Study: Pathologist workforce decreased 17% between 2007 and 2017

yferi

5+ Year Member
Mar 24, 2013
1
0
1
Status
...Yet we still hear about trainees having difficulty finding jobs. To me this is concerning.

The paper suggests that while the number of new cancer cases (per pathologist) increased by 41% during the same time period, this may have been offset by increased efficiency (laboratory consolidation, new IT, etc.) and/or pressure to read more cases.

Thoughts?

Paper: Trends in the US and Canadian Pathologist Workforces From 2007 to 2017
 

Dro133

5+ Year Member
Mar 7, 2013
271
268
181
Status
Medical Student
There's no way that increased efficiency would make up for a 41% increase in workload, right? Seems insane. Wonder how that compares to US physicians in other specialties.
 
  • Like
Reactions: dukeresident

Spikebd

7+ Year Member
May 2, 2010
396
154
181
Status
Resident [Any Field]
My anecdotal experience is that everybody is getting pretty good jobs.
The real concern will be when this country forces all-out socialized medicine on us. I wouldn’t be surprised to see some version of Medicare for all in before 2030. We’ll have to see how pathology fares under such a system. There will likely be rationed, bundled payments. It might not be that bad, but who knows how badly other specialties will throw us under the bus, like some GI docs appear to do. At least pathology doesn’t require us to pull 28 hour shifts ever, unlike some of these other fields. Imagine doing that with no incentive for extra pay.
 

jupiterianvibe

2+ Year Member
Mar 3, 2016
206
119
81
Status
Post Doc
The tone is far more measured than other shortage screeds. They neglect a few points tho. They talk of quality issues yet also suggest heavy recruitment of fmgs as a solution, without mentioning the varying quality of fmg training. They also do not address the persistently unpopular state of pathology with amgs.
 
  • Like
Reactions: dukeresident

Alteran

10+ Year Member
Feb 10, 2008
230
78
271
Border war zone
Status
Attending Physician
One of the issues with this paper is that it does not correlate the pathologist workforce levels with surgical volumes. Anecdotally, I can say that in my practice, its a zero sum game for an ever diminishing surgical volume. If your practice is experiencing a growth in surgical volume, its because those specimens are being diverted from another facility/practice to yours.

The data presented in this paper may just be reflecting a decreasing surgical volume coupled with increased efficiency. We may not need that many pathologists at the end of the day.
 

AZpath

5+ Year Member
Nov 1, 2012
417
93
121
Status
Attending Physician
There's no way that increased efficiency would make up for a 41% increase in workload, right? Seems insane. Wonder how that compares to US physicians in other specialties.
If this were true then my email would be filled with job offers.
Have CAP and other US pathology organizations reported a loss of membership ?
 

AZpath

5+ Year Member
Nov 1, 2012
417
93
121
Status
Attending Physician
Our accession counts have been dropping for years. Cases are more complex and time consuming though and there has been an increase in money losing procedures like ROSE.
Most of the simple biopsy's went to independent surgery centers or IOP labs in our area.
That left hospital pathologists doing all the hard cases and big resections
Time per RVU goes up

The data base they used shows 17.5% loss of practicing pathologists. Hard to believe.
These studies are the info ACGME uses to add more pathology residents
 

y2k_free_radical

2+ Year Member
Sep 25, 2015
196
71
71
Most of the simple biopsy's went to independent surgery centers or IOP labs in our area.
That left hospital pathologists doing all the hard cases and big resections
Time per RVU goes up

The data base they used shows 17.5% loss of practicing pathologists. Hard to believe.
These studies are the info ACGME uses to add more pathology residents
If there were a true shortage,we wouldn't have to prostitute ourselves to big labs,urologists,gastroenterologists etc.Most pathology groups i know could handle more work.In my area insurance payments are falling and the number of self pays=no pays are rapidly increasing with this including illegal immigrants.
 

WEBB PINKERTON

7+ Year Member
Dec 16, 2010
1,403
286
181
Status
Non-Student
Sounds like they need more pathologists in Idaho according to that study. I know how much posters here like rural jobs.

I don't know of any path groups turning away work. When I stop seeing groups entering into client billing and other sleazy arrangements, I will start to believe there is a shortage.
 
  • Like
Reactions: y2k_free_radical

path24

7+ Year Member
Sep 29, 2009
296
47
161
Status
Attending Physician
You can't be in a workforce when there are no jobs (not literally). The job market is crap. The smart move is to leave the field. The really smart move is to not go into it in the beginning.

The work is obviously getting done and with this decrease in pathologists.

The solution is to train more, so more can't find work. Great plan.

Stay away from this hell people.
 

path24

7+ Year Member
Sep 29, 2009
296
47
161
Status
Attending Physician
Some recent pathoutlines testimonials. Yep still an oversupply!

"Yes! It (the response to our ad) was awesome. We filled it with someone who applied via Path Outlines." S. Lopez, Allegheny Health Network, Pennsylvania, 7 January 2019

"We received a tremendous response and I will use your service in the future should the need arise." A. Khan, M.D., Integrated Cellular & Molecular Diagnostics, Maryland, 17 December 2018

"Would you please take down our ad? It was very successful, and we've hired an excellent pathologist because of it." P. Massard, Duke University Medical Center, North Carolina, 30 November 2018

"I use PathologyOutlines every day. It has the most current information. Immensely helpful for selecting immunohistochemical stains. I’ve also used PathologyOutlines when advertising to find a new colleague. Within a few hours of the advertisement going live, we had dozen of applicants, many of whom were very well qualified for the position, and the pathologist we hired came from PathologyOutlines. I thank PathologyOutlines every day." Dr. Bill Kasimer, Chief of Pathology at South Shore Hospital, Massachusetts, 22 October 2018

"We've had a good response from the ad!" A. Schweitzer, Cincinnati Children's, Ohio, 20 September 2018

"We had an overwhelming response, the posting definitely exceeded expectations!" B. McLaughlin, Indian River Medical Center, 7 September 2018


No shortage, just pure over training. Stay away med students...all med students.
 
