Pathology: Is it worth it?

[Matte Kudesai]

In the next decade where will the majority of fellowship trained pathologists be? (as the need for general pathologist continues to diminish)

Will mega labs keep undercutting prices so smaller groups will go bellyup?

With a busted medicare will there be digital outsourcing to US trained FMG's living back in their home countries?

Where will all the GU, GI, cytopath, dermpath, hemepath... trained doctors be working.

Academics? Will there be a shift back to academics because people do not want to work in factories?

Why are there so many cytopathology and hematopathology academic openings?

It can't be just that people do not like to signout in these areas at academic centers.

Are people just flushing out to private practice after training?
What is the difference between doing heme or cyto in an academic setting vs. private practice?
Simply more money?
.... But don't you make more money signing out GU in private practice as well? or for that matter GI?

How easy/hard is it to get a private practice GU/GI job that is not a factory?

Yaah or anyone....do you know????!!!

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[mcfaddens]

In the next decade where will the majority of fellowship trained pathologists be? (as the need for general pathologist continues to diminish)

Will mega labs keep undercutting prices so smaller groups will go bellyup?

With a busted medicare will there be digital outsourcing to US trained FMG's living back in their home countries?

Where will all the GU, GI, cytopath, dermpath, hemepath... trained doctors be working.

Academics? Will there be a shift back to academics because people do not want to work in factories?

Why are there so many cytopathology and hematopathology academic openings?

It can't be just that people do not like to signout in these areas at academic centers.

Are people just flushing out to private practice after training?
What is the difference between doing heme or cyto in an academic setting vs. private practice?
Simply more money?
.... But don't you make more money signing out GU in private practice as well? or for that matter GI?

How easy/hard is it to get a private practice GU/GI job that is not a factory?

Yaah or anyone....do you know????!!!

I know

1. Fellowship won’t mean much if everyone has one, if you can get a job that’s the best fellowship. Plus the need for a generalist will never diminish, most places will require you to it all anyway.

2. Maybe but not likely, you still need someone in house

3. No

4. The same places they work at now

5. That would be great

6. People want to go into private practice because they have other things in their lives that they have to pay for.

7. Depends at an academic place you might have to do a bit more research depends on the place, a private fellowship might help you if that’s the kind of setting where you want to end up

8. You get paid the same anywhere, just depends on who is running the show and how much of a cut they will give you

9. Finding a job at a non factory can be done, but keep in mind they can screw you too.

Bottom line there are too many people being trained in path and not enough jobs for them to go into, hence multiple fellowships on single individuals. Having fellowships will not necessarily make you look good to an employer (can make you look bad i.e. this guy can’t find work so he keeps doing these fellowships) You are not guaranteed anything no matter what fellowship you do. Good communication and networking will make you stand out and get the job you want.

 

[Matte Kudesai]

1. Fellowship won't mean much if everyone has one, if you can get a job that's the best fellowship. Plus the need for a generalist will never diminish, most places will require you to it all anyway.

When you say most places what do you mean..... I am asking about the health care crunch and the next president likely promoting keeping costs down. Large labs will have an advantage because they can undercut smaller groups. Why do you think general pathology will continue to be needed in the future when there is so much subspecialization


4. The same places they work at now

How will they work at the same places they work now if labs continue to gain more strength and market share... This type of job may be the trend of the future. Residencies are already shifting to a "lifestyle" oriented model creating lifestyle oriented residents. Is this setting us up for a 9 to 5 factory culture. Shoot people already want to work 9 to 5 so they are selecting residencies that are less "malignant". If you can make 250-350K in cubicle with no call no autopsies and a decent vacation package you might be tempted... Even if its factory work.


6. People want to go into private practice because they have other things in their lives that they have to pay for.

This is precisely what I am trying to find out... If factories are the private practice of the future will people still flock to them. More pay.. subspecialized (only GU, GI, etc).


8. You get paid the same anywhere, just depends on who is running the show and how much of a cut they will give you

I don't understand... you mean reimbursement is the same everywhere and if you are Epstein trained you may get 450K instead of 200K?

