In the end it doesn't matter who is innovative or what the supply-demand ratio of a specialty is because $$$ reimbursement is about to plummet regardless. The pharmacists at my medical center get paid more than the junior pathology attendings, but hey that is about to happen to most every other specialty as well. They couldn't find a way to get the SGR fix into the reform bill being voted on tomorrow. What makes you think they will fix it after the fact with a $200 billion price tag? The year to year fix is over and medicare cuts are coming big time (radiology is going to get hit the hardest of all specialties probably). Private insurers will follow suit soon enough. Since everyone is required to hold insurance and they reimburse based on medicare plus a %, private insurance companies are about to make $$$ hand over fist.
So, the bottom line is "who cares". We are all just trying to get our student loans paid off ASAP so we aren't saddled with the equivalent of another mortgage payment when our income gets cut in half. The same goes for clinicians too. It is going to get ugly as every specialty tries to fight over the RVU scraps that fall from the table while health care costs keep going up. Good thing they are screwing physicians, whose reimbursement accounts for less than 10% of healthcare spending, rather than insurance companies.
What physicians should have done is banded together to prevent this from happening. The problem with physicians is that they are selfish greedy bastards who only look out for number one. That attitude has landed them in this mess.
If they had worked together and lobbied extensively, physicians would be far better off and would not even be having this discussion. I bet the public doesn't even know how much money the insurance companies make. Compared to them, doctors make peanuts. Yet the political push has been to cut physician income, because the public's perception is that we are paid so much.
We needed to work the lobbying angle as a collective group, but we didn't and we epic failed. The public is like a child: tell it something often enough and it believes you. We didn't tell it often enough that physicians, if anything, are underpaid and the flack should go towards the middlemen insurers.
As a result, physicians should now vote with their wallets. If they're going to get screwed by insurance, they should be cash-only from now on. All primary care should be boutique. All payments should be out of pocket. If the government fails physicians, we should go back to free-market principles. Wild West medicine.
That is absolute hogwash. A great amount of innovation in path comes from FMGs, just as a great amount comes from AMGs. To be sure, there are probably too many path training programs and many of the lesser ones do the field a disservice by their poor quality of training. A lot of people who probably shouldn't be pathologists end up getting trained and certified this way. To your other point, pathology uses a lot of cutting edge technology - this argument you made is so weak. The reason a 100 year old technology (the H&E) is still used is because it remains an effective way (as well as a cost-effective and quick way) to practice. Why don't radiologists give up chest xrays? Why don't cardiologists give up the stethoscope? This is not a "reflexive insult" but a refutation of ignorant statements. Many of your other statements are pertinent, but the ones I quoted are pure bunk mixed with xenophobia. I agree with you that path needs to do a better job of attracting better applicants. Lots of great people go into it, but lots who would be suited for it don't for various reasons.
I would bet that far less innovation in path comes from FMGs than AMGs. I would go as far as saying that the more FMGs in the field, the less push there will be towards innovation. I'm not saying this because I think FMGs are incapable. I'm saying it because to innovate requires that one challenge the status quo, and FMGs are more cautious about doing this due to stigma and prejudice. It's a shame that this part of the world still has that kind of mindset, but it does. I'm not xenophobic. I'm commenting on the culture of xenophobia present in American medicine preventing FMGs from taking a stand towards innovating fields and challenging the status quo.
I'm not bashing the H&E. I'm bashing the microscope. It's day should be numbered, the same way films have been numbered in radiology. Digital is just better. Storage is easier and cheaper. Quality control is better. As a teaching tool it is better. Digital algorithms can be utilized to assist in diagnosis. It's more portable. It's faster. But there's been very little enthusiasm for it even though I cannot find any cogent arguments that support the superiority of the microscope. All I've encountered is "it's what we have been using for years" and "The resolution is better"(which is false with modern technology) and "It's cheaper"(in the short term yes. Long term it isn't. Digital storage space is far cheaper than physical, and computers are cheaper than microscopes) As for other components of pathological diagnosis such as molecular and genetic, the general docility of practitioners of the field is allowing other fields to be first in line to make inroads regarding the use of such modalities. Path should not allow that kind of encroachment to happen.
For your other points about cardiology: Nobody will support the diagnosis of a definitive valvular abnormality without an Echo, so in a way the stethoscope has been relegated to very coarse cardiovascular assessment and use by medical students and residents as a rudimentary screening tool. It's been shown that inter-rater reliability of auscultation of everything but the most obvious of murmurs is poor. As for the X-ray, it like the stethoscope is useful for some specific abnormalities in certain clinical situations. In a lot of other cases, any true definitive answers regarding anatomy are better found using CT, such as tumor masses, interstitial lung diseases, etc. But I've never heard any radiologists, save for some mammographers, comment that plain films are just better than digital and therefore digital should not be used.
