Hey how do I have a competitive pathology application for the upcoming match year in 2020?
Pathology residency?
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Could use help man
Yup not hard to get into pathology.
Pathology is filled in lower tier programs with subpar candidates that match every year just like this person....we need to do better as a field to raise the bar so subpar candidates don’t get in. For the sake of patients and our field in general. We have to do better.
seriously how would you feel if someone diagnosed your loved ones biopsy who chose pathology because it was the least unbearable field where they could sleep and have weekends free?
The bar is set too low in pathology and it’s ruining our field.
Pathology is filled in lower tier programs with subpar candidates that match every year just like this person....we need to do better as a field to raise the bar so subpar candidates don’t get in. For the sake of patients and our field in general. We have to do better.
seriously how would you feel if someone diagnosed your loved ones biopsy who chose pathology because it was the least unbearable field where they could sleep and have weekends free?
The bar is set too low in pathology and it’s ruining our field.
I kinda don't like that attitude i believe it would be tough for IMG even in pathology but suffice to say would still have to work hard to get in. Unfortunately not much is told about pathology in our med school and I had no clinical rotations in it so I would want to know more about it so I learn and be a strong candidate for it
Get an observership if your a IMG. If you can’t, do pathology research with a big name in the Pathology field and get letters of recommendation. Do pathology related research, not some bench side stupid basic science research. Hopefully the person you do research with will let you sit in at signout sessions.
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D
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What is your story and what is with the “lost cause” bit? If you are an MD/PhD grad you are assured a residency.
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lol because you were in the group that didn't have to be supervised 24/7 and relieved of his bootlaces & belt.
...maybe that's what ends up happening to the other group...they end up going to medical school and applying to path...
To give the (?huge) benefit of the doubt, perhaps this poster (in the picture) has some sort of chronic fatigue issue, and can't handle night shifts, and needs to get enough sleep on the weekends so they can be more "fresh" on weekdays. Or maybe he has undiagnosed depression / dyslexia / ADHD.
That being said, he still needs to study for his exams. If he doesn't study and pass his exams, he won't be able to complete the training program and apply for an attending job.
And if he has other personal issues that need attending to, then he needs to seek for help...
The bar is set low in our field that’s why. The field isn’t competitive to get into.
People apply to pathology and don’t even know how to put a competitive application together sadly.
People apply to pathology and don’t even know how to put a competitive application together sadly.
Lower to some mid tier programs, not talking about higher tier programs
I think Pathology is a very important specialty as it influences numerous other medical specialties,
and plays a large role in the clinical decision-making process.
However, the Medicare reimbursements / rebate values for various pathology items (especially histology) have severely declined in real terms,
which has directly / indirectly led to the specialty's "degradation".
A consultant / attending in 2020 (in Australia) would have to report a lot more cases compared to their predecessors in the pre-2000 period (from what I've read, perhaps up to ~50% more cases) in order to "justify" their salary of $AU 180-300K (~$US 123 - 206K, anecdotally).
Anecdotally for this salary, they'd be expected to report anywhere from ~4,000 - 10,000 Cases / year (depending on the institution)...
The decreasing Medicare rebates along with poor control of trainee numbers (seemingly more so in US) leads to graduate oversupply,
which further depresses the offered private consultant / attending salaries.
This situation is almost the polar opposite of Dermatology and Opthalmology.
GP (Family Medicine) training here is officially 3 years, with full-time GPs earning ~$AU 180-200K,
even when bulk-billing ALL of their patients (bulk-billing = no gap fee or co-payment from the patient).
In contrast, AP training here is officially 5 years, with a lot more exams than GP.
Apparently a lot of people fail at least one exam, so training gets extended to 6 or 7 years.
I've heard of a few people who took 9 or 10 years to complete their AP or General Pathology (AP / CP) training,
which sounds painfully long, but kudos to them for sticking it out and persevering.
In 10-20 years' Time, it might get to the point where someone can earn more money working in GP / Family Medicine and have more job security, than in AP...???
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I was under the impression that US/AMG applicants would've needed to put in a competitive application just to get accepted into med school to begin with,
unless you meant competitive application for pathology alone...?
It might be due to lack of exposure to diagnostic pathology (as opposed to pathophysiology) during med school though.
It might help to organize med school electives in pathology, and start "networking"...
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The funny thing CDX-2 is that the lower wages in Australia are only part of the story. Not only is 200K Aus only now roughly 137K USD, but the cost of the living of most of the country is high, like on the order of Chicago.
Which then means the standard of living of pathologists and physicians in general is abysmally low in many other countries. I guess to people who dont know anything different than their low standard of living, its far less material, like poor children in Uganda, its all they know.
