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

[mlw03]

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Academic centers keep in touch with their trainees. As a specific example, when the pathologist is credentialed they contact the residency programs to verify the training period.

All of our trainees, both residents and fellows, have jobs. Every single pathology chair and residency director with whom I speak tells me that everyone has a job.

The only place that one hears about unemployed pathologists is on studentdoctor.net.

A job does not equal a good job. By good job I mean one that pays a fair wage for the work one does and does not exploit the pathologist. I imagine some of the worst exploitation is performed by academic institutions. Young faculty are given huge workloads yet still are expected to be academically productive. It's rough and quite unfair, but hey, it's a job, as you keep pointing out.

 

[handwriting]

Sometimes radiologists have template/prepared-paragraphs saved in the computer and when they see a change in signal intensity they press one button and a cookie-cutter paragraph gets pasted on the screen.

 

[Substance]

Sometimes radiologists have template/prepared-paragraphs saved in the computer and when they see a change in signal intensity they press one button and a cookie-cutter paragraph gets pasted on the screen.

It's still a paragraph, and it still looks like an interpretation.

You guys just have lists and little parametric tick-boxes. It doesn't look like a person did it but instead looks like a robot did it.

 

[handwriting]

It's still a paragraph, and it still looks like an interpretation.

You guys just have lists and little parametric tick-boxes. It doesn't look like a person did it but instead looks like a robot did it.

Sounds like a case of "judging a book by its cover." ...I mean, since pathologists do at least as much brain-work when coming to a diagnosis as radiologists do. Maybe in the future artificial intelligence will do all the work. Maybe microscopy will become obsolete.

 

[path24]

A pathology opening gets 40-50+ applicants, pathologist's applying for pa jobs, doing multiple fellowships because you can't find an opening, being another doc's employee, can't live where you want, constantly fighting for contracts, reading out biopsies for $10, never making partner, minimal job security (I am sure there are more)....but these things won't change in 5-10 years (actually ever). Pathology is a poor choice for any med student. You deserve better, go into another field.

People may want to be positive, but this is reality (some or all of the above) for a signifcant amount of pathologists.

 

[mlw03]

I can only imagine how confusing this forum must be for med students. One the one hand, lots of folks say how bad things are from the professional side of things. Then there's a small minority, including the chair of a pathology department, saying all is well and everyone who wants one has a job. I think discussion is generally a good thing, but for a med student deciding what to do for the next 30 years, they must feel quite perplexed. Is it really as bad as some claim? As good as others claim? Or like many things in the US, is the reality somewhere in the middle, but no one is speaking for this group? I don't know, as I'm not really in the same job market as most of you. How do we get unbiased, honest information to med students to let them make the right choice for them. This isn't a game or a competition - the goal should be a strong job market where pathologists are respected as important members of the treatment team, where good work is rewarded appropriately, and where patients get good diagnoses.

 

[DIce3]

A pathology opening gets 40-50+ applicants, pathologist's applying for pa jobs, doing multiple fellowships because you can't find an opening, being another doc's employee, can't live where you want, constantly fighting for contracts, reading out biopsies for $10, never making partner, minimal job security (I am sure there are more)....but these things won't change in 5-10 years (actually ever). Pathology is a poor choice for any med student. You deserve better, go into another field.

People may want to be positive, but this is reality (some or all of the above) for a signifcant amount of pathologists.

The above is all true. I show up here a couple times a month to share my story just because my family's life was on edge for many years because of my wife's career. If she had joined me in internal medicine back when we couples matched years ago, life would have been much easier for us. I only wish there was someone like myself that told us of the pain we would endure for years only to push the restart button. That said, all is great now and we have a very different view of things as primary care doctors.

To re-post our personal experience: my wife is a top notch AMG from a solid medical school who did a pathology residency and fellowship at a top university and became triple board certified (AP/CP/fellowship). She started out at one job that seemed ok but really was a slavery factory. Turned out the same factory was across the street at the other hospital system. Thinking that it was a fluke job, she fairly easily found another job in another city that offered partnership etc. Strange thing was once there, no one made partner and the younger people seemed to work about twice as hard as the partners. The other two groups in town were exactly the same also. She could not figure this out. So after about six years out of fellowship, she moved to another city. The market was worse now but she was a very solid applicant. She really critically looked at the jobs and picked the absolute best one in the country after a multi-month search.

Amazingly, after a few months, it become obvious that yet again the same situation existed in this third city. And again, the exact same slavery factories she discovered existed across town at the other systems. She was very social and watched all her friends from medical school and residency prospering in all sorts of other specialties. They were full partners in their respective groups with significant job security. Yet her pathology friends though mostly employed were almost all in the same situation as she was in. Moving from town to town every few years or so. Employed at two pod labs or an oppressive corporate lab or under a tyrant or two. A couple of lucky ones did find really good groups however. So after about 11 years of watching this nonsense, she was tired of being a slave. She cashed in her chips and started an internal medicine residency. At the end of the fourth month, now an intern as a PGY-17 she says... it is odd.. I get more respect as a medicine intern than I ever did as a private attending pathologist......

 

[KeratinPearls]

The above is all true. I show up here a couple times a month to share my story just because my family's life was on edge for many years because of my wife's career. If she had joined me in internal medicine back when we couples matched years ago, life would have been much easier for us. I only wish there was someone like myself that told us of the pain we would endure for years only to push the restart button. That said, all is great now and we have a very different view of things as primary care doctors.

