Supply/Demand Projections and Job Market Survey

[deleted314957]

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Completely agree with your last point. Even if I could make as much or a little more doing primary care, I wouldn't go into it as primary care totally sucks. Subspecialization is inherently more interesting. Now if I could pull 7 figures doing FP, then it is a no brainer, but that will never be the case.

Would you really do FP for $1,000,000/yr? You'd probably have a gun in your mouth within 6 months. I know I would. I did it for a couple years in late 70's and you are right on---it totally sucks.

 

[scienceguy19]

I agree some people are passionate enough about pathology to do it regardless of the 'competitiveness'. There are also people who would hate doing pathology if you paid them 1,000,000 a year. However, I do believe there are a substantial number of people who are less decisive and could be swayed depending on their job prospects. Within this group include some intelligent individuals who would be dissuaded from entering the field. We shouldn't underestimate the role of economics in people's decision making. Some people don't do primary care because they don't like the pay. I know of people who won't do radiology because of the possibility of outsourcing. Some people won't do pathology because of the perceived lack of jobs, in my personal experience.

Specialties with excellent job prospects tend to have more applicants, thus they can be more selective. In the past, one could easily get a dermatology residency as an average student. The average dermatologist was less intelligent. With the advent of managed care, and the development of new cosmetic procedures, people realized that dermatology proved to be lucrative. If you look at your medical school class now, the average person doing dermatology is near the top. There are plenty of dermatologists who don't care about patient interaction. The two experiences I've had with dermatologists are that they want to spend 10 seconds looking at your rash and get you out as soon as possible.

Like pathologists, radiologists also don't see patients but they attract more intelligent applicants as measured by USMLE scores. If you think clinicians would be so resistant to do pathology, maybe radiologists would be amenable to it.

My understanding is that no primary care residency goes unfilled. If no American grad wants to take a certain primary care position, there are plenty of foreign grads who will. And it's inevitable that some residency spots will be filled by foreign graduates. The total number of residency positions available exceeds the number of American medical school graduates.

I'm not sure pathology fails to attract the best candidates - pathology attracts great candidates. There is just a mismatch between number of great candidates and number of spots (number of spots outnumbers great candidates). Thus, it is "less competitive." Less competitive does not mean we are failing to attract the best candidates. I don't necessarily buy the argument that by making pathology "more competitive" you are somehow going to increase the number of great candidates who want to go into it. I think that would have a minor impact, not like dermatology.

Pathology is a different field because there is no patient contact, and a lot of people are not going to consider it no matter what the benefits. So while your points are legitimate, I think you overblow this particular one. I personally agree there are too many pathology residency spots.

Giving them to primary care, not sure if that will help. Primary care spots already go unfilled - it isn't as though the problem with primary care is a shortage of residency spots. It's a shortage of people who want to go into it.

 

[zao275]

Raider, I think you should get involved in one of the organizations. You have zeal and passion and strong opinions about how to correct these issues. This goes for everyone involved in this conversation. And it doesn't need to be CAP. ASCP, ACGME, or even (gasp!) AMA. Even if we disagree with some of the positions of these organizations, only by being involved and exerting pressure can we effect change.

 

[pathstudent]

Raider, I think you should get involved in one of the organizations. You have zeal and passion and strong opinions about how to correct these issues. This goes for everyone involved in this conversation. And it doesn't need to be CAP. ASCP, ACGME, or even (gasp!) AMA. Even if we disagree with some of the positions of these organizations, only by being involved and exerting pressure can we effect change.

I think raider and Webb and thrombus should start a new organization solely focused on representing young newly minted pathologists.

