Reasons for pathologists do not receive "due recognition"

[raider]

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Constructive and well thought out comments, please (directed at pathstudent specifically).

If you disagree with "the title opinion" please state your reasons.

My "opinion" is based on:

(1) Lack of recognition of our "invaluable" contribution to patient care, compared to say surgeons.

(2) Lack of recognition of us as a legitimate clinical discipline by both health care professionals (including medical students) and lay people.

(3) Our complete failure to protect our revenues going to other specialities.

(4) Administration pinching our clinical laboratory revenues.

(5) Lack of "political power" to enact legislation that protects and boosts our revenues.

Ps. Sorry for the "typo" in the title, should read "Reasons pathologists do not receive due recognition"

 

[Art]

Posts like this . . . .
Creates the impression that al we do is whine on the internet. Perhaps we should call Whine-one-one and ask for a real doctor.

 

[raider]

I repeat "Constructive and well thought out comments, please".

This is supposed to be a discussion, if you disagree post your reasons.

There is a distinct difference between "complaining for the sake of complaining" whining vs. trying to understand:

(1) If a problem exists.
(2) What are the causes of this problem?
(3) What can be done to remedy this problem?

Hopefully, the comments that follow will address these areas.

 

[Art]

I repeat "Constructive and well thought out comments, please".

This is supposed to be a discussion, if you disagree post your reasons.

There is a distinct difference between "complaining for the sake of complaining" whining vs. trying to understand:

(1) If a problem exists.
(2) What are the causes of this problem?
(3) What can be done to remedy this problem?

Hopefully, the comments that follow will address these areas.

I did post a constructive comment. My opinion is that incessant whining on the internet creates the impression that we do nothing constructive. Contrast this with efforts by other groups who actually make suggestions, lobby Congress, propose and advocate for legislation, collect data to support claims etc. The constructive comment is that we need to engage in those activities and whine less.

1) Problem primarily exists in the minds of limited individuals
2) Cause, not really a problem because there really isn't a problem
3) Solution, do more, whine less.

Excuse me, I need to email my Congressman about stem cell research.
Others can call a whinebulance about this non-issue.

 

[Enkidu]

1) Surgeons are the ones who talk to the patients and give the impression that they have personally diagnosed them. Most people only think of pathologists doing autopsies, due to the popularity of forensic crime lab television shows.

2) Medical students aren't exposed to the actual practice of pathology, just a pretty difficult class that they dislike. Medical students who are interested in pathology are concerned that they won't be taken seriously because of the item 1 above. Medical students are extremely susceptible to peer pressure.

 

[raider]

Agree with both above.

True story....A medical secretary who moved to the pathology department after working for a couple of years with a surgeon, was "shocked" when she realized that it was not the surgeon who made the "diagnosis".

(1) I think physicians should be required to explicitly state that the diagnosis was made by Dr. So and so and in her/his opinion you have tumor X. In this way, the patient will know why he/she is paying X dollars to Dr. So and so when the bill comes.

(2) Med student and all fields "dependent" on surgical pathology should have rigorous exposure to "real world surgical pathology" by having some actual patient "diagnosis" responsibilities just like they have some patient "care" responsibilities in surgery/medicine etc.

 

[2121115]

Pathologists at my institution receive plenty of "recognition" from their clinical colleagues. Patients never see us so I am not surprised that they don't know what we do.

 

[pathstudent]

(1) I think physicians should be required to explicitly state that the diagnosis was made by Dr. So and so and in her/his opinion you have tumor X. In this way, the patient will know why he/she is paying X dollars to Dr. So and so when the bill comes.

i was going to rest my fingers but WTF!? How could you ever "require" that and then enforce it?

Moreover, your name is on the report.

 

[malchik]

Constructive and well thought out comments, please (directed at pathstudent specifically).

If you disagree with "the title opinion" please state your reasons.

My "opinion" is based on:

(1) Lack of recognition of our "invaluable" contribution to patient care, compared to say surgeons.