To re-post our personal experience: my wife is a top notch AMG from a solid medical school who did a pathology residency and fellowship at a top university and became triple board certified (AP/CP/fellowship). She started out at one job that seemed ok but really was a slavery factory. Turned out the same factory was across the street at the other hospital system. Thinking that it was a fluke job, she fairly easily found another job in another city that offered partnership etc. Strange thing was once there, no one made partner and the younger people seemed to work about twice as hard as the partners. The other two groups in town were exactly the same also. She could not figure this out. So after about six years out of fellowship, she moved to another city. The market was worse now but she was a very solid applicant. She really critically looked at the jobs and picked the absolute best one in the country after a multi-month search.

Amazingly, after a few months, it become obvious that yet again the same situation existed in this third city. And again, the exact same slavery factories she discovered existed across town at the other systems. She was very social and watched all her friends from medical school and residency prospering in all sorts of other specialties. They were full partners in their respective groups with significant job security. Yet her pathology friends though mostly employed were almost all in the same situation as she was in. Moving from town to town every few years or so. Employed at two pod labs or an oppressive corporate lab or under a tyrant or two. A couple of lucky ones did find really good groups however. So after about 11 years of watching this nonsense, she was tired of being a slave. She cashed in her chips and started an internal medicine residency. At the end of the fourth month, now an intern as a PGY-17 she says... it is odd.. I get more respect as a medicine intern than I ever did as a private attending pathologist......

Your post sounds like complete BS.

 

[DIce3]

"The phrase 'No good deed goes unpunished' is a sardonic commentary on the frequency with which acts of kindness backfire on those who offer them. In other words, those who help others are doomed to suffer as a result of their being helpful. It has been attributed to several luminaries, including Billy Wilder,[1] banker Andrew W. Mellon,[2] and Oscar Wilde.[3] The phrase is featured prominently in the song No Good Deed from the hit Broadway musical Wicked.[4]"

--Wikipedia

 

[KeratinPearls]

"The phrase 'No good deed goes unpunished' is a sardonic commentary on the frequency with which acts of kindness backfire on those who offer them. In other words, those who help others are doomed to suffer as a result of their being helpful. It has been attributed to several luminaries, including Billy Wilder,[1] banker Andrew W. Mellon,[2] and Oscar Wilde.[3] The phrase is featured prominently in the song No Good Deed from the hit Broadway musical Wicked.[4]"

--Wikipedia

Strange how your top notch AMG wife cannot find a good job when I know there are others who have a job. They do not complain to me about their jobs. Some are in academics some are private. I just cannot believe this post. A top notch AMG from a good program that works in a pod lab/corporate lab? Even gbwillner's comrades have jobs. I just cannot believe your story. I am not saying the job market is great but your story sounds off the wall.

 

[path or no path]

"The phrase 'No good deed goes unpunished' is a sardonic commentary on the frequency with which acts of kindness backfire on those who offer them. In other words, those who help others are doomed to suffer as a result of their being helpful. It has been attributed to several luminaries, including Billy Wilder,[1] banker Andrew W. Mellon,[2] and Oscar Wilde.[3] The phrase is featured prominently in the song No Good Deed from the hit Broadway musical Wicked.[4]"

--Wikipedia

Dear Dlce3,

Your efforts are much appreciated 👍

 

[Thrombus]

"The phrase 'No good deed goes unpunished' is a sardonic commentary on the frequency with which acts of kindness backfire on those who offer them. In other words, those who help others are doomed to suffer as a result of their being helpful. It has been attributed to several luminaries, including Billy Wilder,[1] banker Andrew W. Mellon,[2] and Oscar Wilde.[3] The phrase is featured prominently in the song No Good Deed from the hit Broadway musical Wicked.[4]"

--Wikipedia

Dice, I can relate. The cities are predominantly factories where young grads are churned and burned for pennies on the dollar. The soothsayers will always be more popular than those of us who are out there fighting the good fight. It is sad as we go around trying to get business. I almost feel like a panhandler in talking to docs who should be my colleagues. I would have been a drug rep if I wanted to do this again!

 

[gbwillner]

Dice, I can relate. The cities are predominantly factories where young grads are churned and burned for pennies on the dollar. The soothsayers will always be more popular than those of us who are out there fighting the good fight. It is sad as we go around trying to get business. I almost feel like a panhandler in talking to docs who should be my colleagues. I would have been a drug rep if I wanted to do this again!

Whom are you fighting?

It seems from reading your posts that your fight is against quality residents in our field, since every other day you post a new thread about how terrible everything is and how no one can get a job and how the world is ending, and all prospective students should go elsewhere.

Let us know when you deal with CAP/GME to get what you are biatching about.

 

[KeratinPearls]

Whom are you fighting?

It seems from reading your posts that your fight is against quality residents in our field, since every other day you post a new thread about how terrible everything is and how no one can get a job and how the world is ending, and all prospective students should go elsewhere.

Let us know when you deal with CAP/GME to get what you are biatching about.

Would have to agree. It seems like those that are biatching (Thrombus) are those that prob got business taken away from them, etc in the private sector. They come on here with so much negativity. Hey, I would prob be the same way if that happened to me, but seriously you arent doing anything by doing that. Seriously getting tired of reading all your negative posts.

Thrombus, I bet you have a job and get paid well. Am I right?

 

[Thrombus]

Whom are you fighting?

It seems from reading your posts that your fight is against quality residents in our field, since every other day you post a new thread about how terrible everything is and how no one can get a job and how the world is ending, and all prospective students should go elsewhere.

