The Dark Report

[mike-sheree]

The Dark Report has a snippet that refers to an “industry wide lack of pathologists…”. Is this currently the case? This confuses the s*** out of me. Seems the polar opposite of everything I hear.

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[KeratinPearls]

What exactly does the article say? I see on the cover the article reads “Demand for Pathologists Exceeds Supply”.

Locums is in the area of $1500-2000 a day so I guess that supports the article but I’m still not seeing many advertised jobs near me. A few but not many considering all the graduating trainees near where I live. I’m guessing jobs are via word of mouth then.

Im thinking good higher paying jobs near larger cities don’t need to advertise still even in this market. They just full their spots via connections or word of mouth. It’s only the jobs that are farther away from larger cities (2 hours plus) that still feel the need to advertise. That’s been my observation so far.

There’s more jobs now on pathoutlines than before Covid (obviously).

I just wonder how long this will last…

 

[Alteran]

I think the real story should be: Demand for competent pathologists that can bill in excess of their salary exceeds supply.

I can always find mediocre, at best, pathologists who barely bill in excess of their salaries/expenses to the group.

 

[Spikebd]

I think the real story should be: Demand for competent pathologists that can bill in excess of their salary exceeds supply.

I can always find mediocre, at best, pathologists who barely bill in excess of their salaries/expenses to the group.

The baby boomer workforce and some Gen X who sign out loads of cases a day is rapidly getting phased out and is being replaced by millennials that are pretty jaded about medicine in general, especially because everybody can see partners salaries getting slashed, student debt levels sky high, etc.

The old saying I heard from Boomer doctors about doctors in Russia was “the government pretended to pay doctors and the doctors pretended to work.”

Welcome to the future

 

[Spikebd]

The Coming Collapse of the U.S. Health Care System

The nursing strike in New York is emblematic of the huge stresses the U.S. health care faces coming out of the pandemic

time.com

Even Pathologists are getting more scarce. Things are real bad out there.

 

[KeratinPearls]

DEMAND FOR ANATOMIC PATHOLOGISTS WILL CONTINUE TO OUTSTRIP SUPPLY, challenging pathology practices that have a growing number of case referrals but not enough physicians to perform diagnostics work.

Consider these figures for full- and part-time pathologists as posted on the job board at PathologyOutlines.com:

• 2022 for Q1 though Q3 had 1,200 job postings, which looks for the full year to be pulling ahead of 2021 significantly.
• 2021 had 1,359 job postings, a 78.1% increase from 2020.
• 2020 had 763 job postings, a 9.7% decrease from 2018. Note the website did not compile totals for 2019.
• 2018 had 845 job postings, a 28% increase from 2017.

In reviewing the above statistics, it is conceivable that when PathologyOutlines.com releases its final 2022 figures, the amount of open pathologist jobs in the U.S. will have doubled within five years. The anatomic pathology industry is falling short of training enough pathologist to meet current demand, and there are no signs that this will improve in 2023.

What to Know

It is widely acknowledged that the ongoing retirement of Baby Boomer pathologists is a factor in the marketplace supply/demand equation. Not only does the retirement of these pathologists reduce the supply of professionals available to fill open positions, but these retirements are causing a shrinkage in the number of independent private practices.

In pathology groups of three to six physicians, the retirement of one or two of these pathologists—and the inability of the remaining partners to recruit replacements—often means that this independent private practice agrees to merge or sell itself to a larger regional pathology group.

This pattern of mergers and acquisitions involving pathology groups has been happening for years. A quick online search shows an active year in 2022 for pathology practice consolidation.

Actions to Take

During 2023, acquisition-minded pathology practices should have a favorable market in which to seek out new opportunities. Big pathology groups are likely to become bigger over the course of the year.

Meanwhile, any pathology group being squeezed by the lack of available talent will need to assess their recruitment options to offer a combination of salary and benefits that attract all candidates, with the addition of work/life balance and perhaps even social causes that can attract younger pathologists who are Millennials or older Generation Z members.

Additionally, technologies such as digital pathology and artificial intelligence may gain a greater foothold in 2023 if they can ease logjams with case reviews.

For example, if digital pathology adoption increases in the new year, it may enable pathologists to remotely view cases from regions with limited access to these professionals. (See Trend #3 above for more details.)

