Private Practice Pathology Business Model in full collapse now

[LADoc00]

Anyone have any clue wth is going on in groups near them? Im seeing a near panic levels of recruitment for either FT or PT staff pathologists but wages dont seem to be moving.

And Im seeing 3-4 month blocks needed that are comically impossible to cover. Is this pregnancy leave for the giant gender flux occurring? I have never seen locums needs that long before in this volume.

Is the arbitrage model of private practice owners now officially dead?? Is there is literally zero income potential hiring a staff pathologist and making money off the difference between collections and costs?

We maybe watching a 75+ year old practice system literally die like a carcass desiccating in the Mojave desert.

Someone grab the popcorn!

---

Members don't see this ad.

 

[Napoleon1801]

I've definitely heard of some private group staffing shortages in Louisiana.

 

[Guest8]

A former co-resident of mine was begging for any leads on good pathologists for his private practice in the Northeast. There might actually be a bit of a shortage right now, who knows.

 

[Med Director New England]

I am only seeing this driving more lab consolidation…many of the dying labs don’t have any business being in operation anyways.

Just hastening efficiencies that need to happen imo

 

[KeratinPearls]

A former co-resident of mine was begging for any leads on good pathologists for his private practice in the Northeast. There might actually be a bit of a shortage right now, who knows.

Yeah the email I got might suggest there’s a bit of a shortage. How much who knows?

A locums job paying ALOT for one month.

 

[Spikebd]

Yeah the email I got might suggest there’s a bit of a shortage. How much who knows?

A locums job paying ALOT for one month.

MGMA median is like $380k in private practice Pathology. Not too shabby.

 

[AZpath]

Anyone have any clue wth is going on in groups near them? Im seeing a near panic levels of recruitment for either FT or PT staff pathologists but wages dont seem to be moving.

And Im seeing 3-4 month blocks needed that are comically impossible to cover. Is this pregnancy leave for the giant gender flux occurring? I have never seen locums needs that long before in this volume.

Is the arbitrage model of private practice owners now officially dead?? Is there is literally zero income potential hiring a staff pathologist and making money off the difference between collections and costs?

We maybe watching a 75+ year old practice system literally die like a carcass desiccating in the Mojave desert.

Someone grab the popcorn

 

[AZpath]

Anyone have any clue wth is going on in groups near them? Im seeing a near panic levels of recruitment for either FT or PT staff pathologists but wages dont seem to be moving.

And Im seeing 3-4 month blocks needed that are comically impossible to cover. Is this pregnancy leave for the giant gender flux occurring? I have never seen locums needs that long before in this volume.

Is the arbitrage model of private practice owners now officially dead?? Is there is literally zero income potential hiring a staff pathologist and making money off the difference between collections and costs?

We maybe watching a 75+ year old practice system literally die like a carcass desiccating in the Mojave desert.

Someone grab the popcorn!

If this is true large private equity groups in RADS and Anesthesia are dead men walking already.

 

[Alteran]

I'm also getting a noticeably higher volume of unsolicited emails asking if I can do locums coverage for weeks at a time. I'm told though that the going rate for a locums is about $1,100/day on average in my state, which is slightly up from about a decade ago of $800/day. For comparison, traveling nurses are, or were, being paid ~$150-200/hr with travel and lodging included.

I suspect that a lot of hospitals and outpatient centers folded or realigned during COVID leading to a mass consolidation of work putting some pathology groups out of business and making other groups expand more quickly than they had anticipated. And as always, the LabCorps and Quests are on the prowl seeing what they can buy on the cheap.

I would like to say that this is a pathology only phenomenon, but I've seen the same with IM, ER, anesthesia, and diagnostic radiology. Pure hospital-based practices are either being folded into the hospital structure or being sent packing so the hospital's group can come in and provide service. Anatomic pathology means peanuts to a hospital's overall budget, so they won't bother folding most pathology groups into that kind of structure unless it's a matter of convenience. For an administration it's just easier to outsource it to the lowest bidder, though part A rates are so comically low overall that it's a matter of time before some bored bureaucrat starts looking into it.

