megalabs contract with the clinicians or hospital for a low rate upfront, which cannot be matched by local private practice groups because of the low salaries and high output of the megalab. Then they hit the clinicans with 'back end' charges from stains and ancillary tests which brings up their profit margin. It would be very interesting to see a cost comparison on cases from a private practice pathology group versus a megalab. I sometimes think that clinicians/patients may wind up paying more for their diagnosis while using the megalabs, but I'm sure there is absolutely no way to get ahold of that sort of data. It would definitely help in the quest to get pathology back on track though.

 

[yaah]

Yeah, we got an upper GI bx set today from some GI lab and they had ordered an H Pylori immunostain on both the stomach and the GE junction (both were histologically normal). They had ordered a CD3 on the duodenum "to rule out sprue" (it was not sprue, it was duodenal bulb with a little more prominent gastric metaplasia than normal) and also a chromogranin and synaptophysin because there were a few too many endocrine cells.

 

[Arctic Char]

Yeah, we got an upper GI bx set today from some GI lab and they had ordered an H Pylori immunostain on both the stomach and the GE junction (both were histologically normal). They had ordered a CD3 on the duodenum "to rule out sprue" (it was not sprue, it was duodenal bulb with a little more prominent gastric metaplasia than normal) and also a chromogranin and synaptophysin because there were a few too many endocrine cells.

its language like that makes me all giddy and love path even more . . . clinicians are bums!!!!

 

[Psychopathology]

How do the mega-labs stay in business if they demonstrate this sort of indiscretion and incompetence? Are there performance comparisons or cost comparison surveys comparing them to traditional private practices?

 

[Nilf]

How do the mega-labs stay in business if they demonstrate this sort of indiscretion and incompetence? Are there performance comparisons or cost comparison surveys comparing them to traditional private practices?

Good question. When I posed this to a senior resident several years ago, I was told that they basically use a lot of bread-and-butter marketing schemes which are not an option for small pathology groups. For instance they say to clinicians: 'if you send us your cases, we'll give you shiny new office equitpment'. I don't have enough insight into the business model of these entities to explain why it is a viable strategy, but apparently it is.
It all begins with oversupply of cheap pathology workforce tho.

 

[yaah]

Megalabs provide

1) Quick turnaround time
2) Low cost

To many clinicians, this is all that matters as long as they get a diagnosis they can believe. As to how they know they can believe the diagnosis, it depends on how effective the lab is at marketing. This is why you will see on megalab reports lots of fancy pictures and graphics and the pathologist will often have "Gastrointestinal pathologist" under their name, instead of just "pathologist." And when they market their services they can float credentials of their pathologists, etc. In a sense, for many clinicians it doesn't really matter who is signing out the biopsy of colon cancer - it's still colon cancer. And most patients think their clinicians are the ones making the diagnosis anyway (unless it's controversial or wrong, in which case then the clinicians will be sure to quickly point out who made it).

Don't forget - sleaze is not restricted to pathologists. There are many many clinicians who are in this business to make money. They ditch patients without insurance, they do excessive procedures to bill for them, etc etc.

"Indiscretion" and "incompetence" are in the eye of the beholder.

 

[KeratinPearls]

Megalabs provide

1) Quick turnaround time
2) Low cost

To many clinicians, this is all that matters as long as they get a diagnosis they can believe. As to how they know they can believe the diagnosis, it depends on how effective the lab is at marketing. This is why you will see on megalab reports lots of fancy pictures and graphics and the pathologist will often have "Gastrointestinal pathologist" under their name, instead of just "pathologist." And when they market their services they can float credentials of their pathologists, etc. In a sense, for many clinicians it doesn't really matter who is signing out the biopsy of colon cancer - it's still colon cancer. And most patients think their clinicians are the ones making the diagnosis anyway (unless it's controversial or wrong, in which case then the clinicians will be sure to quickly point out who made it).

Don't forget - sleaze is not restricted to pathologists. There are many many clinicians who are in this business to make money. They ditch patients without insurance, they do excessive procedures to bill for them, etc etc.

"Indiscretion" and "incompetence" are in the eye of the beholder.

Really sucks to see pathologists working in these factory-type jobs. Too bad there are pathologists out there who are willing to take these jobs.

As yaah said before, there are many pathologists out there who are willing to take these jobs because it's 9-5, no call, no weekends with a good salary. The idea of making much more money for a guy sitting at home smoking his phat cigar whle picking his a#$ really is unattractive to me. I'd rather be "that guy" rather than some chump passing glass all day. Don't be a sucka.

 

[KeratinPearls]

Question: do these megalabs exist in radiology. I consider path and rads to be similar (all procedures) and would think rads would also be subject to a megalab-type business model.

 

[Matte Kudesai]

Megalabs provide

1) Quick turnaround time
2) Low cost

To many clinicians, this is all that matters as long as they get a diagnosis they can believe. As to how they know they can believe the diagnosis, it depends on how effective the lab is at marketing. This is why you will see on megalab reports lots of fancy pictures and graphics and the pathologist will often have "Gastrointestinal pathologist" under their name, instead of just "pathologist." And when they market their services they can float credentials of their pathologists, etc. In a sense, for many clinicians it doesn't really matter who is signing out the biopsy of colon cancer - it's still colon cancer. And most patients think their clinicians are the ones making the diagnosis anyway (unless it's controversial or wrong, in which case then the clinicians will be sure to quickly point out who made it).

