Reasons for a weak job market

[raider]

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(1) Near death of clinical pathology reimbursement. Future pathologist estimates should not try to bump up figures by making up CP positions. Pathologist are either paid pittance or no longer paid for these activities. CLINICAL PATHOLOGY IS DEAD FOR REIMBURSEMENT PURPOSES.

(2) Increase workload handled by each AP pathologist.

(3) Increasing population of pathologists working past 60 years.

(4) Pathology mills forcing pathologists to churn out cases, with emphasis on quantity rather than quality.



Keep on adding to this list.

 

[Pathologee]

.

(1) Near death of clinical pathology reimbursement. Future pathologist estimates should not try to bump up figures by making up CP positions. Pathologist are either paid pittance or no longer paid for these activities.

(2) Increase workload handled by each AP pathologist.

(3) Increasing population of pathologists working past 60 years.

(4) Pathology mills forcing pathologists to churn out cases, with emphasis on quantity rather than quality.

(5) The economy. What are you going to do, make a house payment or get a prostate needle biopsy?

Keep on adding to this list.

 

[raider]

(6) F-cking encroachment of private practice pathology by companies like the one advertising below:

A combined reference and hospital laboratory pathology group of 7 pathologists is recruiting a full- time pathologist. The pathologist must be AP/CP board certified with a Florida license. Experience in gastrointestinal and genitourinary pathology is necessary. The position is salaried and would be employed by Aurora Diagnostics, a national pathology company. Practice offers a wide range of cases for a general surgical pathologist including limited intraoperative consultations.

If we did not thave this excess supply problem and the resultant weak market the only approach to these LEECHES/BLOOD PARASITES would be GIVE ME MY FAIR SHARE OR F-CK OFF YOU MBA/ADMIN TYPE LOSER.

The only reason they can do this sh-t and lowball pathologists is because they know how desperate the job situation is (the only ones unaware are our great organizations).

 

[Doormat]

(1) Near death of clinical pathology reimbursement. Future pathologist estimates should not try to bump up figures by making up CP positions. Pathologist are either paid pittance or no longer paid for these activities. CLINICAL PATHOLOGY IS DEAD FOR REIMBURSEMENT PURPOSES.

(2) Increase workload handled by each AP pathologist.

(3) Increasing population of pathologists working past 60 years.

(4) Pathology mills forcing pathologists to churn out cases, with emphasis on quantity rather than quality.

(5) Meteoric rise of phyisician in-office laboratories

(6) LabCorp, Quest, Caris, and other megalabs specifically targeting the "easy money" outpatient biopsies and using fair and unfair incentives to attract clients

Independent private labs are going to fade away along with the lucrative pathology private practices that minted cash off them in the 1970s, 1980s, 1990s, and early 2000s. Megalabs and in-office labs are the immediate future. For the long term, look to Kaiser permanente in N. california and group health in seattle (hint, these pathologists are employed and salaried). These are big capitated ACO-like non-profit organizations where the payer is the provider.

The senior pathologists who are now retiring rode the gravy train all the way to the end. Now the train has gone off the tracks. Some of them actually know how lucky they were.

 

[pathstudent]

First we need data that shows that there is a bad job market rather than just a bunch of bs stories like the guy who said he had to mow lawns to survive and the current bs story about 87 board certified pathologists applying to be pas in rural Louisiana for quest.

Every job survey I have ever seen shows a strong job market and reag the interview with silva on the sticky thread. All evidence shows a reasonable job market.

But there are some valid points listed above. From my discussions with generalist comm practice pathologists reimbursement for cp used to be a significant part of their income but private insurers simply refuse to reimburse for it anymore and that hospitals basically rig their contracts so that pathologists get nada for part a and basically they get nothing for managing the lab in exchange for the right to get the ap. And of course we all know about the the quests and ameripaths and pod labs.

Basically most comm practice pathologists are bottom feeders dependent on for profit physicians hospitals and insurers to break them off something. Neurosurgeons orthosurgeons and others are predators who eat what they kill and generate tons of money for hospitals and hardware manufacturers therefore they get paid 2000 to take call and get payola from the hardware makers.

It is called capitalism and if you don't like it go to Russia!