(2) Lack of recognition of us as a legitimate clinical discipline by both health care professionals (including medical students) and lay people.

(3) Our complete failure to protect our revenues going to other specialities.

(4) Administration pinching our clinical laboratory revenues.

(5) Lack of "political power" to enact legislation that protects and boosts our revenues.

Ps. Sorry for the "typo" in the title, should read "Reasons pathologists do not receive due recognition"

(6) Widespread poor use of English and punctuation, as exemplified in this post, does not exactly command respect. It appears that you have replaced your fascination with colored text and underlining with quotation marks highlighting "a" few random "words" per sentence.

 

[KCShaw]

I kinda go back and forth on this. It's certainly true that most people, including most patients, don't understand the role of a pathologist. Some people may perceive that as a problem. Others may not. It seems to also be that many pathologists make no particular effort to "do" above and beyond their workload requirements -- but really, I don't think that's much different than in any other specialty. Merely that the few who "do" in other specialties perhaps get more popular attention.

What I go back and forth on is how much of a "problem" it is, and what an individual pathologist or pathologists as a group should "do."

First, I agree that the best thing most pathologists can do is..their job, and do it well. This includes effective, regular communication with the clinicians they're consulting for, and purposefully getting involved in those clinicians' relevant activities. You don't have to be an in-house academic to do this; even the so-called slide-mill conglomerates can and should.

Second, although any given "problem" is in the perception, it doesn't change what most people know, don't know, or think they know about pathology. If that accounts for adequate or inadequate due recognition I suppose is up to perception.

Third.. I also agree that, in general, the alpha approach is far more effective than the hands-on-hips-and-shoulders-sag-while-complaining approach. If you want more recognition (the positive kind), go do something about it. Simply saying I don't get the recognition I should just ain't gonna cut it. Gotta earn it, not just say we think we already have.

Sure, I think it's true that part of the reason most people don't know what pathologists do is that clinicians, using all available information -including- pathology, interpret for a patient what's going on with them and what their offered plan is. This isn't likely to change, and to be honest, it probably shouldn't. Then, within health care, most never have exposure to real day-to-day pathology, including medical school. That probably limits the size of our recruiting class each year; but can the curriculum support another..what..6 weeks? more? taken from something else and added to pathology? (I think the answer is yes, but that's probably not a comfortable answer for most medical schools already set in their ways.)

Right now, as a group, my impression is that the "big" pathologist organizations are milling around more than making an impact. Trying to be reactive more than proactive. And individuals are largely milling around waiting for the big organizations to "do" rather than getting at it themselves.

 

[raider]

Some interesting points have been made (wish posters would refrain from needless digressions and personal attacks as they are just a waste of space and time).

I believe the major driving force behind the phenomenon mentioned in the title is " the current business model of hospitals".

Before elaborating further, I would like to hear if anyone has thoughts on this.

 

[KeratinPearls]

Some interesting points have been made (wish posters would refrain from needless digressions and personal attacks as they are just a waste of space and time).

I believe the major driving force behind the phenomenon mentioned in the title is " the current business model of hospitals".

Before elaborating further, I would like to hear if anyone has thoughts on this.

Why dont you educate us what is the current business model of hospitals and how it relates to pathology for those of us not yet in practice or will soon be?

 

[HbyHA]

(2) Med student and all fields "dependent" on surgical pathology should have rigorous exposure to "real world surgical pathology" by having some actual patient "diagnosis" responsibilities just like they have some patient "care" responsibilities in surgery/medicine etc.

I agree. The best pathologists are ones that understand how their diagnosis affects the patient's clinical management. I think the best clinicians understand the basic process of rendering that diagnosis. Pathologists get exposure to most clinical fields in med school, and we're the minority of med students. Shouldn't there be some exposure to at least surgical pathology for the majority of students who will end up using our "services", even if they don't realize it?

They could at a minimum realize they need to give us some friggin' history😛

 

[C5toC9]

I think radiology shares many of the same concerns that pathology does

 

[pathstudent]

^That is a good point. Radiologists make many diagnoses that are definitive and do not go to pathology. Pneumonia for example.

