Pathology trends

[LADoc00]

Lewis Dark: Pathology Clients Now Competing Against Pathologists

THIS ENTIRE ISSUE IS DEVOTED TO A SINGLE TOPIC: the exploding interest by specialist physicians in establishing their own in-practice ancillary service in anatomic pathology (AP). Once again, THE DARK REPORT is first to provide the pathology profession with a concise and insightful assessment of a disruptive trend.

I use the word “disruptive” for good reason. Pathologists are about to confront a business nightmare as a significant segment of their customers —primarily urology and gastroenterology groups—decides to enter the anatomic pathology business themselves. As our editor points out, “anytime a profession’s major source of business and revenues decides to compete against its supplier, that’s a major development.”

So far, this phenomenon is concentrated in certain regions of the United States. For those of you working in those regions, it’s likely that you’ve already seen major urology and gastroenterology clients divert their specimens away from pathology group practices in your community and into their own in-practice ancillary AP service. It’s likely that these customer defections have had a serious impact on the financial viability of the pathology practices which lost access to those specimens.

There are still areas of the United States where this trend has yet to surface. For example, a pathology sales manager told me last week that, after making a week’s worth of calls on urology offices in Southern California, she had heard no discussion of TC/PC arrangements or inhouse AP labs. The situation is exactly the opposite in states like New York and New Jersey, where many urology and GI groups are actively involved in capturing at least some of the revenues generated by their anatomic pathology case referrals.

Even if this trend were to be derailed, because of, say, legislative prohibitions or actions by Medicare and private payers to prevent specialist physicians from submitting claims for anatomic pathology services, I believe the old businessmodels in anatomic pathology are being permanently overturned.

I recommend that your pathologists and practice administrators carefully study the business intelligence presented in this issue, then use it as the basis for a strategic planning session. Timely preparation may help your group save several important client relationships.

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[juddson]

Welcome to the market for anything.

If it is true that the market for pathology reading is shifting (in some areas) from stand-alone pathology services to "in-house" services, it is because the stand-alone pathology services are not competitive in the market. This means, essentially, that in-house services are able to get the same results for less money. This means they either (1) are able to do the same work with the same expertise in a more efficient manner or (2) they save money because good results require less expertise. The second explanation suggests you are over-qualified for the work you do (at least with respect to the services who are moving work inhouse). The first explanation suggests you are over-paid or wasteful or slow (at least with respect to the work being brought in-house).

IF (on the other hand) the expertise required to sign-out the cases produced by these practices absolutely requires the services of a board certified pathologists then you either have nothing to worry about (because those pathologists will demand the same sorts of salaries you do) or you have everything to worry about because these practices are able to do the same job more efficiently while still paying a competitive salary.

There is a third consideration as well, I suppose: In-house services do the same work with the same expertise along the same line of efficiency (ie., with the same sorts of overhead) as your stand-alone services do, but that the urologists and ENT's would prefer that all profits accrue to them rather than to pathologists. Again, though, if these services require the services of a board certified pathologist, it is these pathologists (who are willing to ***** themselves out for a set salary with no prospects of partnerships and participation in profit) who are knifing the rest of you in the back. Again, though, if these in-house services don't actually require the services of a pathologist, then you are over-qualified for the cases these services had previously paid you to do.

Personally I hate all this because I'm a 3rd year med student and I like pathology. It has become increasing clear to me (however) that much of the market share that physicians occupy (among all healthcare providers) as well as that occupied by specialists (among all physicians) is supported by artificial barriers to competition by non-physicians (or non-specialists). To the extent that these barriers are artificial (whether because they are erected to protect a speciality from preditors or because they are based on the false premise that it requires a board certified blah blah to diagnose a blah blah) a competitive marketplace for the provision of healthcare MUST wipe clean these barriers. All specialties (and physicians generally) are feeling this.

Judd

 

[pathstudent]

Welcome to the market for anything.

If it is true that the market for pathology reading is shifting (in some areas) from stand-alone pathology services to "in-house" services, it is because the stand-alone pathology services are not competitive in the market. This means, essentially, that in-house services are able to get the same results for less money. This means they either (1) are able to do the same work with the same expertise in a more efficient manner or (2) they save money because good results require less expertise. The second explanation suggests you are over-qualified for the work you do (at least with respect to the services who are moving work inhouse). The first explanation suggests you are over-paid or wasteful or slow (at least with respect to the work being brought in-house).





Judd

Judd, it is not about being able to do something for less money. Medicare and insurance companies compensate what they compensate. From what I have been reading in the posts here and elsewhere is that we have pathologists who are willing to let some one else take a cut of their professional fee. The payment for the technical histology services is another issue, and one that is not as big of a concern as others skimming pathologists professional services. It is the big reference labs and these little uro and GI groups who are offering to pay path people like an employee while they skim the profits.

I imagine it is the young people right out of training who take these jobs. They think "holy crap! someone is paying me 250K a year to read a bunch of biopsies. That's great cash!", when they don't realize that they are generating 500K.


It is kinda sad.

 

[juddson]

Judd, it is not about being able to do something for less money. Medicare and insurance companies compensate what they compensate.

This is precisely right - which is why this has everything to do with being able to do the job for less money. Reimbursements are the same no matter who does the work. But if overhead is lower, profit is higher. Hence, In-House Pathology operates more efficiently (at least with respect to the cases it brings in-house) and therefore produces more profit for the owners.

From what I have been reading in the posts here and elsewhere is that we have pathologists who are willing to let some one else take a cut of their professional fee. The payment for the technical histology services is another issue, and one that is not as big of a concern as others skimming pathologists professional services. It is the big reference labs and these little uro and GI groups who are offering to pay path people like an employee while they skim the profits.