 

[raider]

Zao,
I have lots of hope. Right now we are in a predicament because of lack of foresight and assertiveness of the last generation. I think the current generation of pathologists are more vocal and have more business savvy and assertiveness. Gone are the days when pathologists were relegated to some basement, hid from all clinical contact and crumbled under slight pressure from other clinicians. These days , through tumor boards etc., we have much more visibility. I will say it clear and loud "Pathologists thus far have failed to create their true image as an indispensible part of medicine". If you see other specialities, they are much more vocal and take a great pride in who they are. We have to be like that. There should be no question in our mind that we are the brightest and the best in medicine i.e. cream of the crop and we should never hesitate to emphasize our indispensible role in clinical medicine at each and every opportunity we have. We should be not be recognized as someone whose only talent is "managing a lab" but should be acknowledged for what we are truly doing viz. MAKING DIAGNOSIS BY OUR KNOWLEDGE,TALENT AND EXPERIENCE THAT NOONE ELSE IN MEDICINE CAN DO. WE ARE ONE OF THE MOST, IF NOT THE MOST IMPORTANT "DOCTOR" FOR THE PATIENT.

In the next few years, I intend to take this message to national and international meetings. It is time everyone knows who "actually" makes the diagnosis and directs prognosis and therapeutic options. Everyone can be a "pill dispenser" or a "cutter", but it takes a special mind to have the kind of predictive powers a good surgical pathologist has. Such people need to be truly respected and treasured for their "clinical" expertise.

 

[scienceguy19]

Let's be more vocal as pathologists. Make our presence known among the public. Maybe we should change our name to something like 'Diagnostic Pathology' or 'Diagnostic Laboratory Medicine" to emphasize our important role in directing therapeutic decisions and de-emphasize the stereotypical image of a pathologist spending all day in the morgue performing autopsies. Let's actively participate in pathology organizations and networking events. Let's be in the newspapers and television educating the public about cancer. We need to put our foot down!

 

[scienceguy19]

I just want to point out that the survey's claim that 100% of respondents received at least one job offer can be misleading too. The survey targets pathologists who have finished training and are in practice less than 3 years.

Therefore it does not include people who looked for a job, couldn't find one, and decided to accept another fellowship. There are certainly people in this category.

It would be wrong to conclude that your chance of getting a job is 100% when you finish training.

 

[oldfatman]

I think raider and Webb and thrombus should start a new organization solely focused on representing young newly minted pathologists.

They'll cause more damage than good.

 

[redapple123]

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[redapple123]

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[WEBB PINKERTON]

They'll cause more damage than good.

Yea you are right oldfatman. We might as well keep the status quo going and just be silent. Pathology's future is so bright I gotta wear shades.😎

Maybe I can get a job as Joe Plandowski's replacement once he croaks. Help set up POD labs and throw as many pathologists under the bus as you old sell-outs did.

 

[Whiskeyjack]

Yea you are right oldfatman. We might as well keep the status quo going and just be silent. Pathology's future is so bright I gotta wear shades.😎

Maybe I can get a job as Joe Plandowski's replacement once he croaks. Help set up POD labs and throw as many pathologists under the bus as you old sell-outs did.

I really don't like that guy-Plandowy. Really think we should put a poster up of him at all meetings and excommunicate any pathologists that work with him. Bad enough our clinical colleagues our screwing us let alone this bottom feeding, low rung admin/tech *****. 😡

 

[WEBB PINKERTON]

Yea, we should put posters up at all meetings and say dont let this guy in. He just wont admit that POD labs are self referral. The evidence looks clear to me that physicians order more tests when they profit from it. Lot more FISH tests etc. Hell, let every office have a in-house pharmacy too while we are at it. Florida pain clinics are doing quite well with this arrangement.

I will give Plandow credit for one thing, at least he realizes how dumb the current system is with sending path specimens across the country (Very little interaction with physicians, specimens getting lost). Sitting at a desk at Bostwick Lab in Orlando Florida signing out endometrial biopsies on patients from all over the united states doesnt seem any better to me.

 

[futuredoc15]

The Feds are currently considering cutting GME funding by 2/3:
https://www.aamc.org/download/253650/data/acgmestatementonmedicarereimbursement.pdf

I think that these huge GME cuts would cause a large reduction in residency spots. Since path residents don't generate much income for the hospitals compared to OB/GYN, IM, and surgery residents etc. I think that path residents would be cut to a greater degree than most other specialties. So I think pathologists will be better off if the GME cuts are enacted.

 

[scienceguy19]

Check out the interesting NY times article.

