Study: Pathologist workforce decreased 17% between 2007 and 2017

[Alteran]

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.

By being unimpressed, I’m not talking about subspecialty knowledge or one’s comfort with pathology esoterica. I will admit as much as the next person that I’ll be the first to turf medical lung and kidney, and skin for that matter, off my desk as fast as it hits it.

What I’m talking about are some of the following things I’ve personally seen:
- Fellows completely unwilling to function on their respective services independently because they’ll have to do all the work without having a resident to split the work with; they thought is was unfair.
- Junior academic attendings who take 2-3 days to finally get around to having the courage to sign out TAs.
- Other academic attendings who level through every TA looking for high-grade dysplasia - and then bringing every one of them to a QA session - for years on end.
- New hires who are paralyzed by what is generally considered routine surgical pathology, bread and butter stuff.
- New hires who for every malignancy, even the established ones, tie up all the benchmark II ultras with at least dozen IHC stains, per case. Absolutely no attempt is made at formulating a differential given a history, site of biopsy, and morphology; just a broad throw mud at the wall and see what sticks approach.
- The absolute inability to author a final report that ties in a plausible diagnosis with the clinical picture.
- The absolute inability to communicate effectively with surgical and clinical colleagues, in any setting, that promptly causes my phone to ring with an irate colleague on the other end with a problem that I have to clean up.

I could go on, but I think we all get the point. Notice that most of my problems are not with medical knowledge (I classify the last two as the most problematic for me), but the actual performance of the job. I’ve only rarely encountered pathologists who were totally clueless about what they were looking at under the microscope. The real issue I have is our training in “how to be a pathologist”. Residency and fellowship are generally regarded as dress rehearsals for the real deal, and yet for pathology that’s the exception rather than the rule...and it shows.

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[deleted314957]

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.

Easier for ABP to fail 40% than to get those 50% cuts.

 

[Unty]

By being unimpressed, I’m not talking about subspecialty knowledge or one’s comfort with pathology esoterica. I will admit as much as the next person that I’ll be the first to turf medical lung and kidney, and skin for that matter, off my desk as fast as it hits it.

What I’m talking about are some of the following things I’ve personally seen:
- Fellows completely unwilling to function on their respective services independently because they’ll have to do all the work without having a resident to split the work with; they thought is was unfair.
- Junior academic attendings who take 2-3 days to finally get around to having the courage to sign out TAs.
- Other academic attendings who level through every TA looking for high-grade dysplasia - and then bringing every one of them to a QA session - for years on end.
- New hires who are paralyzed by what is generally considered routine surgical pathology, bread and butter stuff.
- New hires who for every malignancy, even the established ones, tie up all the benchmark II ultras with at least dozen IHC stains, per case. Absolutely no attempt is made at formulating a differential given a history, site of biopsy, and morphology; just a broad throw mud at the wall and see what sticks approach.
- The absolute inability to author a final report that ties in a plausible diagnosis with the clinical picture.
- The absolute inability to communicate effectively with surgical and clinical colleagues, in any setting, that promptly causes my phone to ring with an irate colleague on the other end with a problem that I have to clean up.

I could go on, but I think we all get the point. Notice that most of my problems are not with medical knowledge (I classify the last two as the most problematic for me), but the actual performance of the job. I’ve only rarely encountered pathologists who were totally clueless about what they were looking at under the microscope. The real issue I have is our training in “how to be a pathologist”. Residency and fellowship are generally regarded as dress rehearsals for the real deal, and yet for pathology that’s the exception rather than the rule...and it shows.

Thanks for the info. Yeah that’s what I mean by residency programs having trainees fall through the cracks and going out into the workforce like you mentioned.

 

[senior pathologist]

By being unimpressed, I’m not talking about subspecialty knowledge or one’s comfort with pathology esoterica. I will admit as much as the next person that I’ll be the first to turf medical lung and kidney, and skin for that matter, off my desk as fast as it hits it.