I guess I don't understand this. All fees are recovered from the insurer, right. If that is the case, what difference does it make to differentiate between histology fees and professional fees?

Of course you are right about the second point - as long as pathologists (or any professional or worker for that matter) is willing to take less in terms of compensation (from whatever source) that drives down compensation (and/or opportunity/work) for the rest of the pathologists in the field.

I thought there used to be rules (ie., artificial barriers to competition) that prevented non-MD's from owning medical practices.

I imagine it is the young people right out of training who take these jobs. They think "holy crap! someone is paying me 250K a year to read a bunch of biopsies. That's great cash!", when they don't realize that they are generating 500K.

Indeed. But that has been the main thrust of market efficiencies for decades.

Judd

 

[juddson]

BTW, there's an easy solution to the problem you point out above. If young pathologists are willing to work as rank employees (with no chance of profit participation) for giant labs rather than for independant groups it is because the starting salaries (and/or working conditions, etc.) offered by the private groups are not competitive in the market-place. If these groups want to prevent new graduates from going to large labs (which will scalp work down the road) they need to offer more competitive terms.

To the extent that revenues are fixed (and they no doubt are given reimbursement trends) the migration to giant labs (and in-house services) reflects little more than their ability to operate more efficiently (ie., by doing the same amount of work on less over-head = more profit).

Judd

 

[Mountain Path]

Tis true...

The three largest GI groups in the Mile High City have announced that they are forming their own AP lab and going to hire two pathologists as employees. They are taking 8,000 specimens from us. Some of the older guys in this group had worked with these gastros for years and even went to med school with them. I figure the 50 gastros in the three groups will only make about 15-30K a year (though the consultants who talked them into this are probably telling them a much higher number). But hell it is 15-30K that they are getting for doing absolutely nothing.

They plan on offering 250K to two gi trained fellows to sign out their 30,000 non-medicare cases a year (this would be illegal in medicare's eyes). The TC/PC from this will generate approx. 3 million a year. The fresh out of fellowships will probably think they are getting a great deal not realizing that we (the pathologist community) were splitting about 1.5 million to sign these cases out. In other words they will only be getting about 1/3 the PC. Oh well, at least they won't have to take call or cover frozens, right?

This is the future of path. There will be outpatient pathologists working in the lucrative side of path but only getting a fraction of what they create. Plus they will be the employees of the gastros (or any out patient tissue obtaining physician) just like a nurse or PA or tech or receptionist. And there will be hospital based pathologists who have to work their ass off to make 250K.

This is the future for now, in ten years things will probably be totally different, but it is hard to imagine that we will ever go back to a system where hospitals got the TC and we got the PC and no one worried it.

At the national meetings that the clinicians go to there are booths of business people persuading our fellow physicians to take a piece of the pathology pie, not only all the TC but a major chunk of the PC too.

The irony in this is that this will be a nightmare for the reference labs as they are losing their big money makers (derm, gi, uro), and the reference labs are the ones that started all this TC/PC greedy BS.

 

[juddson]

Tis true...

The three largest GI groups in the Mile High City have announced that they are forming their own AP lab and going to hire two pathologists as employees. They are taking 8,000 specimens from us. Some of the older guys in this group had worked with these gastros for years and even went to med school with them. I figure the 50 gastros in the three groups will only make about 15-30K a year (though the consultants who talked them into this are probably telling them a much higher number). But hell it is 15-30K that they are getting for doing absolutely nothing.

They plan on offering 250K to two gi trained fellows to sign out their 30,000 non-medicare cases a year (this would be illegal in medicare's eyes). The TC/PC from this will generate approx. 3 million a year. The fresh out of fellowships will probably think they are getting a great deal not realizing that we (the pathologist community) were splitting about 1.5 million to sign these cases out. In other words they will only be getting about 1/3 the PC. Oh well, at least they won't have to take call or cover frozens, right?

why does the TC/PC generate about 3 million when the captured path practice does the work, but only 1.5 million when your group does the work? Is there something I am missing here?

This is the future of path. There will be outpatient pathologists working in the lucrative side of path but only getting a fraction of what they create. Plus they will be the employees of the gastros (or any out patient tissue obtaining physician) just like a nurse or PA or tech or receptionist. And there will be hospital based pathologists who have to work their ass off to make 250K.

This is the future for now, in ten years things will probably be totally different, but it is hard to imagine that we will ever go back to a system where hospitals got the TC and we got the PC and no one worried it.

At the national meetings that the clinicians go to there are booths of business people persuading our fellow physicians to take a piece of the pathology pie, not only all the TC but a major chunk of the PC too.

The irony in this is that this will be a nightmare for the reference labs as they are losing their big money makers (derm, gi, uro), and the reference labs are the ones that started all this TC/PC greedy BS.

This is amazing to me, but I don't get it. Why on God's green earth would a fresh GI path fellow ***** himself out to a group of GI docs for a salary with no chance of participating in the profits. The GI docs are dead in the water with the AP signing out the cases. That makes him a critical part of the revenue stream and, unlike other "critical cogs" in revenue streams, the supply of GI trained fellows in pathology is necessarily limited. Any pathologist (and, of course, any GI, derm, etc. trained fellow) does work that no other physician can (or wants to) do (compare this to gas docs who constantly have CRNA's who CAN do and WANT TO DO everything and anything the gas docs do - and for less money, to boot). A GI path fellow who's trained as long or longer than any GI doc and willingly throws away the sin quo non of professional practice - the opportunity to participate in profits - should be run out of the profession.

Which brings up the following question - why can't your practice offer as much to start (or more) with the opportunity to participate in profits down the road? Something doesn't jibe here.

