Rather than sitting home job-less. Lets ...

[LADoc00]

Pathology's problems are mostly those of medicine in general.

Actually this couldnt be further from the truth. There is no area of medicine perhaps aside from Radiology that faces such extreme pressure of commoditization than Pathology. That is the truly dark side of this profession.

Medicine in general has cost issues but Pathology is truly unique in the ruthless manner our skill test is being bought and sold.

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[lipomas]

Actually this couldnt be further from the truth. There is no area of medicine perhaps aside from Radiology that faces such extreme pressure of commoditization than Pathology. That is the truly dark side of this profession.

Medicine in general has cost issues but Pathology is truly unique in the ruthless manner our skill test is being bought and sold.

Are you serious? Doesn't sound further from the truth at all to me. They all are facing pressure of commoditization, except for the highly specialized surgical and medical fields. It's just a different type of commoditization. Go talk to an anesthesiologist about how they aren't being commoditized, or a primary care. Even ER. Everything is coming down to billing and time spent. At least pathologists don't have midlevels doing our job for cheaper amounts.

 

[lipomas]

Pathology's problems are mostly those of medicine in general. Whatever these problems are, and people will have different opinions on which are more important, having excellent candidates enter the field is most certainly not one of them. One problem is actually having too few excellent candidates enter the field. Many individuals' impressions of the field of pathology stem directly from the pathologists that they encounter most frequently. Unfortunately this is not always a good thing.

yep

Most of the problems people whine about on this forum are perpetuated by the numbers of weak pathologists out there. The solution always put out on here is to decrease residency spots, which sounds great in theory but no one ever seems to acknowledge how actually difficult this would be to accomplish politically.

Our group has a good reputation. But there are groups in my area that are most definitely not respected (either by clinicians or other pathologists). They order too many tests. They don't communicate much, and when they do they are often wrong or ignorant. And the other unfortunate thing is that many of them are actually excellent pathologists, but their communication skills are kind of weak or they work in a group with some weaker pathologists so they get tarred with that brush.

I don't know how to solve this either, but getting better people into the field would be helpful.

 

[mlw03]

Are you serious? Doesn't sound further from the truth at all to me. They all are facing pressure of commoditization, except for the highly specialized surgical and medical fields. It's just a different type of commoditization. Go talk to an anesthesiologist about how they aren't being commoditized, or a primary care. Even ER. Everything is coming down to billing and time spent. At least pathologists don't have midlevels doing our job for cheaper amounts.

On this point, did anyone see the story about ER physicians on 60 minutes recently? If not, worth checking out. Basically ER docs of a private hospital company were told admit 20% of patients or they got the boot.

 

[KeratinPearls]

On this point, did anyone see the story about ER physicians on 60 minutes recently? If not, worth checking out. Basically ER docs of a private hospital company were told admit 20% of patients or they got the boot.

Yup I wish 60 minutes would do a spot on self referral in medicine and medicare fraud. Ive been reading about all these stories on medicare fraud on pathologyblawg. Seems to be billions of dollars. There has got to be a way of controlling fraud in this country better. Its killing us.

That VP of the healthcare company was denying it all...LOL.

 

[yaah]

Actually this couldnt be further from the truth. There is no area of medicine perhaps aside from Radiology that faces such extreme pressure of commoditization than Pathology. That is the truly dark side of this profession.

Medicine in general has cost issues but Pathology is truly unique in the ruthless manner our skill test is being bought and sold.

Um huh? The specifics of pathology are obviously unique but the general trend really isn't. I think it depends on how you define "commoditize." The points above about ancillary and midlevel staff starting to do things that used to be confined to doctors is important. In some places midlevels are starting to become the gatekeepers, they need fewer doctors. This might be beneficial in some ways, but try going into anesthesia's forum and posting about how great CRNAs are and see what kind of response you get.

All of medicine is moving towards the employment model. There was a study on medscape that said something like 75% of new hires will be "employed by hospitals." And this isn't only because hospitals want it - new doctors want it too.

 

[Thrombus]

Huh? Nowhere in there do you say how it is helping. I am not really arguing with your points, the criticisms you make about the field are valid to some extent. But this is really not an effective place to make these criticisms, other than making you feel important when people tell you how right you are. It does nothing for the field.

What I was saying is that your complaining and whining here are not at all helpful to solving the problems you are putting forth. It actually does a disservice.

Again, how is it helpful? You might claim it is "helpful" in that it helps future pathologists who are on the fence choose something else. But that isn't really the problem. The problem in pathology is most definitely NOT having too many excellent candidates enter the field. You do a disservice.

It is the problem. I would rather have excellent candidates enter other fields who we do business with and work with. We need more good people seeing patients and less seeing specimens. If you have too much to do, I will send a courier to your practice next week and sign out all your 88305s.