Let us know when you deal with CAP/GME to get what you are biatching about.

We are fighting:
1. Corporate labs (and their abused pathologists) who offer kickbacks to our clients for specimens
2. Client billing (Clients who want us to get 8$ for an 88305 while they bill 78$)
3. Hospitals threatening to hire their own pathologists and pay them pennies on the dollar (because they can due to the oversupply)
4. Insurance companies: Who won't even sit down to negotiate with us because they have "exclusive contracts" with corporate lab (and their pathologists who get paid pennies on the dollar)
5. Decreasing re-imbursements
6. Increased costs (health care) for each employee plus trying to afford giving them raises in this environment


I will let you know we voice our concerns to CAP but they are ineffective and have done nothing other than potentiate the problem as many of their members are academics who rely on subsidized residents/fellows/"junior pathologists" (academics receive 150-200K per resident, plus free grunt work). I have found the most effective way is to shine light on these problems in forums such as these. I would have appreciated this information when I was considering my options. I had 2 pathologists warn me about these things but the soothsayers in academia told me otherwise and convinced me to go into path. Now I realize those folks had no pulse on the state of the profession and were on the take besides. 😡😡😡

 

[Thrombus]

Would have to agree. It seems like those that are biatching (Thrombus) are those that prob got business taken away from them, etc in the private sector. They come on here with so much negativity. Hey, I would prob be the same way if that happened to me, but seriously you arent doing anything by doing that. Seriously getting tired of reading all your negative posts.

Thrombus, I bet you have a job and get paid well. Am I right?

I do okay, Keratin, but things are not looking good on the horizon. Certainly not as "ok" as it could be if I could get as much work as I wanted and get paid what the so-called "going rate" is. Many of my friends are not doing okay. We do not need any more "help" in this field. It is saturated at the moment.

 

[Johnny Sunshine]

2. Client billing (Clients who want us to get 8$ for an 88305 while they bill 78$)
...
...many of their [CAP] members are academics who rely on subsidized residents/fellows/"junior pathologists" (academics receive 150-200K per resident, plus free grunt work).

In regards to client billing, I was flabbergasted a few years ago when I learned this is so common. If CMS/insurance agrees to pay $78 for a pathologic specimen examination, shouldn't they just flat-out refuse to pay when anyone other than a legit lab submits a claim? Seems like this issue could be solved overnight in a sane world, were we not painted into a corner due to decades of not standing up for ourselves properly.

The more I think on it, the more an oversupply of pathologists makes sense as the primary culprit in our lack of power.

As far as academic medicine goes, yes they are far too dependent on free residents and subsidies to objectively contribute to solutions. A sterling example of how government help can get out of hand and make problems worse. In addition, too liberal distribution of education funds likely heavily contributes to the skyrocketing med school tuition and this nation's growing student debt troubles.

Overall we need to direct our focus less on convincing others to help us, and more on ways to independently take charge.

 

[veo1]

Thrombus, these guys don't want to hear the truth. We welcome stories from everyone here, both positive and negative. I can only tell things as I see it. I see you are a 7+ year member (clearly not trolling as some might suggest). I'm going to continue to express my feelings in the hope that med students on the brink give serious consideration to other specialties if they aren't 'all in' on path. To be honest I wouldn't choose another specialty (not now, and not if I was privy to this information before I started residency). In all I like my job but am extremely frustrated in the atrocities that are being leveled our way without any sign of relief in the foreseeable future. I also express my feelings in the hope that people in positions of power that read or post on this forum (e.g. BU Pathology) understand the issues that general pathologists face. The CAP does not need to focus on training pathologists to perform ultrasound guided FNA or creating a breast certification program. Their energy is channeled into the wrong places.

 

[rollwithit]

I would have been a drug rep if I wanted to do this again!

What's stopping you? You are more than qualified. If the grass is greener, go for it.

 

[path24]

Find the private pathology groups websites in the larger cities in your area. They generally list the staff creds. Look at them, a lot are impressive. In my area I see the big names...(NE and Midwest). These people (top amgs) are employees and nothing more...aka labcorp with a different name, and never will be partners. They make a few hundred thousand while the partners (the old white guys) make millions. They generally don't list the partners, but you can ask around the old guys will tell you who owns the group. And no you won't be different and end up a partner. Dice3's story is easily true.

 

[Substance]

Your organization, the CAP, is full of greedy *****s. Because of these idiots, you are considered commodities and are working for urologists, rather than for patients.

Here in Canada, radiation oncologists can't find jobs. They are training too many. Here's what their professional society is going to do about it:

http://www.caro-acro.ca/Assets/President$!27s+Message/2011+Message+from+the+President.pdf

See the difference?

 

[mlw03]

Your organization, the CAP, is full of greedy *****s. Because of these idiots, you are considered commodities and are working for urologists, rather than for patients.

Here in Canada, radiation oncologists can't find jobs. They are training too many. Here's what their professional society is going to do about it:

http://www.caro-acro.ca/Assets/President$!27s+Message/2011+Message+from+the+President.pdf

See the difference?

Very interesting. I think the odds of US pathology residency directors doing something along those same lines are about the same as a 25C day in Churchill, Manitoba in December.