Judd

 

[juddson]

And is this same thing happening to radiology? Are the outpatient practices starting to do thier own studies in order to take a peice of the radiology pie as well. It seems to me that if this can happen to pathologists, it can happen to radiologists as well.

If it is not happening to rads people, could it be that no outpatient group can afford to pay a radiologist what he could make within the radiology community?

Judd

 

[LADoc00]

Tis true...

The three largest GI groups in the Mile High City have announced that they are forming their own AP lab and going to hire two pathologists as employees. They are taking 8,000 specimens from us. Some of the older guys in this group had worked with these gastros for years and even went to med school with them. I figure the 50 gastros in the three groups will only make about 15-30K a year (though the consultants who talked them into this are probably telling them a much higher number). But hell it is 15-30K that they are getting for doing absolutely nothing.

They plan on offering 250K to two gi trained fellows to sign out their 30,000 non-medicare cases a year (this would be illegal in medicare's eyes). The TC/PC from this will generate approx. 3 million a year. The fresh out of fellowships will probably think they are getting a great deal not realizing that we (the pathologist community) were splitting about 1.5 million to sign these cases out. In other words they will only be getting about 1/3 the PC. Oh well, at least they won't have to take call or cover frozens, right?

This is the future of path. There will be outpatient pathologists working in the lucrative side of path but only getting a fraction of what they create. Plus they will be the employees of the gastros (or any out patient tissue obtaining physician) just like a nurse or PA or tech or receptionist. And there will be hospital based pathologists who have to work their ass off to make 250K.

This is the future for now, in ten years things will probably be totally different, but it is hard to imagine that we will ever go back to a system where hospitals got the TC and we got the PC and no one worried it.

At the national meetings that the clinicians go to there are booths of business people persuading our fellow physicians to take a piece of the pathology pie, not only all the TC but a major chunk of the PC too.

The irony in this is that this will be a nightmare for the reference labs as they are losing their big money makers (derm, gi, uro), and the reference labs are the ones that started all this TC/PC greedy BS.

AND what the hell are you going to do about it? Sit around and cry into your beers at night..."ooo poor us, poor us" Pathetic!! Take f-king action!

The SOBs are a menace. A total menace, not just to you but the whole medical ecosystem. Here is what you do:
1.) First off, if there are hospitals getting TC that will now be lost to these fckers, they are stealing from the whole community, not just your practice. Mobilize your hospitals. Get support from everyone you can,.
2.) Form a political action committee, Concerned Citizens for Medical Ethics.
3.) Take a full page ad in the Denver Post: Concerned citizens are worried that a select group of local physicians are endangering the financial security of their local hospitals, their trauma network etc. NAME THEM. Suggest alternative GI docs who do still send you business. Shame these greedy ****s, openly, in public. They wanna come over to your lab and start ****, beat their ass.
4.) Take out another ad offering FREE expert witness testimony to anyone who feeling like this group has committed malpractice against them. In fact retain an attorney and PI to explore these case, ALL GI docs will eventually perf on an endoscopy, hang em with it. Establish a 1-800 toll free number to call if anyone has had a possible malpractice case.
5.) Your PAC is lobbying DAY AND F_CKING night, you never sleep. You are calling Owens office everyday, meeting with whatever low level staffers you can. You are pleading with Owens to ban the GI arrangements on the grounds of a gross violation of medical ethics and self-referral guidelines. Bill Owens' passion is Russian politics, you get some Russian speaking pathologist in your group to connect with him.
6.) You are calling every state senator and assemblyman. Everyone.
7.) You find out who the hell they hire to read their slides, maybe Denver isnt the safe and serene place they thought it was. You make some visits, explain to them they are being used and abused like little bitches. Hell, maybe you have to get in someone's face, so be it.
8.) Colorado is great, because guess what, you mobilize the religious fanatics, I dont care if they follow baby Jesus or wear a red dot, they are picketing, 8-5 in front of the GI group's offices. If the hospitals are forced to cut back on stuff due to a lost TC, children will die, its that simple. If they can protest abortion clinics, they can stand the line at the GI offices too.
9.) You get your ass down there with a bullhorn, leading them. You make signs, offer donuts and coffee.
10.) Fliers, you bombard neighborhoods with fliers, pictures of sick kids wishing their hospital had back the TC so they could get the treatment they need.
11.) You go to the GI docs churches and ask pastors why they would betray Baby Jesus like that...those bastards!
12.) You ask every hospital you contract with to remove the GI docs from hospital staff on ethical grounds. You sit a pathologist on every f-cking committee your hospitals has.

You make that the hardest extra 15k/year they ever earned. You go to war.

Have em meet your firm:

I'm forever blowing bubbles / Pretty bubbles in the air / They fly so high / They reach the sky / And like my dreams they fade and die / Fortunes always hiding, I've looked every where / I'm forever blowing bubbles, pretty bubbles in the air!

 

[djmd]

why does the TC/PC generate about 3 million when the captured path practice does the work, but only 1.5 million when your group does the work? Is there something I am missing here?

They plan on offering 250K to two gi trained fellows to sign out their 30,000 non-medicare cases a year (this would be illegal in medicare's eyes). The TC/PC from this will generate approx. 3 million a year. The fresh out of fellowships will probably think they are getting a great deal not realizing that we (the pathologist community) were splitting about 1.5 million to sign these cases out. In other words they will only be getting about 1/3 the PC.

He is splitting it up between the two gi fellows..

The rest, I will leave to LADoc's solidarity now post..