  • Like
Reactions: dukeresident

Alteran

10+ Year Member
Feb 10, 2008
230
78
271
Border war zone
Status
Attending Physician
If there were a true shortage,we wouldn't have to prostitute ourselves to big labs,urologists,gastroenterologists etc.Most pathology groups i know could handle more work.In my area insurance payments are falling and the number of self pays=no pays are rapidly increasing with this including illegal immigrants.
Absolutely. We're deliberately holding off on hiring and just diffusing the extra work across the group because of the volatility of the field at the moment. This paper makes it sound like an increase in cancer diagnoses = more work. IT DOES NOT. I can diagnose a malignant GI biopsy, or any other frankly malignant specimen, just as easily as a TA or normal colon biopsy to rule out microscopic colitis. Also, malignant specimens are the minority (very small minority in some instances) of the cases a community pathologist sees unless you're at a busy tertiary care center or academic center with an oncologic focus. I personally find the premise of the paper deeply flawed and just a lazy attempt by academic pathologists to further justify the need for more training spots.

If you wanted to do this paper correctly, we should look at CMS billing data (because good luck trying to get the information from private entities, insurers) and look at the CPT code count/RVU values per pathologist over time with comparisons - especially the RVUs - to other specialties. I think the answer would be quite illuminating.
 
Aug 20, 2018
75
61
81
I do think the daily volume the avg path signs out is up substantially in the past 20 yrs. Hospitals with 12k annual AP accessions and clinical labs used to be staffed by 4 full time paths. Nowadays that would be badly overstaffed and a $ loser.

Less grossing, better IT, CP being outsourced and / or run by PhDs, pressure from lower pro reimbursement, Hospitals consolidating, have all contributed to paths becoming more efficient.

Shortage ! Are we still going with that? What a croc.
 
Last edited:
Mar 2, 2018
88
32
21
Some recent pathoutlines testimonials. Yep still an oversupply!

"Yes! It (the response to our ad) was awesome. We filled it with someone who applied via Path Outlines." S. Lopez, Allegheny Health Network, Pennsylvania, 7 January 2019

"We received a tremendous response and I will use your service in the future should the need arise." A. Khan, M.D., Integrated Cellular & Molecular Diagnostics, Maryland, 17 December 2018

"Would you please take down our ad? It was very successful, and we've hired an excellent pathologist because of it." P. Massard, Duke University Medical Center, North Carolina, 30 November 2018

"I use PathologyOutlines every day. It has the most current information. Immensely helpful for selecting immunohistochemical stains. I’ve also used PathologyOutlines when advertising to find a new colleague. Within a few hours of the advertisement going live, we had dozen of applicants, many of whom were very well qualified for the position, and the pathologist we hired came from PathologyOutlines. I thank PathologyOutlines every day." Dr. Bill Kasimer, Chief of Pathology at South Shore Hospital, Massachusetts, 22 October 2018

"We've had a good response from the ad!" A. Schweitzer, Cincinnati Children's, Ohio, 20 September 2018

"We had an overwhelming response, the posting definitely exceeded expectations!" B. McLaughlin, Indian River Medical Center, 7 September 2018


No shortage, just pure over training. Stay away med students...all med students.
Wish I had taken that advice.
 

path24

7+ Year Member
Sep 29, 2009
296
47
161
Status
Attending Physician
Now there is even a video on pathoutlines/testimonials. Within hours, dozens of qualified applicants from South Shore Hospital in Massachusetts.

Easy to find a pathologist. The workforce has to decrease when there is not enough work.

Reminder: We are in a shortage!! A huge shortage!!!! Published. Seriously.
 
Last edited:
  • Like
Reactions: Napoleon1801

Granular

7+ Year Member
Jul 29, 2009
53
26
151
Status
Attending Physician
Any med student, US grad or FMG, considering path should really have their head examined. If you are a US grad, only pursue it if you are independently wealthy and compensation will not matter to you. In that vein, I've met path-trained MDs in my research endeavors, who basically were earning PhD dollars, but they weren't concerned because they were married to spouses who made bank (usually MDs in gas, cards, derm, etc.). If you are an FMG and want to get to the US at any cost, maybe path residency is OK, but you should not have expectations to find a job in the US, or if you do, that you will be well compensated or respected. This says nothing about you or your abilities; this is the environment. You will be strung along in private practice and never offered partnership, or patronized in academia while getting an "instructor" title. Or getting paid 15% of what you are billing at a commercial lab.
This is no joke. You invest years of your life in school, accumulate debt, generate high expectations for yourself, etc., only to realize you made one poor decision along the way that negates all that effort. The Medscape compensation report (not that any of these reports are 100% reliable) showed path was one of few fields where compensation decreased from 2017 to 2018. New graduates have trouble finding jobs - I bet this is unique in medicine in the US.
This is basic economics - supply and demand. Supply is huge, based on current and historical over-training, while demand is probably unchanged. Insurers know this and this is driving their assault on reimbursement. There is abundant evidence of the oversupply if you look anywhere that is not academia-influenced (hiring/abuse by other specialties, trouble finding jobs, reimbursement cuts, increased use of proxies, etc.).
The power brokers (large commercial labs and academia) love this situation, which is why it has persisted. A steady supply of free grossing-monkeys, and cheap, well-trained board certified pathologists is what these players want. Don't sacrifice your future by accommodating these entities. You are not special. You are not the exception that will overcome these challenges. The system will destroy you. Don't go into path!
 