 

[WEBB PINKERTON]

Thrombus, these guys don't want to hear the truth. We welcome stories from everyone here, both positive and negative. I can only tell things as I see it. I see you are a 7+ year member (clearly not trolling as some might suggest). I'm going to continue to express my feelings in the hope that med students on the brink give serious consideration to other specialties if they aren't 'all in' on path. To be honest I wouldn't choose another specialty (not now, and not if I was privy to this information before I started residency). In all I like my job but am extremely frustrated in the atrocities that are being leveled our way without any sign of relief in the foreseeable future. I also express my feelings in the hope that people in positions of power that read or post on this forum (e.g. BU Pathology) understand the issues that general pathologists face. The CAP does not need to focus on training pathologists to perform ultrasound guided FNA or creating a breast certification program. Their energy is channeled into the wrong places.

Exactly, CAP needs to spend ALL its energy fighting billing abuses. It has never been more critical that we get direct billing laws passed. It is shameful that only 17 states have it. Grease politicians, do whatever needs to be done!

This forum is very useful for explaining to potential students how the lab business works. I wish I would have known what a cesspool it was. It was a rude awakening once out in the real world.

 

[Johnny Sunshine]

Very interesting. I think the odds of US pathology residency directors doing something along those same lines are about the same as a 25C day in Churchill, Manitoba in December.

Likely true, sad to say. Most pathology training programs are much more interested in getting all the funding and free workforce they can, rather than maintaining the status and workability of their profession.

But this is probably mostly due to a system that makes a steady supply of residents necessary, rather than any greed.

 

[mlw03]

Likely true, sad to say. Most pathology training programs are much more interested in getting all the funding and free workforce they can, rather than maintaining the status and workability of their profession.

But this is probably mostly due to a system that makes a steady supply of residents necessary, rather than any greed.

Now I'll disagree with you. I don't think residents are necessary, just convenient. PAs, or even attendings, can gross and do autopsies. Pathology residents are generally superfulous, in my experience, there to learn and help a bit; not necessary cogs in the machine like peds, IM, or surgical residents. There's also the desire to have path residents around to facilitate research, because we all know how important brown-staining every tumor under the sun for every immunostain we can develop is to advancing the field of medicine. But someone has to look at those micro-arrays.

In any case, I agree with your first point though, so the rest is academic quibbling over the details.

 

[Pathosophy]

All of you truth tellers just sound like a bunch of crybabies who messed in their diapers and feel entitled to a clean pair without doing jack about it. Why dont you do something??!! You're not a "fighter" if all you do is expose "the truth" on a message board. All that is, is venting and it accomplishes next to nothing. How the hell can that motivate others or improve the situation if you yourselves sit back and do nothing? Complain, provoke hate, keep the negativity going, all the while thinking you are actually doing something by complaining. This is grade school understanding, yet the world is full of little babies who didnt have things turn out the way they expected so they spend the majority of their waking life crying inside. You stink up this forum and likely everyone around you.
Also, spare me your appeal to authority by claiming "you're only a med student." You dont need an M.D. to recognize B.S.
Tough job market or not, I will make it, because I will fight tooth and nail, spend all my energy for what I want to earn in life. And even if I don't because their are powers greater than me, I will accept what I can't control and make the best of it, or I will DO SOMETHING about it. Even if a great depression hits and i have to shovel ****e to make a living, I will do it and won't complain. Why? Because complaining does nothing.

"But I'm not complaining, I'm exposing the truth!" You expose yourself and your empty approach to life..you add to the suffering of others. You don't care, you just want more without doing anything about it yourself...please stop talking.

...You all think you are entitled, you don't deserve jack.

Some people here actually understand that what you put out into the public sphere influences other people. They are able to articulate the challenges of the profession without being negative or illogical. No one here is putting their heads in the sand, there is a way to talk intelligently. Have some self respect and try to uphold some honor in being a physician. Doing that even in spite of the challenges is true honor. No one likes a cry baby

 

[pathgeek42]

I am a long time reader and I must say that there is definitely a dichotomy here between the responding pathologists (i.e., things are fine or they stink). I think things stink for private practice pathologists and this is why (based on real world private practice experience):

1) Reference labs can steal local business by offering perks, i.e., agree to finance the new EHR system (up to 85% of the initial cost).
2) Urologists, dermatologists, etc... can also demand the pathology group to finance the new EHR system or risk losing business (the clinicians control where the specimen goes).
3) Client billing: a dermatologist can read out his own slide but contract with a pathologist to do the TC. The dermatologist wants to global bill and will pay $5 for the tc to the pathologist. If you turn it down, the dermatologist will go elsewhere and always find someone.
4) In office Pathology: clinicians are making money off of pathologists for doing no work. They are stealing the pathologist's right to bill. An offer to receive a lot of money for no additional work is irresistable for a greedy clinician. The sell out pathologists who will read out the case for $10 are a detriment to the profession.
5) There are too many pathologists. Every pathology group big or small has to compete for specimens. The competition is fierce and there is definitetly not enough specimens to go around unless you are happy with a smaller/declining income.
6) Reimbursement issues. It seems like the lab/pathologists typically take a larger medicare cut than other specialties because we are behind the scenes. The 88305 and 88304 TC cuts will hurt big time. And that is just the tip of the iceberg. Wait until the government demolishes 88342 and possibly 88112 next year.
7) Academics is different than private practice. The money side of things doesn't matter as much in academics because the collective resources are shared if one department is struggling. Academic credo (in my opinion): Pathology residents exist to gross and perform research; if they learn pathology along the way, then good for them. Once the residents/fellows complete their training, then they are out of sight out of mind. The CAP leaders are predominantly academic oriented who don't have a huge interest in private practice pathology except that they would like to get their specimens.
8) Good jobs are often not advertised. Advertised positions are limited and each one gets a lot of applications (>50 but more likely >100). Many groups only offer word of mouth jobs to top level programs (which is ridiculous because there are amazing residents at less prestigious places). If you go to an ordinary path place due to geographic/family restrictions then you might have a harder time landing a private job. Also, if you can't speak english very well, then private practice will be tough.
9) Partnership track private practice is declining. As reimbursements/revenue decrease current partners don't want their income to decline, so they don't offer partnership even if you are on a partnership track. Everybody wants to make more money. There are enough pathologist trainees and even seasoned pathologists who are salivating for job openings that they will take even a bad offer. There are places that will even fire you when it is time for your partnership promotion (or you can stay on as an employee, I guess).