Which then means the standard of living of pathologists and physicians in general is abysmally low in many other countries. I guess to people who dont know anything different than their low standard of living, its far less material, like poor children in Uganda, its all they know.
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I literally have no idea where these numbers are coming from. 200k AUD is only possible petty much in the lowest paying state, as a total newly qualified pathologist, and EXCLUDING various add ons such as bonuses and CME allowance.
A longitudinal study by MABEL surveying 8000 doctors in Australia revealed the 50th percentile for pathologists in Australia to be around 360,000 AUD, and 75th percentile to be around 470,000 AUD. These figures are completely in keeping with my experiences job hunting last year. I've been qualified less than a year, but I can tell you I would not even get out of bed, let alone report cases, if I got paid $200000 a year.
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Hi Centropyge,
a public full-time 1st year consultant (with no right to private practice) in my state (Victoria) now gets ~$AU 235K, which progresses up to 9th year consultant getting ~$AU 324K.
The full-time executive director of the public pathology lab is apparently getting ~$AU 373K according to the latest EBA document.
Public consultants here also receive CME reimbursement of up to ~$28K / year, along with Salary Packaging of $9K / year (pre-tax deduction).
If you'd like, you can also factor in an additional 9.5% for superannuation / retirement contributions.
This is great, except that 1st year public consultant jobs are very scarce to obtain (for Victoria at least).
For the past 3 years, I don't recall seeing any more than 5 job ads total for a public consultant position in Victoria, and 1 of them was specifically for a senior consultant position.
To my knowledge, the vast majority of AP graduates from my state for the past 3 years at least, are working in, or are applying for jobs in private/corporate labs, or applying interstate (especially NSW and QLD) where they'll be competing with more AP graduates.
In any case, in a private lab, a large focus is on obtaining adequate case volume, to bill Medicare, and to generate a profit for the company.
Re: that study stating $360K (50th %ile) or $470K (75th %ile), I'm quite interested in knowing the following:
- How many of the 8000 doctors interviewed were anatomical pathologists?
- What proportion of those anatomical pathologists are working in public and/or private?
- How many years senior are they? How many of these pathologists are "executive directors" or "departmental heads"?
(Victorian executive director is supposedly ~$AU 373K which is just above the 50th %ile of that study).
- Are they "employees" or "partners" in the pathology firm?
- How many cases they are reporting in order to generate that income?
- Is the hospital / company they are working in charging a Gap Fee / Co-Payment to the patient for the histology cases?
- What %age of the Medicare rebate gets pocketed by the Pathologist (after factoring in other costs or "profits" for the company)?
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The $AU 180-200K was my estimate of what the first-year consultant was earning at my previous corporate lab in 2018.
This is based on my calculations of the Medicare revenue (Histology + Immunohistochemistry codes along with PEI: Patient Episode Initiations) generated from that consultant from our histology caseload for that year.
That consultant reported ~4000 histology cases and ~300 cytology cases.
Medicare revenue breakdown based on MBS (Medicare Benefits Schedule) is approximately as follows:
MBS #72838 (Level 7 Biopsy, eg Breast WLEs) x 200 = $466.85 x 200 = $93,370
MBS #72836 (Level 6 Biopsy) x 250 = $417.20 x 250 = $104,300
MBS #72830 (Level 5 Biopsy) x 300 = $274.15 x 300 = $82,245
MBS #72826 (Level 4 Biopsy for 8-11 Specimens) x 150 = $194.60 x 150 = $29,190
MBS #72825 (Level 4 Biopsy for 5-7 Specimens) x 300 = $180.25 x 300 = $54,075
MBS #72824 (Level 4 Biopsy for 2-4 Specimens) x 900 = $141.35 x 900 = $127,215
MBS #72823 (Level 4 Biopsy for 1 Specimen only) x 1200 = $97.15 x 1200 = $116,580
MBS #72817 (Level 3 Biopsy for 2-4 Specimens) x 200 = $96.80 x 200 = $19,360
MBS #72816 (Level 3 Biopsy for 1 Specimen only) x 300 = $86.35 x 300 = $25,905
MBS #72813 (Level 2 Biopsy, eg Vas Deferens) x 200 = $71.50 x 200 = $14,300
MBS #73049 (Cytology of single FNAs WITHOUT Pathologist attendance) x 150 = $68.15 x 150 = $10,222.50
MBS #73051 (Cytology of single FNAs WITH Pathologist attendance) x 150 = $170.35 x 150 = $25,552.50
Immunohistochemistry I estimated it to be another ~$60,000 (inclusive of the routine/mandatory IHC for breast and bowel cancers).
PEI (Patient Episode Initiations) is $14.65 x 4300 = $62,995
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Gross Medicare revenue (Histology + Cytology + IHC + PEI) = $825,310
But then as part of the Pathology tender with that public hospital, the actual rebate received by the private company is apparently 75% of the MBS
(the public hospital pockets the other 25%).
