Pathology the only medical specialty that is CAPPED on daily workload?

[LADoc00]

Quick ?: Is Pathology via cytology workload CMS interpretation literally the only medical specialty that is capped on how much work you can do each 24hr period?

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[Torsed]

Prolly. That dates back to the PAP mills and the legislation about CLIA 88 (I know there was a CLIA before that as well). The unintended consequence of limiting PAP smears was the collateral damage that its spilled over into non gyn cytology which screws us today.

As far as I understand there is no limit to the number of pain Rx one can write until they get busted.

 

[BamaAlum]

Quick ?: Is Pathology via cytology workload CMS interpretation literally the only medical specialty that is capped on how much work you can do each 24hr period?

True, but only applies to primary screening. Everyone out there screening their own non-GYNs? I have a cytotech primary screen all of my non-GYNs. As long as they are good it saves a ton of time and I don’t have to worry about slides counts for myself.

 

[WEBB PINKERTON]

The problem you run into is when you have a pulmonologist who stacks cases a few days a week and you end up with over 100 slides on those days. It delays cases if you screen the slides yourself the next day. It is a stupid rule that was supposed to stop Pap mills but has been applied to FNA/non gyn work. The regulations need changed. Cytopathology is a dying field so it isn't easy to find a cytoscreener and you can't justify paying a cytotechnologist to just prescreen some sporadic nongyn work.

 

[deleted314957]

Quick ?: Is Pathology via cytology workload CMS interpretation literally the only medical specialty that is capped on how much work you can do each 24hr period?

By federal regulations, yes.

 

[Alteran]

By federal regulations, yes.

Yes, we are the only specialty singled out by a federal regulation as to how we can practice. I believe its limited to cytology only, but no other specialty has any federal law regulating any part of its practice.

 

[Zarniwoop]

I'd say that path and radiology have the largest workload swings without caps (outside of the cyto example which only applies to the techs, and not the paths). There is only so many patient encounters a real doc can have in 24 hours. However, there is no reason your pathology or radiology overlord cannot put 100's of cases in your queue, regardless of which laws of time and physics would need to be suspended to finish that steaming pile.

 

[maxxor]

Yes, we are the only specialty singled out by a federal regulation as to how we can practice. I believe its limited to cytology only, but no other specialty has any federal law regulating any part of its practice.

I mean the Nuclear Regulatory Commission is pretty strict with radiation safety, though a lot of the dose limits apply to our technologists rather than the NucRads.

 

[LADoc00]

Here is an interesting math ?: given in many parts of the country you have to pay six figures for a 1.0 FTE cytotech AND in CA they are limited to 80 slides every 24 hours...is it mathematically possible to make any money reading pap smears assuming no other high volume ancillary testing?

I would argue no unless you assume the pathologist's time re-screening the 10% of negatives is at zero cost hahahahahaa

 

[WEBB PINKERTON]

6 figures? I doubt they make that much money in many parts of the country. Don't compare California salaries to the rest of the US. I don't understand why any laboratory would want to be in California, especially AP considering you can throw the specimen into formalin or methanol and send it anywhere.

 

[LADoc00]

6 figures? I doubt they make that much money in many parts of the country. Don't compare California salaries to the rest of the US. I don't understand why any laboratory would want to be in California, especially AP considering you can throw the specimen into formalin or methanol and send it anywhere.

I would guess pay for a cytotech ranges at low end at least 30 bucks an hour in lower paid parts of the US up to 50/hr where I am.

62K-104K, adding in 50% for benefits, payroll tax and accounting expense would be like 91K-152K roughly.

If you take the 100K for this, add in the price of the thin prep vials, the capital costs of the device, the courier, the compliance, software lease, price for interface lease etc. I dont think pap smears can make money and are a HUGE source of medmal liability...

 

[y2k_free_radical]

I would guess pay for a cytotech ranges at low end at least 30 bucks an hour in lower paid parts of the US up to 50/hr where I am.

62K-104K, adding in 50% for benefits, payroll tax and accounting expense would be like 91K-152K roughly.

If you take the 100K for this, add in the price of the thin prep vials, the capital costs of the device, the courier, the compliance, software lease, price for interface lease etc. I dont think pap smears can make money and are a HUGE source of medmal liability...

The money comes from all the extra testing done on said specimens.

 

[WEBB PINKERTON]

There is a reason most private labs include cytopath along with CP when selling to LabCorp or quest. No money in it. And with cores replacing FNA, for god's sake DO NOT do a cytopath fellowship. You should know all you need to know if you go to a decent program.

 

[MetroPath]

There is a reason most private labs include cytopath along with CP when selling to LabCorp or quest. No money in it. And with cores replacing FNA, for god's sake DO NOT do a cytopath fellowship. You should know all you need to know if you go to a decent program.

Webb, you and LA do not recommend cytopath but sadly, a cytopath fellowship may be the only leverage we have as graduates in getting a job. If you are lucky and a group in the area you want to work in is looking for a cytopathologiat and you do not have a fellowship under your belt then you are out of luck and will not even get interviewed.

Cytopath may not be a big revenue generating specialty but people still have to sign it out and groups look for cytopath trained fellows. The most sought after fellowships I’m seeing right now is hemepath, Cyto and GI.

I know people who are at good programs who still do cytopath fellowships.