It should be expected that the current imbalance in supply-versus-demand for pathologists will be a powerful force in reshaping the profession.

 

[B***F*****]

Digital pathology will change how we practice quicker than we know it.

AI - different story. This will take much more time and is certainly dependent on adoption of digitized slides. This utilization will be slower since AI algorithms need to be trained which requires comparison to a "gold standard" for adequate validation. A "gold standard" is elusive in anatomic pathology because human pathologists, rife with intra-observer and inter-observer variability, are the closest we have to a gold standard. Validation will take a lot of time as a result. But once AI kicks in (I'm giving it a decade for full realization at the earliest since there will be evolving regulatory hurdles, necessary standardization which is very difficult given the diverse practice of anatomic pathology, etc), it will make anatomic pathology easier which results in reduction of mundane tasks. This will not replace pathologists but should reduce demand as a single pathologist can do more work when utilizing AI adequately. Should be more relevant to the next generation of pathologists than those of us who are already well-established in practice.

Anyways, everything is evolving and changing. Maximize earnings now if you see yourself at risk of being a dinosaur. Smart people invested in 2022 and developed alternate income streams. 2023 should be interesting.....

 

[KeratinPearls]

Microsoft to lay off 10,000 employees to cut costs as it doubles down on artificial intelligence

“Microsoft announced a jarring pivot this week by firing 10,000 employees and moving resources toward artificial intelligence.

Paige, the only company FDA-approved for a clinical AI application in digital pathology, is one enterprise a touting recent partnership with the tech giant.

AI-powered pathology company Paige announced the partnership last Wednesday, a week before Microsoft CEO Satya Nadella sent an email to employees announcing the layoffs, according to a filing with the U.S. Securities and Exchange Commission. The 47-year-old company is only the latest in a string of tech giants cutting the fat after accelerating hiring during the pandemic to meet to demand for online services and the expansion of cloud computing.”

 

[KeratinPearls]

“Paige is a digital pathology company also looking to do more with less, specifically fewer pathologists. With a shortage already widespread across the country, Paige CEO Andy Moye, Ph.D., thinks AI-powered pathology can help meet demand.”

So with digital pathology there will be less demand for pathologists since a single pathologist will be able to do more work. Is this what we really need? How’s this going to affect the job market then?

 

[B***F*****]

Clutch onto your job as tightly and as long as you can. Position yourself as best as possible for retirement.

 

[KeratinPearls]

Clutch onto your job as tightly and as long as you can. Position yourself as best as possible for retirement.

It sure doesn’t sound very promising for attracting medical students to our field lol.

 

[mike-sheree]

“Paige is a digital pathology company also looking to do more with less, specifically fewer pathologists. With a shortage already widespread across the country, Paige CEO Andy Moye, Ph.D., thinks AI-powered pathology can help meet demand.”

So with digital pathology there will be less demand for pathologists since a single pathologist will be able to do more work. Is this what we really need? How’s this going to affect the job market then?

Again, here comes the bit about a pathologist shortage. Have I been deluding myself or are there really too few paths to push the glass. I just don’t see it based on the #’s folks seem to be doing. If there is indeed a shortage AND the reimbursement situation is as it seems to be, that REALLY sucks.

 

[B***F*****]

I don't believe there is a shortage at all. Maybe relatively compared to a decade ago, the job market may be a bit better with openings:supply ratio improving marginally but shortage? No. AI will allow pathologists to focus less on mundane tasks and do more work overall. As reimbursement falls and hospital administrators take more of a cut, any perceived "shortage" will be short lived.

So less medical students interested in entering the field? Maybe. But I would argue less interest across medicine in general. Also, this conundrum affects those who are established in the field and may not have the energy to be engaged in AI development. I think the next generation of students, in their peak age of creativity and innovativeness, could be well poised to tackle this challenge head on.

FWIW, the word is getting out there about pathologist lifestyle. And as we navigated through the COVID pandemic, this becomes even more important, especially among the millennial generation. Net effect on entry into the field in the future? Who knows. This will be interesting for my kids...especially the middle kid who actually wants to do pathology.

 

[caffeinegirl]

Digital pathology will change how we practice quicker than we know it.