Unty

New Member
10+ Year Member
Feb 4, 2005
335
105
281
Status
If I was a US grad with strong board scores I would go another route instead of Path.
 
Last edited:

pathslides

2+ Year Member
Aug 7, 2016
244
128
81
Status
Attending Physician
If I was a US grad with strong board scores I would go another route instead of Path.

I wouldn’t. Pathology is the best field. Normal and competent peeps get good jobs. It’s interesting work, has great work life balance, and for the most part, day to day is quite laid back . All of primary care blows, surgery lifestyle is horrendous, radiology is less relaxed, and all other specieties suck cuz they involve direct patient care.
 

Dro133

5+ Year Member
Mar 7, 2013
271
268
181
Status
Medical Student
I wouldn’t. Pathology is the best field. Normal and competent peeps get good jobs. It’s interesting work, has great work life balance, and for the most part, day to day is quite laid back . All of primary care blows, surgery lifestyle is horrendous, radiology is less relaxed, and all other specieties suck cuz they involve direct patient care.
Pretty much describes why I want to do path over rads. Plus, the material just seems more intellectually stimulating to me (cancer, genetic mutations...just a lot more basic science than rads). I understand the job market concerns, the lower pay, the lack of geographic flexibility...I guess I'd rather hope that stuff works itself out than go into a specialty that isn't as interesting. Maybe that's naive...oh well.
 
  • Like
Reactions: Sarahkeet

Unty

New Member
10+ Year Member
Feb 4, 2005
335
105
281
Status
What would you go into?
Rads easy. Better job market and geographic flexibility when it comes to jobs. Better pay.

Everyone who is competent and board certified gets jobs in Pathology but **may*** have to move to secure a job. Your first job may not be at a place of your liking but you can move later in your second or third job.

Few jobs posted on pathoutlines versus plenty of jobs (in nice metropolitan cities and with moving bonuses) on the ACR website.

Do what you enjoy but if you go into Path know what to expect.
 
  • Like
Reactions: Dro133

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,121
233
181
NOT behind a scope.
Status
Attending Physician
Rads easy. Better job market and geographic flexibility when it comes to jobs. Better pay.

Everyone who is competent and board certified gets jobs in Pathology but **may*** have to move to secure a job. Your first job may not be at a place of your liking but you can move later in your second or third job.

Few jobs posted on pathoutlines versus plenty of jobs (in nice metropolitan cities and with moving bonuses) on the ACR website.

Do what you enjoy but if you go into Path know what to expect.
I enjoyed the hell out of path. But, it was a different era and I was EXTREMELY lucky (and well prepared after U S Navy,
AFIP). The situation I was in is a vanishing entity. Path is still very interesting but you will not only have to bite-the-bullet,
you will probably have to eat several bullets if you enter this field. And I sincerely believe the situation will not improve in the foreseeable future. Even if pathologists become rare commodities, by that time there will be no private sector of any significance. You will be an employee of some entity with rare exception.

This is not your Fathers Oldsmobile.
 
  • Like
Reactions: y2k_free_radical

Daddydoc

10+ Year Member
Jul 14, 2005
207
12
251
Status
Attending Physician
Pretty much describes why I want to do path over rads. Plus, the material just seems more intellectually stimulating to me (cancer, genetic mutations...just a lot more basic science than rads). I understand the job market concerns, the lower pay, the lack of geographic flexibility...I guess I'd rather hope that stuff works itself out than go into a specialty that isn't as interesting. Maybe that's naive...oh well.
I agree. I might make less per year, but I work half the hours many others do, with much less stress.
 

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
THERE IS A SEVERE GLUT OF PATHOLOGISTS IN THE US, NOT SHORTAGE

I am middle aged pathologist certified in AP/CP and cytopathology. I have not yet been involved in any lawsuits. My experience is that job market for pathologist in the US is dismal, despite all reports from academia claiming just the opposite.

I currently work in middle size community US hospital. Our hospital had frequently problems attracting qualified physicians and had to hire expensive firms to attract good doctors. However, when we advertised a free position for a pathologist via pathology outlines our secretary received 85 CVs in only 5 days.

My young colleague will finish residency and fellowship in July this year. While his wife, internist, got 30 job offers, he only recently got a single offer, after 9 months search.

Why do calculations from academic centers always get it wrong?

1) People in academia live in special environment and have no idea or interest to see what is going on in the real world. Since academic departments of pathology have incentive to train as many pathologist as possible (cheap labor and government subsidies), they choose to see reality as suits them the most. They do calculations based on previous years and fail to see (intentionally or due to ignorance) the major shift which happened in last 20 years.

2) In last 20 years the work load for most pathologist working outside academia at least doubled, if not tripled.

What caused this sudden increase in work load? It is primarily due to the acquisitions of individually-owned laboratories by large corporations (Quest, Labcorp, HCA and others). In order to increase profit margins, raise stock valuations, and ensure that CEO's are awarded lucrative stock options, corporations have merged many smaller laboratories into large conglomerates. In most situations, a new corporate entity will fire half of the existing pathology staff and increase work expectations for the remaining employees far beyond the prior norm.

And how did academia respond to the overall cosmic change? Teaching hospitals, in their quest for more federal money and cheaper labor (in the form of residents) almost doubled the number of PGY1 positions for pathologists in the same time period – from 335 in 2000 to 605 in 2015. Seeking even more profit, these education teaching hospitals recently added Pathology to the list of specialties in "short supply", enabling them to push for additional slots (and funds) under new legislation.