Deficit Plan Would Reduce Aid to Teaching Hospitals
http://www.nytimes.com/2011/07/13/n...al-centers-1-billion.html?src=me&ref=nyregion

So if we are going to reduce 5.8 billion dollars of funding to teaching hospitals, I suggest some of the cuts happen in training pathologists rather than primary care/internal medicine/surgery.

It is the primary care/internal medicine/surgery doctor who will see the patient to catch a cancer at an early stage. As a pathologist, I would rather make more in-situ carcinoma or early carcinoma diagnoses.

But remember, patients go to those docs for checkups, not pathologists. More pathologists can contribute only as much there are referring doctors who send us specimens.

Of course, this will undergo resistance from teaching hospitals. As the article states, residents support hospitals with their cheap labor. (In the case of pathology, grossing.)

The Feds are currently considering cutting GME funding by 2/3:
https://www.aamc.org/download/253650/data/acgmestatementonmedicarereimbursement.pdf

I think that these huge GME cuts would cause a large reduction in residency spots. Since path residents don't generate much income for the hospitals compared to OB/GYN, IM, and surgery residents etc. I think that path residents would be cut to a greater degree than most other specialties. So I think pathologists will be better off if the GME cuts are enacted.

 

[pathstudent]

The Feds are currently considering cutting GME funding by 2/3:
https://www.aamc.org/download/253650/data/acgmestatementonmedicarereimbursement.pdf

I think that these huge GME cuts would cause a large reduction in residency spots. Since path residents don't generate much income for the hospitals compared to OB/GYN, IM, and surgery residents etc. I think that path residents would be cut to a greater degree than most other specialties. So I think pathologists will be better off if the GME cuts are enacted.

This would be fantastic. They should only fund primary care. A drastic shortage of pathologists would give us huge leverage in Acos.

 

[pathstudent]

The Feds are currently considering cutting GME funding by 2/3:
https://www.aamc.org/download/253650/data/acgmestatementonmedicarereimbursement.pdf

I think that these huge GME cuts would cause a large reduction in residency spots. Since path residents don't generate much income for the hospitals compared to OB/GYN, IM, and surgery residents etc. I think that path residents would be cut to a greater degree than most other specialties. So I think pathologists will be better off if the GME cuts are enacted.

This would be fantastic. They should only fund primary care. A drastic shortage of pathologists would give us huge leverage in Acos. You want your breast biopsy read? You gotta pay us just like if you toilet clogs or car breaks down. The pc on a breast biopsy is 40. How much does a woman pay to have her toilet unclogged by a plumber or her legs waxed.

 

[veo1]

This would be fantastic. They should only fund primary care. A drastic shortage of pathologists would give us huge leverage in Acos.

That would be fantastic. Unfortunately given the glut out there it would take many years before we'd see any change in the job market. Too many residents graduating from programs that shouldn't be in existence. Older pathologists currently in practice made money during the golden age and only death or life-threatening illness seems to pry them away from the microscope. Can you imagine how long this current generation will have to work given the current economic climate and astronomical debt we've taken on in student loans/mortgages. We'll work ourselves to the grave and beyond.

All things considered its kind of sad that we're banking on such drastic legislature and can't even rely on our own governing body (CAP) to save our profession.

 

[Path or bust]

Please, the CAP is working against us. I think a poster put up a letter in another thread that shows the CAP trying to protect funding for pathology residencies. They even want to ADD training positions due to "predicted future shortages".

That would be fantastic. Unfortunately given the glut out there it would take many years before we'd see any change in the job market. Too many residents graduating from programs that shouldn't be in existence. Older pathologists currently in practice made money during the golden age and only death or life-threatening illness seems to pry them away from the microscope. Can you imagine how long this current generation will have to work given the current economic climate and astronomical debt we've taken on in student loans/mortgages. We'll work ourselves to the grave and beyond.

All things considered its kind of sad that we're banking on such drastic legislature and can't even rely on our own governing body (CAP) to save our profession.