Real world, non-academic pathology is a cut throat environment. Any day your revenue stream could suddenly disappear for reasons stated above. It doesn't matter how good of a pathologist you are. In many places, money means more than loyalty. Be careful who you listen to. You also won't know how tough the job market is until you start to apply. You may end up with a job, but you probably weren't expecting the whole job application process to take so long or that you might end up in the middle of nowhere.

 

[yaah]

I will let you know we voice our concerns to CAP but they are ineffective and have done nothing other than potentiate the problem as many of their members are academics who rely on subsidized residents/fellows/"junior pathologists" (academics receive 150-200K per resident, plus free grunt work). I have found the most effective way is to shine light on these problems in forums such as these. I would have appreciated this information when I was considering my options. I had 2 pathologists warn me about these things but the soothsayers in academia told me otherwise and convinced me to go into path. Now I realize those folks had no pulse on the state of the profession and were on the take besides. 😡😡😡

This is not effective at all. Amazed that you can't see it. The only thing that your posts accomplish are discouraging qualified and excellent people from entering the field (because they have options). How, pray tell, do you think your rantings have been "effective?" I suspect "effective" means that you feel good getting something off your chest, it certainly does nothing to solve the problems which you purport to have identified which relate almost entirely to a oversupply of residency spots.

 

[yaah]

A pathology opening gets 40-50+ applicants,

The most recent radiology position at my institution got over 100 applicants.

 

[HerrTex]

I'm applying to both path and rads but cannot figure out which one I enjoy more. I've asked residents their perspective but they either don't really say much about the job market or seem to think it will just work out. I enjoy histology quite a bit but this forum really has put a sour note on path. I am taking a grain of salt from it but from the recent cuts and all the doom and gloom for medicine in general it is making it harder to decide on path.

 

[yaah]

I'm applying to both path and rads but cannot figure out which one I enjoy more. I've asked residents their perspective but they either don't really say much about the job market or seem to think it will just work out. I enjoy histology quite a bit but this forum really has put a sour note on path. I am taking a grain of salt from it but from the recent cuts and all the doom and gloom for medicine in general it is making it harder to decide on path.

It's really hard to know what to expect from any medical job in the future. If you can tie yourself somehow to cash-based practices revolving around cosmetics in some fashion, that is likely to be at least stable. It seems likely that primary care fields will increase in salary (but not that much) although it seems unlikely that administrative burdens and time pressures will improve at all.

There are so many unknowns regarding the political realm and even the private realm.
What will happen as technologic advances increase in medicine?
Will there be more of a role for physicians or less?
Will things continue to get more expensive?
Will the focus be on drugs or procedures?
How will reimbursement change as there is some sort of shift to ACOs and bundling of payments and coordination of care and risk?
Will healthcare continue to consolidate into bigger health systems and hospitals at the expense of smaller ones?
Will the trend towards the "employed physician" model continue to progress?
Will administrators continue to increase in number and influence?
How will the expansion of electronic medical records impact patient access to healthcare as well as their interaction with it?
How will regulations change to allow non-physician providers to provide health care services, and how much?

And this doesn't even factor in the changes in the economy, tax and regulatory burden, legal/malpractice framework, etc.

There isn't really anyone who is going to be able to predict these trends with any degree of certitude. Thus, for the future and young physicians, what do you do? You can try to predict the trends for yourself or listen to others (either people you know or random people you don't know), or you can find something you enjoy doing and excel at and find your own niche. If you are in healthcare and are good at what you do I seriously doubt you are going to have trouble finding a successful career. But if you're noncomittal or in things for the wrong reason, trouble and unhappiness are going to find you.

 

[KeratinPearls]

It's really hard to know what to expect from any medical job in the future. If you can tie yourself somehow to cash-based practices revolving around cosmetics in some fashion, that is likely to be at least stable. It seems likely that primary care fields will increase in salary (but not that much) although it seems unlikely that administrative burdens and time pressures will improve at all.

There are so many unknowns regarding the political realm and even the private realm.
What will happen as technologic advances increase in medicine?
Will there be more of a role for physicians or less?
Will things continue to get more expensive?
Will the focus be on drugs or procedures?
How will reimbursement change as there is some sort of shift to ACOs and bundling of payments and coordination of care and risk?
Will healthcare continue to consolidate into bigger health systems and hospitals at the expense of smaller ones?
Will the trend towards the "employed physician" model continue to progress?
Will administrators continue to increase in number and influence?
How will the expansion of electronic medical records impact patient access to healthcare as well as their interaction with it?
How will regulations change to allow non-physician providers to provide health care services, and how much?