AI - different story. This will take much more time and is certainly dependent on adoption of digitized slides. This utilization will be slower since AI algorithms need to be trained which requires comparison to a "gold standard" for adequate validation. A "gold standard" is elusive in anatomic pathology because human pathologists, rife with intra-observer and inter-observer variability, are the closest we have to a gold standard. Validation will take a lot of time as a result. But once AI kicks in (I'm giving it a decade for full realization at the earliest since there will be evolving regulatory hurdles, necessary standardization which is very difficult given the diverse practice of anatomic pathology, etc), it will make anatomic pathology easier which results in reduction of mundane tasks. This will not replace pathologists but should reduce demand as a single pathologist can do more work when utilizing AI adequately. Should be more relevant to the next generation of pathologists than those of us who are already well-established in practice.

Anyways, everything is evolving and changing. Maximize earnings now if you see yourself at risk of being a dinosaur. Smart people invested in 2022 and developed alternate income streams. 2023 should be interesting.....

Completely agree with this 100%. AI won't replace pathologists, but will make them more efficient - which will mean that one pathologist can sign out many more cases than before. Given the costs of implementation of digital pathology and AI, that does not mean that the payment to the pathologist will increase (ie. you'll be signing out more cases quicker but for the same total pay, since the payment per case will decrease). I'm all for a good validated AI that can screen cases (like a good dermpath fellow preparing cases prior to sign out with the attending).
It's not just about the algorithm, but also about integrating it into existing workflows (digital slide viewers and LIS) which will be the most important.
The field is evolving quickly, and many companies are working in this space (Paige, Proscia, PathAI and more). Here's dermpath work from PathologyWatch

High-fidelity detection, subtyping, and localization of five skin neoplasms using supervised and semi-supervised learning

Skin cancers are the most common malignancies diagnosed worldwide. While the early detection and treatment of pre-cancerous and cancerous skin lesions…

www.sciencedirect.com

 

[path24]

A lot of pathologists can't get their full PC and they still claim there is a shortage. Get real. Always say shortage (academics/corp labs), always want cheaper labor. New year, same crap.

If you want to have control over your career you need direct access to patients. A medical student should never go with pathology. Pathologist=pawn (not all cases but the vast majority).

 

[Spikebd]

Completely agree with this 100%. AI won't replace pathologists, but will make them more efficient - which will mean that one pathologist can sign out many more cases than before. Given the costs of implementation of digital pathology and AI, that does not mean that the payment to the pathologist will increase (ie. you'll be signing out more cases quicker but for the same total pay, since the payment per case will decrease). I'm all for a good validated AI that can screen cases (like a good dermpath fellow preparing cases prior to sign out with the attending).
It's not just about the algorithm, but also about integrating it into existing workflows (digital slide viewers and LIS) which will be the most important.
The field is evolving quickly, and many companies are working in this space (Paige, Proscia, PathAI and more). Here's dermpath work from PathologyWatch

High-fidelity detection, subtyping, and localization of five skin neoplasms using supervised and semi-supervised learning

Skin cancers are the most common malignancies diagnosed worldwide. While the early detection and treatment of pre-cancerous and cancerous skin lesions…

www.sciencedirect.com

I wonder if the neural networks will pick up new pathology(diseases) that we never even knew existed until we

Is there a way for labs to bill for digitizing your slides? I suspect Cms will find a way to reward this activity, as the AI revolution is all we hear about currently.

 

[caffeinegirl]

A lot of pathologists can't get their full PC and they still claim there is a shortage. Get real. Always say shortage (academics/corp labs), always want cheaper labor. New year, same crap.

If you want to have control over your career you need direct access to patients. A medical student should never go with pathology. Pathologist=pawn (not all cases but the vast majority).

Pathologists are unique in the field of medicine - we provide a service, and our clients are other physicians - not patients. It is more difficult for a pathologist to "set up shop" on their own than a family practice physician. We are cogs in a wheel, and are more susceptible to economies of scale. Radiology also provide a service, but the volume of testing far exceeds the provider supply. I agree with path24 above - you have less control over your career than other fields. However, given the consolidation of medicine in general, the era of the "solo practitioner" in the majority of medical specialties is at an end.