Community hospital pathologists (80% of pathologists) cannot simply leave positions, even where they are abused with excessive workloads, as there are no alternative positions available. The market is hyper-saturated and there are no viable alternative options offered to pathologists. Fearing the loss of their jobs, pathologists obediently do whatever is demanded of them by corporate managers. The severe surplus of trained pathologists threatens the livelihoods of established pathologists. The only exceptions to this dilemma are Pathologists who go into academia and administration and who then push for more training positions, further exacerbating the problems faced by existing practicing pathologists. It's a fact that pathologists' concern for their jobs makes them willing to do more and more work to avoid losing their positions. Pathology departments in teaching hospitals claim there is a shortage of pathologists and seek to train more pathologists in order to be awarded more federal funds.

This situation has created a problematic scenario with a vicious cycle that repeats itself. No wonder there is a severe glut and high unemployment rate among US pathologists. The main problem in pathology is not a lack of awareness of the value of pathologist, but the oversupply. This would be rectified if PGY1 positions were to be decreased.

I appeal to you to STOP SPREADING NONSENSE ABOUT SHORTAGE. There is no shortage for trained pathologist outside academic centers.

 
Last edited:
Jul 30, 2018
217
156
41
THERE IS A SEVERE GLUT OF PATHOLOGISTS IN THE US, NOT SHORTAGE

I am middle aged pathologist certified in AP/CP and cytopathology. I have not yet been involved in any lawsuits. My experience is that job market for pathologist in the US is dismal, despite all reports from academia claiming just the opposite.

I currently work in middle size community US hospital. Our hospital had frequently problems attracting qualified physicians and had to hire expensive firms to attract good doctors. However, when we advertised a free position for a pathologist via pathology outlines our secretary received 85 CVs in only 5 days.

My young colleague will finish residency and fellowship in July this year. While his wife, internist, got 30 job offers, he only recently got a single offer, after 9 months search.

Why do calculations from academic centers always get it wrong?

1) People in academia live in special environment and have no idea or interest to see what is going on in the real world. Since academic departments of pathology have incentive to train as many pathologist as possible (cheap labor and government subsidies), they choose to see reality as suits them the most. They do calculations based on previous years and fail to see (intentionally or due to ignorance) the major shift which happened in last 20 years.

2) In last 20 years the work load for most pathologist working outside academia at least doubled, if not tripled.

What caused this sudden increase in work load? It is primarily due to the acquisitions of individually-owned laboratories by large corporations (Quest, Labcorp, HCA and others). In order to increase profit margins, raise stock valuations, and ensure that CEO's are awarded lucrative stock options, corporations have merged many smaller laboratories into large conglomerates. In most situations, a new corporate entity will fire half of the existing pathology staff and increase work expectations for the remaining employees far beyond the prior norm.

And how did academia respond to the overall cosmic change? Teaching hospitals, in their quest for more federal money and cheaper labor (in the form of residents) almost doubled the number of PGY1 positions for pathologists in the same time period – from 335 in 2000 to 605 in 2015. Seeking even more profit, these education teaching hospitals recently added Pathology to the list of specialties in "short supply", enabling them to push for additional slots (and funds) under new legislation.

Community hospital pathologists (80% of pathologists) cannot simply leave positions, even where they are abused with excessive workloads, as there are no alternative positions available. The market is hyper-saturated and there are no viable alternative options offered to pathologists. Fearing the loss of their jobs, pathologists obediently do whatever is demanded of them by corporate managers. The severe surplus of trained pathologists threatens the livelihoods of established pathologists. The only exceptions to this dilemma are Pathologists who go into academia and administration and who then push for more training positions, further exacerbating the problems faced by existing practicing pathologists. It's a fact that pathologists' concern for their jobs makes them willing to do more and more work to avoid losing their positions. Pathology departments in teaching hospitals claim there is a shortage of pathologists and seek to train more pathologists in order to be awarded more federal funds.

This situation has created a problematic scenario with a vicious cycle that repeats itself. No wonder there is a severe glut and high unemployment rate among US pathologists. The main problem in pathology is not a lack of awareness of the value of pathologist, but the oversupply. This would be rectified if PGY1 positions were to be decreased.

I appeal to you to STOP SPREADING NONSENSE ABOUT SHORTAGE. There is no shortage for trained pathologist outside academic centers.

How many path spots went unfilled out of those 600? I feel like even 300 is too many.
 

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
How many path spots went unfilled out of those 600? I feel like even 300 is too many.
http://www.nrmp.org/match-data/nrmp-historical-reports/ (NOW DEFUNCT)


year # PGY1 % filled US % filled total

2015 605 46.6 93.7
2014 597 42.9 91.5
2013 583 45.1 96.4
2012 521 50.3 89.4
2011 518 51.9 91.9
2010 503 65 96.2
2009 522 61.5 94.3
2008 508 58.7 91.1
2007 513 57.7 90.8
2006 525 60 91.4
2005 526 61.9 91.4
2004 477 61.2 91.8
2003 443 59.6 90
2002 398 49.7 83.6
2001 383 44.3 81.4
2000 335 37.9 73.4
1999 344 42.4 81.6
1998 355 36 69.8
1997 359 39.2 69
1996 426 53.7 77.7
1995 438 61.4 83.7
1994 450 56.6 75.5
1993 517 53.7 67.5
1992 518 49.0 61.5
1991 513 52.6 62.1
1990 486 50 60
1989 475 53.2 64.2
1988 443 41.5 56.8
1987 471 44.3 58.6
1986 477 41.3 57.9
1985 468 40.6 60
1984 479 55 69
1983 484 55 67
1982 557 42.4 49.6
1981 574 42.5 56.6
1980 573 38.2 42.1
1979 612 46.1 49.7
1978 582 42 48
1977 585 no data no data
 

Unty

New Member
10+ Year Member
Feb 4, 2005
335
105
281
Status
THERE IS A SEVERE GLUT OF PATHOLOGISTS IN THE US, NOT SHORTAGE

I am middle aged pathologist certified in AP/CP and cytopathology. I have not yet been involved in any lawsuits. My experience is that job market for pathologist in the US is dismal, despite all reports from academia claiming just the opposite.

