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Stop complaining abt job market- do something if you are really concerned!
- Thread starter redapple123
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Spelled it wrong. You left out an R.
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I think that this is the article:
July 2010
Stephen N. Bauer, MD
Global impressions
I recently traveled with CAP teams to China, India, and the United Arab Emirates (UAE), all countries in which there has been increasing interest in CAP laboratory improvement programs. The journeys were long but the effort was worthwhile. No secondhand accounts could have taught us so much so quickly; some things have to be experienced personally.
The challenges we talk about at home pale beside those our peers face in some other parts of the world. The pathologists we met share our commitment to quality care for their patients, but where we have deep resources, they often have steep challenges.
The International Monetary Fund provides an estimate of gross domestic product that takes cost of living into account. By this measure, the average person in the U.S. earns $47,123 annually while the average income in China is $7,518, and in India, $3,290. Of course, this is changing rapidly, as these economies are growing much faster than ours, but, needless to say, resources to care for much of the world's population today are greatly stretched.
We met with an administrator in Mumbai responsible for 16 public hospitals providing care at no charge to anyone in need. Her budget for all 16 is a fraction of what we spend on one hospital.
Medical practice varies from country to country. For example, India grapples with resource constraints and a high prevalence of infectious disease. When our colleagues there see granulomas in a colon biopsy, their first thought is tuberculous enterocolitis, not Crohn's disease. Despite the differences in our medical and resource issues, the pathologists we met are interested in our laboratory improvement programs because of their commitment to durable quality. However, as in the U.S., there is cost associated with quality. There, as here, pathologists must justify every investment against competing priorities.
There is an enormous and growing demand for laboratory services in India and China; the worries I sometimes hear about U.S. laboratory work being outsourced to Asia are currently exaggerated. Physicians there struggle to keep up with the demand in their own country. If anything, there could come a day when specialized or consultation work would flow in the opposite direction.
The situation in the UAE differs in several respects. Although weakened in the recent financial downturn, the UAE's economy is healthier. The average annual income in the UAE is $36,973. As in India and China, UAE pathologists have been advocating for improved standards for some time. Now with strong government support, UAE pathologists can do more of the things they would like to do for quality improvement. The CAP already has accredited, or is in the process of accrediting, the majority of large government and independent laboratories in two emirates of the UAE (Abu Dhabi and Dubai). While I was there, we signed an agreement to conduct a CAP accreditation readiness assessment in three hospitals and two primary care centers in two of the smaller emirates.
The CAP now accredits 36 laboratories in India and 15 in China. Most are larger independent laboratories and laboratories that conduct research for pharmaceutical companies. There is growing interest in adopting CAP standards in hospital- and pathologist-operated laboratories where greater resources are also more often available.
A number of the Indian pathologists we met operate their own laboratories. Their practices involve a good deal of direct patient care and are often referred to as clinics. (In Delhi, the sign outside my laboratory might simply say, "Dr. Bauer's Pathology Clinic.") Many of their patients come to them before deciding what primary care they may need, and many have come to the same pathologist for this care for 20 or 30 years.
On a bus trip that our group took to see the Taj Mahal and to meet with pathologists in Agra, I had an opportunity to see this practice model in action. A pathologist seated near me took a call on his cell phone from a patient's mother. Her child's studies had indicated a urinary tract infection; the mother was alarmed. The Indian pathologist explained to her that a UTI is of concern but readily treatable. He comforted her. I could see why he was so satisfied in his practice.
This primary care model of pathology might not work in the U.S., but it was a fine illustration of a pathologist providing a valuable service by interacting directly with patients for primary care. Patients in the U.S. with serious conditions like cancer might welcome the opportunity to consult with their pathologists. A pathologist who communicates well with patients would bring great value to the new accountable care organization practice model as well.