Raider, you said that Pathology should be renamed "diagnostic medicine". Well that doesn't make sense as thousands of diagnoses are made all the time without a pathologist. They are made via radiology, physical exam, endocscopy etc.....

Pathologists absolutely do not have a monopoly in the diagnostic process. Morever many times we just describe things which a clinician takes and makes a diagnosis out of by combining it with what she knows is going on (dermatitidies or medical lung for example). Yes for things like prostate cancer it is very cut and dry and we don't really need clinical input, but just think about how many times we need input from the clinicians to make our diagnoses. It is a team effort.

 

[KCShaw]

Although in radiology they are dealing primarily with images that most clinicians have some ongoing experience and rudimentary practical training in -- x-rays, CT scans, etc. are familiar and tie in fairly well with med school education and simple gross anatomy. Heck, anatomy is sometimes -taught- using CT scans, or sections of bodies in planes familiar when reviewing CT scans.

As a group, radiologists also seem to be doing a relatively good job of "doing," being proactive, and inserting themselves a little more visibly in patient care. However, they also don't carry the same burden of perfection expected from surgical pathologic diagnoses. While we question every new possible test coming down the pipe (AP or even CP related), radiologists (IMO) are better able to explore new views and methodologies, and embrace the latest new hotness. They can, and do, "describe" more, while we generally seem to feel that -only- giving a descriptive result, for tumor pathology at least, is somehow copping out and showing weakness (with notable exceptions of course).

 

[raider]

Food for thought

Between 1999 and 2007, the technical component of
the primary anatomic pathology Current Procedural Terminology
(CPT) code (CPT 88305 surgical pathology, gross
and microscopic examination, level IV) from Medicare increased
from $19.80 to $64.95, whereas the professional
component diminished from $45.15 down to $38.05 (unadjusted
for geographic practice cost differences). This
corresponds to a compound annual growth rate of 16.0%
for the technical component versus -2.9% for the professional
component. When a biopsy-generating practice sees
the role of the pathologist as a commodity, its strongest
incentive is to improve its own economics at the expense
of a commodity broker (1).

(1).Friedberg RC.Time for a reality check: the hospital-based laboratory's perspective.Arch Pathol Lab Med. 2008 May;132(5):781-4.

 

[raider]

Do you see how we are the "pawn".

If not , I recommend looking into "How CMS decides reimbursement" and "AMAs RUC" and how much representation pathologists have in the process. The RUC makes recommendations to HCFA with respect to the physician work component of the relative value units contained in the RBRVS. The RUC has 26 physician members, of whom 22 represent medical specialty societies.

Now, guess out of those 22 how many are surgeons and how many are pathologists??? (And you, mistakenly, thought surgeons got paid more because they worked more)

For each service being evaluated, a specialty society surveys at least 30 physicians. Based on a vignette describing a typical patient and service for the CPT code, respondents are asked to assign work values to the services in comparison to a list of reference services, to identify the services that served as key reference services in their evaluation, and to provide descriptive information about the time involved before, during, and after the service. A committee of the specialty evaluating the service reviews the surveys and other pertinent information and develops a recommendation to the RUC. The specialty society recommendations are discussed at a meeting of the full RUC.

To be submitted to HCFA, recommendations must be accepted by two-thirds of RUC voting members.


Welcome to wonderland, Alice.

For the smart surgical pathologists (my true and respected colleagues) it would be worth reading the medscape article on "What every physician should know about RUC".

 

[Art]

Always nice to work with facts.

Here is the original article about RUC written by family physicians in 2008.
http://www.aafp.org/fpm/2008/0200/p36.html

According to the information on the pathology Wiki with the AMA physician database, pathologists are about 2.5% of the physician population.

According to the article above, pathology is one of the 23 appointed positions out of the 29 total positions. 1 out of 29 is about 3% of the group, which matches our percentage of physicians.