 

[yaah]

I don't buy the 87 applicants thing, unless a lot of these people are former pathologists who do not want to be pathologists anymore. Even then I don't buy it because it's not like PAs are easy to find. Our group is a great group to work for, we are a private group and everyone is a partner or on partner track and we don't get 87 applications for positions. More like 20-30, and half of these are unqualified or are 60 year olds who have 10+ positions listed on their CV. In my experience, there are definitely people who have trouble finding jobs after fellowship. Most of these are IMGs, or AMGs with issues in their CV (lots of missing years, disciplinary action, etc). There are good applicants who have trouble also, and all of them I have met are geographically restricting their search for family or personal reasons.

 

[futureresident]

There seems to have been a lot of discussion with regard to the pathology job market. I would encourage you to participate in the below CAP survey so that the CAP can make an objective and informed decision regarding the current status of the job market. Details are below. You have to be a CAP member to participate. There is an email address below for someone to contact, who will be able to provide you with an appropriate link to take the survey.

Dear Colleagues,

A joint working group of the Association of Pathology Chairs (APC) and the College of American Pathologists (CAP) is seeking to better understand the job market for pathologists. Please follow the link below to share your experiences and perceptions of the current job market. All individual survey responses are completely confidential; only aggregate results will be reported.

The survey should require no more than 10 minutes of your time. Please complete this survey by Friday June 17, 2011. We thank you in advance for your participation.

If you encounter any difficulties completing this survey, please contact Kristen Johnson ([email protected]).

Sincerely,

J. Allan Tucker, M.D.; Chair, APC Graduate Medical Education Committee

Michael L. Talbert, M.D.; Chair, CAP Graduate Medical Education Committee

 

[yaah]

That survey took 30 seconds of my time, it only asked me one question, whether I had changed jobs in the past two years.

 

[Doormat]

I like the Russia comment. Capitalism is our system. The unfortunate corollary is that corporations are king in the capitalist model and they will eventually rule the day.

I remember talking a VP for LabCorp (LH) on the west coast. It was great. I pretended like I was interested in working for this douche. He tried to recruit me to work for LH.

He had a target list of all the independent private practices in the region. His plan was to take them all down or at the very least clip their wings. A smart and aggressive MBA. When big corporations target a cottage industry full of inefficient small labs, it's like shooting fish in a barrel. Corporations can make and interpret slides for cheaper. Any private practice planning outreach should think again.

When I asked him about in-office pathology labs, he replied "I'm OK with that model." If there is a dollar to be made, LH is OK with taking 10 cents and letting the GI/urologist keep the other 90 cents.

These corporations do indeed suck the big one. Recall that for-profit corporations (LH, DGX) are accountable only to their stockholders. Stockholders care only the stock price, which is depends on quarterly profits. Now that's good health care!

Although I have not worked for a corporate megalab, I have heard stories. I know contracts are often re-negotiated on an annual basis. Can you imagine that?

 

[WEBB PINKERTON]

We dont have a free market. If it was a free market, the patient might actually play a role in what lab his/her specimens are sent to. I think some patients might be interested to know their skin biopsy was one of hundreds read that day by a pathologist or that her pap test was one of 150 read by a tech.

I am tired of these reckless sweatshop labs.

 

[sbp]

I agree with some of the reasons posted before like people not retiring, megalabs, but i would like to include:

residency programs were cut from 5 to 4 years, so in one year (spread out in two-three because of fellowships) there were 2 classes of graduating pathologists looking for a job. Also the number of residency spots stayed the same, they did not go down by 1/5, so since then there are 1/5 more people/year on average looking for jobs.

i think this is a factor that is greatly overlooked. No program is going to willingly shrink the amount of spots, they don't want to pay PA's for the subsidised labor the residents are providing.

 

[raider]

I agree with some of the reasons posted before like people not retiring, megalabs, but i would like to include:

residency programs were cut from 5 to 4 years, so in one year (spread out in two-three because of fellowships) there were 2 classes of graduating pathologists looking for a job. Also the number of residency spots stayed the same, they did not go down by 1/5, so since then there are 1/5 more people/year on average looking for jobs.

i think this is a factor that is greatly overlooked. No program is going to willingly shrink the amount of spots, they don't want to pay PA's for the subsidised labor the residents are providing.

This is a very good point.

 

[WEBB PINKERTON]

Here is a terrible stat that I cut and pasted from the Dark Report.
Even worse times are ahead. Is the rise of POLs gonna be good for pathologist assitants?

