Pod Labs vs. Twincrest Labs

They pay well, especially when you are just starting out. There are lots of pathologists out there, maybe for some it is the right situation, I dunno. Doesn't sound like anything I would want to do. The pathologists are vital to the organization, so they will likely be treated well and compensated well, albeit at the "whim" of whoever the boss is. People who do not want the pressure of being a new person and fighting to become a partner, or who want an immediately financial reward, or simply don't have a ton of patience or confidence in their own abilities may jump at these opportunities. Would you answer an ad that said "$350k + per year with unlimited benefits, no call, M-F only?" Some people don't read between the lines.

Everything in this country (not just medicine) is trending towards maximizing profits (although generally only profits for major investors) and minimizing expenses. This is another attempt to do this. However, any medical endeavor that puts patient care secondary to profits and greed is unlikely to have long term success - an example being the outpatient surgery centers like the one where the guy died after having back surgery when they had to call 911 after he started crashing.

The more people take advantage of loopholes or procedural schemes to maximize profits, the more that these schemes will become scrutinized. I think one of the interesting aspects of medicine is seeing where things will go - will medicine become dominated by hedge funds, outside investors, and basically be used as a money making opportunity or will it shift away from that and towards patient care more. You can't really have it both ways, unless you are a gigantic private institution.

We have seen cases that come from outside places where profits are more important. Things such as # of slides, quality of staining, quality of sections, etc, are minimized in comparison to quality labs. It does impact patient care!

In a sense, to say that pathologists "don't participate" in profits at pod labs/condos/whatever is a bit inaccurate, since the pathologist is a key part of the scheme. The profits related to the pathology service won't exist without the pathologist, obviously. As long as there is a supply of pathologists willing to be taken advantage of, however, schemes like this are likely to continue where the pathologist is given less of a say and participation in this business itself.

When medicine becomes strictly a business, people start to suffer. I know I didn't go into medicine strictly for the money. The money is a nice benefit, and I am not going to take less than market value for my services, but I also am not going to compromise patient care for another 5-10%, which unfortunately is what many people are willing to do - and many of these people are the ones making the decisions.

 

The thing is, are pod labs really worse than massive labs like Ameripath or Bostwick or whatever? There really isn't much difference.

I saw a newsletter today hanging around the department about path economics or something. I will have to look again to see what it is called. But the current issue was about podlabs and how podlabs are fighting back against ASCP and others who would deny them. Their arguments include 1) we are actually better for pathologists than ameripath,bostwick,quest, whatever 2) We don't cut corners and we are better for patient care because we are local, there are more direct interactions, etc.

It's all BS, it's all about $$$ anyway. This same article said the reason for podlabs is that urologists and GI docs (with heme onc likely to follow) are losing income via reiumbursements, and so they are trying to make up the difference in creative ways. So they hire a pathologist and make a path lab, and make an extra million dollars a year for the group, which amounts to an extra $75 k per doc after paying the path techs and pathologist. And then the pathologist gets paid well and gets lots of benefits. At least, so goes the sales pitch.

Either way, if pod labs go away then someone else will just try to steal biopsy technical fee money, most likely a mega lab.

I kind of think mega labs are more of a threat than pod labs - that of course assumes that pod labs actually do what they say and provide quality care. That may be a big assumption.

 

Good points, I agree with those. I found the journal (pamphlet?) it is called laboratory economics and you can download a sample issue (which is the one I was referring to which talks about podlabs) at www.laboratoryeconomics.com

This same issue talks about how medicare reimbursement for the professional fee has been cut, but reimbursement for the technical fee is increasing. No doubt this plays in.

I think you are right that podlabs are more of an irritant than mega labs. At least mega labs have the pathologist with more power. But at the same time, this pamphlet talks about how the average annual collected revenue per ameripath pathologist is 1.5 million (doubled in the past 7-8 years). Pathologists are getting compensated more based on incentives (but ameripath pathologists do not make even 1/4 of that 1.5 million). To me, that sounds like an employee, not a partner.

I think it's irritating that bean counters and greedy 21st century robber barons are now in health care and making money off of others' work. But such is the way of things. It's not just pathology. It's all about the shareholders and the executive board.

In all of this "pod lab vs mega lab vs private practice" no where does the discussion ever seem to turn to pathologists themselves and what is best for them. It's either about saving money via volume or making money for the clinician (with the pathologist as a willing partner). Somehow I doubt pathologists will stand up to this though. Unlike urologists or gastroenterologists who can theoretically get patients to come to them, pathologists have to depend on other physicians sending their business. It's already a disadvantage.