 

[LADoc00]

The big cause of all this: there are WAY the hell too many pathology trainees, especially IMGs. Way way too many fellowship trained pathologists. And way the hell too many training programs. There needs to be a cut in like half of all residencies. They need to change to boards fail rate to 50%+. I would even say a 5 year total moratorium on pathology training in surplus states like NY, CA and MA. In addition a revocation of all licensure/board certification of physicians past the age of 72-75 unless they recertify and pass the complete AP/CP exam. I would also limit the number of applicants able to sit for the each subspeciality exam, maybe raising the the fail rate for cyto and heme. In addition, I would *expand* dramatically the number of dermpath seats, doubling them at least. There should be a 1:3 to 1:4 ratio of dermpath fellows:total trainees/year. Basically, AP should = dermpath fellowship. I would eliminate surgpath fellowships completely, instead everyone would do a combo of derm/GI/GU for that year AND be able to sit for the boards in dermpath (that is easily accomplished). I would also mandate 100 lecture hours for pathology business models, billing, insurance and contracts law. I would say we are closing on full on crisis mode now.

 

[juddson]

The big cause of all this: there are WAY the hell too many pathology trainees, especially IMGs. Way way too many fellowship trained pathologists. And way the hell too many training programs. There needs to be a cut in like half of all residencies. They need to change to boards fail rate to 50%+. I would even say a 5 year total moratorium on pathology training in surplus states like NY, CA and MA. In addition a revocation of all licensure/board certification of physicians past the age of 72-75 unless they recertify and pass the complete AP/CP exam. I would also limit the number of applicants able to sit for the each subspeciality exam, maybe raising the the fail rate for cyto and heme. In addition, I would *expand* dramatically the number of dermpath seats, doubling them at least. There should be a 1:3 to 1:4 ratio of dermpath fellows:total trainees/year. Basically, AP should = dermpath fellowship. I would eliminate surgpath fellowships completely, instead everyone would do a combo of derm/GI/GU for that year AND be able to sit for the boards in dermpath (that is easily accomplished). I would also mandate 100 lecture hours for pathology business models, billing, insurance and contracts law. I would say we are closing on full on crisis mode now.

Well, if what you say is true, you can count me out (which will help your cause in the end).

judd

 

[LADoc00]

Well, if what you say is true, you can count me out (which will help your cause in the end).

judd

How does that help? Your spot will just be snatched up by an IMG....sigh.

 

[juddson]

How does that help? Your spot will just be snatched up by an IMG....sigh.

BTW, who determines how many pathologists will be trained each year anyway?

Judd

 

[yaah]

The big cause of all this: there are WAY the hell too many pathology trainees, especially IMGs. Way way too many fellowship trained pathologists. And way the hell too many training programs. There needs to be a cut in like half of all residencies. They need to change to boards fail rate to 50%+. I would even say a 5 year total moratorium on pathology training in surplus states like NY, CA and MA. In addition a revocation of all licensure/board certification of physicians past the age of 72-75 unless they recertify and pass the complete AP/CP exam. I would also limit the number of applicants able to sit for the each subspeciality exam, maybe raising the the fail rate for cyto and heme. In addition, I would *expand* dramatically the number of dermpath seats, doubling them at least. There should be a 1:3 to 1:4 ratio of dermpath fellows:total trainees/year. Basically, AP should = dermpath fellowship. I would eliminate surgpath fellowships completely, instead everyone would do a combo of derm/GI/GU for that year AND be able to sit for the boards in dermpath (that is easily accomplished). I would also mandate 100 lecture hours for pathology business models, billing, insurance and contracts law. I would say we are closing on full on crisis mode now.

I think people should just be able to take fellowship boards if they want. If you can't pass, you can't pass. Sure, you can learn a bit in derm clinic if you are doing dermpath, but simply certifying that someone goes to clinic shouldn't be a huge boundary to letting people take the boards.

I agree though, too many training programs. What I am curious about is where do all these people who go to the subpar programs go for jobs?

 

[soopa]

How does that help? Your spot will just be snatched up by an IMG....sigh.

yep........like me.

 

[LADoc00]

I think people should just be able to take fellowship boards if they want. If you can't pass, you can't pass. Sure, you can learn a bit in derm clinic if you are doing dermpath, but simply certifying that someone goes to clinic shouldn't be a huge boundary to letting people take the boards.

I agree though, too many training programs. What I am curious about is where do all these people who go to the subpar programs go for jobs?

Big commericial labs, chop shops, shake and bake start ups especially in cytology, derm and hemepath, I have seen it firsthand. We are talking people who barely scraped by at totally ****ty residency programs, ones SO bad that even the faculty said the program is crap AND they come out with almost no one willing to even write them a recommendation. Im talking people who sign out with an English-Chinese (and Im sorry if Im baggin on IMGs but this was the case) dictionary IN HAND. Ive seen board certified pathologists HAPPY they are working a job that is 50 hours/week and are making a solid 70K/year. I knew one IMG that had to come in at 3am and sign out before 9am, to limit her interactions with the remaining staff because they had so much disdain for her. That crap is sad. Often they are given part time salary, sometimes in the 40-50k/year range but forced to work 40 hours/week. And the best part: they get like no benefits, we are talking about docs who are in such sorry shape they have to get their healthcare at FREE clinics. I have seen a full on board certified pathologist beg for scraps at a heme conference lunch to feed his family. I damn near thought I was in war torn Liberia or Lebanon. Im serious, I was teary eyed when I saw that crap, I even gave the guy 5 bucks I had in my wallet.