 

[caffeinegirl]

I wonder if the neural networks will pick up new pathology(diseases) that we never even knew existed until we

Is there a way for labs to bill for digitizing your slides? I suspect Cms will find a way to reward this activity, as the AI revolution is all we hear about currently.

CPT codes have been created - which is the first step.

New Digital Pathology Codes Announced for 2023

The American Medical Association CPT Editorial Board recently announced 13 new digital pathology codes that will go into effect Jan. 1, 2023.

www.lighthouselabservices.com

Training an AI is based on ground truth diagnoses that are fed into the algorithm. In my experience, when finding a novel entity, it will either not give a result, or try to place it into an existing bucket (with an indefinite or low confidence result). That's why it's important to train the algorithm with mimics (BCC vs trichepithelioma for example).
AI has been great for determining new morphological determinants for treatment (what tumor morphology responds to what type of drug for example). It's pretty cool stuff.

 

[Spikebd]

I don't believe there is a shortage at all. Maybe relatively compared to a decade ago, the job market may be a bit better with openings:supply ratio improving marginally but shortage? No. AI will allow pathologists to focus less on mundane tasks and do more work overall. As reimbursement falls and hospital administrators take more of a cut, any perceived "shortage" will be short lived.

So less medical students interested in entering the field? Maybe. But I would argue less interest across medicine in general. Also, this conundrum affects those who are established in the field and may not have the energy to be engaged in AI development. I think the next generation of students, in their peak age of creativity and innovativeness, could be well poised to tackle this challenge head on.

FWIW, the word is getting out there about pathologist lifestyle. And as we navigated through the COVID pandemic, this becomes even more important, especially among the millennial generation. Net effect on entry into the field in the future? Who knows. This will be interesting for my kids...especially the middle kid who actually wants to do pathology.

I imagine If you’re a super duper expert pathology will remain lucrative as people will send you many cases for expert review picked up by the AI.

 

[mike-sheree]

A lot of pathologists can't get their full PC and they still claim there is a shortage. Get real. Always say shortage (academics/corp labs), always want cheaper labor. New year, same crap.

If you want to have control over your career you need direct access to patients. A medical student should never go with pathology. Pathologist=pawn (not all cases but the vast majority).

Indeed. It has always been about who controls the patients (clinicians). Ergo, our goal must be to try to control the clinicians thru affability, availability, ability as well as ingratiation with payors (how?) and stroking admin’s egos. The clinician route was always easiest for me. I was ok with being a false flattering, humble wh*** as long as I was a well paid w****.

 

[Spikebd]

Another thing about AI I found interesting is that ChatGPT did worst on Step 1 of USMLE compared to the other steps. The authors of the study hypothesized maybe the nuances of pathophysiology are harder to pinpoint than “clinical” medicine where it’s perhaps more algorithmic.

Who knows what this means for pathologists

 

[octopusprime]

Where is radiology in the course of AI? I would think incorporating AI into the diagnostics of imaging would be easier than the algorithms necessary to screen and triage tissue on glass slides.

 

[KeratinPearls]

Where is radiology in the course of AI? I would think incorporating AI into the diagnostics of imaging would be easier than the algorithms necessary to screen and triage tissue on glass slides.

Here’s a company:

Medical Imaging Cloud AI for Radiology | Arterys

 

[WEBB PINKERTON]

Speaking of technology. Anyone seen this new rapid on-site pathology device? Maybe you won't be needed in endo much longer if this pans out? Some docs north of me are using it.

Lung biopsies - AQUYRE Biosciences

The situation To collect biopsies of the lung, two main methods are currently used: Transthoracic needle biopsy (TTNA) requires a needle to be inserted through the chest wall from outside the body. The risk of a collapsed lung (pneumothorax) can result up to 61% of the time with an average of...

aquyre.com

 

[mike-sheree]

Another thing about AI I found interesting is that ChatGPT did worst on Step 1 of USMLE compared to the other steps. The authors of the study hypothesized maybe the nuances of pathophysiology are harder to pinpoint than “clinical” medicine where it’s perhaps more algorithmic.

Who knows what this means for pathologists

Wow! You can’t imagine how blown away a post like this makes a 71 y.o. retired (10 yr) path feel.
”AI and ChatGBT” !?! How absolutely cool for y’all. You are in exciting times.