And this doesn't even factor in the changes in the economy, tax and regulatory burden, legal/malpractice framework, etc.

There isn't really anyone who is going to be able to predict these trends with any degree of certitude. Thus, for the future and young physicians, what do you do? You can try to predict the trends for yourself or listen to others (either people you know or random people you don't know), or you can find something you enjoy doing and excel at and find your own niche. If you are in healthcare and are good at what you do I seriously doubt you are going to have trouble finding a successful career. But if you're noncomittal or in things for the wrong reason, trouble and unhappiness are going to find you.

Yaah you are probably the most reasonable person in this path forum. 👍

 

[HerrTex]

yeah, I plan on choosing what I will enjoy the most. The issue is I could see myself doing both. I know there is no way to predict the future and to do so is usually pointless. It is just hard to go into a program while hearing so many negative aspects for the past year or two. At least if I do path I will knowingly be going in preparing for the worse

 

[mlw03]

yeah, I plan on choosing what I will enjoy the most. The issue is I could see myself doing both. I know there is no way to predict the future and to do so is usually pointless. It is just hard to go into a program while hearing so many negative aspects for the past year or two. At least if I do path I will knowingly be going in preparing for the worse

If you go in with a negative attitude, you'll doom yourself. For all the badness on here, pathology is absolutely a viable, important career. You have to decide for yourself based on all the factors. Also would strongly urge you to talk to local pathologists face to face. There's a big difference between a real conversation and an internet forum.

 

[turtle1966]

Signing bonuses are provided in Boston, a location where multiple pathology residents and fellows train.

All the academic pathology groups in the Boston area provide a signing bonus by paying relocation expenses or providing a lump sum at the time of recruitment. This information was confirmed just today.

"Medical students considering a career in pathology should be re-assured that pathology is a great field, with plenty of jobs available for good candidates. "

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

Medical students considering a career in pathology should be re-assured that pathology is a great field, with plenty of jobs available for good candidates.

Dear Dr. Remick,

1-with all due respect, your statement sounds self-laudatory.

2-you remind me of the "illustrious and far-sighted" Dr. Roger Smith (I think this was his name), Chairman of U of Cincinnati in 1980-90, who used to proclaim a "bright" future for our field and was very vocal for return of autopsy as the "future" of pathology. Simply put, he was a typical Ivory Tower Chairman with his head firmly stuck in the sand.

3-what about the not so "good candidates"? Would you consider them as deserving of a "decent" job as well? Why would you even bother to train and graduate not so "good candidates", unless you needed slaves? Do you not feel a professional and ethical obligation, as a Chairman, to call for a serious national study of supply and demand in our field?

4-I have been in the field for close to 30 years (it is remarkable how time flew!), and accumulated the following "shorts":

a-there are decent and wonder pathology groups, however, these are a vanishing breed.

b-pathology is a "high beta" or "highly pyramidal" or "dog eat dog" field. I have seen many do very well and others semi-starve.

c-academic centers recruit poor medical students, mostly by misrepresentation of the field, and "slowly cook them to perfection", i.e., to make them accept what would have been utterly unacceptable at the outset.

d-academic Chairmen use residents as a cheap/slave labor for self-aggrandizement, and, because of this, as a group, are a bunch of heartless liars.

e-national commercial labs, urologists, dermatologist and GI's have all learned from "greedy" pathologists.

f-I know of a few POLabs staffed by younger pathologists who are employees of other pathologists; for the latter even a single dollar per case would be a freebie. What is the difference whether you are exploited by a pathologist or by a dermatologist? The answer, the latter is usually more polite.

5-To medical students: pathology has been very good to me, however, I do not feel good recommending it to you if you have other options. All goods and ills of the field mentioned in the Board are true. Do you feel lucky, then go into the field, otherwise, do not waste your valuable career. Be forewarned that I have heard what is being said now 30 years ago; should this not mean something to you?

 

[Thrombus]

This is not effective at all. Amazed that you can't see it. The only thing that your posts accomplish are discouraging qualified and excellent people from entering the field (because they have options). How, pray tell, do you think your rantings have been "effective?" I suspect "effective" means that you feel good getting something off your chest, it certainly does nothing to solve the problems which you purport to have identified which relate almost entirely to a oversupply of residency spots.

I disagree and feel it is effective. It is one of several ways in which I hope to do my part in helping the field. If you think that having pathologists placed in positions of "junior faculty" after 2-4 fellowships, poorly reimbursed, cutthroat jobs answering to some suit with a BA, or getting paid 8$ for an 88305 (or less, depending on the setup) is acceptable, you are part of the problem.

I personally have failed to identify anyone who is signing out more cases (and is being compensated the going rate:at least the price Medicare pays) and I know folks in most parts of the country in many practice situations. I also find myself with minimal leverage in negotiation and do not know any pathologist who does not feel this way. These traits are simply not present in many other medical fields.

I and others I know have identified the problem: the subsidization of academia whose production usually lags community path and who are subsidized by their ACGME programs. These folks have no incentive to cut back resident production not do they have their pulse on the market in many cases.

If you cannot see the problems, you need to go talk to some in the business community. Ideally pathology residents could enter the profession and begin practice seeing the fruits of their labor with reasonable capital outlay. In many cities in this country there is almost no hope for this even during a whole career.