 

[2brads]

If this is true large private equity groups in RADS and Anesthesia are dead men walking already.

About 30% of all radiology job listings are PE. Not sure how they’re making it work. That’s like 400-500 openings. Radpartners has 311 listings alone.

 

[LunaOri]

MGMA median is like $380k in private practice Pathology. Not too shabby.

Some practices pay even more—my hospital is currently offering about $435K, plus benefits, and they can’t get any decent candidates. Northeast, not too far from NYC, so it’s not that the location is the problem.

 

[KeratinPearls]

Some practices pay even more—my hospital is currently offering about $435K, plus benefits, and they can’t get any decent candidates. Northeast, not too far from NYC, so it’s not that the location is the problem.

I’ve read on here that people mention that they can’t find decent candidates. Now are we talking about candidates who don’t fulfill the subspecialty you are looking for (thus not a decent candidate) or are new trainees just that bad? Are you looking for signout experience?

Why exactly do you consider these people applying for your job less than decent? Some places have high standards so I’m wondering if that may be a reason?

I ask because I feel there’s just a lot of crappy candidates out there applying for jobs. Is it really that hard to find someone from the Northeast who is competent in general surgpath?

 

[Med Director New England]

Some practices pay even more—my hospital is currently offering about $435K, plus benefits, and they can’t get any decent candidates. Northeast, not too far from NYC, so it’s not that the location is the problem.

Wait , what ?

435 salary and no one applying in path
Or are you talking about rads.

 

[2brads]

$435k would be lower end starting for rads.

 

[LunaOri]

I’ve read on here that people mention that they can’t find decent candidates. Now are we talking about candidates who don’t fulfill the subspecialty you are looking for (thus not a decent candidate) or are new trainees just that bad? Are you looking for signout experience?

Why exactly do you consider these people applying for your job less than decent? Some places have high standards so I’m wondering if that may be a reason?

I ask because I feel there’s just a lot of crappy candidates out there applying for jobs. Is it really that hard to find someone from the Northeast who is competent in general surgpath?

Not well trained. Limited experience. Poor social skills.

 

[LunaOri]

Wait , what ?

435 salary and no one applying in path
Or are you talking about rads.

Path. PM me if you know any possible candidates.

 

[KeratinPearls]

Not well trained. Limited experience. Poor social skills.

Lol sounds like most graduating residents I know.

I’ve always thought we, as a field, have too many programs most of which are pumping out subpar candidates who arent even competent to practice.

That’s why I think we should have a practical exam which will serve as a QA for ALL RESIDENCY PROGRAMS, which was suggested earlier by Alteran.

There are a bunch of programs inManhattan. I’m surprised you can’t find one. Not even a surgpath fellow from MSK which I hear has good training? Most grads have limited to no signout experience. Maybe that’s why you can’t find someone. You are looking for experience.

 

[LunaOri]

Lol sounds like most graduating residents I know.

I’ve always thought we, as a field, have too many programs most of which are pumping out subpar candidates who arent even competent to practice.

That’s why I think we should have a practical exam which will serve as a QA for ALL RESIDENCY PROGRAMS, which was suggested earlier by Alteran.

There are a bunch of programs inManhattan. I’m surprised you can’t find one. Not even a surgpath fellow from MSK which I hear has good training? Most grads have limited to no signout experience. Maybe that’s why you can’t find someone. You are looking for experience.

We’d take a new grad, but they seem to want subspecialty practice at an academic center, not general practice.

 

[path24]

A bunch of programs that won't hire the people they train (train them to gross/do paperwork). Shut down the freaking program.

 

[LunaOri]

Lol sounds like most graduating residents I know.

I’ve always thought we, as a field, have too many programs most of which are pumping out subpar candidates who arent even competent to practice.