The CAP Foundation and Transformation Program Office (TPO) cosponsored patient consultation simulation exercises at CAP ‘10 that were extremely well received. Participating pathologists, more than half of whom had been in practice for more than 20 years, met with a trained "patient" in a scenario involving news of a positive biopsy for breast cancer. The pathologists explained the diagnosis and the significance of tumor markers and showed the patients their slides. The experience was rated "excellent" by 70 percent and "good" by the remainder. The only serious complaint was insufficient time to talk with the patient.
The Foundation and TPO plan to sponsor at least three more patient consultation simulation opportunities, including two before CAP '11. They have not yet announced the sites; state pathology meetings are one possibility. I participated at CAP ‘10 and strongly suggest taking part if you have the opportunity.
We learn so much about ourselves when we are in foreign situations. On our journey we learned, for example, that there is an opportunity for the CAP to participate in raising the quality of care internationally. But perhaps the most valuable thing we learn through such personal experience is that everyone has something to teach us as well.
July 2010
Stephen N. Bauer, MD
Global impressions
I recently traveled with CAP teams to China, India, and the United Arab Emirates (UAE), all countries in which there has been increasing interest in CAP laboratory improvement programs. The journeys were long but the effort was worthwhile. No secondhand accounts could have taught us so much so quickly; some things have to be experienced personally.
The challenges we talk about at home pale beside those our peers face in some other parts of the world. The pathologists we met share our commitment to quality care for their patients, but where we have deep resources, they often have steep challenges.
The International Monetary Fund provides an estimate of gross domestic product that takes cost of living into account. By this measure, the average person in the U.S. earns $47,123 annually while the average income in China is $7,518, and in India, $3,290. Of course, this is changing rapidly, as these economies are growing much faster than ours, but, needless to say, resources to care for much of the world's population today are greatly stretched.
We met with an administrator in Mumbai responsible for 16 public hospitals providing care at no charge to anyone in need. Her budget for all 16 is a fraction of what we spend on one hospital.
Medical practice varies from country to country. For example, India grapples with resource constraints and a high prevalence of infectious disease. When our colleagues there see granulomas in a colon biopsy, their first thought is tuberculous enterocolitis, not Crohn's disease. Despite the differences in our medical and resource issues, the pathologists we met are interested in our laboratory improvement programs because of their commitment to durable quality. However, as in the U.S., there is cost associated with quality. There, as here, pathologists must justify every investment against competing priorities.
There is an enormous and growing demand for laboratory services in India and China; the worries I sometimes hear about U.S. laboratory work being outsourced to Asia are currently exaggerated. Physicians there struggle to keep up with the demand in their own country. If anything, there could come a day when specialized or consultation work would flow in the opposite direction.
The situation in the UAE differs in several respects. Although weakened in the recent financial downturn, the UAE's economy is healthier. The average annual income in the UAE is $36,973. As in India and China, UAE pathologists have been advocating for improved standards for some time. Now with strong government support, UAE pathologists can do more of the things they would like to do for quality improvement. The CAP already has accredited, or is in the process of accrediting, the majority of large government and independent laboratories in two emirates of the UAE (Abu Dhabi and Dubai). While I was there, we signed an agreement to conduct a CAP accreditation readiness assessment in three hospitals and two primary care centers in two of the smaller emirates.
The CAP now accredits 36 laboratories in India and 15 in China. Most are larger independent laboratories and laboratories that conduct research for pharmaceutical companies. There is growing interest in adopting CAP standards in hospital- and pathologist-operated laboratories where greater resources are also more often available.
A number of the Indian pathologists we met operate their own laboratories. Their practices involve a good deal of direct patient care and are often referred to as clinics. (In Delhi, the sign outside my laboratory might simply say, "Dr. Bauer's Pathology Clinic.") Many of their patients come to them before deciding what primary care they may need, and many have come to the same pathologist for this care for 20 or 30 years.
On a bus trip that our group took to see the Taj Mahal and to meet with pathologists in Agra, I had an opportunity to see this practice model in action. A pathologist seated near me took a call on his cell phone from a patient's mother. Her child's studies had indicated a urinary tract infection; the mother was alarmed. The Indian pathologist explained to her that a UTI is of concern but readily treatable. He comforted her. I could see why he was so satisfied in his practice.