What I’m talking about are some of the following things I’ve personally seen:
- Fellows completely unwilling to function on their respective services independently because they’ll have to do all the work without having a resident to split the work with; they thought is was unfair.
- Junior academic attendings who take 2-3 days to finally get around to having the courage to sign out TAs.
- Other academic attendings who level through every TA looking for high-grade dysplasia - and then bringing every one of them to a QA session - for years on end.
- New hires who are paralyzed by what is generally considered routine surgical pathology, bread and butter stuff.
- New hires who for every malignancy, even the established ones, tie up all the benchmark II ultras with at least dozen IHC stains, per case. Absolutely no attempt is made at formulating a differential given a history, site of biopsy, and morphology; just a broad throw mud at the wall and see what sticks approach.
- The absolute inability to author a final report that ties in a plausible diagnosis with the clinical picture.
- The absolute inability to communicate effectively with surgical and clinical colleagues, in any setting, that promptly causes my phone to ring with an irate colleague on the other end with a problem that I have to clean up.

I could go on, but I think we all get the point. Notice that most of my problems are not with medical knowledge (I classify the last two as the most problematic for me), but the actual performance of the job. I’ve only rarely encountered pathologists who were totally clueless about what they were looking at under the microscope. The real issue I have is our training in “how to be a pathologist”. Residency and fellowship are generally regarded as dress rehearsals for the real deal, and yet for pathology that’s the exception rather than the rule...and it shows.

We came to the point where knowledge of pathologist and their ability to function independently is not the most important virtue.
What counts most today, in time of turbo-capitalism, is their obedience to poorly educated administrators (high school graduates, sometimes MBA), speedy sign out, and ability to charge many CPT codes for diagnoses which do not need to be very accurate.

The show in the US is run by corporations, not by idealists or ivy league professors. The only thing corporations care is profit. Managers know very well that there is a large pool of pathologist begging for jobs and willing to work more for less. As long as they have dozens of offers for one single position, they do not care what you think or say. Unfortunately, academia is filled with dreamers. Professors keep publishing articles about "severe lack of pathologist" for so long that finally they believe in a self perpetuating lie. In this respect, academia behaves like a religious cult or communist party.

 

[senior pathologist]

Easier for ABP to fail 40% than to get those 50% cuts.

Why so?
Training people for positions that do not exist is immoral at least.

 

[tensoranalysis]

There is an incredible range in competency among graduating trainees. Unfortunately, the number of poor diagnosticians outnumbers the good ones. Though, what I am learning is that it doesn't matter. Pathology should be objective, and we all strive to uncover and describe truth, but a field that requires human judgement is inherently subjective. Only a minor cases of the most egregious errors ever come to light.

It's a fun field to be training in.

 

[LADoc00]

CAP is honestly falling apart. I have it on good information that labs are dumping CAP accreditation for Joint Commission. In addition, there is a big push by hospital systems to switch to budget proficiency testing services that are springing up faster than hippies with herpes at Coachella.

Go look at the CAP budget for last year, over NINETY-TWO percent of their operating revenue is PT and CAP inspections.

They are doomed.

And folks we KNOW why Academia continues to take too many PGYs in Path and ABP fails them: $$$.

PGYs represent massive free labor in GME that isnt present to this degree in other specialties. Either attendings at universities would have to gross for 2-4 hours a day, type and proofread their own reports, make and answer calls on cases, etc or they would have pay others to do this. They love all the free man hours of labor but when it comes time to cut these folks loose on healthcare, the same Academics through ABP decide they need to fail a good chunk of them because they should have never really been there to begin with. Its a scam, always has been.

 

[y2k_free_radical]

CAP is honestly falling apart. I have it on good information that labs are dumping CAP accreditation for Joint Commission. In addition, there is a big push by hospital systems to switch to budget proficiency testing services that are springing up faster than hippies with herpes at Coachella.

Go look at the CAP budget for last year, over NINETY-TWO percent of their operating revenue is PT and CAP inspections.

They are doomed.

And folks we KNOW why Academia continues to take too many PGYs in Path and ABP fails them: $$$.

PGYs represent massive free labor in GME that isnt present to this degree in other specialties. Either attendings at universities would have to gross for 2-4 hours a day, type and proofread their own reports, make and answer calls on cases, etc or they would have pay others to do this. They love all the free man hours of labor but when it comes time to cut these folks loose on healthcare, the same Academics through ABP decide they need to fail a good chunk of them because they should have never really been there to begin with. Its a scam, always has been.

View attachment 268465

What sayeth DR. REMICK ????????????????????????????????????

 

[Unty]

CAP is honestly falling apart. I have it on good information that labs are dumping CAP accreditation for Joint Commission. In addition, there is a big push by hospital systems to switch to budget proficiency testing services that are springing up faster than hippies with herpes at Coachella.