 

[caffeinegirl]

Where is radiology in the course of AI? I would think incorporating AI into the diagnostics of imaging would be easier than the algorithms necessary to screen and triage tissue on glass slides.

Radiology is far ahead in using AI than us for screening and assisting diagnosis. They also have specific CPT codes approved last year.

New CPT code for radiology AI brings hope, but patience is needed

The recent approval of a Current Procedural Terminology (CPT) code for radiology artificial intelligence (AI) by the American Medical Association was an important milestone. But actual reimbursement will likely take some time.

www.auntminnie.com

The Economics of Artificial Intelligence: Focusing on the Metrics • APPLIED RADIOLOGY

 

[ScubaV]

I think people should be cautious when using pathoutlines numbers to make judgments about the job market. I suspect job searching and job postings are consolidating, much like the rest of the field and medicine in general. I think using journals or CAP Today as a job advertisement has almost completely gone away. And in large health networks, which represent a growing fraction of the physician pool, there's likely a recruiter spearheading the search who is probably using pathoutlines rather than word of mouth or some other method. So those numbers may reflect pathoutlines getting a larger and larger percentage of job posts as much or more so than raw numbers going up.

"In pathology groups of three to six physicians, the retirement of one or two of these pathologists—and the inability of the remaining partners to recruit replacements—often means that this independent private practice agrees to merge or sell itself to a larger regional pathology group."

Somehow I doubt this is the order of operations. If it's a decent group and not in the middle of Armpit, Nowhere such groups should have no difficulty finding recruits (if they know how to look, see above). More likely, the small to medium group is losing business to regional corporate or academic center predation and discerning recruits can see which way the wind is blowing in terms of job security. Sad, but such is life nowadays.

 

[mike-sheree]

I think people should be cautious when using pathoutlines numbers to make judgments about the job market. I suspect job searching and job postings are consolidating, much like the rest of the field and medicine in general. I think using journals or CAP Today as a job advertisement has almost completely gone away. And in large health networks, which represent a growing fraction of the physician pool, there's likely a recruiter spearheading the search who is probably using pathoutlines rather than word of mouth or some other method. So those numbers may reflect pathoutlines getting a larger and larger percentage of job posts as much or more so than raw numbers going up.

"In pathology groups of three to six physicians, the retirement of one or two of these pathologists—and the inability of the remaining partners to recruit replacements—often means that this independent private practice agrees to merge or sell itself to a larger regional pathology group."

Somehow I doubt this is the order of operations. If it's a decent group and not in the middle of Armpit, Nowhere such groups should have no difficulty finding recruits (if they know how to look, see above). More likely, the small to medium group is losing business to regional corporate or academic center predation and discerning recruits can see which way the wind is blowing in terms of job security. Sad, but such is life nowadays.

The allure and pressure and attraction to sell are huge when confronted with the scenario
you outline above is great. It is about the only way you can realize decent equity. The alternative is : you retire and get the $200k buy-in from the new onboarding “partner”.
And maybe a gold watch from the remaining partners. Big whoop. Much better to settle for 6x EBITDA (or whatever the multiple is today. that was ‘96)

 

[ScubaV]

I wonder how many actual sales are going on today. The health system I work for bought two previously independent hospitals that had pathology groups (only 2 members each). I'm not privy to all the details, but they were both debt-ridden, failing hospitals. I suspect we acquired their debt to expand our footprint, the execs maybe got some parachute money because that's what execs do, and the pathologists probably got nothing.

I know personally of another group (3 people) that had a local hospital contract. The hospital wasn't failing, but became a satellite branch of the regional academic center. That center wanted their own people, so the contract ended and the pathologist group dissolved (some retired, some didn't) with nothing.

 

[mike-sheree]

Retiring with nada after the dissolution of a 50 yr hx pp group is 1. piss poor planning 2. an epic failure. Groups need to be strategically proactive. You can usually see these things coming. We did, and sold while we still smelled like roses. No sense in waiting until we knew we would smell like s***. Took advantage of the MBA’s and VC’s who THOUGHT they knew the field and local medical politics but had zero REAL sense of what was going on and what was coming. But, this may not even be possible today. The camel is already in the tent it seems.
You can’t just be carried along like a leaf in a stream.