I currently work in middle size community US hospital. Our hospital had frequently problems attracting qualified physicians and had to hire expensive firms to attract good doctors. However, when we advertised a free position for a pathologist via pathology outlines our secretary received 85 CVs in only 5 days.

My young colleague will finish residency and fellowship in July this year. While his wife, internist, got 30 job offers, he only recently got a single offer, after 9 months search.

Why do calculations from academic centers always get it wrong?

1) People in academia live in special environment and have no idea or interest to see what is going on in the real world. Since academic departments of pathology have incentive to train as many pathologist as possible (cheap labor and government subsidies), they choose to see reality as suits them the most. They do calculations based on previous years and fail to see (intentionally or due to ignorance) the major shift which happened in last 20 years.

2) In last 20 years the work load for most pathologist working outside academia at least doubled, if not tripled.

What caused this sudden increase in work load? It is primarily due to the acquisitions of individually-owned laboratories by large corporations (Quest, Labcorp, HCA and others). In order to increase profit margins, raise stock valuations, and ensure that CEO's are awarded lucrative stock options, corporations have merged many smaller laboratories into large conglomerates. In most situations, a new corporate entity will fire half of the existing pathology staff and increase work expectations for the remaining employees far beyond the prior norm.

And how did academia respond to the overall cosmic change? Teaching hospitals, in their quest for more federal money and cheaper labor (in the form of residents) almost doubled the number of PGY1 positions for pathologists in the same time period – from 335 in 2000 to 605 in 2015. Seeking even more profit, these education teaching hospitals recently added Pathology to the list of specialties in "short supply", enabling them to push for additional slots (and funds) under new legislation.

Community hospital pathologists (80% of pathologists) cannot simply leave positions, even where they are abused with excessive workloads, as there are no alternative positions available. The market is hyper-saturated and there are no viable alternative options offered to pathologists. Fearing the loss of their jobs, pathologists obediently do whatever is demanded of them by corporate managers. The severe surplus of trained pathologists threatens the livelihoods of established pathologists. The only exceptions to this dilemma are Pathologists who go into academia and administration and who then push for more training positions, further exacerbating the problems faced by existing practicing pathologists. It's a fact that pathologists' concern for their jobs makes them willing to do more and more work to avoid losing their positions. Pathology departments in teaching hospitals claim there is a shortage of pathologists and seek to train more pathologists in order to be awarded more federal funds.

This situation has created a problematic scenario with a vicious cycle that repeats itself. No wonder there is a severe glut and high unemployment rate among US pathologists. The main problem in pathology is not a lack of awareness of the value of pathologist, but the oversupply. This would be rectified if PGY1 positions were to be decreased.

I appeal to you to STOP SPREADING NONSENSE ABOUT SHORTAGE. There is no shortage for trained pathologist outside academic centers.

Yup. I hope the numbers of US grads going into Path continue to dwindle. Maybe that’ll open up some eyes.

But most academics think it’s due to a lack of exposure in medical school. No it’s because the word is out about the dismal job market.
 
Jul 30, 2018
217
156
41
Yup. I hope the numbers of US grads going into Path continue to dwindle. Maybe that’ll open up some eyes.

But most academics think it’s due to a lack of exposure in medical school. No it’s because the word is out about the dismal job market.
Holy ****. They are still filling >90% of the spots. Just plugging in those FMGs. so basically it will never get any better. What a sham
 

AZpath

5+ Year Member
Nov 1, 2012
417
93
121
Status
Attending Physician
The issue needs to be raised with the CAP house of delegates. Contact your CAP HOD rep for your state.
Also you can go to the CAP meeting and attend the HOD.
Their has been little to no activism from CAP members on this issue.

Why should anyone care if there is no pressure from CAP members.
A number of people have to become very visible and through down the gauntlet.
Academic pathologists and commercial labs are influential. You have to be vocal to take on that faction.
 

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
The issue needs to be raised with the CAP house of delegates. Contact your CAP HOD rep for your state.
Also you can go to the CAP meeting and attend the HOD.
Their has been little to no activism from CAP members on this issue.

Why should anyone care if there is no pressure from CAP members.
A number of people have to become very visible and through down the gauntlet.
Academic pathologists and commercial labs are influential. You have to be vocal to take on that faction.
Wrong, Totally Wrong.
PATHPAC (Political action committee of College of American Pathologists) has been actively lobbying for the increase of Pathology PGY1 positions for years. According to CAP: “The increased funding for GME has been more of a rhetorical priority for members of Congress than real issue; GME is expensive and it’s not yet become a priority for most members. Additionally, not all residency slots have been used, which makes arguing for an increase more challenging. Nevertheless, PATHPAC will continue to pursue an increase in pathology residency slots”.http://www.cap.org/apps/docs/advocacy/advocacy_issues/gme.pdf

In my opinion, persuading academic pathologists or members of CAP about oversupply of pathologist in the US is same task as convincing members of communist part that planned economy does not work.
 

AZpath

5+ Year Member
Nov 1, 2012
417
93
121
Status
Attending Physician
You made my case and I basically agree with you
The academic folks are politically active in CAP.
People in private practice not so much.

We can complain here until the cows come home on Mars.
It is not likely to matter unless elected CAP governors have to respond to this issue from its members.

Otherwise, we wait for a major hit to CMS PC fee schedule or some other economic disaster
Then there will be too many unemployed pathologist to ignore.
 