9. Finding a job at a non factory can be done, but keep in mind they can screw you too.

I know you can get screwed...... I just can't figure out how F*&^ed up pathology might become. Unfortunately it does lend itself nicely to a FACTORY model. If some tool can figure out how to save the government tons of money by promoting it..... IT WILL HAPPEN.

We are treading on thin ice with our d0uche6ag leadership right now.

With all these people being trained and not that many jobs as you stated.. factories may become attractive. All this specialized training has to end up earning something!! They will probably start recruiting hard core in the next 3-5 years.

It freaking depressing. Looks like academics is the best bet. But there they'll probably make you write grants.

 

[Matte Kudesai]

My prediction is that pathology will be at two extremes in the coming future.

Factories on one end and academics on the other. The middle will be squeezed out.

Digital pathology will allow global pilfering and undercutting.

US trained and licensed IMG's working back in their home countries for a major conglomerate associated with these factories.

This will all happen to save the economy and at the same time afford insurance for everyone.

We are at the brink man !!!!......

 

[mcfaddens]

Alright dude calm down a bit, relax and take a couple of deep breaths. Yes if you want to go down the catastrophe route you will freak yourself out. And I have heard your theory of academics vs. pod labs before (by some well known individuals). I just don’t think that such a major change can happen over night or even in a decade. The pod vs. academics idea has been floating around for at least 10 years or more and the scene has only changed a little. Also during training most of us are in academic centers in oversaturated areas with too many path people, thus this type of mentality is prominent. But you also have to take into consideration the rest of America, the PP groups in less urbanized areas where this doesn’t pose such a great threat. No one shouldn’t spend their time getting scared about what might happen; instead focus on how you are going to prevent yourself from ending up in a situation you don’t want to be in (i.e. pod). If the next prez is a democrat all of health care is in for some hard times granted including the mega lab biz so expansion is not gonna be ideal at this time. Looking for a sub specialized robot to work in a pod lab might not be the #1 priority for the lab if they can just claim that someone is a GU guy even if they are not. They realize that most clinicians don’t know what that means and can call anyone whatever they want (GIpathologist ect). Yes I was referring to reimbursement doesn’t matter who reads out the hyperplastic polyp you will still get paid the going rate for an 88305, if Epstein or Bill Unknown trained you. Once you get to the top of your PP group then you can decide how much of a cut of the profits you can get. If you really want to work for a pod lab or academics based on the reasoning in your post I would rethink it. No one can predict the future but it makes no sense making huge decisions based on paranoia.

 

[Matte Kudesai]

Alright dude calm down a bit, relax and take a couple of deep breaths. Yes if you want to go down the catastrophe route you will freak yourself out. And I have heard your theory of academics vs. pod labs before (by some well known individuals). I just don't think that such a major change can happen over night or even in a decade. The pod vs. academics idea has been floating around for at least 10 years or more and the scene has only changed a little. Also during training most of us are in academic centers in oversaturated areas with too many path people, thus this type of mentality is prominent. But you also have to take into consideration the rest of America, the PP groups in less urbanized areas where this doesn't pose such a great threat. No one shouldn't spend their time getting scared about what might happen; instead focus on how you are going to prevent yourself from ending up in a situation you don't want to be in (i.e. pod). If the next prez is a democrat all of health care is in for some hard times granted including the mega lab biz so expansion is not gonna be ideal at this time. Looking for a sub specialized robot to work in a pod lab might not be the #1 priority for the lab if they can just claim that someone is a GU guy even if they are not. They realize that most clinicians don't know what that means and can call anyone whatever they want (GIpathologist ect). Yes I was referring to reimbursement doesn't matter who reads out the hyperplastic polyp you will still get paid the going rate for an 88305, if Epstein or Bill Unknown trained you. Once you get to the top of your PP group then you can decide how much of a cut of the profits you can get. If you really want to work for a pod lab or academics based on the reasoning in your post I would rethink it. No one can predict the future but it makes no sense making huge decisions based on paranoia.