We do not need any more help practicing pathology. The field is saturated, will be saturated for the next few decades at least, and folks who enter the field are the competition.

The CAP and other leadership organizations have FAILED and are doing worthless things such as trying to get us to see patients for zero reimbursement???

Academia is being subsidized with money that the taxpayers do not have to sit on their butts and do as little as possible. They have become the problem while we work our tails off out in the field and have 10 companies all trying to pry off our business as a result of the oversupply.

 

[MetroPath]

It is the problem. I would rather have excellent candidates enter other fields who we do business with and work with. We need more good people seeing patients and less seeing specimens. If you have too much to do, I will send a courier to your practice next week and sign out all your 88305s.

We do not need any more help practicing pathology. The field is saturated, will be saturated for the next few decades at least, and folks who enter the field are the competition.

The CAP and other leadership organizations have FAILED and are doing worthless things such as trying to get us to see patients for zero reimbursement???

Academia is being subsidized with money that the taxpayers do not have to sit on their butts and do as little as possible. They have become the problem while we work our tails off out in the field and have 10 companies all trying to pry off our business as a result of the oversupply.

Do clinicians care that you are the local pathologist who they know and can trust? Or do inducements by companies win every time? If I had to send my biopsy miles away to some factory to an unknown pathologist, I would be kind of worried.

 

[pathstudent]

Do clinicians care that you are the local pathologist who they know and can trust? Or do inducements by companies win every time? If I had to send my biopsy miles away to some factory to an unknown pathologist, I would be kind of worried.

It goes on all the time. The urologists on my campus (probably the premier group in the city that caters to the affluent) send their biopsies hundreds of miles away. I got a prostatectomy one time with the biopsy included. I looked up the pathologist and it was someone who graduated from a medical school in Guadalajara. Now I am not saying that she couldn't have been an awesome pathologist, but if these urologists needed to refer their patient to a cardiologist or gastroenterologist, there is no way these affluent patients would accept an equivalent situation.

THis is the hypercommoditization of pathology. Anatomic pathology is becoming like a CBC, physicians don't care what lab does the CBC or who reads the biopsy, they just want an accurate result and fast and one that will give them a kickback if possible.

 

[NuckingFuts]

THis is the hypercommoditization of pathology. Anatomic pathology is becoming like a CBC, physicians don't care what lab does the CBC or who reads the biopsy, they just want an accurate result and fast and one that will give them a kickback if possible.

Interestingly, I was speaking with a friend who practices in a semi-specialized academic setting in the southern US. She was telling me how her institution recently hired a new Chair of Urology. This Chair intends to sell the business by including his GU Pathologists and GU Oncologists as part of the "VIPish" package that all patients will be lucky to have when they choose that institution for treatment. The idea is, come to University X, get the right diagnosis the first time around from a "dedicated" GU specialist, and then get the best treatment in the south by a top-rate academic surgeon/oncologist.

This is the type of shi! the medical community needs to get behind. Sure, there may be cons to this setting, but hey, at least the pathologists are being acknowledged up front and center along with the surgeons and oncologists.

 

[Enkidu]

Interestingly, I was speaking with a friend who practices in a semi-specialized academic setting in the southern US. She was telling me how her institution recently hired a new Chair of Urology. This Chair intends to sell the business by including his GU Pathologists and GU Oncologists as part of the "VIPish" package that all patients will be lucky to have when they choose that institution for treatment. The idea is, come to University X, get the right diagnosis the first time around from a "dedicated" GU specialist, and then get the best treatment in the south by a top-rate academic surgeon/oncologist.

This is the type of shi! the medical community needs to get behind. Sure, there may be cons to this setting, but hey, at least the pathologists are being acknowledged up front and center along with the surgeons and oncologists.

I kind of think that patients would shop for the best pathologist if they knew that pathologists existed. That's really a marketing fault. Perhaps a PR campaign could highlight that a patient's treatment is only as good as the diagnosis that drives it, and that diagnoses come from pathologists.

I can imagine something like the "milk, it's what for dinner". Maybe the classic "pathologists, your doctor's doctor". Some images of surgeons standing around waiting for a frozen section, patient just chilling on the table. It would probably hurt megalab business.

 

[MetroPath]

I kind of think that patients would shop for the best pathologist if they knew that pathologists existed. That's really a marketing fault. Perhaps a PR campaign could highlight that a patient's treatment is only as good as the diagnosis that drives it, and that diagnoses come from pathologists.

I can imagine something like the "milk, it's what for dinner". Maybe the classic "pathologists, your doctor's doctor". Some images of surgeons standing around waiting for a frozen section, patient just chilling on the table. It would probably hurt megalab business.

