The whining on here is rather pathetic at times. Any of you want struggling to find work want a guaranteed job for the next 20 years do 3 things: 1) complete a forensic pathology fellowship and pass the board exam 2) speak and write English well 3) not be a d-bag. Do those things, and you'll find work somewhere in the US or Canada for the next 20 years.
You had posted once that you had gone into Path for FP. Most of us do not like FP and, ABSOLUTELY, had NO expectation of leaving our state or country for a job. That is not the NORM for vast majority of other fields in Medicine. Otherwise, there are many jobs in Africa that we could recommend.
Your point that in Capitalism we are not guaranteed a job would be a fair argument, had our plight been a natural result of a free market. It is not, it is an entirely our incompetent leadership-made. Would you say that no one should expose the Law schools? Capitalism you describe is a "crony Capitalism" so prevalent in the third world countries.
Path residents (most of whom are Canadian) up here laugh at the notion of going to the US for crappier pay, far worse working conditions, and having to do multiple fellowships to have a chance to do that.
So if our plight is so well known even in Canada, how come our great leaders are not aware of it? Rather, they are urging "a drastic, immediate increase in residency spots and lamenting and apologizing (my jaw drops!) for not having minted more residents, thereby jeopardizing our field !!" Does not this fact alone bespeak of inner moral and ethical bearings of our leaders? I had first heard about the upcoming shortage from CAP in late 1980, and I have not seen it yet.
Maybe you can do us a favor by having your Canadian colleagues to write to leader that you guys are laughing about us.
The gist of the issue is whether our non-elected leaders, to whom "minting press" was granted, can abuse their position to a degree that borders a "stealing".
I came to the conclusion that those in this Forum who feel the job shortage is relative are those from Top programs, junior faculty in a tenure track, a
Pollyannaish Chairman and those whose career aspiration is just to live day by day. They are either the direct beneficiary of the surplus or unable to utter a word against the situation because their future career is in line.
Those clamoring are those who are newbies unable to find jobs and older experienced (in path and in business) pathologists in private practice who have Institutional memory of the past, see through the smoke being blown by the Academia, see what is coming and have a social conscience for the newbies.
Now I am convinced the Academics from Top Institutions are blinded for selfish reasons and will do nothing to elevate the Field. Therefore, my advice to those who CAN, AVOID PATHOLOGY, or if you are attracted to Pathology (as moths are to flame) go to Top programs only ! Those who have no options (I speak in code) do your best and be prepared for a rough career, but always watch for a way out.
In my opinion, biopsy volume will gradually decrease due to cost containment and new diagnostic technologies. The pathology as practiced in Academia is way too inefficient, I would say at most 50% efficiency of private practices. Even many private practice could get far more efficient. Old timers used to say: "Pathologist are underpaid for what we could do, and way overpaid for what we do". Now with the cuts they will do more. Most private practices could tighten their belts and do at least 20-30% more volume with current staffing by improving their work flow and reporting format, using PAs, locums, etc.
At macro level, before, RVS, we had the "usual and customary" fee schedule which meant you could charge what the Market determined. Now, with RVS, the Government got us by measuring all aspect of our work. Medicare used to pay us around 200k for 2080 hours of work for Part A (I do not what they pay now). This means they have our hours and have conversion factor that they control unilaterally. Those of moderately savvy in business can see what the G can do going forward with this type of setup.
Cut in 88346-26 did not surprise me, however, what surprised me was the extent and the way they did it (i.e., ignoring established rules and conventions, by using G codes).
For newbies, I suspect there are more codes out there that have not been looked at closely by Medicare, therefore, subject to cuts; AND there are other ESTABLISHED reimbursement fee schedules paying less than the one used now. Had Medicare used the rationale they used this year, they could have implemented the 88346-26 cut years ago.
For historical comparison, I remember that in 1980's, Medicare used to pay 1600-1800 for cataract (one side), now I think it is 500-600. I used see one guy do 20-30 cataracts in one morning, 3 times a week, all by himself. Back then AAO, had a video explaining the procedure where one cataract extraction, there were two fully scrubbed ophthalmologist and 2 nurses and taking over an hour for each site.
It is unfortunate that as we are entering a perfect storm of decreasing volume, reduced reimbursement and zero bargaining power in a position of oversupply without end in sight.
I stated in a post that you went into Path for FP. That is not the case for most of MSs, rather FP is the last thing they want to.