Office-Based Physicians Want In-Clinic Laboratories
Consultant says number of POLs is growing as doctors seek more revenue from ancillary services
CEO SUMMARY: Interest by office-based physicians in creating an in-clinic medical testing laboratory is on the increase. This has direct consequences for independent commercial labs, hospital lab outreach programs, and anatomic pathology groups, since officebased physicians are a primary source of lab test referrals. One consultant says that 60% to 70% of the volume of tests going out of many physicians’ offices are routine tests that can be done in a physician office laboratory (POL).​

 

[pathstudent]

I agree with some of the reasons posted before like people not retiring, megalabs, but i would like to include:

residency programs were cut from 5 to 4 years, so in one year (spread out in two-three because of fellowships) there were 2 classes of graduating pathologists looking for a job. Also the number of residency spots stayed the same, they did not go down by 1/5, so since then there are 1/5 more people/year on average looking for jobs.

i think this is a factor that is greatly overlooked. No program is going to willingly shrink the amount of spots, they don't want to pay PA's for the subsidised labor the residents are providing.

Don't completely agree. There might have been a small bump in applicants but must people did 5 years of AP/CP back then with the flex year being a fellowship of some kind. Now people do 4 years of AP/CP with an extra designated fellowship.

Residency didn't really shorten. It is just that residents can't do a board certified fellowship during residency anymore. It used to be not rarely uncommon for someone to do two years of AP/CP and then a year of a board certified fellowship like cytopath, blook bank or derm path, followed by completing their last two years of residency.

 

[Thrombus]

Don't completely agree. There might have been a small bump in applicants but must people did 5 years of AP/CP back then with the flex year being a fellowship of some kind. Now people do 4 years of AP/CP with an extra designated fellowship.

Residency didn't really shorten. It is just that residents can't do a board certified fellowship during residency anymore. It used to be not rarely uncommon for someone to do two years of AP/CP and then a year of a board certified fellowship like cytopath, blook bank or derm path, followed by completing their last two years of residency.

Obviously you don't understand. Programs are approved for x number of spots. A program with 20 spots used to put out 4 pathologists/year and now puts out 5 per year.

 

[Enkidu]

Obviously you don't understand. Programs are approved for x number of spots. A program with 20 spots used to put out 4 pathologists/year and now puts out 5 per year.

Maybe residency should be lengthened to 6 years. Everyone will be better trained, less people will want to go to pathology, the job market will improve... sounds awesome... except for those 6 years, I guess.

 

[pathstudent]

Obviously you don't understand. Programs are approved for x number of spots. A program with 20 spots used to put out 4 pathologists/year and now puts out 5 per year.

I agree with that.

 

[Doormat]

This would all make sense if you could get a job after 4 years of AP/CP. Most residents can't get hired with no fellowship, unless you work for a megalab or the VA/military.

Higher-end pathology jobs require 4 years of AP/CP + 1-3 years of fellowship to get your foot in the door.

The ABP could do a lot to help us out. Betsy Bennett's replacement should raise the fail rate on the boards to 50%. Require an oral board exam as well. IMGs would fail in droves. The ABP could make lots more money and improve the job market.

The ABP could phase out the lifetime certificate for path board certification. The old guys would run (shuffle) for the exits if they found out they had to fly to Tampa, FL to take a 2-day recertification exam.

 

[pathstudent]

This would all make sense if you could get a job after 4 years of AP/CP. Most residents can't get hired with no fellowship, unless you work for a megalab or the VA/military.

Higher-end pathology jobs require 4 years of AP/CP + 1-3 years of fellowship to get your foot in the door.

The ABP could do a lot to help us out. Betsy Bennett's replacement should raise the fail rate on the boards to 50%. Require an oral board exam as well. IMGs would fail in droves. The ABP could make lots more money and improve the job market.

The ABP could phase out the lifetime certificate for path board certification. The old guys would run (shuffle) for the exits if they found out they had to fly to Tampa, FL to take a 2-day recertification exam.

The ABP has phased out the lifetime certificate. It took place in 2007. For those that passed the exam before that, they cannot be decertified. They took it with the gpremise that it was for life. Undoing that would be a sueable action.

And FYI the recert exam is just a few hours, not two days.

 

[KCShaw]

That's already happening, it's just that there's no realistic way to tell someone with a non-time-limited certificate that it is now time limited. It's just not going to happen. But the non-time-limited certificates are being phased out because they are no longer being issued. There doesn't seem to be any particular evidence to support that being a good thing for the specialty, for quality, or for patients, merely that other specialties have evidently being doing it and politically it sounds nice. That doesn't mean there is no role for regulation or quality control/assurance, just that there should be an evidenced reason for doing something -- particularly of this magnitude.

Now, it -might- alter the number of individuals who retire at certain times or don't get recertified, which -might- alter the job market at some point in the future. But it's way too early in the process to put much stock in those possibilities.