Thanks man.... you brought me back from the edge.

So should we all vote republican?

Can you direct me to any literature that shows these scenarios played out?

By less urbanized areas do mean North Dakota .. etc.?

Is a podlab different than a factory? By factory I don't mean podlab. I mean
places like Ameripath and Quest...

This is definition of Pod lab.. I Think..

[FONT=Verdana, Arial, Helvetica, sans-serif]"The term is used to denote a variety of different business structures that permit a referring physician, who frequently orders anatomical or pathology services, to share in the revenues earned on those referrals, even though the referring physician does not actually perform or supervise the services.".​

 

[mcfaddens]

Thanks man.... you brought me back from the edge.

So should we all vote republican?

Can you direct me to any literature that shows these scenarios played out?

By less urbanized areas do mean North Dakota .. etc.?

Is a podlab different than a factory? By factory I don't mean podlab. I mean
places like Ameripath and Quest...

This is definition of Pod lab.. I Think..

[FONT=Verdana, Arial, Helvetica, sans-serif]"The term is used to denote a variety of different business structures that permit a referring physician, who frequently orders anatomical or pathology services, to share in the revenues earned on those referrals, even though the referring physician does not actually perform or supervise the services.".​

No problem dude
Would be nice to get someone competent in the white house, but even if we all banded together if probably wouldn’t make a difference. We can act at the local level though. By this I mean doing something that is part of our job anyway...education. More specifically educating our clinicians about their options. They are the ones sending us business so instead of rolling over to the pod lab reps, we need to get in their faces and let them know what is going on (in a nice way). I don’t mean begging that looks weak and gives the impression of incompetence. I mean being active with the clinical side of our job, picking up the phone and giving a call or 2 on the cases you get, going to offices and finding out how to make your service more effective, refusing frozens on cases that were sent out to pod labs and you didn’t review the slides before surgery. ect ect. Pod lab folks can't do this; clinical people would rather have someone they trust vs. some over glorified title on a report that came from 2000 miles away. From my impression pod labs are a broad term to designate all of the entities that you refer to (in office path working for GI, Ameripath, Quest) The fundamental difference is that you no longer have a say or control over what you do ( I know that there are varying degrees of this Ameripath allows some autonomy but in the end if someone tells you your fired or replaced there’s nothing you can do about it).That is the price you pay to have the salary vacation ect. Sounds good initially but if you end up hating going to work everyday it’s not worth it. Personally I would rather fail on my own then get fired by a 26 year old MBA from University of Phoenix Online. Unfortunately there is a group of path folks content on living this way... and that’s bad... ummm kay. But there is still allot we can do to survive in this environment. As far as less urbanized I mean not NYC and on the other side of the coin not Nort Dakota. Im talking about the points in between. Your regular community hospital in the town you grew up in or the near by area. Really the best source for information on this topic would be contacting as many people in the diffrent practice types we have (academics, PP, pod) and gathering their input. This way you get a feel of the kind of people who work in the diffrent places and then you can make an informed decision on where you want to be. Im sure your program director or attendings know former grads that you can contact and talk about this topic.

 

[Matte Kudesai]

My prediction is that pathology will be at two extremes in the coming future.

Factories on one end and academics on the other. The middle will be squeezed out.

Digital pathology will allow global pilfering and undercutting.

US trained and licensed IMG's working back in their home countries for a major conglomerate associated with these factories.

This will all happen to save the economy and at the same time afford insurance for everyone.

We are at the brink man !!!!......

If we do ever get the two extremes of factory and academics prevailing... that would be a nice symbiotic/mutualistic/parasitic relationship.

Lots of consults for academic departments... and an opportunity for the "big names" to make some cashola on the side.

 

[Iquitos]

Umm yes, that is exactly what I said in the post.

There is mismatch between the type of person training programs are producing (metro-centered, hyper reliant on subspecialized consult services, err feminine types...) and the type of person needed in small community hospitals (masculine, self reliant and doesnt take crap).

This is your average trainee

this is what groups are looking for

LMAO