 

[pathstudent]

That would be fantastic. Unfortunately given the glut out there it would take many years before we'd see any change in the job market. Too many residents graduating from programs that shouldn't be in existence. Older pathologists currently in practice made money during the golden age and only death or life-threatening illness seems to pry them away from the microscope. Can you imagine how long this current generation will have to work given the current economic climate and astronomical debt we've taken on in student loans/mortgages. We'll work ourselves to the grave and beyond.

All things considered its kind of sad that we're banking on such drastic legislature and can't even rely on our own governing body (CAP) to save our profession.

Let's hope our leaders have sense to dramatically undershoot projected Pathology demand. That would do so much to strengthen our profession.

 

[scienceguy19]

Also we must remember people are living longer.

This combined with declining retirement savings, increased costs of education for kids, increased taxes due to alleviate federal debt, increased cost of health care, lower annual salary translates into a decision to retire later for most people. I would assume older pathologists are also retiring later.

Many new jobs are going to pathologists who already have (8+ years)of experience, as younger pathologists cannot compete with them. (and these places can afford to raise the bar) Don't believe me then look at the job ads and their experience requirements. Younger pathologists, if lucky, end up getting a job in an undesirable location away from friends and family.

That would be fantastic. Unfortunately given the glut out there it would take many years before we'd see any change in the job market. Too many residents graduating from programs that shouldn't be in existence. Older pathologists currently in practice made money during the golden age and only death or life-threatening illness seems to pry them away from the microscope. Can you imagine how long this current generation will have to work given the current economic climate and astronomical debt we've taken on in student loans/mortgages. We'll work ourselves to the grave and beyond.

All things considered its kind of sad that we're banking on such drastic legislature and can't even rely on our own governing body (CAP) to save our profession.

 

[Whiskeyjack]

Is there a reason this scares me or am I just getting paranoid. I cant artiiculate my misgivings but I've got a horrible feeling feel that I'm a pawn on the losing side of some big game. see below.


Stealthy Trend - Insurers Buying Hospitals and Providers

The nation’s largest health insurers have begun, in the last year, a program to acquire physician groups and hospitals around the nation. Although still at an early stage, this signals a longer term strategy to control costs through tighter management of clinical practice.

A recent Kaiser Health News article reports “United's health services wing is quietly taking control of doctors who treat patients covered by United plans in several areas of the country -- buying medical groups and launching physician management companies, for example.”<SUP>1</SUP>

Ted Schwab, partner at management consulting firm Oliver Wyman, commented on the insurer acquisition spree, "There is definitely a national landgrab over primary care physicians."<SUP>2</SUP>

Hospital laboratories should keep watch for news of acquisition activity, and consider collaborating with clinicians to plan for clinical care pathways.

 

[raider]

16% and 22% of forensic and hematopathology fellows, respectively, and about one-quarter of transfusion medicine fellows did not receive any job offers despite active applications. These data are equivalent or only slightly higher than 2010, but still quite concerning for a persistent imbalance between the number of fellows seeking employment versus the number of job openings.

Wow just wow! This is seriously f-cked.

 

[deleted314957]

i always thought it would be great if we could hold the diagnosis "in escrow". you know, tell the clinician and patient that we have the diagnosis and it will be released upon payment. after all, we don't have an office reception room with a sign that says "payment is customarily expected at the time of service".
stiff your clinician a couple times and you may be "discharged" from practice.
A big problem with path is our service/billing model. we are virtually forced to take all comers without ANY knowledge of their ability/willingness to pay, the bill is sent after-the-fact.

maybe the patients should have to have an "office visit" with a path office person prior to the biopsy (whenever possible) and inform them of the facts of life as iterated above.

no tickee-no washee

 

[senior pathologist]

Did you read the projected supply/demand data (beginning on page 85)? If I understand correctly, this data suggests that although current supply slightly outweighs demand, demand should rapidly outpace supply beginning in the next 5 years or so. I do not understand the science behind this market research, nor am I qualified to comment on its veracity, but this is the data that was presented.

When I joined pathology training program in 1991 we were congratulated on our wise decision. We were told that the job prospects are wonderful, because so many older pathologist are just about to retire.

WELL IT NEVER HAPPENED.

Currently (June 2014) the job market for pathologist is at historical low. Occasionally, there are few openings here and there - with about 500 newly-minted pathologists vying for these few positions.