 

[Nilf]

A lot of pathologists can't get their full PC and they still claim there is a shortage. Get real. Always say shortage (academics/corp labs), always want cheaper labor. New year, same crap.

If you want to have control over your career you need direct access to patients. A medical student should never go with pathology. Pathologist=pawn (not all cases but the vast majority).

THIS. It takes a while to sink in. That's why the worst primary care doc >>> best pathologist when it comes to demand. Think about it and act accordingly.

 

[octopusprime]

Retiring with nada after the dissolution of a 50 yr hx pp group is 1. piss poor planning 2. an epic failure. Groups need to be strategically proactive. You can usually see these things coming. We did, and sold while we still smelled like roses. No sense in waiting until we knew we would smell like s***. Took advantage of the MBA’s and VC’s who THOUGHT they knew the field and local medical politics but had zero REAL sense of what was going on and what was coming. But, this may not even be possible today. The camel is already in the tent it seems.
You can’t just be carried along like a leaf in a stream.

I just don't think there is such a thing as being 'strategically proactive' for many specialties in this day and age, and pathology is a prime example. There is ALWAYS someone willing to do the work for cheaper, and those 'someones' are increasingly large corporations that continue to expand. When the cost of running a lab is too much, and some admin sits down and actually calculates the money they could skim off the top by employing the group rather than contracting with them, or the revenue saved by outsourcing to a corporate lab, no amount of goodwill and proactive planning will save you.

We just don't hold the reins on any sort of patient population, or unique business aspect / tangible assets that can't be outsourced for cheaper.

An anesthesiologist friend of mine joined a group several years ago right out training and it was an amazing opportunity; super high reimbursement and amazing partnership potential. He finally makes parter a few years later than boom--COVID hit. Their group essentially went under; they were insolvent, but the main hospital they worked with didn't necessarily know that. The hospital was on the verge of buying them out when some hotshot admin did some investigating and realized how desperate they were for the work that the offer was rescinded, they got lowballed, and within 24 hrs what went from a multimillion dollar payout went to being a mediocre employed option. Half the group quit or retired, the other half acquiesced.

We're simply cogs in a wheel, and fodder for the whims of hospital administrations, which are uniformly operating in the red for the foreseeable future.

 

[mike-sheree]

I just don't think there is such a thing as being 'strategically proactive' for many specialties in this day and age, and pathology is a prime example. There is ALWAYS someone willing to do the work for cheaper, and those 'someones' are increasingly large corporations that continue to expand. When the cost of running a lab is too much, and some admin sits down and actually calculates the money they could skim off the top by employing the group rather than contracting with them, or the revenue saved by outsourcing to a corporate lab, no amount of goodwill and proactive planning will save you.

We just don't hold the reins on any sort of patient population, or unique business aspect / tangible assets that can't be outsourced for cheaper.

An anesthesiologist friend of mine joined a group several years ago right out training and it was an amazing opportunity; super high reimbursement and amazing partnership potential. He finally makes parter a few years later than boom--COVID hit. Their group essentially went under; they were insolvent, but the main hospital they worked with didn't necessarily know that. The hospital was on the verge of buying them out when some hotshot admin did some investigating and realized how desperate they were for the work that the offer was rescinded, they got lowballed, and within 24 hrs what went from a multimillion dollar payout went to being a mediocre employed option. Half the group quit or retired, the other half acquiesced.

We're simply cogs in a wheel, and fodder for the whims of hospital administrations, which are uniformly operating in the red for the foreseeable future.

Well, then it it appears that ship has sailed. Damned shame.

 

[mike-sheree]

I wonder how many actual sales are going on today. The health system I work for bought two previously independent hospitals that had pathology groups (only 2 members each). I'm not privy to all the details, but they were both debt-ridden, failing hospitals. I suspect we acquired their debt to expand our footprint, the execs maybe got some parachute money because that's what execs do, and the pathologists probably got nothing.

I know personally of another group (3 people) that had a local hospital contract. The hospital wasn't failing, but became a satellite branch of the regional academic center. That center wanted their own people, so the contract ended and the pathologist group dissolved (some retired, some didn't) with nothing.

This is what happens when you wait until you are in a position of weakness. You become a leaf in a stream.