Go look at the CAP budget for last year, over NINETY-TWO percent of their operating revenue is PT and CAP inspections.

They are doomed.

And folks we KNOW why Academia continues to take too many PGYs in Path and ABP fails them: $$$.

PGYs represent massive free labor in GME that isnt present to this degree in other specialties. Either attendings at universities would have to gross for 2-4 hours a day, type and proofread their own reports, make and answer calls on cases, etc or they would have pay others to do this. They love all the free man hours of labor but when it comes time to cut these folks loose on healthcare, the same Academics through ABP decide they need to fail a good chunk of them because they should have never really been there to begin with. Its a scam, always has been.

View attachment 268465

Yup cheap labor. Savings by residency programs by having residents and fellows gross cases and do tumor boards.

I’ve seen a bunch of weak foreign grads interview at places where I did residency and fellowship. One person was a girl who’s did dermatology in her own country and interviewed and mentioned she wanted to do dermpath but could also “do the other stuff in pathology.” She wasn’t ranked. It’s people like these that get an interview because there are an abundance of spots and weak applicants get in, who otherwise wouldn’t if there were fewer spots.

Don’t get me wrong but there are some good foreign grads and then there are some who you could tell just wanted a residency spot.

 

[Med Director New England]

CAP is honestly falling apart. I have it on good information that labs are dumping CAP accreditation for Joint Commission. In addition, there is a big push by hospital systems to switch to budget proficiency testing services that are springing up faster than hippies with herpes at Coachella.

Go look at the CAP budget for last year, over NINETY-TWO percent of their operating revenue is PT and CAP inspections.

They are doomed.

And folks we KNOW why Academia continues to take too many PGYs in Path and ABP fails them: $$$.

PGYs represent massive free labor in GME that isnt present to this degree in other specialties. Either attendings at universities would have to gross for 2-4 hours a day, type and proofread their own reports, make and answer calls on cases, etc or they would have pay others to do this. They love all the free man hours of labor but when it comes time to cut these folks loose on healthcare, the same Academics through ABP decide they need to fail a good chunk of them because they should have never really been there to begin with. Its a scam, always has been.

View attachment 268465

LA - welcome back.

Agree that CAP is rotten to the core - but are you really seeing labs with cap certification dropping out ? Hope you are right but I am seeing the opposite. whispering in new England is that MGH is finally going to become CAP certified. This has always been a black eye for CAP to have one of the most well known hospitals in the world opting out of cap.

The issue with Outrageous PT costs will undue cap in one way or another. This is one of the forces pushing lab consolidation leading to less clias and less billable PT.

CAP is picking up other dirty revenue streams like SAMs which prolly generates 75 bucks / hr credit. Each diplomate (post 2006) needs 10 hrs / yr, that compounds pretty quickly....

 

[senior pathologist]

IMG'S AND PATHOLOGY: FANTASY AND REALITY

Many of you complain here about the poor quality of IMG as if US administrators are patriots who want to protects AMG. I am a middle aged US graduate working in Pathology for about 30 years. I do work in commercial setting. I have been around for a long time.

Few years ago our Laboratory chain let go five US graduates who were all solid professionals aged 48 to 62. Three of them were brilliant graduates of Ivy League programs. Five well trained US graduates were replaced by (only) three junior FMG's, two from China and one from India. Their diagnostic skills were poor, their English skills a disaster.

Man in charge of change was a 32 y old American born administrator with a BA. He is not an MD and has no MBA, but is obedient member of corporation. His main skill is the ability to squeeze more work out of "his slaves - the working Pathologists". Each of the three new Pathologists is paid only one half of what the fired one made. And all of the rest have to work harder in order to compensate for diminished number of less capable MD's. No one is complaining in fear of joining the five fired members.

Our young administrator who can now hire and fire well trained doctors told others that he prefers to work with FMG's because they complain less and are easier to lead.

The corporation rewarded the almighty administrator with a fat bonus.

Welcome to America.

 

[caffeinegirl]

This is not just the case for IMGs but unfortunately for even AMGs right out of fellowship. There are many private practices out there who will dangle the "partnership" bait and keep new hires on a fixed or lower salary for perpetuity, taking advantage of the recent graduate's naïveté and inexperience. They will fire or "retire" full partners in order to do so.
Greed knows no bounds, and in my experience is more prevalent in private practice.