Dam272

2+ Year Member
Oct 4, 2015
103
40
111
Gotham
Yup. I hope the numbers of US grads going into Path continue to dwindle. Maybe that’ll open up some eyes.

But most academics think it’s due to a lack of exposure in medical school. No it’s because the word is out about the dismal job market.
I agree. That fact was the only “reasoning” given to my wife to steer away from pathology when she was applying for residency.

She still applied and matched into pathology, just coz she loves it
 
  • Like
Reactions: path_spouse

path_spouse

2+ Year Member
Apr 1, 2016
13
5
51
Thanks for this data.

http://www.nrmp.org/match-data/nrmp-historical-reports/ (NOW DEFUNCT)


year # PGY1 % filled US % filled total

2015 605 46.6 93.7
2014 597 42.9 91.5
.
.
.
The data was difficult for me to interpret without a visual, so I plotted it (see attached). I'll throw it open for all of your interpretation, but from my quick glance, the number of residency spots goes up and down, but hasn't changed that much since the 1970's. The percentage of AMGs going into spots also fluctuates, but hasn't changed that much since the 1970s either.

The difference between the past and present seems to be that spots that previously went unfilled are now being filled with IMGs.

As an observation from a non-pathologist browsing pathoutlines, your job market seems similar to the one I encountered when seeking a tenure-track position in basic science: A handful of jobs around the country, jobs frequently in remote rural areas, one or more postdocs necessary to find a position, and any and all job postings drawing 85-100 applicants. Every few years someone writes an article in the NYT about the overproduction of science PhDs. But universities need PhD students to survive, so nobody ever actually does anything about it.

Well, I hope things are different for all of you (I sure have an interest in their being so!)
 

Attachments

Alteran

10+ Year Member
Feb 10, 2008
230
78
271
Border war zone
Status
Attending Physician
Thanks for putting that chart together. That pretty sums up what I have noticed anecdotally in looking at the NRMP match data since I got into field myself.

My biggest critique of pathology training is with quality control. There is none. I've read the ACGME program requirements for pathology residency programs and they are so ambiguous and loose, seemingly anyone can open one anywhere irrespective of what actual material there is to learn from or whether the faculty actually have an interest in running a legitimate training program. And the methods of evaluation and promotion are so capricious from program to program, we don't have any idea how to pick one good recent trainee from one that's going to leave us high and dry. So, not only are we overtraining, but a significant proportion of pathology graduates are substandard - in my opinion - with respect to either knowledge base or their actual ability to perform their job independently.

I don't know what other's experiences with recent graduates are on here, but I can say from personal experience that I'm very unimpressed with current trainees up to the fellow level. Even the new hires with some experience can't seem to function well. I don't think doing 30 cases of routine surgicals a day is asking too much, but apparentlty for most recent graduates I've encountered, it seems to be.
 

Dro133

5+ Year Member
Mar 7, 2013
271
268
181
Status
Medical Student
Thanks for putting that chart together. That pretty sums up what I have noticed anecdotally in looking at the NRMP match data since I got into field myself.

My biggest critique of pathology training is with quality control. There is none. I've read the ACGME program requirements for pathology residency programs and they are so ambiguous and loose, seemingly anyone can open one anywhere irrespective of what actual material there is to learn from or whether the faculty actually have an interest in running a legitimate training program. And the methods of evaluation and promotion are so capricious from program to program, we don't have any idea how to pick one good recent trainee from one that's going to leave us high and dry. So, not only are we overtraining, but a significant proportion of pathology graduates are substandard - in my opinion - with respect to either knowledge base or their actual ability to perform their job independently.

I don't know what other's experiences with recent graduates are on here, but I can say from personal experience that I'm very unimpressed with current trainees up to the fellow level. Even the new hires with some experience can't seem to function well. I don't think doing 30 cases of routine surgicals a day is asking too much, but apparentlty for most recent graduates I've encountered, it seems to be.
Do you notice any general difference in quality of graduates coming from "big-name" programs versus those coming from less prestigious programs?
 

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
Do you notice any general difference in quality of graduates coming from "big-name" programs versus those coming from less prestigious programs?
Today, everyone is trying to open pathology residency. Why? Because of the high tuition revenues involved. Medicare provides Indirect Medical Education (IME) and Direct Medical Education (DME) reimbursements to hospitals that train residents, regardless of what the job market is. This is a considerable amount of money. Medicare subsidies for GME total about $10.1 billion annually, an average 112,642 per resident. Residents in Pathology also represent a very cheap, but highly skilled, labor group that is relatively inexpensive for what it does. The value of a ''total package''(value of GME subsidies and value of services) for one resident calculates to about $150K per year if the resident also performs the full time duties of a Physician Assistant (PA), such as during rotations in Surgical Pathology. Rather than employ a PA, whose annual salary might average $100K, the hospital instead will require a resident to perform similar tasks for only $60K, saving the difference. Teaching hospitals are motivated to seek these government tuition payments while exploiting their residents.

Residents are for teaching hospitals what are specimens for community hospitals: source of money...
Many community hospitals, however, want to have both revenues. Recently HCA in Fort Lauderdale opened two PGY1 positions in two community hospitals with no diversity of material. The plan, however, is to have 4 PGY1 positions in near future.

And what did we community pathologist do in last 3 decades to protect our positions?

Except complaining NOTHING....
 
Last edited:
  • Like
Reactions: y2k_free_radical

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
You made my case and I basically agree with you
The academic folks are politically active in CAP.
People in private practice not so much.

We can complain here until the cows come home on Mars.
It is not likely to matter unless elected CAP governors have to respond to this issue from its members.