That’s why I think we should have a practical exam which will serve as a QA for ALL RESIDENCY PROGRAMS, which was suggested earlier by Alteran.

There are a bunch of programs inManhattan. I’m surprised you can’t find one. Not even a surgpath fellow from MSK which I hear has good training? Most grads have limited to no signout experience. Maybe that’s why you can’t find someone. You are looking for experience.

We would take a new grad. They all want to be academic subspecialists.

 

[Spikebd]

We’d take a new grad, but they seem to want subspecialty practice at an academic center, not general practice.

Some academic attendings tell residents they’re never gonna make it and be unemployable unless they’re subspecialized.

 

[shikimate]

Something that really ticks me off is a lot of older IMG work and think like useless government bureaucrats. Maybe that's how it works back in their homeland. They always find ways to either be on vacation or some other excuse to be not in their office, even when the specimens are like a week behind.

 

[HeyDalaron]

Something that really ticks me off is a lot of older IMG work and think like useless government bureaucrats. Maybe that's how it works back in their homeland. They always find ways to either be on vacation or some other excuse to be not in their office, even when the specimens are like a week behind.

If you're referring to Ontario, that's because they are paid like useless government bureaucrats. There's no incentive to excel.

 

[Pathprimer]

A former co-resident of mine was begging for any leads on good pathologists for his private practice in the Northeast. There might actually be a bit of a shortage right now, who knows.

A former co-resident of mine was begging for any leads on good pathologists for his private practice in the Northeast. There might actually be a bit of a shortage right now, who knows.

Hi! You mentioned your friend is looking for a pathologist. I have been in practice for a year and now I am looking for other opportunities. Would you mind sharing which hospital is hiring? You can PM me if needed. Thanks!

 

[maxxor]

$435k would be lower end starting for rads.

(Am rads): My state must be a hellhole. No place pays that much starting, but the ossified partners are making twice that off their pyramid partnerships where the associates start sub 300…

 

[KeratinPearls]

(Am rads): My state must be a hellhole. No place pays that much starting, but the ossified partners are making twice that off their pyramid partnerships where the associates start sub 300…

180-200 starting was the norm when I applied for jobs in pathology so don’t feel too bad lol.

 

[LADoc00]

I am only seeing this driving more lab consolidation…many of the dying labs don’t have any business being in operation anyways.

Just hastening efficiencies that need to happen imo

I will be honest because I have spent several hours thinking about due to my own situation: There is no role for lab "consolidation" to make any difference whatsoever. Small "in town" regional efforts in histology might be possible, but unless there is widespread adoption of virtual microscopy combined with remote directorships, I dont need how this football moves forward.

3 elements need to become near universal for what will be the next phase of the disruptive pathology transformation:
1.) Virtual microscopy where cases are grossed by low level staff at facilities, move to a core lab and are read at banks of cubicles by staff pathologists. This would have to include frozen sections. Eventually this moves completely to a cloud environment where pathologists are at home, can remotely see specimens grossed on video feeds, read and order follow on testing via computer terminals in their residence & massively reducing overhead.
2.) Remote directorships where clinical labs as well as tumor boards, staff meetings and conferences are 100% video calls. Here you have 20 "at home" pathologists you could pay maybe minimally due to flexibility and cover 100 hospitals.
3.) The staff to power this model.

I think the above is actually inevitable now due to the sea change in the gender distribution of pathology, the fact that women much prefer at home work options and greater flexibility and the acceptance that at the end of the day pathologists who dont have procedures as part of their practice (vast majority of us now), do not need to ever step foot in a hospital or clinic as we have COVID mini outbreak after outbreak. The above model is completely resistant to lockdowns, emerging infectious disease and local labor shortages. Its actually even resistant to national-level issues like taxes as I could employ licensed staff living abroad very easily.

You build this model to be 100% vertically integrated from having your own residency and fellowship (remote of course), to training your own pathology assistants for the hospital component up to the IT cloud management of the massive data storage needed. Eventually you produce your own formalin/fixation chemicals, histology equipment, stains, antibodies etc. You lock the market completely down and make the ghost of John D. Rockefeller proud.