 

[cerev]

The big cause of all this: there are WAY the hell too many pathology trainees, especially IMGs. Way way too many fellowship trained pathologists. And way the hell too many training programs. There needs to be a cut in like half of all residencies. They need to change to boards fail rate to 50%+. I would even say a 5 year total moratorium on pathology training in surplus states like NY, CA and MA. In addition a revocation of all licensure/board certification of physicians past the age of 72-75 unless they recertify and pass the complete AP/CP exam. I would also limit the number of applicants able to sit for the each subspeciality exam, maybe raising the the fail rate for cyto and heme. In addition, I would *expand* dramatically the number of dermpath seats, doubling them at least. There should be a 1:3 to 1:4 ratio of dermpath fellows:total trainees/year. Basically, AP should = dermpath fellowship. I would eliminate surgpath fellowships completely, instead everyone would do a combo of derm/GI/GU for that year AND be able to sit for the boards in dermpath (that is easily accomplished). I would also mandate 100 lecture hours for pathology business models, billing, insurance and contracts law. I would say we are closing on full on crisis mode now.

There was a lot of talk of the glut of pathologists at the end of 2005 when two classes of AP/CP residents graduated. One thing that I haven't seen mentioned is that going from 5 years to 4 years has caused a significant increase in the number of pathologists entering the job market every year. AP/CP programs that had 20 pathologists (4 per class for 5 years) before the switch, needed to increase class size by one a year (or 25%) in order to keep their total resident workforce constant after the switch. While the total number of path residents hasn't changed much, the number pumped out every year has increased substantially.

If you don't believe me, see for yourself:

http://www.nrmp.org/res_match/data_tables.html (see Table 5)

If you look at the data, there has been a 44% increase in the number of path residency spots between 2002 and 2005— even more than predicted. The only other specialty that has seen a comparable increase is anesthesiology, and I am sure they are undergoing the same problems that pathologists are experiencing.

One has to ask, what the hell are the program directors thinking? My guess is that the academics knew that their programs would have a labor shortage when the transition phased in. What did they do? Rather than hire more trained pathologists and technicians to share the burden, they decided to take the easy road and boost the ranks of their slave-labor residents. This had the negative effect of dramatically increasing the number of trainees and thus future pathologists. An increase in the supply of pathologists can only cause downward pressure on wages and jobs. I don't know if this will be offset by the watershed that the aging population is suppossed to bring, but I am skeptical.

 

[LADoc00]

One has to ask, what the hell are the program directors thinking? My guess is that the academics knew that their programs would have a labor shortage when the transition phased in. What did they do? Rather than hire more trained pathologists and technicians to share the burden, they decided to take the easy road and boost the ranks of their slave-labor residents. This had the negative effect of dramatically increasing the number of trainees and thus future pathologists. An increase in the supply of pathologists can only cause downward pressure on wages and jobs. I don't know if this will be offset by the watershed that the aging population is suppossed to bring, but I am skeptical.

They are thinking: screw you all. Clearly, they care as much for pathology as California does for its overburdened prison system.


OMFG pathology slots went from 335 to 525 in 5 years?! Holy shiat. This is screwed. Total FUBAR!!!!!!!!

Okay, Im gonna call for lifeboats now unless someone has a bright idea out of this dunghole.

 

[juddson]

OMFG pathology slots went from 335 to 525 in 5 years?! Holy shiat. This is screwed. Total FUBAR!!!!!!!!

Okay, Im gonna call for lifeboats now unless someone has a bright idea out of this dunghole.

Not sure about the rest of your post, but those numbers are ****ed up!!!

Judd

 

[pathdoc68]

You guys are depressing the s***t out of me! I have got a family to provide for.

 

[LADoc00]

You guys are depressing the s***t out of me! I have got a family to provide for.

RUN, for the love of God, run.

Everyone needs to tell your PD about this thread, we need to shut down programs NOW. Close all residencies, **** we need to do something dramatic or we're f-ckin doomed!!

Juan Rosai found!!!!

**** Im almost ready to call "Game Over"....and yesterday things seemed so rosey.....

 

[LADoc00]

Not sure about the rest of your post, but those numbers are ****ed up!!!

Judd

2006 CAP MEETING
Theme: We bankrupted an entire medical speciality, WE OWN!
Topics to include but not limited to:
What to do when homeless ex-residents wont leave the residents' room.
Junior faculty forum: Why your foodstamps are more than you f-cking deserve.
Spotting vitamin deficiencies amongst your clinical fellows: The growing problem of scurvy in academic cytology training programs.
Fun forums that will include: What will your female residents do for a crisp 10 dollar bill and piece of cold chicken?

Come join us now in the fresh San Diego sun. Our friendly sponsors at Ameripath and Quest Diagnostics are hosting our speakers at the downtown county homeless shelter.

Warning: City police have already warned us panhandling will not be tolerated. In addition, please have your passports ready if you are not a U.S. citizen.

ENJOY!

 

[Mountain Path]

@LADoc

All your suggestions sound good hypothetically, but if we make too much of a fuss, then we lose any hope of working with these guys at all. There is still their medicare cases which they can't send to themselves. And who knows if they will even be able to pull this off or maybe state/national law will change that will disallow such for profit self referral ventures. Once you spend a couple decades doing this you realize there are always ups and downs.

However, I think we may have hit end-game. If the people that supply the tissue are going to keep if for themselves and hire pathologists to work for 1/3-1/2 the normal compensation, then there really isn't way out of that.

Pathology is never going to die, and pathology will always be a rewarding and interesting life, but I think it will be moving more down towards the lower end on the monetary scale now that so many others have figured out how to take a cut for themselves.

I think Pathology is a great career, and I have never been unhappy at work, but if I was starting over today, given the life I wanted to provide for my family and children, I would go surgical subspecialty or gastroenterology or cardiology. Those are very interesting and rewarding areas of medicine and they are undergoing continual explosion.

 

[djmd]

However, I think we may have hit end-game. If the people that supply the tissue are going to keep if for themselves and hire pathologists to work for 1/3-1/2 the normal compensation, then there really isn't way out of that.