So the private company gets $825,310 x 75% = $618,982.50
Further costs include:
- Funding half the cost of the histology scientists / lab assistants along with the histology transcriptionists in that specific lab (~$120,000, the other consultant can fund the other half).
- Partial funding of the AP registrars / residents (~$30K).
- Partial funding of specimen reception staff (conservatively ~$10K).
- Partial funding of the data entry staff (conservatively ~$15K).
- Partial funding of the couriers (conservatively ~10K).
- Histology lab materials / reagents (very conservatively at least ~$30K).
- The "leftover money" then becomes ~$403,982.50
Of this "leftover money", this private company in particular would expect to keep AT LEAST 50% as "Profits",
and then let the other 50% go towards the consultant as the salary,
which means the 1st year consultant in that lab at best gets $201,991.25.
I am personally much more suspicious however that this private company keeps 55% of the money as "Profits",
which means that the consultant receives 45%, ie $181,792.13.
Therefore my estimate for the 1st year consultant in that private lab is somewhere between $181,792.13 - $201,991.25
However, I don't think this private company could get away with keeping 60% of the "leftover money",
coz that would mean consultant pay (40%) of $161,593 would be similar or slightly less than the most senior registrar!!!!!
- In such a scenario, NOBODY would want to work in this lab and the histology lab would just shut down, with the cases being sent elsewhere.
This is based on my calculations of the Medicare revenue (Histology + Immunohistochemistry codes along with PEI: Patient Episode Initiations) generated from that consultant from our histology caseload for that year.
That consultant reported ~4000 histology cases and ~300 cytology cases.
Medicare revenue breakdown based on MBS (Medicare Benefits Schedule) is approximately as follows:
MBS #72838 (Level 7 Biopsy, eg Breast WLEs) x 200 = $466.85 x 200 = $93,370
MBS #72836 (Level 6 Biopsy) x 250 = $417.20 x 250 = $104,300
MBS #72830 (Level 5 Biopsy) x 300 = $274.15 x 300 = $82,245
MBS #72826 (Level 4 Biopsy for 8-11 Specimens) x 150 = $194.60 x 150 = $29,190
MBS #72825 (Level 4 Biopsy for 5-7 Specimens) x 300 = $180.25 x 300 = $54,075
MBS #72824 (Level 4 Biopsy for 2-4 Specimens) x 900 = $141.35 x 900 = $127,215
MBS #72823 (Level 4 Biopsy for 1 Specimen only) x 1200 = $97.15 x 1200 = $116,580
MBS #72817 (Level 3 Biopsy for 2-4 Specimens) x 200 = $96.80 x 200 = $19,360
MBS #72816 (Level 3 Biopsy for 1 Specimen only) x 300 = $86.35 x 300 = $25,905
MBS #72813 (Level 2 Biopsy, eg Vas Deferens) x 200 = $71.50 x 200 = $14,300
MBS #73049 (Cytology of single FNAs WITHOUT Pathologist attendance) x 150 = $68.15 x 150 = $10,222.50
MBS #73051 (Cytology of single FNAs WITH Pathologist attendance) x 150 = $170.35 x 150 = $25,552.50
Immunohistochemistry I estimated it to be another ~$60,000 (inclusive of the routine/mandatory IHC for breast and bowel cancers).
PEI (Patient Episode Initiations) is $14.65 x 4300 = $62,995
---------------------------------------------------------------------------------
Gross Medicare revenue (Histology + Cytology + IHC + PEI) = $825,310
But then as part of the Pathology tender with that public hospital, the actual rebate received by the private company is apparently 75% of the MBS
(the public hospital pockets the other 25%).
So the private company gets $825,310 x 75% = $618,982.50
Further costs include:
- Funding half the cost of the histology scientists / lab assistants along with the histology transcriptionists in that specific lab (~$120,000, the other consultant can fund the other half).
- Partial funding of the AP registrars / residents (~$30K).
- Partial funding of specimen reception staff (conservatively ~$10K).
- Partial funding of the data entry staff (conservatively ~$15K).
- Partial funding of the couriers (conservatively ~10K).
- Histology lab materials / reagents (very conservatively at least ~$30K).
- The "leftover money" then becomes ~$403,982.50
Of this "leftover money", this private company in particular would expect to keep AT LEAST 50% as "Profits",
and then let the other 50% go towards the consultant as the salary,
which means the 1st year consultant in that lab at best gets $201,991.25.
I am personally much more suspicious however that this private company keeps 55% of the money as "Profits",
which means that the consultant receives 45%, ie $181,792.13.
