small town pathology

[Arctic Char]

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say you have a town of 20K people with one small hospital that has no in house pathologist - everything is sent out. theoretically, could one just move into town and start taking the cases? would contracts in place be violated? would there be enough volume for a pathologist? what other kinds of issues would need to be addressed?

just curious about what all would need to be considered . . . thanks

 

[2121115]

Start taking what cases? There are no surgeons who do cancer cases. No gastro's/uro's for outpatient biopsies. No radiologists doing biopsies. Where would these specimens come from if the only docs in town are primary care and the only surgeons are doing appendectomies and dead bowels.

 

[pathstudent]

say you have a town of 20K people with one small hospital that has no in house pathologist - everything is sent out. theoretically, could one just move into town and start taking the cases? would contracts in place be violated? would there be enough volume for a pathologist? what other kinds of issues would need to be addressed?

just curious about what all would need to be considered . . . thanks

Sure they would probably love to have an in-house pathologist. They would just write a contract with you and terminate the other one. Most pathology contracts have rules for how to terminate it by each side.

But seriously, I can't imagine anything more boring than doing small town pathology like that. A few years ago when I was a resident we got a consult case for a gi biopsy from a place like you describe. It was a straight forward malt lymphoma. The pathologist from there said it was the biggest deal they had seen out there in years. I thought '**** we see that a few times a week and they are not even in the top 100 of challenging types of cases we get."

 

[wholeheartedly]

Start taking what cases? There are no surgeons who do cancer cases. No gastro's/uro's for outpatient biopsies. No radiologists doing biopsies. Where would these specimens come from if the only docs in town are primary care and the only surgeons are doing appendectomies and dead bowels.

I think you might be jumping to some inaccurate assumptions about small towns. I worked in the clinical lab adjoining the pathology lab at the hospital in my hometown of 10,000 people and there were two pathologists to cover the work and they were debating adding additional help such as a path. asst. We did have local surgeons and specialists and visting specialists such as GI, uro, cards, neuro, hem/onc. etc, who came at least weekly from bigger cities and utilized our pathologists quite heavily and liked to consult with them in person if they had a chance. They had me in showing me all kinds of cool things. I've heard similar things from my former classmates as well, so I don't think small town necessarily equals no work or less work.

 

[KCShaw]

Depends on the existing contracts, the local population, logistics...a whole myriad of things. You have to consider what lab/technical and administrative facilities you would use. If they already send everything out, there may be no local histology lab, no method for storing specimens, the LIS might not support AP reporting, etc. Some small population centers are close enough to larger centers that specialists have no need to set up additional rotations/clinics. And, in my experience, some small population centers are more physically isolated, making it more efficient to transport in a rotation of specialists than locals constantly trying to trek to a larger center.

These are all things you'll have to figure out for the particular location you're interested in. If you don't know the questions to ask, it may be a difficult process -- on the other hand, there may be a hospital administrator or someone else there who has a good idea and may -want- to help you out. Or they may give you a hard time, if they don't see a way you can save them money, now or in the future.

 

[schrute]

you can certainly try, but as others have mentioned, you'll more than likely be stepping on someone's toes.

Example: my home town in WI is around 65K, not counting surrounding towns...there are 2 path groups in town, 1 private practice (about 5 strong), which contracts with 1 of the 2 main health systems in town, and NUMEROUS smaller hospitals in the surrounding region.

the other group, also 5 or 6 strong, is affiliated with Mayo, so they're hospital employees, so they cover the other 'large' health system in town and whatever contracts Mayo has worked out.

you may think 12 pathologists is too many for a town of 65k, but keep in mind the surronding area is peppered with towns of several thousand, and the nearest large regional med center is...well...3 hrs away in Madison.

and a town of 30k isn't necessarily going to be "nothing" specimens....it may be in a "BFN" location, but have a large volume (eg. Marshfield Clinic in Marshfield, WI).
Who wants to live in Marshfield, WI, pop ~30k? Hardly anyone...but the volume is considerable, and more than appy's and colon polyps.