Pathology Job Market

[WEBB PINKERTON]

Whoa, don't be lumping anyone with Thrombus.

Why don't you create even more usernames than you already have on here? You are a catfish trying to get people to sign some stupid petition.

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[gbwillner]

Whoa, don't be lumping anyone with Thrombus.

Why don't you create even more usernames than you already have on here? You are a catfish trying to get people to sign some stupid petition.

Catfish??? Please explain. I don't watch MTV.

 

[Over9000]

Pathologists behave similar to discriminated minorities.

Most pathologists are discriminated minorities...

 

[doctalaughs]

Most clinicians don't have a clue about quality. They are more satisfied by glossy picture filled reports and a free meal from a sexy lab rep than an accurate diagnosis. I suspect this can only get worse.
Large and small pathology groups will be sold to corporations that often don't provide lab services much less health care to real patients.

As a dermatologist I don't really understand this. Our group sends probably 100+ specimens a day to the pathology group we work with. I usually speak with the dermatopathologist at least twice a week about a difficult case. I'm pretty sure that if the quality sucked I would notice pretty quick. If they suddenly replaced half the pathologists with FMGs that didn't speak english I guarantee we would take our business elsewhere within 2 days. We have no interest in sending specimens to a megalab halfway across the country with faceless interchangeable slaves.

Why is it so different elsewhere? Is it because dermatologists have at least some training in pathology so we understand the importance better?

 

[Over9000]

As a dermatologist I don't really understand this. Our group sends probably 100+ specimens a day to the pathology group we work with. I usually speak with the dermatopathologist at least twice a week about a difficult case. I'm pretty sure that if the quality sucked I would notice pretty quick. If they suddenly replaced half the pathologists with FMGs that didn't speak english I guarantee we would take our business elsewhere within 2 days. We have no interest in sending specimens to a megalab halfway across the country with faceless interchangeable slaves.

Why is it so different elsewhere? Is it because dermatologists have at least some training in pathology so we understand the importance better?

Probably true.

Then again, I'm sure not every dermatologist has the same clinical standards. There are probably a few out there who'll employ a stooge on the cheap. Same could be said for GI and bladder biopsies but I don't see many GIs or urologists complaining about their barely-coherent cheap pathologists.

 

[WEBB PINKERTON]

Speaking of derm...

Is anyone familiar with Forefront Dermatology? They are buying up practices in my area and the derms tell me that they are then required to send their path specimens to a lab in Wisconsin. We pretty much gave up on ever getting any derm accounts back. Either in-office labs or arrangements like this are making it difficult to get any volume.

https://forefrontdermatology.com/

 

[Tamahawk]

Probably true.

Then again, I'm sure not every dermatologist has the same clinical standards. There are probably a few out there who'll employ a stooge on the cheap. Same could be said for GI and bladder biopsies but I don't see many GIs or urologists complaining about their barely-coherent cheap pathologists.

I think there are a few inherent differences between GI/urology vs dermatology:
1) Sheer number of diagnoses that are commonly encountered. Dermpath has hundreds of commonly-encountered diagnoses, and countless less-commonly-encountered variations thereof. Also, subtle histopath differences in inflammatory disorders often matter a lot clinically (eg. psoriasis vs psoriasiform dermatitis, which have completely different clinical implications and treatment options). There are simply fewer such problems in GI or urologic path.
2) Dermatologists know more about their organ's histopath than any other medical or surgical specialty, so they can more easily detect bad pathologists.
3) Dermatologists are some of the most type-A people and are into minutiae. So, they are more likely to take offense to any type of pathology misread, including ones that may not matter clinically (eg., erythema annulare centrifugum vs. pityriasis rosea-like eruption).
4) Rather than employ a stooge, dermatologists are more likely to cherry pick their path, and then send out stuff they don't want to read. After all, why would you pay someone to sign out a BCC when you can sign it out yourself and collect 100% of the revenue?

 

[turtle1966]

I can understand why academic pathologists are too scared to complain ......
What I don't understand is why pathologists allow the CAP to act against their interests.

1-Passivity
2-Fear
3-Belief that CAP is rigged
4-CAP is rigged.
5-Academia is rigged.

At present, Pathology is a very wonderful specialty for those at the top. Revenue goes down or CEO curtails benefits? Regale newbies with losses and more hours and garner kudos from CEO for being a team player and effective leader.

 

[turtle1966]

FMG'S AND PATHOLOGY: FANTASY AND REALITY

I am a middle aged US graduate working in Pathology for about 30 years. I do work in commercial setting.

Recently our Laboratory chain let go five US graduates who were all solid professionals aged 48 to 62. Three of them were brilliant graduates of Ivy League programs. Five well trained US graduates were replaced by (only) three junior FMG's,

Our young administrator who can now hire and fire well trained doctors told others that he prefers to work with FMG's because they complain less and are easier to lead.

I had posted that it would be a matter of time before CEOs would use FMGs to screw better paid AMGs. It is so logical, why not?! I am sure those let go had felt secure and smug till a day before. The tragedy is that commercial lab pathologists are usually not the best fit for hospital practices.

 

[MarcMarc]

Most pathologists are discriminated minorities...

I do not understand this. You seem to enjoy being a slave, so why do you want to retrain ? Keep doing what you are doing. Remain obedient meek Pathologist.