It appears we have adequate representation.

This circles back to my original response, only the whiners lack respect. The people who do the work, like the CAP representative on the RUC, get plenty of respect.

Less whining + more work = the credit you deserve

 

[malchik]

Raider, you said that Pathology should be renamed "diagnostic medicine". Well that doesn't make sense as thousands of diagnoses are made all the time without a pathologist. They are made via radiology, physical exam, endocscopy etc.....

Pathologists absolutely do not have a monopoly in the diagnostic process. Morever many times we just describe things which a clinician takes and makes a diagnosis out of by combining it with what she knows is going on (dermatitidies or medical lung for example). Yes for things like prostate cancer it is very cut and dry and we don't really need clinical input, but just think about how many times we need input from the clinicians to make our diagnoses. It is a team effort.

Yea, but Dr. House's office door says "Diagnostic Medicine." The average dumb-as-a-post House viewer/congressman will be very impressed when you tell them that you are like House and his underlings who do absolutely everything and get away with unethical shenanigans because you are a rock star. Image is everything.

 

[Freak]

This RVU/RUC stuff (and the thread in general) is interesting ... definitely not taught in medical school at all 🙂

I have 2 questions ...
1.) it appears that the RUC does not concern itself with professional liability determinations for the RVU ... who does that (just the CMS)?

2.) Pathology and Radiology have the same amount of representation on the board (if I am reading it right). Why is it that the Radiologists seem to be doing so much better than the Pathologists then (more effective lobbying of the group), or is it a workflow issue (ie. reading a film is faster than processing a specimen).

 

[zao275]

I attended CAP Advocacy School in DC a couple of years ago and I was shocked to learn about how much legislation comes close to being passed by Congress all the time that would affect our patients and our practice very much. I was also amazed at how much lobbying CAP does on the behalf of pathology. They have a group of professional lobbyists (PathPAC) that is headed up by pathologists. To my knowledge, CAP is the ONLY pathology organization that does any lobbying. I donate to PathPAC every year now (on a resident/fellow salary, no less!) because my experience in Washington convinced me that the CAP IS working harder than anyone else to protect the future of pathology.

Disclosure: I do a lot of work with the CAP, but I am not a paid employee. I will be the first to admit that I am a CAP-man, through and through, but that is because my experiences with CAP have convinced me that ARE doing something for us as pathologists. Of the many posters who seem to often question why CAP is not doing more for us, I wonder how many are actually involved in CAP directly (versus sitting on the sidelines and criticizing without really knowing what is going on)? I may be wrong, of course, but it makes me wonder why I see CAP in a very different light from many other posters (maybe I am naive and blind?).

To bring it around to your question of what can be done, raider, I think more pathologists (including residents and fellows) should get involved in the professional societies (AMA, CAP, USCAP, ASCP, etc). Volunteer, get on committees, pay dues (gasp!), go to residents forum, write letters...if more people are involved and making their voice heard to the societies, perhaps their voices will incite actions that are more in line with everyones desires for the future of our specialty.

 

[zao275]

According to the information on the pathology Wiki with the AMA physician database, pathologists are about 2.5% of the physician population.

Where on the pathology wiki? Could you please post a link? I am curious. Thanks!

 

[path24]

Pathologists are essentially a lab test that clinicians order. Specimens get sent across the country with a one line clinical history (or any at all). We would be "recognized" if we weren't a dime a dozen and competing across the country for work. (Maybe have an actual demand for our services!!)

I wouldn't join AMA or USCAP. AMA sold physicians out on healthcare and USCAP goes around promoting a pathologist shortage. ASCP puts out the bs job market analysis.

 

[lipomas]

Who says pathologists don't get "due recognition?" They do where I work. We are well respected members of the community. Our viewpoints are just as important as others. To be sure, we have a customer service angle to our practice which relates quite a bit to keeping other physicians happy, but this doesn't mean we are their bitch. Pathologists are not "a lab test" unless the pathologist makes themselves a lab test, same as every other lab.