I personally think all should be able to work as hard as they want and see the fruits of their labor. Medicine as a whole does not need more pathologists right now!!! Most of us could be successful and enjoy a career in many different fields! I feel that mine and others messages about the state of the field may be helpful to those ears. For me personally I enjoy the art of pathology extremely. I do not enjoy the lack of leverage, the undercutting I constantly dealing with and repelling, or the fact that I can't work as hard as I want (earn what I feel I could). I narrowly chose path over Surgery and Medicine (oncology) and would have probably not gone down this road because of the insecurity of this field, despite loving and enjoying the art of pathology, pushing glass, grossing, etc etc.

Quite honestly I don't expect everyone to agree with this approach, but I hope most will give me the benefit in that I want those in my field to THRIVE. This is not happening now for many!

 

[Thrombus]

Medical students considering a career in pathology should be re-assured that pathology is a great field, with plenty of jobs available for good candidates.

Dear Dr. Remick,

1-with all due respect, your statement sounds self-laudatory.

2-you remind me of the "illustrious and far-sighted" Dr. Roger Smith (I think this was his name), Chairman of U of Cincinnati in 1980-90, who used to proclaim a "bright" future for our field and was very vocal for return of autopsy as the "future" of pathology. Simply put, he was a typical Ivory Tower Chairman with his head firmly stuck in the sand.

3-what about the not so "good candidates"? Would you consider them as deserving of a "decent" job as well? Why would you even bother to train and graduate not so "good candidates", unless you needed slaves? Do you not feel a professional and ethical obligation, as a Chairman, to call for a serious national study of supply and demand in our field?

4-I have been in the field for close to 30 years (it is remarkable how time flew!), and accumulated the following "shorts":

a-there are decent and wonder pathology groups, however, these are a vanishing breed.

b-pathology is a "high beta" or "highly pyramidal" or "dog eat dog" field. I have seen many do very well and others semi-starve.

c-academic centers recruit poor medical students, mostly by misrepresentation of the field, and "slowly cook them to perfection", i.e., to make them accept what would have been utterly unacceptable at the outset.

d-academic Chairmen use residents as a cheap/slave labor for self-aggrandizement, and, because of this, as a group, are a bunch of heartless liars.

e-national commercial labs, urologists, dermatologist and GI's have all learned from "greedy" pathologists.

f-I know of a few POLabs staffed by younger pathologists who are employees of other pathologists; for the latter even a single dollar per case would be a freebie. What is the difference whether you are exploited by a pathologist or by a dermatologist? The answer, the latter is usually more polite.

5-To medical students: pathology has been very good to me, however, I do not feel good recommending it to you if you have other options. All goods and ills of the field mentioned in the Board are true. Do you feel lucky, then go into the field, otherwise, do not waste your valuable career. Be forewarned that I have heard what is being said now 30 years ago; should this not mean something to you?

Good post. Most in the private world of path that I know share these sentiments. I personally am in what I hope will be as good a situation as possible considering many of the horrid alternatives that are out there!!

Put an emphasis on part C! The graduating resident has been conditioned/reprogrammed to a state that most surgeons would never even think of tolerating! It is like 4 years of demoralization watching your buddies get actively recruited with sweet signing bonuses, salaries, and plenty of workload while the average path resident has to take care not to offend the disgruntled accessioner or it will mean no jr. Faculty (75k salary) after 3 fellowships!

 

[WEBB PINKERTON]

Pathology suffers the worse case of "learned helplessness" in all of medicine. A few actually do think things are fine.

Potential future pathologists, listen to Thrombus. He/she is telling the truth.

 

[2121115]

...while the average path resident has to take care not to offend the disgruntled accessioner or it will mean no jr. Faculty (75k salary) after 3 fellowships!

I have seen this happen; he is not exaggerating.

 

[Thrombus]

I disagree and feel it is effective. It is one of several ways in which I hope to do my part in helping the field. If you think that having pathologists placed in positions of "junior faculty" after 2-4 fellowships, poorly reimbursed, cutthroat jobs answering to some suit with a BA, or getting paid 8$ for an 88305 (or less, depending on the setup) is acceptable, you are part of the problem.

I personally have failed to identify anyone who is signing out more cases than he/she wants or is able (and is being compensated the going rate:at least the price Medicare pays) and I know folks in most parts of the country in many practice situations. I also find myself with minimal leverage in negotiation and do not know any pathologist who does not feel this way. These traits are simply not present in many other medical fields.

I and others I know have identified the problem: the subsidization of academia whose production usually lags community path and who are subsidized by their ACGME programs. These folks have no incentive to cut back resident production nor do they have their pulse on the market in many cases.

If you cannot see the problems, you need to go talk to some in the business community, who can demonstrate to you how the market functions. Ideally pathology residents could enter the profession and begin practice seeing the fruits of their labor with reasonable capital outlay. In many cities in this country there is almost no hope for this even during a whole career.

I personally think all should be able to work as hard as they want and see the fruits of their labor. Medicine as a whole does not need more pathologists right now!!! Most of us could be successful and enjoy a career in many different fields! I feel that mine and others' messages about the state of the field may be helpful to those ears. For me personally I enjoy the art of pathology extremely. I do not enjoy the lack of leverage, the undercutting I constantly am dealing with and repelling, nor the fact that I can't work as hard as I want (earn what I feel I could). I narrowly chose path over Surgery and Medicine (oncology) and if given the chance again would almost certainly not have gone down this road because of the insecurity of this field, despite loving and enjoying the art of pathology, pushing glass, grossing, etc etc.