 

[WEBB PINKERTON]

They must be looking for someone to do the scut work of standing in endoscopy half the day saying "I have lymphocytes on 4R!". That is about all cytopath is nowadays besides thyroid fna, dwindling paps and some body fluids. I seriously wouldn't recommend doing a fellowship in it.

To quote Luke Skywalker in the Last Jedi "the cytopathologist should end"

 

[MetroPath]

They must be looking for someone to do the scut work of standing in endoscopy half the day saying "I have lymphocytes on 4R!". That is about all cytopath is nowadays besides thyroid fna, dwindling paps and some body fluids. I seriously wouldn't recommend doing a fellowship in it.

To quote Luke Skywalker in the Last Jedi "the cytopathologist should end"

Hey if it gets you a job with a nice partner salary (unless they fire you before making partner) you do what you got to do, unless you totally hate it. The job market is TIGHT.

Places will have you signout Cyto even without a fellowship. That’s why I recommend everyone to bust their butt in residency looking at as much Cyto as possible so you don’t have to do a fellowship.

I think you can get comfortable at Cyto within 6 months or less. You don’t need to do a fellowship but certification with the knowledge that comes with it helps.

I agree Cyto is dying though but groups are still looking for fellowship trained folks. Some comm hospitals no longer have paps. Just thyroid and nongyns.

 

[WEBB PINKERTON]

The type of cytopath specimens is becoming fewer and fewer. I remember vividly doing breast FNA a lot back in the day. Now they are gone. Cores have replaced virtually everything at the institutions I have worked at. Thyroid, pulmonary and GI are about it. I think you could learn the field in less than 3 months. You can disregard probably 90 percent of the chapters in cytopath books because they are pretty antiquated. The specimens don't exist any more.

 

[MetroPath]

The type of cytopath specimens is becoming fewer and fewer. I remember vividly doing breast FNA a lot back in the day. Now they are gone. Cores have replaced virtually everything at the institutions I have worked at. Thyroid, pulmonary and GI are about it. I think you could learn the field in less than 3 months. You can disregard probably 90 percent of the chapters in cytopath books because they are pretty antiquated. The specimens don't exist any more.

Agree. I recommend all residents look at all ebus, ercp, nongyns and eus slides as well as all the thyroids so you don’t have to waste a year to do a fellowship. Be able to identify malignant cells or identify cells that look atypical and need immunostaining.

Then again, jobs look for Cyto fellowship trained grads so they may not consider you if you didn’t do a fellowship. Same goes with GI. You don’t need a fellowship but employers are looking for GI fellowship trained grads.

 

[LADoc00]

I had a partner who was before his retirement a very accomplished cytopathologist who flat out told me the field is dead.

GI GU Heme and derm are all far better.

Although I have to eat crow and say that in my deeper discussions with recruitment companies that Molecular Path is very well compensated right now specifically in industry.

 

[WEBB PINKERTON]

Same here. A very accomplished cytopathologist I know retired in recent years and they said the exact same thing on their way out the door. For years, they had been saying the exact opposite, spewing out garbage about how cytology is perfect for personalized medicine etc. It doesn't take Poirot to figure out if you lose your highest volume test to molecular and FNA to cores that that the field is in deep ****. Sounds like cell free DNA tests will be replacing urine cytology in the very near future so there will be even more lost accessions. Looking for lymphs at 4R, 11R, Station 7 doesn't necessitate a cytopathology fellowship. The only time an FNA should be considered is due to location. If you can core it, you should core it. We owe that to our patients, not to waste their time with paucicellular specimens that contribute next to nothing.

Molecular path, wave of the future dude.

 

[MetroPath]

Same here. A very accomplished cytopathologist I know retired in recent years and they said the exact same thing on their way out the door. For years, they had been saying the exact opposite, spewing out garbage about how cytology is perfect for personalized medicine etc. It doesn't take Poirot to figure out if you lose your highest volume test to molecular and FNA to cores that that the field is in deep ****. Sounds like cell free DNA tests will be replacing urine cytology in the very near future so there will be even more lost accessions. Looking for lymphs at 4R, 11R, Station 7 doesn't necessitate a cytopathology fellowship. The only time an FNA should be considered is due to location. If you can core it, you should core it. We owe that to our patients, not to waste their time with paucicellular specimens that contribute next to nothing.

Molecular path, wave of the future dude.

Depends on your FNA technique and whether you can get adequate diagnostic material. You can get a diagnosis immediately with FNA + cell block if you get adequate material. If your technique isn’t good and you get a paucicellular specimen where you can’t make a diagnosis then yeah FNA is of course, useless.

 

[BamaAlum]

Depends on your FNA technique and whether you can get adequate diagnostic material. You can get a diagnosis immediately with FNA + cell block if you get adequate material. If your technique isn’t good and you get a paucicellular specimen where you can’t make a diagnosis then yeah FNA is of course, useless.

I agree. I despise cores for lymph nodes looking for mets. The diagnosis requires literally 10 seconds with a good FNA and a Diff Quik smear. Thankfully our radiologists realize this and haven’t fallen into the trap that a core is automatically a superior specimen. Also, FNA samples a greater cross sectional area than a core biopsy does.

Like most things, no single modality is better for every situation. Breast cores are obviously better than FNA but thyroid cores are hot garbage. Sometimes a lesion is in a tight spot where a core is not feasible but an FNA is less dangerous. Every organ and every situation is unique.

I also see a lot of labs with crappy cell blocks. My lab can make a cell block out of anything so that really helps obviate the need or desire for a core in a lot of situations.