Otherwise, we wait for a major hit to CMS PC fee schedule or some other economic disaster
Then there will be too many unemployed pathologist to ignore.
They will not ignore unemployed pathologists.
They will write new articles claiming that job market is wonderful.... no matter what...


Talking to academia or CAP about pathology job prospects in the USA makes as much sense as talking to this man about free market economy:
 
Last edited:

Unty

New Member
10+ Year Member
Feb 4, 2005
335
105
281
Status
Thanks for putting that chart together. That pretty sums up what I have noticed anecdotally in looking at the NRMP match data since I got into field myself.

My biggest critique of pathology training is with quality control. There is none. I've read the ACGME program requirements for pathology residency programs and they are so ambiguous and loose, seemingly anyone can open one anywhere irrespective of what actual material there is to learn from or whether the faculty actually have an interest in running a legitimate training program. And the methods of evaluation and promotion are so capricious from program to program, we don't have any idea how to pick one good recent trainee from one that's going to leave us high and dry. So, not only are we overtraining, but a significant proportion of pathology graduates are substandard - in my opinion - with respect to either knowledge base or their actual ability to perform their job independently.

I don't know what other's experiences with recent graduates are on here, but I can say from personal experience that I'm very unimpressed with current trainees up to the fellow level. Even the new hires with some experience can't seem to function well. I don't think doing 30 cases of routine surgicals a day is asking too much, but apparentlty for most recent graduates I've encountered, it seems to be.
I know plenty of people, even experienced attendings who couldn’t signout medical lung, medical renal, medical liver, neuro or dermpath unless you have years of experience and have taken it upon yourself to become better at a particular organ system.


Attendings where I did my surgpath fellowship just gave their medical liver biopsies to the GI attending to signout for example.

The thing is surgical pathology is broad and no one can be good at everything. If you are straight out of training and are able to confidently sign out all the above then hats off to you. You should however be able to signout bread and butter basic cancer cases like lung, urothelial, breast, etc. You should be able to workup cancer cases.

You will only be as good as the number of cases you preview and signout with the attending. You may not be able to see as many bladder biopsies or breast biopsies as you’d like and the different pathologies for each organ system (depending on how your program is structured) but it’s up to you to look at slides on your free time or after hours if need be.

I do agree some programs don’t do a good job at training residents. They allow some to fall through the cracks with weaknesses in diagnostic skills, then they graduate, pass their boards and go into the workforce with diagnostic issues.

Advice to all medical students going into Path. Go to a busy residency program with at least 20-25,000 surgical volume where you get to preview as many cases as possible. Go to a brand name residency and fellowship so that you have leverage when applying for jobs.
 
Last edited:

Unty

New Member
10+ Year Member
Feb 4, 2005
335
105
281
Status
Thanks for putting that chart together. That pretty sums up what I have noticed anecdotally in looking at the NRMP match data since I got into field myself.

My biggest critique of pathology training is with quality control. There is none. I've read the ACGME program requirements for pathology residency programs and they are so ambiguous and loose, seemingly anyone can open one anywhere irrespective of what actual material there is to learn from or whether the faculty actually have an interest in running a legitimate training program. And the methods of evaluation and promotion are so capricious from program to program, we don't have any idea how to pick one good recent trainee from one that's going to leave us high and dry. So, not only are we overtraining, but a significant proportion of pathology graduates are substandard - in my opinion - with respect to either knowledge base or their actual ability to perform their job independently.

I don't know what other's experiences with recent graduates are on here, but I can say from personal experience that I'm very unimpressed with current trainees up to the fellow level. Even the new hires with some experience can't seem to function well. I don't think doing 30 cases of routine surgicals a day is asking too much, but apparentlty for most recent graduates I've encountered, it seems to be.
What issues have you been seeing with new junior attendings?
 

jupiterianvibe

2+ Year Member
Mar 3, 2016
206
119
81
Status
Post Doc
Today, everyone is trying to open pathology residency. Why? Because of the high tuition revenues involved. Medicare provides Indirect Medical Education (IME) and Direct Medical Education (DME) reimbursements to hospitals that train residents, regardless of what the job market is. This is a considerable amount of money. Medicare subsidies for GME total about $10.1 billion annually, an average 112,642 per resident. Residents in Pathology also represent a very cheap, but highly skilled, labor group that is relatively inexpensive for what it does. The value of a ''total package''(value of GME subsidies and value of services) for one resident calculates to about $150K per year if the resident also performs the full time duties of a Physician Assistant (PA), such as during rotations in Surgical Pathology. Rather than employ a PA, whose annual salary might average $100K, the hospital instead will require a resident to perform similar tasks for only $60K, saving the difference. Teaching hospitals are motivated to seek these government tuition payments while exploiting their residents.

Residents are for teaching hospitals what are specimens for community hospitals: source of money...
Many community hospitals, however, want to have both revenues. Recently HCA in Fort Lauderdale opened two PGY1 positions in two community hospitals with no diversity of material. The plan, however, is to have 4 PGY1 positions in near future.

And what did we community pathologist do in last 3 decades to protect our positions?

Except complaining NOTHING....
This is an interesting finding that, were the government more aware of it, perhaps they would want to save that money and reduce the number of pathology residencies. GME is not cheap, after all. Universities paying for PAs is not the government's problem so I doubt that would be a sufficient reason to continue the overexpansion of residency programs.

Perhaps a presentation or paper outlining the issues could be published in the ASCP journal. I would suggest APLM due to its readership but that's owned by CAP which we all know has a vested interest in a continued overproduction of lousy pathologists for the benefit of the major laboratory corporations.

Complaining online does nothing to help us. In fact it probably hurts us as fewer AMGs will pursue pathology, and the desperate droves from the third world that take the positions will tolerate conditions that no AMG ever would, while providing substandard service on average.