This primary care model of pathology might not work in the U.S., but it was a fine illustration of a pathologist providing a valuable service by interacting directly with patients for primary care. Patients in the U.S. with serious conditions like cancer might welcome the opportunity to consult with their pathologists. A pathologist who communicates well with patients would bring great value to the new accountable care organization practice model as well.
The CAP Foundation and Transformation Program Office (TPO) cosponsored patient consultation simulation exercises at CAP ‘10 that were extremely well received. Participating pathologists, more than half of whom had been in practice for more than 20 years, met with a trained "patient" in a scenario involving news of a positive biopsy for breast cancer. The pathologists explained the diagnosis and the significance of tumor markers and showed the patients their slides. The experience was rated "excellent" by 70 percent and "good" by the remainder. The only serious complaint was insufficient time to talk with the patient.
The Foundation and TPO plan to sponsor at least three more patient consultation simulation opportunities, including two before CAP '11. They have not yet announced the sites; state pathology meetings are one possibility. I participated at CAP ‘10 and strongly suggest taking part if you have the opportunity.
We learn so much about ourselves when we are in foreign situations. On our journey we learned, for example, that there is an opportunity for the CAP to participate in raising the quality of care internationally. But perhaps the most valuable thing we learn through such personal experience is that everyone has something to teach us as well.
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As callous as this is, I don't give a crap about how US practices compare to those in the Middle and Far East. It's a useless comparison. Stop worrying about Mumbai and worry about the future of your profession.
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Perhaps this focus on the middle east and india stems from the high numbers of fmgs present in pathology who are from those parts of the world?
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Pathology job market is gonna be bad for a long time. Most labs are becoming sweatshops since profit margins are getting killed by all the inducements used to get business. You gotta sign out a ton of cases just to keep the doors open.
Specialists wanna do their own pathology or at least be in control of the revenue generated. Technology is gonna make it possible to make diagnosis point of care. Look at all the devices getting ready to hit the market in the near future. No way will the antiquated system of removing tissue and sending to a laboratory last forever. The only question is when will it end.
Specialists wanna do their own pathology or at least be in control of the revenue generated. Technology is gonna make it possible to make diagnosis point of care. Look at all the devices getting ready to hit the market in the near future. No way will the antiquated system of removing tissue and sending to a laboratory last forever. The only question is when will it end.
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Really? What diagnostic modality could possibly provide more information than direct examination of the diseased tissue? My impression is that pathologists have the ability to provide more information to clinicians than they can currently use. As our ability to treat diseases becomes more precise, the value of the precise diagnosis provided by pathology will grow, not become obsolete.
And even if some other high-tech jedi machine could deliver information sufficient to diagnose everything that pathologists diagnose by just looking at a slide, do you think it could be more cost effective? I expect that internal medicine decision-making will be easier to automate than pathological diagnosis.
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Regardless of what technologies will exist out there, there is still going to be a need to have tissue removed, cancer surgically excised, and tissue examined by experts. That's us. Maybe our role gets reduced, who knows, but it won't disappear. Make yourself essential by doing great work and striving to provide as much clinical input as you can. Work with clinicians, not against them.
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The End is near. Repent now sinners, for the time is nigh.
D
deleted314957
All I have heard since 1981 when I started residency after several clinical years is "gloom and doom". you would have thought TERFA in '83 was going to end the world.
It hasn't happened and i am still doing the same thing as i was 20+ years ago.
I must admit to pathstudent that the "glory days" are probably gone but one can still make a good living in pathology with career satisfaction.
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exactly!
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Why dont you guys draft a respectful letter and send it to Dr. Bauer with your concerns?
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In getting input from someone who has the perspective that has seen Pathology as a field since the 80's you can probably agree that the glory days are gone universally from medicine. Path isn't alone as many fields have suffered...I think surgeons have been pretty vocal about changing reimbursements. I guess the consistent complaint that keeps circling on these boards is unlike other fields path has a significant glut of training compared to what the market needs?