A while back (in a different tread I think) I mentioned where a GI group ran into problems because their Biopsy were read by and their internal guy, but then the surgical colons (they were called positive for Adeno) were negative, and the biopsy were requested for review. Which were also not adeno, but TA.

Maybe talking with the surgeons they refer to? Those surgeons aren't getting any thing extra for them doing their internal biopsies, and are acting on the GI groups pathologist.

I wonder how pathology groups could run the reverse.. We hire our own people to Biopsies... (ala LADoc's Spa experience)

 

[LADoc00]

@LADoc

All your suggestions sound good hypothetically, but if we make too much of a fuss, then we lose any hope of working with these guys at all. There is still their medicare cases which they can't send to themselves. And who knows if they will even be able to pull this off or maybe state/national law will change that will disallow such for profit self referral ventures. Once you spend a couple decades doing this you realize there are always ups and downs.

However, I think we may have hit end-game. If the people that supply the tissue are going to keep if for themselves and hire pathologists to work for 1/3-1/2 the normal compensation, then there really isn't way out of that.

Pathology is never going to die, and pathology will always be a rewarding and interesting life, but I think it will be moving more down towards the lower end on the monetary scale now that so many others have figured out how to take a cut for themselves.

I think Pathology is a great career, and I have never been unhappy at work, but if I was starting over today, given the life I wanted to provide for my family and children, I would go surgical subspecialty or gastroenterology or cardiology. Those are very interesting and rewarding areas of medicine and they are undergoing continual explosion.

So are we raising the white flag or what? Should we advise the residents slap the Cemtex/C-4 into their packs and head into the departments on one last suicide bomber run....

****, and I just got here! I feel like not only did I miss the housing boom, but everything else as well.

B-school, here I come!

circa 360 BC Hippocrates coins the term carcinoma
1761 A.D. Giovanni Morgagni performs the first post mortem examinations of oncology deaths
1855 A.D. Rudolf Virchow publishes Omnis cellula e cellula, founds microscopy
August 8th, 2006 A.D. Pathology officially collapses as a viable medical speciality as illegal immigrants are offered residency positions at academic institutions due to the massive scaleback in the construction industry

Pathology

1855-2006

 

[cerev]

They are thinking: screw you all. Clearly, they care as much for pathology as California does for its overburdened prison system.


OMFG pathology slots went from 335 to 525 in 5 years?! Holy shiat. This is screwed. Total FUBAR!!!!!!!!

Okay, Im gonna call for lifeboats now unless someone has a bright idea out of this dunghole.

If you believe that pathology has been negatively impacted by an oversupply of pathologists, then the best solution is to decrease the number of pathology training spots. As far as I can see, these will be the consequences (of course speculations):

1) The quality of pathology residents will increase
- fewer spots means that path should become more competitive
- fewer spots also means that there will be more work during residency. This will decrease the number of people entering path because they perceive it as a "lifestyle" specialty (and select for people who actually like what they are doing). Further, having a higher percentage of well-trained, intelligent pathologists can only help increase the prestige of the field and benefit patient care.

2) Stopgap measures that limit the number of practicing pathologists (like high failrure rates for ABP boards) will no longer be necessary. My guess is that the high failure rates for the AP/CP boards are only in place because the professional organizations realize that there are too many pathologists and are trying to stem the tide of pathologists entering the field. Failure rates (if we actually knew what they were) probably increased during the last couple years as more and more newly minted pathologists have sat for the boards. This is silly-- why waste the effort to train people if you are only going to put up barriers to their entering the field once finished?

3) Job availability and pay will normalize. Less competition between pathologists for the available jobs means that there will be more work and thus more opportunities for pathologists. Subpar employers that feed on desperate patholgists will fall by the wayside as jobs become more plentiful.

Of course, there are vested interests that probably will fight to ensure that this does not happen. They are:

1) The GI docs noted above and large path firms that prey on the desperate. Do they want pathologists to have the opportunity to choose between decent, well compensated jobs and their crap jobs?

2) Academic departments that make the residents do all the work or think that anyone working for an academic medical center must spend time doing research. My guess is that the problem started here. There is a certain amount of work that any academic medical department relies on the residents to perform. In pathology the total number of residents finishing every year has increased in the last 5-6 years (and likely has plateaued). The fact that the job market cannot absorb these people once they graduate (as I am not a pathologist, I am taking what you people say about this on faith) suggests that there is assymetry between the academic and non-academic settings.

 

[juddson]

There's quite a bit of speculation here. Here's my question - some of you no-doubt can answer - have pathologists seen a decline in income over the past 5 years that cannot be attributed to decreases in reimbursements? Either way, is the pathology community predicting a decrease in compensation going forward?

Judd

 

[CameronFrye]

- fewer spots also means that there will be more work during residency. This will decrease the number of people entering path because they perceive it as a "lifestyle" specialty (and select for people who actually like what they are doing).

I don't know how it is at all programs, but I didn't notice a lack of work at any of the places I interviewed at. In fact, most of the programs I visited are having trouble with some of the new ACGME rules (specifically, the 10 hours off between shift rule).

Now, if you're talking about CP, that's a different story.

 

[djmd]

So are we raising the white flag or what? Should we advise the residents slap the Cemtex/C-4 into their packs and head into the departments on one last suicide bomber run....

****, and I just got here! I feel like not only did I miss the housing boom, but everything else as well.

B-school, here I come!

circa 360 BC Hippocrates coins the term carcinoma
1761 A.D. Giovanni Morgagni performs the first post mortem examinations of oncology deaths
1855 A.D. Rudolf Virchow publishes Omnis cellula e cellula, founds microscopy
August 8th, 2006 A.D. Pathology officially collapses as a viable medical speciality as illegal immigrants are offered residency positions at academic institutions due to the massive scaleback in the construction industry

Pathology

1855-2006

I'm not dead yet!