Therefore my estimate for the 1st year consultant in that private lab is somewhere between $181,792.13 - $201,991.25
However, I don't think this private company could get away with keeping 60% of the "leftover money",
coz that would mean consultant pay (40%) of $161,593 would be similar or slightly less than the most senior registrar!!!!!
- In such a scenario, NOBODY would want to work in this lab and the histology lab would just shut down, with the cases being sent elsewhere.
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Very interesting point. Sad but true.
I get the impression that the rebates for the histology specimens in US are lower than Australia,
yet the salaries seem higher.
A single GI biopsy here is worth $97.15 (MBS #72823).
Apparently US 1st year attending salary of $US 180K is considered really "terrible",
yet the 1st year public consultant pay in my state ($AU 235K or ~$US 157) is less than that!!!
Interestingly, Sonic corporation (which acquired Aurora Diagnostics) operates both in US and Australia.
I'm extremely curious as to how much attendings get paid in the US Sonic labs, compared with the Australian Sonic labs...
I heard that a junior consultant/attending for one of the Sonic labs here is being offered up to ~$AU 300K (~$US 201K), but they're expected to report ~10,000 Cases / Year...
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Hmm we have a very different english definition of the word 'rebate'. Rebate is a partial refund on a payment here but I understand what you are saying.
On per CPT code basis your income is somewhat in the ballpark to us, but you make way less. The obvious explanation is you are seeing less material per year. But its a general observation to my fellow Americans who whine constantly that no general population in any major country (Singapore, Kuwait City etc excluded) has it even remotely as good as we have it right now. This is the absolute ZENITH of creature comforts for a human population. My cleaning lady drives a BMW X5! That is insane.
As an aside about Sonic:
I have some path buddies here who each got 5m from Sonic. for their practice.
5 mil....nice when you are about 35 years old. Paid off house, any student loans and still a few mill to churn on passive income.
On per CPT code basis your income is somewhat in the ballpark to us, but you make way less. The obvious explanation is you are seeing less material per year. But its a general observation to my fellow Americans who whine constantly that no general population in any major country (Singapore, Kuwait City etc excluded) has it even remotely as good as we have it right now. This is the absolute ZENITH of creature comforts for a human population. My cleaning lady drives a BMW X5! That is insane.
As an aside about Sonic:
I have some path buddies here who each got 5m from Sonic. for their practice.
5 mil....nice when you are about 35 years old. Paid off house, any student loans and still a few mill to churn on passive income.
Yeah ~4000 histology cases + 300 cytology cases was what the 1st year consultant reported to earn ~$AU 180-200K in that corporate lab.
Mind you, that lab didn't have Dragon transcription software, and the IT system crashed a lot,
so I think that's about as much as they could handle without having to live in the lab 24/7...
I've seen a 1st year consultant in another company report ~6000-7000 cases, but their lab had Dragon and a slicker IT system.
I think that consultant was getting ~$AU 250K which is almost the same as a public consultant (who gets public hospital benefits), but that's still less than the low-ball offer of $US 180K (for a 1st year attending) in the US...
I wonder how many histology cases / accessions your friend's lab had prior to getting sold to Sonic...?
$5 million's a very sweet deal that'll most likely set him up for life,
but Sonic wouldn't buy it unless they felt they had something to gain from it.
Do the Sonic labs in the US also host AP residents (they do here in Australia)?
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Late to the party.
People are right, path is the easiest field to match in. But there are lots of low-tier programs that match exclusively sub-par residents, and these programs tend to graduate Pathologists that go to sub-par fellowships and get sub-par jobs. The good news is that if you are an average applicant with a genuine interest in Pathology it's pretty easy to get into a decent program. And from a decent program,it's not terribly difficult to find a good fellowship.
Be warned: malignant programs are malignant and will use you as a grossing slave, leaving you wholly unprepared for actual signout duties and passing your AP/CP boards.
People are right, path is the easiest field to match in. But there are lots of low-tier programs that match exclusively sub-par residents, and these programs tend to graduate Pathologists that go to sub-par fellowships and get sub-par jobs. The good news is that if you are an average applicant with a genuine interest in Pathology it's pretty easy to get into a decent program. And from a decent program,it's not terribly difficult to find a good fellowship.
Be warned: malignant programs are malignant and will use you as a grossing slave, leaving you wholly unprepared for actual signout duties and passing your AP/CP boards.
I don’t think Pathology is the easiest residency to get into. I think it’s family medicine.
Yeah if you go to a decent program you can get into a strong fellowship if you were a good resident.
if you go to a subpar program you can still get into a strong surgpath or cytopath fellowship.
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Thank You for your input I believe currently, atleast as an IMG, even pathology is becoming challenging to match in from what im hearing from different people though I don't have any personal experience with it yet