What will help is, like I said before, making a case to the payers that they should not be paying for this anymore.
 
  • Like
Reactions: Spikebd

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
This is an interesting finding that, were the government more aware of it, perhaps they would want to save that money and reduce the number of pathology residencies. GME is not cheap, after all. Universities paying for PAs is not the government's problem so I doubt that would be a sufficient reason to continue the overexpansion of residency programs.

Perhaps a presentation or paper outlining the issues could be published in the ASCP journal. I would suggest APLM due to its readership but that's owned by CAP which we all know has a vested interest in a continued overproduction of lousy pathologists for the benefit of the major laboratory corporations.

Complaining online does nothing to help us. In fact it probably hurts us as fewer AMGs will pursue pathology, and the desperate droves from the third world that take the positions will tolerate conditions that no AMG ever would, while providing substandard service on average.

What will help is, like I said before, making a case to the payers that they should not be paying for this anymore.
..."What will help is, like I said before, making a case to the payers that they should not be paying for this anymore. ..."
WHAT ABOUT SIGNING YOUR NAME HERE ?
 

jupiterianvibe

2+ Year Member
Mar 3, 2016
206
119
81
Status
Post Doc

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
Nobody cares about online petitions.
Writing print letters to representatives is more effective.
Have you seen who signed that? John Cena. Come on now, it's impotent.
Which representative?
Representative in Congress listen to CAP, not to individual pathologist. The ones that complain are perceived as losers.
I have noticed that most pathologist do not have guts to do anything. They behave like a minority, being quiet hoping to keep job for another year or so...
This is how black people behaved 100 years ago and gay men 50 years ago...
When will we grow up?
 
Last edited:

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,121
233
181
NOT behind a scope.
Status
Attending Physician
I know plenty of people, even experienced attendings who couldn’t signout medical lung, medical renal, medical liver, neuro or dermpath unless you have years of experience and have taken it upon yourself to become better at a particular organ system.


Attendings where I did my surgpath fellowship just gave their medical liver biopsies to the GI attending to signout for example.

The thing is surgical pathology is broad and no one can be good at everything. If you are straight out of training and are able to confidently sign out all the above then hats off to you. You should however be able to signout bread and butter basic cancer cases like lung, urothelial, breast, etc. You should be able to workup cancer cases.

You will only be as good as the number of cases you preview and signout with the attending. You may not be able to see as many bladder biopsies or breast biopsies as you’d like and the different pathologies for each organ system (depending on how your program is structured) but it’s up to you to look at slides on your free time or after hours if need be.

I do agree some programs don’t do a good job at training residents. They allow some to fall through the cracks with weaknesses in diagnostic skills, then they graduate, pass their boards and go into the workforce with diagnostic issues.

Advice to all medical students going into Path. Go to a busy residency program with at least 20-25,000 surgical volume where you get to preview as many cases as possible. Go to a brand name residency and fellowship so that you have leverage when applying for jobs.
I would like to emphasize what I consider Unty’s most salient point. It is SUPER IMPORTANT to see as many cases/push as much glass as possible during residency. And it is SUPER IMPORTANT that you be required to review all your cases and come to a reasoned DDX before any s/o with attending.
 

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
I would like to emphasize what I consider Unty’s most salient point. It is SUPER IMPORTANT to see as many cases/push as much glass as possible during residency. And it is SUPER IMPORTANT that you be required to review all your cases and come to a reasoned DDX before any s/o with attending.
Agree.
But how will this solve the problem of hypersaturation?
Why Pathology is not specialty of few and proud, a special club like ENT, dermatology or ophthalmology?
 
Last edited:

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,121
233
181
NOT behind a scope.
Status
Attending Physician
Agree.
But how will this solve the problem of hypersaturation?
Why Pathology is not specialty of few and proud, a special club like ENT, dermatology or ophthalmology?
Well, this may be exceedingly unpopular, but I think the ABP should fail a HELL OF A LOT MORE than they do on the boards. It is a JOKE that as many pass as do when most of them have a pretty crappy background. And, lest y’all jump on my case, many of these marginal folks ( and some not so marginal) will be the first to tell you that they can’t do this or are unprepared for that or (fill in the blank). Get back to a failure rate of ~40%. You will see the numbers of both people going into path and those exiting residency with boards plummet. And, most of the folks who will fail are the weak ones anyway. We should not be the field that coddles the mediocre.
 

jupiterianvibe

2+ Year Member
Mar 3, 2016
206
119
81
Status
Post Doc
Well, this may be exceedingly unpopular, but I think the ABP should fail a HELL OF A LOT MORE than they do on the boards. It is a JOKE that as many pass as do when most of them have a pretty crappy background. And, lest y’all jump on my case, many of these marginal folks ( and some not so marginal) will be the first to tell you that they can’t do this or are unprepared for that or (fill in the blank). Get back to a failure rate of ~40%. You will see the numbers of both people going into path and those exiting residency with boards plummet. And, most of the folks who will fail are the weak ones anyway. We should not be the field that coddles the mediocre.
I agree. It amazes me that a field that requires precise communication essentially considers English proficiency optional.
 

senior pathologist

2+ Year Member
Jun 25, 2014
20
12
51
Status
Attending Physician
I agree. It amazes me that a field that requires precise communication essentially considers English proficiency optional.
There is no need to fail 40 % of candidates.
Much better would be to decrease number of PGY1 position for 50% and make residency in pathology as competitive as dermatology, ENT or ophthalmology.

In this case, however, teaching hospitals would not be able to obtain federal funds by training physicians for positions which do not exist.
 
Last edited:
  • Like
Reactions: y2k_free_radical