Part of the reason for patchy development of this is that some states have laws that prevent kickback and self referal in all Insured patients...

Which means that pathology may continue to exist else where...
(or that those other states may start to adopt similar laws... )

(nice visual there LADoc. Cemtex...)

 

[LADoc00]

I'm not dead yet!

Part of the reason for patchy development of this is that some states have laws that prevent kickback and self referal in all Insured patients...

Which means that pathology may continue to exist else where...
(or that those other states may start to adopt similar laws... )

(nice visual there LADoc. Cemtex...)

Arnold just issued an order attempting to ban balanced billing, if that holds, California is OVER. Evac, big time. **** man, is it just me or all of the sudden this week did the sky really start falling!!

Run bunny RUN!

 

[juddson]

Arnold just issued an order attempting to ban balanced billing, if that holds, California is OVER. Evac, big time. **** man, is it just me or all of the sudden this week did the sky really start falling!!

Run bunny RUN!

What is balanced billing and why does its banning tend to induce fantasies of suicide.

Judd

 

[SaltySqueegee]

This might be a naively gestured thought, but:

How will the ageing population of babyboomers fit into the equation?

Good for pathology, i.e. more business?

Bad for pathology, push for cheaper access to medicine, i.e. GI docs with their own internal path labs will benefit even more?

 

[LADoc00]

This might be a naively gestured thought, but:

How will the ageing population of babyboomers fit into the equation?

Good for pathology, i.e. more business?

Bad for pathology, push for cheaper access to medicine, i.e. GI docs with their own internal path labs will benefit even more?

READ:

http://www.amazon.com/gp/product/02...1034/ref=pd_bbs_2/104-4947667-6207968?ie=UTF8

In 2030, as 77 million baby boomers hobble into old age, walkers will outnumber strollers; there will be twice as many retirees as there are today but only 18 percent more workers. How will America handle this demographic overload? How will Social Security and Medicare function with fewer working taxpayers to support these programs? According to Laurence Kotlikoff and Scott Burns, if our government continues on the course it has set, we'll see skyrocketing tax rates, drastically lower retirement and health benefits, high inflation, a rapidly depreciating dollar, unemployment, and political instability. The government has lost its compass, say Kotlikoff and Burns, and the current administration is heading straight into the coming generational storm.

But don't panic. To solve a problem you must first understand it. Kotlikoff and Burns take us on a guided tour of our generational imbalance, first introducing us to the baby boomers -- their long retirement years and "the protracted delay in their departure to the next world." Then there's the "fiscal child abuse" that will double the taxes paid by the next generation. There's also the "deficit delusion" of the under-reported national debt. And none of this, they say, will be solved by any of the popularly touted remedies: cutting taxes, technological progress, immigration, foreign investment, or the elimination of wasteful government spending.

 

[Mountain Path]

There's quite a bit of speculation here. Here's my question - some of you no-doubt can answer - have pathologists seen a decline in income over the past 5 years that cannot be attributed to decreases in reimbursements? Either way, is the pathology community predicting a decrease in compensation going forward?

Judd

Compensation fluctuate due to changes in medicare (which tends to dictate what the large carriers will offer). Medicare has actually given us a bump up the last couple of years.

Pathology has always done well, but it is hard to compare different years as you are not always comparing apples to apples.

When I was younger in my career in the early 90s, I by far made the most, but we were working with the minimum number of people. Literally none of us had any vacation for four years (except for major holidays). But we were all on the same page, so it was OK. And we did more back then then we do now where we work with the minimum number of people in order that pretty much some one can always be off ensuring 8 weeks of vacation a year. There was a different mentality in medicine back then (late 80s early 90s). No one ever talked about lifestyle. We worked every day but didn't care because the job was so much fun. Docs weren't obsessed with money. Medicine was a genteel respected profession. Venture capitalists weren't buying hospitals or histology labs. Doctors weren't involved in all these money making schemes, trying to open up their own labs, their own surgery centers, their own MRIs, their own this and that.

That all changed in mid to late 90s. Now it is a free for all food fight.

Things have been fine the last five years. Even in this locked in managed care market the path groups that don't work very hard (working only 4 days a week with 8 weeks vacation) earn over 300. The lean groups that work hard (10 hours a day 5 days a week) but still with some vacation can easily earn over 400.

But these new trends are scary. It might be very different in a few years if the people producing the tissue keep "the rights" to it to make money off the preparation and interpretation of the histology.

 

[LADoc00]

But these new trends are scary. It might be very different in a few years if the people producing the tissue keep "the rights" to it to make money off the preparation and interpretation of the histology.

I predict this will and should be unethical and illegal, but we will have to see. The obvious prohibition of self-referral laws dont seem to be kicking in like they should.

 

[Mountain Path]

I predict this will and should be unethical and illegal, but we will have to see. The obvious prohibition of self-referral laws dont seem to be kicking in like they should.

It is definitely unethical. Biopsies will for sure be going up.

However, I think a lot of pathologists groups which run their own labs for processing outpatient also are involved with unethical practices. There is one large group in town who has their own lab, and I was reviewing a pancreatic adenocarcinoma which they had worked up. They ordered 12 immunohistochemistry stains. The patient had no history of carcinoma, so it was not like there was a possible other primary site.

Pathologists owning their own histo labs is equally unethical and should be done away with.

 

[juddson]

Pathologists owning their own histo labs is equally unethical and should be done away with.