 

[2121115]

Raising the fail rate of the boards would be a much simpler solution than trying to massively decrease residency spots (which is not really feasible). For first time test takers the pass rate is like 90% right? Move that down to 75% even and there will be an improvement.

 

[pathstudent]

Raising the fail rate of the boards would be a much simpler solution than trying to massively decrease residency spots (which is not really feasible). For first time test takers the pass rate is like 90% right? Move that down to 75% even and there will be an improvement.

Don't think so. It will just force more pathologists into the seedy world of pod labs and quest. You only need to be bc/be to work at real hospitals.

 

[KCShaw]

Even if the board arbitrarily did that -- set a pass/fail rate rather than a pass/fail score -- there is diminishing return as far as the goal of doing so being to limit the number of new board certified pathologists, unless you also don't let people re-take the exam. I think it's a pretty impractical and possibly litigation prone method of decreasing the number of new BC pathologists each year. To me to achieve the same goal it's more reasonable to decrease the number of residency positions, though doing so means facing off against at least a few schools/institutions who aren't going to want to give up their cheap labor without a fight.

 

[raider]

doing so means facing off against at least a few schools/institutions who aren't going to want to give up their cheap labor without a fight.

Cheap labor + 100,000 dollar /resident from medicare. Talk about win-win.

They should just slash the path residencies in half and give the GME money to primary care residencies

 

[Doormat]

Great point about being board eligible (BE) only. Raising the bar for the board certification exam would not stop in-office labs and megalabs from hiring some BE ***** who cannot pass the boards. The in-office clowns would clear 60K a year signing out cases 8 hours a week in some urology practice basement.

It is true that the ABP would never revoke all unlimited certifcates for everyone pre-2007. Maybe ACOs could simply require all pathologists in their system to have time-limited certificates.

Because it's not 2015 yet (you must take the re-cert exam in the 2-year window 8-10 years after your inital certification) I think the recertification exams are not fully developed. I've heard they consistent of a selectable menu of modules for AP and CP. I doubt it will be only a few hours long.

No easy answers...

 

[deleted314957]

This would all make sense if you could get a job after 4 years of AP/CP. Most residents can't get hired with no fellowship, unless you work for a megalab or the VA/military.

Higher-end pathology jobs require 4 years of AP/CP + 1-3 years of fellowship to get your foot in the door.

The ABP could do a lot to help us out. Betsy Bennett's replacement should raise the fail rate on the boards to 50%. Require an oral board exam as well. IMGs would fail in droves. The ABP could make lots more money and improve the job market.

The ABP could phase out the lifetime certificate for path board certification. The old guys would run (shuffle) for the exits if they found out they had to fly to Tampa, FL to take a 2-day recertification exam.

You act like some exam is gonna scare all us "old guys". I got voluntarily recertified. It was a piece of cake and a little check. you gotta remember, I've been doing this (general hospital based pathology-anatomic and clinical) for 30 years and I think I am at least as sharp as when I passed the boards in my senior year of residency without any difficulty.

 

[pathstudent]

You act like some exam is gonna scare all us "old guys". I got voluntarily recertified. It was a piece of cake and a little check. you gotta remember, I've been doing this (general hospital based pathology-anatomic and clinical) for 30 years and I think I am at least as sharp as when I passed the boards in my senior year of residency without any difficulty.

I agree. A lot of us newtimers assume old pathologists couldn't handle the boards. I think you old timers generalists would rock them, both AP and CP without studying.


Yes there would be some obscure detailed stuff that you might not have heard of, but I would put my money on an old-timer over a new-timer every time.

 

[Autopsy Sweet]

Cheap labor + 100,000 dollar /resident from medicare. Talk about win-win.

They should just slash the path residencies in half and give the GME money to primary care residencies

Now, I have absolutely no knowledge of this, but $100,000/resident from Medicare seems like it's a bit of an exaggeration. I remember hearing somewhere (great source, I know) that Medicare pays somewhere around $35,000 per resident (this was 4 years ago) for salary and the hospital may choose to add funds to this to increase the salary and make their benefits more desirable. This is why the salaries are so varied between residencies, since some programs add quite a bit more while others are limited to what they receive from Medicare.

Maybe there's more money going to the hospital for our training that would make up the rest of that $100,000? Although I can't imagine it costs and extra $65,000 per year to educate me.