I wonder what patients would think if they knew their biopsies were being sent to factory type labs? I also agree with the fact that most ppl do not even know who makes the diagnosis of their tissue. It is just a diagnosis that is given to them by their clinician who they hopefully trust. People think all we do are autopsies or CSI-type stuff.

If I was a patient and I knew that my biopsy was being sent to another state to a factory lab I would be pretty upset. Patients don't know what goes on in pathology.

I think that is what the transformation of pathology was supposed to be about. To show patients who we are and what we do. It's a great idea but I just dont think it can work since there are just so many cases that pathologists have to signout and have little time for patient interaction. You cannot possibly discuss every GI, cervical biopsy with everyone. Maybe discuss cancer cases.

If patients know who we are, they may want to say I want that doctor to make the diagnosis on my case. I think this is how transformation in pathology may be beneficial to us as pathologist but I dont know how feasible this is.

If we can some way make patients aware that their biopsy is being sent to a large reference lab across the country rather than the local pathologist, maybe we can get business back from large reference labs. I am sure most ppl would rather have their local pathologist look at their biopsy rather than having their tissue being sent to a factory. We need to somehow find a way to educate patients. The question is how are we going to do it?

 

[pathstudent]

Interestingly, I was speaking with a friend who practices in a semi-specialized academic setting in the southern US. She was telling me how her institution recently hired a new Chair of Urology. This Chair intends to sell the business by including his GU Pathologists and GU Oncologists as part of the "VIPish" package that all patients will be lucky to have when they choose that institution for treatment. The idea is, come to University X, get the right diagnosis the first time around from a "dedicated" GU specialist, and then get the best treatment in the south by a top-rate academic surgeon/oncologist.

This is the type of shi! the medical community needs to get behind. Sure, there may be cons to this setting, but hey, at least the pathologists are being acknowledged up front and center along with the surgeons and oncologists.

I disagree that we should get behind that. The literature overwhelming proves that prostate cancer is over-treated and that all these biopsies and prostatectomies are doing more harm than good to society as a whole.

Having said that, it is nice to see a clinician that appreciates pathologists and is using that as part of his marketing campaign to generate revenue for his program.

But having said that, I don't think you need to have spent a few extra months studying prostate biopsies as a fellow post-residency to be completely competent in signing out prostate cancer.

 

[Enkidu]

I disagree that we should get behind that. The literature overwhelming proves that prostate cancer is over-treated and that all these biopsies and prostatectomies are doing more harm than good to society as a whole.

Having said that, it is nice to see a clinician that appreciates pathologists and is using that as part of his marketing campaign to generate revenue for his program.

But having said that, I don't think you need to have spent a few extra months studying prostate biopsies as a fellow post-residency to be completely competent in signing out prostate cancer.

So your objection is that they are advertising the pathologists as GU specialists?

 

[NuckingFuts]

I disagree that we should get behind that. The literature overwhelming proves that prostate cancer is over-treated and that all these biopsies and prostatectomies are doing more harm than good to society as a whole.

Having said that, it is nice to see a clinician that appreciates pathologists and is using that as part of his marketing campaign to generate revenue for his program.

But having said that, I don't think you need to have spent a few extra months studying prostate biopsies as a fellow post-residency to be completely competent in signing out prostate cancer.

Really? THAT'S your reply?

I don't frequent this forum so I must have missed what I would like to ask of you- why don't you enlighten me on what YOU do to advance our field?

And by the way, when you DO choose to reply to my posts, please, at least stay coherent in regards to the content of my post. Neither did I mention anything about fellowships, nor did I talk about folks being prostate biopsy experts. An academic GI pathologist, at least at my institution, does much more than tubular adenomas, and GU pathologists, much more than prostate biopsies.

Based on this single post, I imagine you're far removed from academia- academic GU fellowships, FYI, are much beyond churning out prostate biopsies. They're not like certain Ameripath-type GI fellowships that I've heard of.

To the med students out there who may be reading posts on this forum- do yourselves a favor and, as others have mentioned before, take much of what your read here with a HUGE grain of salt. There's a lot of truth behind what folks here say, and there's also much nonsense.

 

[pathstudent]

I don't frequent this forum so I must have missed what I would like to ask of you- why don't you enlighten me on what YOU do to advance our field?

And by the way, when you DO choose to reply to my posts, please, at least stay coherent in regards to the content of my post. Neither did I mention anything about fellowships, nor did I talk about folks being prostate biopsy experts. An academic GI pathologist, at least at my institution, does much more than tubular adenomas, and GU pathologists, much more than prostate biopsies.

Based on this single post, I imagine you're far removed from academia- academic GU fellowships, FYI, are much beyond churning out prostate biopsies. They're not like certain Ameripath-type GI fellowships that I've heard of.I

To the med students out there who may be reading posts on this forum- do yourselves a favor and, as others have mentioned before, take much of what your read here with a HUGE grain of salt. There's a lot of truth behind what folks here say, and there's also much nonsense.[/QUOTE]

 

[deleted314957]

Over my fairly long career I can comfortably say that there is no such thing as loyalty when money enters the picture as it relates to clinician clients or hospital administrators.