The situation is very sad. First, pathologists are generally employed by someone else who decides how much we will work and how much we will be paid. Exacerbating this situation is the fact that academic centers train too many residents for positions that do not exist.

This paradox is felt in any state and in most institutions. Pathologists are readily abused by:

1) Pathologists who were able to negotiate contracts with hospitals, know the reality of the job market and underpay their fellow pathologists.

2) Clinicians who open pod labs, keep the entire technical component and $30 per slide of the professional component. On average $6 for code 88305 is given to pathologists. If pathologist complains about unfair share, he is told that he is actually worth only $2 per slide but is compensated three times of his worth as a “gift”.

3) Regardless of how bad a given clinician might be and despite of how good the pathologists may be, the clinicians that supplies specimens behave as if pathologists were their servants and not colleague physicians. The young pathologists quickly realize that he is always wrong and the clinician is always right. The pathologist feels he should behave as waiter or he will be asked to leave since there are so are many unemployed pathologists waiting to replace him and please clinicians for every price.

4) Administrators even with little knowledge of medicine very quickly learn that pathologists (due to oversupply) are at the very bottom of the pecking order. It is not surprise that administrators always side with clinicians.

I think that the number of training spots should be decreased, to at least 200 new pathologist per year (from current 500 per year). We have been listening to thefairy tale about a severe shortage of pathologists due to retirement for decades; however, that simply was not the case and probably never will be until training spots are significantly cut.

I understand that academic and non-academic centers need money from the Government. I also understand that residents cost less than physician assistants. However, academic institutions should be truthful with prospectivepathologists about a grim future. Students should not be mislead with claims of "wonderful job prospects" .

Better use of Government money must be developed to cover needs of academic pathology departments, rather than being used to fund training for jobs that do not, and are not likely to exist in near future.

 

[Thrombus]

Senior pathologist, for a profession that supposedly has those among the best and brightest, it sure doesn't say much when they either refuse to address the economics of exploitation whether it be by ignorance or greed. Well put.

 

[turtle1966]

When I joined pathology training program in 1991 we were congratulated on our wise decision.
We were told that the job prospects are wonderful, because so many older pathologist are just about to retire.

WELL IT NEVER HAPPENED.
.........................
We have been listening to the fairy tale about a severe shortage of pathologists due to retirement for decades; however, that simply was not the case and probably never will be until training spots are significantly cut.
.............................

Students should not be mislead with claims of "wonderful job prospects" .
.

I confirm all the above.

 

[Alteran]

I confirm all the above.

I will also confirm the above too. I've already posted my experiences about the job hunt elsewhere on other threads, so I won't repeat myself too much other than to say that even with the chair and fellowship director calling in every favor they ever had in their respective back-pockets over the past several months, they couldn't even land me an interview through their connections. There was even a group with a significant contingent of alumni looking for a pathologist who basically told my chair "thanks for calling, but we're looking for someone with experience". I ultimately did find something good by total happenstance after about 8 months of looking. Interestingly, the lead pathologist at this group is also an alumnus of the program and knows my chair and fellowship director...so that was a big plus.

The take home message for anyone whose reading this thread thinking about going into pathology is that you have ZERO guarantee of finding a job, let alone a good one. Pathology is not like the clinical specialties where you're inundated with job offers a year before you leave training. Don't deceive yourself, as I did for the past 6 years, that the experiences/reflections you're reading here are merely the rantings of a disgruntled few. There are plenty of people that I know and those I've been told about, who don't post here, who've had similar experiences. There is truth, albeit embellished at times, in these posts and you should only choose pathology as a career knowing that.

 

[LoaLoa]

The take home message for anyone whose reading this thread thinking about going into pathology is that you have ZERO guarantee of finding a job, let alone a good one. Pathology is not like the clinical specialties where you're inundated with job offers a year before you leave training. Don't deceive yourself, as I did for the past 6 years, that the experiences/reflections you're reading here are merely the rantings of a disgruntled few. There are plenty of people that I know and those I've been told about, who don't post here, who've had similar experiences. There is truth, albeit embellished at times, in these posts and you should only choose pathology as a career knowing that.