 

[2121115]

Now, I have absolutely no knowledge of this, but $100,000/resident from Medicare seems like it's a bit of an exaggeration. I remember hearing somewhere (great source, I know) that Medicare pays somewhere around $35,000 per resident (this was 4 years ago) for salary and the hospital may choose to add funds to this to increase the salary and make their benefits more desirable. This is why the salaries are so varied between residencies, since some programs add quite a bit more while others are limited to what they receive from Medicare.

Maybe there's more money going to the hospital for our training that would make up the rest of that $100,000? Although I can't imagine it costs and extra $65,000 per year to educate me.

No. It is 100,000 per resident. The remainder after salary and benefits goes to the program to "fund your education".

 

[KluverB]

Now, I have absolutely no knowledge of this, but $100,000/resident from Medicare seems like it's a bit of an exaggeration. I remember hearing somewhere (great source, I know) that Medicare pays somewhere around $35,000 per resident (this was 4 years ago) for salary and the hospital may choose to add funds to this to increase the salary and make their benefits more desirable. This is why the salaries are so varied between residencies, since some programs add quite a bit more while others are limited to what they receive from Medicare.

Maybe there's more money going to the hospital for our training that would make up the rest of that $100,000? Although I can't imagine it costs and extra $65,000 per year to educate me.

^^^^
This.

This is the reason for a weak job market. Unless you're an IMG (in which case you're excused), but how can anyone go through medical school and not have a clue how billing, reimbursement, etc. and sources of funding for training work around here? Oh wait, that's how it works. Med students are taught squat when it comes to the economics of the medical system, and residency usually adds little; so, they come out of training completely unprepared for the realities of practice in the real world. MBA types then hire these lost souls for pennies on the dollar for their medical mills. Q.E.D.

 

[pathstudent]

^

Too true.

If you want to succeed in life you have to not succeed in school, too well.

The kids that get A's in college go to medical school. The kids that get the B's go to Law school. The kids that get the C's go business school, and those are the ones that get the money.

 

[sbp]

I think you guys are underestimating how much the hospital gets for residents...

medicare rates depend on state/city, on the higher end it is closer to 200k in the lower it is like 140k

the resident slary is 45-60k depending on pgy-level and location, then another 3-15k go to benefits then the rest goes to the hospital/department to "train" the resident.

I have seen the budget of a ny pathology department and I saw these numbers

So a department would never cut the 60+k they get for free labor from the resident, when the alternative is paying a PA 60+k/year

 

[scienceguy19]

The cycle is hard to break. Residency programs get paid a lot of money to 'train' residents. At some residency programs, the bulk of 'training' consists of an excessive amount of scut work, in the form of grossing specimens, doing autopsies (the bane of attendings who admit they don't like them), and paperwork. The 'teaching' amounts to 1 hour of sign-out, hardly a sacrifice from the attending's perspective. Some attendings don't like to answer questions and simply ask the resident to read more. So attendings' salaries are heavily subsidized off of the money they get from the government for 'training' residents. Also, residents labor is much cheaper than paying for expensive pathology assistants, who are in greater demand than pathologists. Lastly, the end result is pathology residents graduating with a lot of skills in completing 'scut' work, but deficient in diagnostic skills. Attendings of course, could care less, as they feel that the resident will do a fellowship anyway. They rely excessively on the fellowship program to train the resident.

 

[2121115]

The cycle is hard to break. Residency programs get paid a lot of money to 'train' residents. At some residency programs, the bulk of 'training' consists of an excessive amount of scut work, in the form of grossing specimens, doing autopsies (the bane of attendings who admit they don't like them), and paperwork. The 'teaching' amounts to 1 hour of sign-out, hardly a sacrifice from the attending's perspective. Some attendings don't like to answer questions and simply ask the resident to read more. So attendings' salaries are heavily subsidized off of the money they get from the government for 'training' residents. Also, residents labor is much cheaper than paying for expensive pathology assistants, who are in greater demand than pathologists. Lastly, the end result is pathology residents graduating with a lot of skills in completing 'scut' work, but deficient in diagnostic skills. Attendings of course, could care less, as they feel that the resident will do a fellowship anyway. They rely excessively on the fellowship program to train the resident.

This is true of many many pathology residencies. The sad truth is that many pathologists benefit from the way things are now, particularly academic pathologists. They have no incentive to do better; residency spots keep filling and fellowships keep filling. Why would they stop? There is no penalty for being a poor teacher or for not teaching at all. There is not even a penalty for not publishing now with all the "clinical track" (LOL) faculty positions. Basically all you have to do to keep your job is sign out.