I have found that many pathologists who incessantly complain about lack of respect are the same ones who badmouth clinical colleagues or who never participate in hospital committees, meetings, things like that. It's a two way street. I see quite a bit of entitlement on this forum from some posters who I am not so sure have a realistic grasp of the world and the business and profession of health care.

If the complaint is that surgeons are getting "more recognition" from patients, that is not going to change. The surgeon is the one with the patient under the knife and is their point of contact.

path24's comments about USCAP are quite off base. USCAP does not really focus on pathology jobs. Their focus is on education and research. They have a large international focus (which does highlight jobs, but mostly in underserved areas). They are not a national organization with significant lobbying function like ASCP or CAP. USCAP (look at their webpage) has about 10 employees. CAP and ASCP have seemingly hundreds.

Freak says radiologists are "doing much better" than pathologists. How so? Their reimbursement is being slashed. Their job market is not good at present (although it is better than path). Have you talked to a graduating radiologist? It is also a larger field with more practitioners so of course they are going to have a larger presence. Our hospital, for example, has twice as many radiologists as pathologists. And that's one hospital.

A lot less whining would be a good start to address the complaints in this thread. As well as a lot more introspection and self analysis instead of a litany of complaints about "the surgeons" or "the national organizations" or "the hospitals." What are YOU doing about it?

The comments about the media and the lack of respect and recognition payed to pathology are true, but there isn't much we can do> I am sure most other fields have similar complaints (ER doctors I know hated ER, for example). The media has been slimming things down for quick public consumption for years and years. This is not going to change. Everything and every profession needs a one line summary. Pathologists are the people who do the autopsies. Occasionally the ones who read the biopsies or run the labs. That's as far as you are going to get with the media.

 

[Art]

Where on the pathology wiki? Could you please post a link? I am curious. Thanks!

Here is the link
http://pathinfo.wikia.com/wiki/Pathology_Job_Market_Data

When you go towards the bottom, the AAMC survey has the numbers for all practicing physicians, and the number in each specialty. Look at page 7 for the information.

It does show that there are twice as many radiologists as pathologists currently practicing, the numbers similar to what lipoma said were practicing at his hospital.

 

[Freak]

lipomas, the reason I asked why Rad does better is because of the common adage of the ROAD specialties being the ones to strive for (work-life balance, etc.). This knowledge about the job market takes a fair bit of time to filter down to the medical students, so maybe that is just the case. However, in your own post, you still stated that still Path market < Rads market, even with the drop in reimbursements.

I guess I can state it best as an example. If you say to a guy on the street, I went to Wash U for residency, they will likely ask, how was Seattle. In this case, confusing Wash U and UW is not too big of an issue (as they are both excellent schools), but the bigger point is that although Wash U may have similar training opportunities as Harvard or JHU, it does not share the same name recognition on the street, which I think is the point of the original poster.

The majority of patients (and in many cases until they hit the wards, med students) are ignorant of what a pathologist does and this is likely an image issue. As an aspiring pathology resident at some point, I would like to see path recognized for its invaluable contribution to patient care.

 

[LADoc00]

What?!

Dude, I dont want recognition. I want to get paid. That's it. I dont want gold stars, cheap plaques, gift certificates to Applebees or even the pat on the back by some over the hill surgeon.

Dead Presidents. But of course even that is losing its luster, so I would prefer inflation-protected commodities.


Seriously though, if you are looking for some type of victory laurels you definitely picked the wrong speciality.

Even the most prominent academic Pathologists in the world are basically no names in medicine. No one goes to Stanford because Kempson might see their case, no one goes to the Mayo Clinic because Colby might see their lung biopsy. No more than someone who books an appointment at Hopkins because they have some elite automated hematology analyzer...

No one cares until we screw up. Lets face it.

Raider, dont kid yourself. Dont try to find some higher purpose to what you do, it will drive you crazy, even suicidal...Just do it and look forward to that week on the beach in Maui sipping sangria.