Once you can give people true 100% remote work, companies can hire pathologists for 150K fairly easily. At some point soon, if it hasnt already occurred, venture capital will see this opportunity and move in to completely crush established large practices (or offer to buy them? who knows) on scale we have never seen (even beyond the Ameripath emergence).

I think the above is a no brainer for a disruptive Silicon Valley-type start up given the notoriously dumb ideas like Cerebral they have put forward and got billions in VC money for already in the last 10 years.

Ive been toying with the idea of creating a pitch deck presentation and selling this to Sand Hill with the Codename: Tiamat so no one steal my idea!!!! I will hunt you

Tiamat, the Dragon of Chaos, will first eat the dying carcass of pathology groups, then feed on the Leicas, Ventanas, Thermo-fishers, etc. Then you eat all the molecular testing companies that currently beg groups and histology labs for blocks. All the blocks will be Tiamat's blocks. All the testing will be Tiamat's property. It will be corporate version of opening a black hole and the gravitational pull drags in a 1000 companies crushing them into the singularity.

 

[KeratinPearls]

Yeah I can see a world where all of pathology is digital. Digital images get sent immediately to fellow pathologists for consult. They get sent to experts immediately if needed. Tumor board conferences handled remotely with digital images utilized for conferences. You can be on your PJs working at home without ever setting foot in a hospital.

A big large company pays pathologists to work remotely to read biopsies, read frozens in the hospital and all consultations with clinicians are done on a Zoom platform.

Glass slides will be a thing of the past.

 

[LADoc00]

Cytopathology in focus: ROSE and telecytopathology: a point-of-care test - CAP TODAY

May 2022—Substantial progress has been made during the past several years in diagnosing and treating various illnesses. Advances in genetic and genomic science; imaging and localization devices; the use of minimally invasive diagnostic sampling procedures; diagnostic, prognostic, and predictive...

www.captodayonline.com

so it begins..

 

[HeyDalaron]

Yeah I can see a world where all of pathology is digital. Digital images get sent immediately to fellow pathologists for consult. They get sent to experts immediately if needed. Tumor board conferences handled remotely with digital images utilized for conferences. You can be on your PJs working at home without ever setting foot in a hospital.

A big large company pays pathologists to work remotely to read biopsies, read frozens in the hospital and all consultations with clinicians are done on a Zoom platform.

Glass slides will be a thing of the past.

I had hoped one day the tech will reach the point where slapping glass will be a memory.

 

[WEBB PINKERTON]

You better hope the guardant360s of the world dont put you out of business.

 

[Mordak]

I have also thought about this model for pathology.

I suppose my thoughts are, the increasing commoditization of the field is fast tracked by digital path. Your plan sounds attractive, but I think it misses something.

It sounds like this would effectively remove any sort of personal connection between pathologist and their clinicians.

If i understand correctly, thinking along the lines of remote path work, clinicians would potentially be getting a different pathologic opinion/interpretation each time as there would likely be little consistency in who is signing out the case. Is there anything in that relationship that would make clinicians less likely to use that service? ..Would it matter?

I personally think that there is added value in retaining some degree of centralized services. In addition to grossing and frozens/rapid interpretations, I still can't see how many centers would totally reduce hospital based pathologists because there is still value in the relationship between pathologist and clinician. Am I naive in this assessment? Maybe I am grossly unaware of the methods of digital pathologist implementation which could mitigate such an issue?

Also, I think your system would require many more path assistants/mid levels who can gross independently, which is an invention of a new problem. Last, while ROSE type assessments sound attractive, they all require hiring professional cytotech staff to help make the slide to scan, so in many cases, it again would require hiring staff which is difficult to find.

I bring this up because we are currently debating about the utility of digital path implementation for our practice and I think need to weigh the pros and cons.

Curious to know others' opinions. I personally don't see a big advantage to our particular group so far.