Why? Histology seems to me to be part and parcel of the profession of pathology. Why shouldn't they operate these labs?

judd

 

[Mountain Path]

Why? Histology seems to me to be part and parcel of the profession of pathology. Why shouldn't they operate these labs?

judd

Because it creates unethical scenarios like the one I mentioned before of piling on immunostains just to raise the bill. If pathologists own them than why shouldn't any physician? It's a money maker. It's not unlike 10 years ago when every group of physicians wanted to own their own out-patient MRIs and CTs. Should radiologists be the only ones entitled to that huge money maker?

We use our hospital's histo lab for our outpatient cases. They charge us a slightly reduced rate and we make a little from the processing. It's a great deal. However, we don't profit from ordering the browns on the blocks. The hospital bills for it or the reference lab we use when we don't have the anti-body available in house.

 

[deschutes]

Since this thread is titled "Trends"...

I'm posting this because I know how much you all like bitchin' Got this survey a few days ago, indirectly from I believe a resident from the Cleveland Clinic. I got the impression that it might somehow be related to the CAP Residents' Forum. Am however removing the contact info for privacy-related concerns - feel free to contact me if you want the email address in question.

"Dear colleagues,

There have been changes afoot in pathology training, with a change in the length residency in pathology and the increased emphasis on additional subspecialty training. As a result, residents are thinking about their post-residency careers much earlier in training. While program directors and the College of American Pathologists have been preparing for and discussing these changes for a long time, we do not have a good idea of the attitudes and opinions of those who are directly affected, the residents themselves. As such, we invite you to participate in a survey, created by residents for residents, about the current trends, attitudes, plans, and worries of our friends and colleagues. Ultimately, we hope to gain a better understanding of how the recent changes in pathology training has affected the current residents, and how this can be reconciled with the expectations of fellowship directors and potential employers. The survey is anonymous, and the findings will hopefully be presented at a national pathology meeting. To enter the survey, simply navigate in your web browser to the following link: http://www.surveymonkey.com/s.asp?u=39112273220 and follow the directions. The entire questionnaire should take approximately 10-15 minutes to complete. The link will be available from August 13th to August 25th."

 

[dermpathlover]

So are we raising the white flag or what? Should we advise the residents slap the Cemtex/C-4 into their packs and head into the departments on one last suicide bomber run....

****, and I just got here! I feel like not only did I miss the housing boom, but everything else as well.

B-school, here I come!

circa 360 BC Hippocrates coins the term carcinoma
1761 A.D. Giovanni Morgagni performs the first post mortem examinations of oncology deaths
1855 A.D. Rudolf Virchow publishes Omnis cellula e cellula, founds microscopy
August 8th, 2006 A.D. Pathology officially collapses as a viable medical speciality as illegal immigrants are offered residency positions at academic institutions due to the massive scaleback in the construction industry

Pathology

1855-2006

Dude you are too funny.

 

[dermpathlover]

I have a brilliant idea. I think I might go derm and GI fellowship and then go around and talk to derm and GI groups about getting their own histo labs set up. I'll get it set up, get it licensed, get it certified, negotiate the contracts with insurance companies, hire the billing company, hire an accountant, and start reading out their cases. Then once it is up and running, I'll hire a couple recently trainged D-path or GI-path trainess to take over. I'll offer them 300K a year with no weekends, no nights and ten weeks of vakay a year. Who wouldn't take that?

And I'll do it all for a long-term cut. I'll negotiate 10% of the profits or cut of the PC or TC or whatever.

Then I'll move on and do it with a group in a new city.

In 5 years or so, I would have 10 pathologists all making money for me.

Then I'll settle down in some small town in New Mexico or Wyoming with a 2000 acre ranch and a private jet and a partner in some lucrative local private practice because I do love pathology, and I'll have a condo on the water in Maui, and an apartment in Paris.

Now that's how you do it.

 

[djmd]

Now that's how you do it.

Just go play yer gitar on the M-TeeVee.

 

[b&ierstiefel]

Just go play yer gitar on the M-TeeVee.

you just have it out for dermpathfanboi, don't you?

 

[djmd]

you just have it out for dermpathfanboi, don't you?

I wouldnt if he didnt say these things...

So you are saying that isn't what you heard when you read that?

If anyone doesnt get the reference I will clear it up tomorrow...

 

[DarksideAllstar]

I wouldnt if he didnt say these things...

So you are saying that isn't what you heard when you read that?

If anyone doesnt get the reference I will clear it up tomorrow...

http://en.wikipedia.org/wiki/Money_for_Nothing_(song)

http://www.guntheranderson.com/v/data/moneyfor.htm

 

[salmonella]

Anyone else has any opinion on the current pathology job market? Is 2007 going to be a better year for Path?

 

[yaah]

I dunno. What do you mean by "A better year?" For new residents? For applicants? For more job openings? Higher salaries? You can't really judge any job market based on one year changes, it's more gradual. Anecdotally though I am seeing a lot more job postings and listings (and not for crap jobs).

 

[mcfaddens]

There is a simple way to stop this kind of crap. What are most clinical docs afraid of the most? Getting sued. Even a threatening letter can scare someone out of doing something. There are plenty of lawyers out there who would do anything for a couple of bucks no matter how frivolous the claim is. So I say get your specialized fellowship and start sewing these bastards for anything, testify against their pathos as an expert witness on any case they screw up on. Hit em hard its not like we dont have any free time in path, while these guys are rounding on their patients we can start screwing with them. Eventually they won't want to deal with the hassle and give up. Make the environment so painful that they invest their cash in something else. We need to start being the offence here and not the victims, if we dont we are finished. This is real f&*ing life, protect your goddamn a$$.

 

[Click Here!]

What are most clinical docs afraid of the most? Getting sewed.

Oh no! Not the needle and thread! No wait, it's suture! Run for your lives!