 

[AZpath]

I think there are a few inherent differences between GI/urology vs dermatology:
1) Sheer number of diagnoses that are commonly encountered. Dermpath has hundreds of commonly-encountered diagnoses, and countless less-commonly-encountered variations thereof. Also, subtle histopath differences in inflammatory disorders often matter a lot clinically (eg. psoriasis vs psoriasiform dermatitis, which have completely different clinical implications and treatment options). There are simply fewer such problems in GI or urologic path.
2) Dermatologists know more about their organ's histopath than any other medical or surgical specialty, so they can more easily detect bad pathologists.
3) Dermatologists are some of the most type-A people and are into minutiae. So, they are more likely to take offense to any type of pathology misread, including ones that may not matter clinically (eg., erythema annulare centrifugum vs. pityriasis rosea-like eruption).
4)

There different problems in other organs systems. They no less tricky.

You suggest that somehow you would know good from bad reads.
That could be hard to know unless you are still up on your dermpath and review some often the cases critically.

" Rather than employ a stooge, dermatologists are more likely to cherry pick their path, and then send out stuff they don't want to read. After all, why would you pay someone to sign out a BCC when you can sign it out yourself and collect 100% of the revenue? "

Your absolutely correct. If you have skill and the time to be proficient that's OK. You have the training to do the basics. Most dermatologist I have met get busy and stop doing this eventually.

The "smart money" is get paid on someone else's labor. That may be a qualified dermatologist / dermatopathologist too.
Dog eat dog...

 

[Tamahawk]

There different problems in other organs systems. They no less tricky.

You suggest that somehow you would know good from bad reads.
That could be hard to know unless you are still up on your dermpath and review some often the cases critically.

" Rather than employ a stooge, dermatologists are more likely to cherry pick their path, and then send out stuff they don't want to read. After all, why would you pay someone to sign out a BCC when you can sign it out yourself and collect 100% of the revenue? "

Your absolutely correct. If you have skill and the time to be proficient that's OK. You have the training to do the basics. Most dermatologist I have met get busy and stop doing this eventually.

The "smart money" is get paid on someone else's labor. That may be a qualified dermatologist / dermatopathologist too.
Dog eat dog...

I agree with your last statement "
The "smart money" is get paid on someone else's labor." However, reading a BCC does not qualify to me (or a lot of dermatologists) as laborious, and you are always better off collecting 100% for these lay ups.

I don't know if this other statement was specifically referring to me "You suggest that somehow you would know good from bad reads" but if it was, then the answer is yes, I personally would know. I am a Board certified Dermatopathologist and currently sign out our group's path and teach Dermpath at the university. More generally speaking though, most dermatologists can pretty easily discern between acceptable/good reads and crappy ones. I agree that it's hard for clinicians in general to distinguish a B+ and A+ pathology interpretation though.

 

[icpshootyz]

I agree with your last statement "
The "smart money" is get paid on someone else's labor." However, reading a BCC does not qualify to me (or a lot of dermatologists) as laborious, and you are always better off collecting 100% for these lay ups.

I don't know if this other statement was specifically referring to me "You suggest that somehow you would know good from bad reads" but if it was, then the answer is yes, I personally would know. I am a Board certified Dermatopathologist and currently sign out our group's path and teach Dermpath at the university. More generally speaking though, most dermatologists can pretty easily discern between acceptable/good reads and crappy ones. I agree that it's hard for clinicians in general to distinguish a B+ and A+ pathology interpretation though.

I think the bigger reason most derms don't sign out their own path is the regulatory and logistics issues that come with it - being certified as a lab and all that comes with that. Hiring someone to make your slides for you. Added risk. In my area I actually don't know of any non-dermpath-trained derms reading their own slides, only those with a dermpath fellowship. There are certainly plenty of in-house labs around these parts, but there's always an actual dermatopathologist (path or derm) doing the dermpath.

 

[Nilf]

I think the bigger reason most derms don't sign out their own path is the regulatory and logistics issues that come with it - being certified as a lab and all that comes with that. Hiring someone to make your slides for you. Added risk. In my area I actually don't know of any non-dermpath-trained derms reading their own slides, only those with a dermpath fellowship. There are certainly plenty of in-house labs around these parts, but there's always an actual dermatopathologist (path or derm) doing the dermpath.

It is actually pretty common for non-dermpath certified dermatologists to sign out their own path. I know 3 dermatologists who do that for sure (I've seen their reports) and I have even seen a family doctor who read his own path.

 

[icpshootyz]

It is actually pretty common for non-dermpath certified dermatologists to sign out their own path. I know 3 dermatologists who do that for sure (I've seen their reports) and I have even seen a family doctor who read his own path.

I didn't say it doesn't happen, it just doesn't seem to happen around here.

 

[WEBB PINKERTON]

Every area is different. The derms in my area are selling their practices to national corporations that have a large core lab in another state. I think the days of the independents are coming to an end for everyone.

 

[senior pathologist]

I am sure those let go had felt secure and smug till a day before.

Five US graduates were self confident. They naively thought they were safe because they were born in the US and because they were good pathologists Three of them were smug, other two average. Two got another less paid job within one year, three have only part time jobs with no benefits.

We have to realize that administrators are not US patriots and know nothing about patient care. It is corporations who are running the show. They want cheap labor to ramp up earnings and keep value of their stocks up.

Yes, in a few years, the same department that let five good pathologist go, might go bankrupt. But, no one sees farther than their nose. They will cross that bridge when they get there. In the meantime, they will destroy many careers.

Pathologists are cheap commodity in surplus. Who cares. If we Pathologist do not care, why should they ?