Quite honestly I don't expect everyone to agree with this approach, but I hope most will give me the benefit in that I want those in my field to THRIVE. This is not happening now for many!

Edited for coherence as I was typing this on my phone while watching college hoops last night!😴😴

 

[veo1]

All of you truth tellers just sound like a bunch of crybabies who messed in their diapers and feel entitled to a clean pair without doing jack about it. Why dont you do something??!! You're not a "fighter" if all you do is expose "the truth" on a message board. All that is, is venting and it accomplishes next to nothing. How the hell can that motivate others or improve the situation if you yourselves sit back and do nothing? Complain, provoke hate, keep the negativity going, all the while thinking you are actually doing something by complaining. This is grade school understanding, yet the world is full of little babies who didnt have things turn out the way they expected so they spend the majority of their waking life crying inside. You stink up this forum and likely everyone around you.
Also, spare me your appeal to authority by claiming "you're only a med student." You dont need an M.D. to recognize B.S.
Tough job market or not, I will make it, because I will fight tooth and nail, spend all my energy for what I want to earn in life. And even if I don't because their are powers greater than me, I will accept what I can't control and make the best of it, or I will DO SOMETHING about it. Even if a great depression hits and i have to shovel ****e to make a living, I will do it and won't complain. Why? Because complaining does nothing.

"But I'm not complaining, I'm exposing the truth!" You expose yourself and your empty approach to life..you add to the suffering of others. You don't care, you just want more without doing anything about it yourself...please stop talking.

...You all think you are entitled, you don't deserve jack.

Some people here actually understand that what you put out into the public sphere influences other people. They are able to articulate the challenges of the profession without being negative or illogical. No one here is putting their heads in the sand, there is a way to talk intelligently. Have some self respect and try to uphold some honor in being a physician. Doing that even in spite of the challenges is true honor. No one likes a cry baby

This is one of the funniest posts I've seen in a long time! Hahaha. I'll be curious to hear your thoughts in 6-7 yrs time.

 

[veo1]

I have seen this happen; he is not exaggerating.

Totally agree. Its a tricky situation for some and incredibly difficult as the so called 'accessioner' or anyone working in tandem with him/her cannot be trusted as a reference when seeking employment elsewhere. They can tell you to your face that they'd be happy to make a few calls on your behalf or serve as a reference, but there is a clear conflict of interest when they'd rather have you stay on as jr faculty and work for peanuts

 

[Johnny Sunshine]

All of you truth tellers just sound like a bunch of crybabies who messed in their diapers and feel entitled to a clean pair without doing jack about it. Why dont you do something??!! You're not a "fighter" if all you do is expose "the truth" on a message board. All that is, is venting and it accomplishes next to nothing.

Oh, the irony.

I don't suppose your initials are C.P., by chance? 🙄

 

[Johnny Sunshine]

...while the average path resident has to take care not to offend the disgruntled accessioner or it will mean no jr. Faculty (75k salary) after 3 fellowships!

God...how I can relate to this. 😳

 

[Pathosophy]

Oh, the irony.

I don't suppose your initials are C.P., by chance? 🙄

Dammit, I was hoping no one would catch the irony.

 

[Pathosophy]

This is one of the funniest posts I've seen in a long time! Hahaha. I'll be curious to hear your thoughts in 6-7 yrs time.

I admit it sounds pretty funnny. I laughed when I read it again. But I am right about you and the others sounding like little beatches.

 

[yaah]

I disagree and feel it is effective. It is one of several ways in which I hope to do my part in helping the field. If you think that having pathologists placed in positions of "junior faculty" after 2-4 fellowships, poorly reimbursed, cutthroat jobs answering to some suit with a BA, or getting paid 8$ for an 88305 (or less, depending on the setup) is acceptable, you are part of the problem.

I personally have failed to identify anyone who is signing out more cases (and is being compensated the going rate:at least the price Medicare pays) and I know folks in most parts of the country in many practice situations. I also find myself with minimal leverage in negotiation and do not know any pathologist who does not feel this way. These traits are simply not present in many other medical fields.

I and others I know have identified the problem: the subsidization of academia whose production usually lags community path and who are subsidized by their ACGME programs. These folks have no incentive to cut back resident production not do they have their pulse on the market in many cases.

If you cannot see the problems, you need to go talk to some in the business community. Ideally pathology residents could enter the profession and begin practice seeing the fruits of their labor with reasonable capital outlay. In many cities in this country there is almost no hope for this even during a whole career.

I personally think all should be able to work as hard as they want and see the fruits of their labor. Medicine as a whole does not need more pathologists right now!!! Most of us could be successful and enjoy a career in many different fields! I feel that mine and others messages about the state of the field may be helpful to those ears. For me personally I enjoy the art of pathology extremely. I do not enjoy the lack of leverage, the undercutting I constantly dealing with and repelling, or the fact that I can't work as hard as I want (earn what I feel I could). I narrowly chose path over Surgery and Medicine (oncology) and would have probably not gone down this road because of the insecurity of this field, despite loving and enjoying the art of pathology, pushing glass, grossing, etc etc.

Quite honestly I don't expect everyone to agree with this approach, but I hope most will give me the benefit in that I want those in my field to THRIVE. This is not happening now for many!

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.

 

[Pathwrath]

The problem in pathology is most definitely NOT having too many excellent candidates enter the field. You do a disservice.

What is the problem in pathology?

 

[pathstudent]

What is the problem in pathology?

Hypercommodotization.

 

[yaah]

What is the problem in pathology?

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.