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I don't understand your idea. In what way do you want pathologists to also be primary care? Primary care is a completely different specialty. In any case, if pathologists were going to take over part of the role of another speciality, primary care would be my last choice. Primary care is crap. Why not add a year of surgery or radiology to do biopsies? At least that would be conceptually related.
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Who would want to share their pie? I sure wouldn't. Pathologist need to grow some balls and just do it. They should start being aggressive and stealing procedures from IR/surgery.
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Well, I'm not fond of this idea, but it would theoretically be simple. Just require pathology residents to do a surgical internship and incorporate biopsies into the curriculum throughout residency, then slowly start refusing to read biopsies from non-pathology trained "surgeons". The argument for stealing the procedure is obvious- continuity of care.
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If new guidelines are followed and a lot of waste is removed from pathology, there will be far fewer biopsies. New breast and cervical screening guidelines calling for less screening. There was an article like a month ago that pointed out how much money is being spent each year on Tonsil and Adenoid microscopic examination. How many times is that actually useful? Health care rationing is coming and a lot of procedures are gonna be scrutinized more.
There is no doubt technology and new guidelines will reduce the number of biopsies. Ive lost count of the number of laser devices being tested to reduce the number of skin biopsies. Some are not far from hitting the market. Does less biopsies in a crowded job market make the future sound rosy to you?
There is no doubt technology and new guidelines will reduce the number of biopsies. Ive lost count of the number of laser devices being tested to reduce the number of skin biopsies. Some are not far from hitting the market. Does less biopsies in a crowded job market make the future sound rosy to you?
Devices like this one?
http://www.ncbi.nlm.nih.gov/pubmed/21346168
Don't overhype this new technology... Whenever a new gadget appears, hype is unbearable... then there is a backlash, and after a decade or two dust settles on a happy new equilibrium...
The in-situe diagnostics are still a long time away IMO. The likes of 'pump-probe photon imaging' will take decades to become mainstream... and EVEN IF THEY DO, all they will cause is increase the percentage of melanomas and scary nevi vs sebks and normal nevi...
BTW, the INCIDENCE of melanoma has been INCREASING for decades now... This trend will likely bring more business than any techology might take away...
Oh and I can't wait to see class-action lawsuits against producers of these gadgets, when they do miss or overcall a melanoma... Take 100 TRULY difficult melanocytic lesion (like traumatized, cryoed lesions fingers of 10 year olds) to a 'pump-probe photon spectroscope', and watch the machine start killing or mutilating patients... And watch lawyers descend...
Don't even let me start on the science behind this particular gadget in the article above, and on their methodology...
But if you are so sure that you know what you are talking about, put your money where your mouth is... Buy the stocks of the companies which make these gadgets, and get back to me in 10 years.
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I always thought it meant Neoplasm I'd Like to Freeze
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LOLing seriously right now.
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http://consumer.healthday.com/Article.asp?AID=650183
Here is one such device. I know they get overhyped and rarely perform as they do in clinical trials. But there is a ton of these underdevelopment and some are gonna hit at some point. Hopefully they will backfire like PET scans and lead to more biopsies. I worry about what General Electric is gonna develop now that they own Clarient. Gonna see many devices that combine Radiology and Pathology I bet.
I love it when people defend the status quo by saying "lawyers will descend". Since when is pathology perfect? Like there aren't lawsuits everyday over misses.
Here is one such device. I know they get overhyped and rarely perform as they do in clinical trials. But there is a ton of these underdevelopment and some are gonna hit at some point. Hopefully they will backfire like PET scans and lead to more biopsies. I worry about what General Electric is gonna develop now that they own Clarient. Gonna see many devices that combine Radiology and Pathology I bet.
I love it when people defend the status quo by saying "lawyers will descend". Since when is pathology perfect? Like there aren't lawsuits everyday over misses.
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This.
I find the idea of a group of CAP execs globe trotting to do some phony analysis on 3rd world Pathology services as part of some tax write off offensive...
CAP thanks again for nothing.