IMG'S AND PATHOLOGY: FANTASY AND REALITY

Many of you complain here about the poor quality of IMG as if US administrators are patriots who want to protects AMG. I am a middle aged US graduate working in Pathology for about 30 years. I do work in commercial setting. I have been around for a long time.

Few years ago our Laboratory chain let go five US graduates who were all solid professionals aged 48 to 62. Three of them were brilliant graduates of Ivy League programs. Five well trained US graduates were replaced by (only) three junior FMG's, two from China and one from India. Their diagnostic skills were poor, their English skills a disaster.

Man in charge of change was a 32 y old American born administrator with a BA. He is not an MD and has no MBA, but is obedient member of corporation. His main skill is the ability to squeeze more work out of "his slaves - the working Pathologists". Each of the three new Pathologists is paid only one half of what the fired one made. And all of the rest have to work harder in order to compensate for diminished number of less capable MD's. No one is complaining in fear of joining the five fired members.

Our young administrator who can now hire and fire well trained doctors told others that he prefers to work with FMG's because they complain less and are easier to lead.

The corporation rewarded the almighty administrator with a fat bonus.

Welcome to America.

 

[senior pathologist]

This is not just the case for IMGs but unfortunately for even AMGs right out of fellowship. There are many private practices out there who will dangle the "partnership" bait and keep new hires on a fixed or lower salary for perpetuity, taking advantage of the recent graduate's naïveté and inexperience. They will fire or "retire" full partners in order to do so.
Greed knows no bounds, and in my experience is more prevalent in private practice.

And why can establishment play that game?
BECAUSE TEACHING HOSPITALS TRAIN WAY TOO MANY PATHOLOGISTS FOR FINANCIAL REASONS.
And why teaching hospitals can keep training way too many pathologists?
BECAUSE WE PATHOLOGISTS LET THEM GET AWAY WITH IT...

Pathologists complain, point fingers into IMG, but when time comes to sign a petition or become politically active, they get scared and do nothing...

 

[LADoc00]

LA - welcome back.

Agree that CAP is rotten to the core - but are you really seeing labs with cap certification dropping out ? Hope you are right but I am seeing the opposite. whispering in new England is that MGH is finally going to become CAP certified. This has always been a black eye for CAP to have one of the most well known hospitals in the world opting out of cap.

I have it on very good authority..ahem...that the some of the largest hospital systems will be completely dumping CAP by the end of 2019. My guess is that alone will drop the bottom like tens of millions.

 

[WEBB PINKERTON]

CAP should be putting more money back into their PT. The slides seem like low quality to me (faded stain etc). If you do the NONGYN interlab program, you seem to get a breast FNA each quarter. Who the hell even does breast FNA anymore? Seems so outdated.

I know of a lot of hospitals dumping them as well.

 

[cmz]

Half of my hospitals are JC. This time next year, ALL of my hospitals will be JC. The corporate organization that owns our labs is mandating that every lab drop CAP in favor of JC. CAP is definitely going to take a hit with us.

 

[senior pathologist]

Bitching about CAP, IMG and poor quality of some pathologist will do nothing.
Getting politically involved will..
Unfortunately wast majority of pathologists even do not have balls to sign a petition....
Too afraid to get exposed, to make waves...

Study: Pathologist workforce decreased 17% between 2007 and 2017
Real life: Pathologist workload doubled between 2007 and 2017

 

[dukeresident]

That’s really bleak...obviously the number needs to go down further. Academics control the professional organizations in pathology.

 

[y2k_free_radical]

Bitching about CAP, IMG and poor quality of some pathologist will do nothing.
Getting politically involved will..
Unfortunately wast majority of pathologists even do not have balls to sign a petition....
Too afraid to get exposed, to make waves...

Study: Pathologist workforce decreased 17% between 2007 and 2017
Real life: Pathologist workload doubled between 2007 and 2017

I signed long ago but we are too divided and betrayed by our own self serving union to fight this remuneration debacle that is coming like an invading MONGOL HORDE.

 

[Torsed]

We live in a fallen world.

 

[turtle1966]

Here is a radical proposal to cure the core ill of the specialty. Make Pathology a sub-specialty of Internal Medicine. ☺

 

[path19]

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.

Agree. It seems unethical to put 40% of trainees through 4 (or in some cases 5 or 6) years of postgraduate training only to fail boards and be unable to practice. It is preferable to shut off the supply at the front end.