While I'm not a fan of the shrill nature of some of the complaining on this board, I generally agree with this comment. Much more so than in most clinical specialties, finding a great job in pathology is a combination of 1,2,3) lucking into being in the right place at the right time, 4-5) making the right connections during your training, and a distant 6) being diagnostically skilled and having a fancy resume.

There is a segment of pathology trainees who disregard "networking" as a waste of time, roll their eyes at going CAP and USCAP meetings, and bury their nose in Rosai (his book, that is.....). They couldn't be more wrong. However, even for the greatest buddy-maker and professional networker among us, there are no guarantees.

 

[LoaLoa]

<edit> oops-accidentally double posted

 

[LADoc00]

The retirement cliff hypothesis poised by academics has been floated since at least the mid nineties. We are approaching 20+ years with literally NO SIGN such a thing exists.

What NEEDS to happen is for Medicare to stop financing all medical training. It created a perverse incentive for training positions to spring up merely as revenue sources. It created massive administrative and staff bloat where once departments even at prestigious universities were lean and mean before the 1960s revolution.

There is a real 12+billion dollar financial incentive to train docs with no concern for the future of the specialty. This is a fact.

END Medicare payments for trainees, reduce the pay of trainees back to bare minimum standards and this ship will self correct.

 

[bauber]

How would a different funding source change things/remove incentive for administrative bloat? Where should that funding come from?

 

[LADoc00]

How would a different funding source change things/remove incentive for administrative bloat? Where should that funding come from?

Not a different funding source, NO funding source. This is how it used to be. Residents earned little to no pay, lived meagerly and programs were small. Drain the $ incentive out of resident training and overtraining will dry up fast. Programs will exist in as much as they actually assist in clinical duties. Gone will be the hordes of ENT and other surg residents who spend a "research year" in a cabin in Vail or Tahoe. Gone will be 25-resident Path progams in areas that literally can absorb NONE for the next 10 years. Gone will be hundreds of academic positions that exist only to 'herd cats' to bring in even more training dollars.

Some (SOME mind you) Academics love to talk about "fee for service medicine" being a source of all ills in healthcare while literally ROBBING the taxpayer blind and hastening the inevitable dissolution of the Medicare system.

 

[bauber]

After being in school nearly their entire lives and going into massive debt, residents should be paid less than they are now for the same amount of work as a solution to fixing oversupply? Shouldn't we be looking to improve conditions for residents rather than make it more like it used to be? I can't tell if you're being serious. I understand that having medicare (or anyone) fund residents creates incentive for more residencies/residents and bloat, but shifting the burden to residents isn't the right way to fix it. And FFS doesn't sound too great for health care according to this - https://en.wikipedia.org/wiki/Fee-for-service#Health_care. I wouldn't call it the source of all ills though.

 

[yaah]

Well, conditions for residents have improved better than probably the conditions for any other job in the world in the past 40 years or so. 40 years ago being a resident meant you were in the hospital far more than you were out of it. A "weekend on" was from friday 7am until monday 5pm. A weekend off was often saturday 10am until monday 7am. Since 1990, total resident stipend has actually doubled, at the same time as total hours worked has plummeted. There is more to learn but it is much more humane. Being a resident now is actually similar to a real job, albeit a very busy one, as opposed to an all-consuming 4-5 year effort.

Other than that, however, I agree that you can't dump on the residents to save money. Cost of med school tuition and amount of loans have also probably more than doubled since 1990.

See here for comparison to prior years https://www.aamc.org/download/265452/data/2011stipendreport.pdf

 

[LADoc00]

Yaah why has med school tuition doubled since the 1990s? Has the cost of educating a med student exploded? Is the cadaver market on fire?

Or has everyone been had in a Long Con by the Educational Industrial Complex??

 

[yaah]

Yaah why has med school tuition doubled since the 1990s? Has the cost of educating a med student exploded? Is the cadaver market on fire?

Because raising prices has not reduced applications. And med schools are competing harder for the best students, which means they have to spend $$$ to build newer and better facilities.