Don't forget - sleaze is not restricted to pathologists. There are many many clinicians who are in this business to make money. They ditch patients without insurance, they do excessive procedures to bill for them, etc etc.

"Indiscretion" and "incompetence" are in the eye of the beholder.

These labs also have a volume level and revenue that can cover medicolegal ramifications of a crappy diagnosis.

Can you visualize a manager admonishing a new worker bee about a worrisome dx made yesterday....

"don't worry about it.. thats why we have lawyers.."

NOW GET BACK TO YOUR CUBICLE AND PASS THE GLASS !!

 

[Gut Shot]

Question: do these megalabs exist in radiology. I consider path and rads to be similar (all procedures) and would think rads would also be subject to a megalab-type business model.

No, the most lucrative aspects of rads right now are the procedure-based modalities, whereas path is still primarily stuck in microscopy-based interpretive tasks that could theoretically be sourced. You can send some slide data to a colleague elsewhere, you still can't do a CT-guided biopsy remotely.

 

[Pingu]

1) Quick turnaround time
2) Low cost

I am still extremely skeptical about the 'low cost' aspect of the megalabs. I think they market themselves upfront as low cost, but then tack on a bunch of stains. I would absolutely love to sit down with the financials of a megalab and see if I'm right or not.

Basically, it's like me saying I'll lease you an Aston Martin for 200 dollars a month, you agree and sign a contract, then I charge you 50 dollars a gallon for gas.

The other problem I see with the megalabs is that you are completely expendable. If you wind up hurting their bottom line, you could find yourself up a creek because there are plenty of other drones waiting to take your place. In some ways I think megalabs and pod labs were able to take such a hold on pathology because we ARE a lifestyle specialty and there will be those people who are looking for the 9 to 5 lifestyle. I don't think we should allow ourselves to be expendable cogs...when you really think about it, pathology is one of the most integral specialties in medicine. Without us, they have no idea what the patient actually has. Radiology might give them a differential, but we can (usually) tell them outright what the tumor is. Without surgical pathology, you render oncology obsolete. Without microbiology, you render infectious disease obsolete. And so on...

 

[yaah]

It's more that they are low cost to clinicians. From what I understand, they may pay for specimen shipment and things like that. Clinicians don't care if they are low cost to the patient (or the patient's insurance)!

 

[MasterThespian]

Question: do these megalabs exist in radiology. I consider path and rads to be similar (all procedures) and would think rads would also be subject to a megalab-type business model.

From an article discussing VRAD and Nighthawk, companies providing digital outsourcing of radiology images-

" Digital diagnostic imaging is expected to grow 15% annually over the next three years. 500 million procedures are expected by 2009. Sector is being driven by an aging population, advances in diagnostic imaging technologies and the growing availability of imaging equipment in hospitals and clinics, as well as by more frequent physician referrals for diagnostic imaging. However the projected number of radiologists is expected to grow just 2% annually in the US. The slower pace of radiologist growth coupled with the 24/7 365 demand has pushed hospitals/clinics to outsource some of their radiologist needs."

and...
"The largest expense line is physician cash expenses at 45%. As this is an operation that depends entirely on their physician radiologists, this expense line will always be significant at the 45% level of revenues."

and...
"Operating margins should improve a bit as VRAD gets some economies of scale on SGA if not on physician radiologist cash expenses."

Why are these companies forced to spend 45% of their expenses on physician compensation, which is NOT projected to decrease even when the companies grow and get "economy of scale"?

Because there is and will continue to be a radiologist shortage, therefore they cannot screw over their physicians no matter how "big" and "pod lab"-like they get. Their physicians will walk away to greener pastures. Pod labs and PP groups are only able to take advantage of pathologists because there is no shortage of replacements. It's simple supply and demand. We are only training 2 radiology residents per path resident- does that make any sense given that there are probably 20X the number of radiology jobs out there. Is it any wonder radiologists pull in such enormous sums?

Almost all other specialties, from primary care to specialists, receive phone calls from recruiters throughout residency and are able to find jobs through both word of mouth AND advertised postings of 100's of jobs. They are geographically restricted only in the sense that they may have to choose between less money in a cool town or more money in a crappy town- either way they can usually choose where they want to live. They don't have to "go where the jobs are" just to get a job. I don't care so much if I don't make $500K like a radiologist, but I WOULD like to be able to get a decent job in a town my husband and I both really like. Even academic radiologists are paid $300K- my exboyfriend is a recent rads graduate who took an academic position at his institution for $300K with 8-hour shifts and 10 weeks vacation but says he fields offers ALL the time from PP groups for way more money. But those jobs also come with increased volume so he's not interested. Why are academic pathologists starting at $90-120K? Because there's no need to pay them any more- they're just glad to be employed in academics at all- and there aren't a million PP groups competing to lure them away with big money.