Reason to be Hopeful

[pathstudent]

---

Members do not see this ad.

You hear a lot of talk about how the whole field of medicine is tanking with it likely to be acutely taking the next few years. Plus pathology has its own additional issues which are aired here frequently.

But I'd say so far things have been pretty good and might continue to be good for a few more years. For instance if Obamacare works, we will have a lot more insured people. We make money by billing insurance so more insured means more potential paying patients (approximately 10-15% of our work is on uninsured who, of course, don't pay anything). Secondly, a private practice group of orthos just got hired by the hospital and one of the guys I hang out with. He told me the contract is paying them 500-750 per orthopod depending on how busy they are and it is guaranteed for five years as long as they hit their RVU requirement.

If medicine was going to fall apart and there was going to be this bundling of payments with everyone taking a huge hit, why would the hospital sign them to a 5 year contract?

 

[KeratinPearls]

Yeah lets try to be positive. Hopefully in the next 5 years more pathologists will retire opening up jobs for graduating fellows.

 

[rollwithit]

If medicine was going to fall apart and there was going to be this bundling of payments with everyone taking a huge hit, why would the hospital sign them to a 5 year contract?

Maybe they are just doing a better job at locking in their piece of the smaller pie?

 

[Pathosophy]

If physicians worked for free, all of health care spending would drop less than 10%. Physician pay is not where the spending is at. Obamacare was written by the pharma and insurance industries, which makes all the emphasis on diagnosis. You can't get paid, you can't bill, you can't order a test without a diagnosis or suspected diagnosis. You can't get your meds without a diagnosis. Question: How many family docs work in a 30 - 45 min palliative care consult when a patient is old, but healthy? In spite of its empiric importance, Zero...you can't bill for that....yet. Wait till there are 30 million more 80 year olds with end stage kidney failure wanting a full code...them you can bill for palliative care, just make sure you talk them into a DNR so we dont have to pay for them to live a few extra weeks on life support. Dolla bill ya'll. Why don't we do it now if it would save money? Ever hear of the AARP? Google how effective they are at lobbying. We need a F'ing crisis before grandma will get the plug pulled, even though 1/3 of health care costs are in the last year of life.

Unless cancer is cured, or AI emerges from us reaching the singularity, the pathologist is absolutely indispensable. Especially in a diagnostic oriented business model. The insurance companies want you into an algorithm as soon as possible. They are going to have to pay extra for you until you are correctly diagnosed. The sooner that happens, the better. Last time I checked, no physician under 50 knows how to do an H&P let alone have the time..so labs, imaging, biopsy: probably not going anywhere.

Corporate takeover is another issue, pathology as we know it may change drastically under new business models...but so will the rest of medicine. But there will always be pathologists. Other specialties (e.g. Family med, anesthesia) may disappear and go to midlevels. Those professions have already proven you don't need a doc to do their job. If anything docs will just be more administrative and oversee the midlevels. Pathology is at the least risk of midlevel encroachment. What about PhD's? Sorry, but when's the last time you heard of a PhD getting sued? You'll need to pay them a physicians salary if you still want to sue someone. And Americans always want to be able to sue someone.

Relax. When path goes down, that means all of health care has gone down, which means printing money no longer works, which means global economic collapse, which means our petty narcissm has caught up with us. Which I'm not ruling out, of course. So feel good! Only WWIII can bring down pathology!

 

[Tissue issue]

Yeah lets try to be positive. Hopefully in the next 5 years more pathologists will retire opening up jobs for graduating fellows.

Like Bigfoot and the Loch Ness monster, that most elusive creature, the "retiring pathologist"