 

[NuckingFuts]

Over my fairly long career I can comfortably say that there is no such thing as loyalty when money enters the picture as it relates to clinician clients or hospital administrators.

I completely agree.

 

[yaah]

It is the problem. I would rather have excellent candidates enter other fields who we do business with and work with. We need more good people seeing patients and less seeing specimens. If you have too much to do, I will send a courier to your practice next week and sign out all your 88305s.

We do not need any more help practicing pathology. The field is saturated, will be saturated for the next few decades at least, and folks who enter the field are the competition.

The CAP and other leadership organizations have FAILED and are doing worthless things such as trying to get us to see patients for zero reimbursement???

Academia is being subsidized with money that the taxpayers do not have to sit on their butts and do as little as possible. They have become the problem while we work our tails off out in the field and have 10 companies all trying to pry off our business as a result of the oversupply.

Again, this makes next to no sense. No one said anything about being too busy or having too much work.

So let me get this straight, your solution to a problem of pathologist oversupply where there are too many subpar pathologists willing to work for reference labs or pod labs and take cut rate fees to sign out stuff like an assembly line is to produce more subpar pathologists?

If I understand you right, you are advocating for fewer smart people to go into pathology, this can only really be for one of two (maybe 3) reasons:
1) The smart people will also take these bad jobs and do an even better job at getting specimens away from your lab.
2) The field will be more flooded with subpar pathologists, and then for some reason this will result in the CAP deciding that residency spots will need to be cut. Noting of course that the CAP doesn't have much to do with residency spots, the CAP will then devote a high amount of financial and political power to decreasing residency spots, which the government will agree to.
3) You think the smart people will be truly disappointed in their future career and you want to protect them from making their own "uninformed" decision.

#3 is total BS. #1 is a rational thought but still kind of idiotic. #2 is a combination of silly and stupid, and would be totally ineffectual.

Again, how is this supposed to help reach your desired goal? I am trying to understand.

 

[gbwillner]

Again, this makes next to no sense. No one said anything about being too busy or having too much work.

So let me get this straight, your solution to a problem of pathologist oversupply where there are too many subpar pathologists willing to work for reference labs or pod labs and take cut rate fees to sign out stuff like an assembly line is to produce more subpar pathologists?

If I understand you right, you are advocating for fewer smart people to go into pathology, this can only really be for one of two (maybe 3) reasons:
1) The smart people will also take these bad jobs and do an even better job at getting specimens away from your lab.
2) The field will be more flooded with subpar pathologists, and then for some reason this will result in the CAP deciding that residency spots will need to be cut. Noting of course that the CAP doesn't have much to do with residency spots, the CAP will then devote a high amount of financial and political power to decreasing residency spots, which the government will agree to.
3) You think the smart people will be truly disappointed in their future career and you want to protect them from making their own "uninformed" decision.

#3 is total BS. #1 is a rational thought but still kind of idiotic. #2 is a combination of silly and stupid, and would be totally ineffectual.

Again, how is this supposed to help reach your desired goal? I am trying to understand.

Isn't thrombus the guy who said we should cut all NIH funding to pathologists for research, because that puts more people in the field, despite the fact that it is an additional revenue stream for academic pathologists?

It should be clear that Thrombus is a troll with dubious motives.

 

[Johnny Sunshine]

At least pathologists don't have midlevels doing our job for cheaper amounts.

I disagree. Many FNA procedures. Bone marrow biopsies. Flow cytometry interpretation. And now, molecular. There are even rumors of having techs interpret IHCs in the near future, as automated scanners and quantitative algorithms are maturing. The life of a pathologist seems to be to deal with constantly having our revenue sources chipped away and delegated to cheaper midlevels.

 

[LADoc00]

Over my fairly long career I can comfortably say that there is no such thing as loyalty when money enters the picture as it relates to clinician clients or hospital administrators.

Absolutely. Gotta realize a snazzy top notch surgeon with good reputation can attract business AND keep it, but a well run local pathology group can be completely undercut in a single afternoon by a sales rep offering to put some Benjamin Franklins into the pocket of a supposedly loyal doc client.

I have lost clients who were doing business with my group for over 30 years on a random Tuesday due a sales rep offering to pay for an EMR etc. There are no loyalities whatsoever.

This is Total War, Carl von Clausewitz-style.

 

[Kilgoretrout 65]

I wouldnt offer a signing or moving bonus. I dont need to, you would be working with me. That is reward enough. Heck, I should be charging fellows to work for me ala Bernie Ackerman!

My reward for voting for Obama is making people like you mad....