Hello everyone. Im currently a pathology resident in the midwest area, and new to this website. Ive been reading about the concerns for job placement after residency, the concerns about not enough pay in the field and the future of the field overall. Can somebody comment on their opinion regarding the future of pathology in addition the repercusions of Health care reform and overall outlook for the field in the future. All of us in the field know that pathologists work hard just as much as other fields in medicine, nonetheless we are not seeing the recognition we deserve . Is there anything we should change in the field in order to become more marketable and respected. Thank you?
The future of pathology
- Thread starter Peter23
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As a resident as well, I can't really say how pathology would be in the next 20 years. I think pathologists will continue to read slides as they always have been doing. One of the attendings at a local hospital said that pathology (looking at slides) will be obsolete in the next 50 years. Doesn't really affect me as I will be retired or six feet under.
From talking to members here, pathology is becoming more and more corporatized. What that will mean to us as a field I dont know. Hopefully at least these pod labs will be illegal in the next few years so we can take back what is ours and put to an end all this exploitation.
I agree. I dont understand why does radiology, being a diagnostic field of medicine as well, can get higher paid than pathology, another component of diagnostic medicine. Perhaps our turnaround time is too long, waiting for the specimens to fix and all those special stains, who knows. ..
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volume.
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Not true at all. Radiology is reimbursed at a higher rate AND they have more volume.
I had an MRI once and my insurance reimbursed 350 for the PC for reading it.
CMS reimburses an 88309 at around 100-120 for the PC. A simple mastectomy, ovarian cancer, kidney cancer, liver biopsy are all billed as 88307s which CMS pays around 70 for. At most private insurance would pay for an 88307 is 100-120. In the time it takes you to read out a 50 gram lump, a radiologist could probably read 3 MRIs and be reimbursed nearly 8-10 times as much.
In other words the highest reimbursing CPT codes for reading radiology studies are much much higher than the highest paying ones for pathology (88309). The only advantage is is reading an MRI is reading one MRI for the radiologist. A breast cancer case can consists of 4-5 88307s (main specimen and additional margins) plus a bunch of 88331s, 88334s, 88305s, and 88342s for multiple sentinel nodes. So that can be a lot more for a breast case than an MRI.
Still overall radiology kills path in terms of PC and TC reimbursement. Plus the volume is so high. Go to any tumor board and you will see that a patient may have 2 or 3 path studies but dozens of rad studies. Plus radiologists have so many interventional procedures which are highly lucrative. Plus radiology is constant evolving. They ride a wave of innovation while the mainstay of pathology is the 200 year-old H&E.
If you like both equally, go into rads.
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Well, then you're saying it IS true . . . just maybe not complete.
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that soon?
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There was a time when CT scans took 20 minutes, now they take 20 seconds. Same with MRI. The field reached a "tipping point" where technology became fast enough and widespread enough to drive high volume ordering of imaging studies. Because a lot of these studies are expensive to perform, they successfully lobbied for high reimbursement. And that's not even mentioning interventional radiology.
So all of a sudden you've got clinicians ordering a high volume of expensive, well reimbursed tests that they find at least ostensibly useful. That equals mad cash. But it also makes them a prime target for cost control.
Compare that to anatomic pathology, which largely rests on 19th century technology. The biggest thing we've pulled off lately is immunohistochemistry, which relies on protein chemistry from the 1970's.
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Have you read "The Tipping Point" by Malcolm Gladwell? Great book.
http://www.amazon.com/Tipping-Point-Little-Things-Difference/dp/0316346624
He also wrote a book called "Blink" which is really fantastic and very applicable to our work as pathologists, I think.
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Although I understand the intent of the first point (who can read the future?), it may be time to realize that current residents, fellows, and new attendings WILL define where pathology will be in 20 years.
I highlight the second point because it implies a certain amount of divestment of responsibility -- we can't really wait around for someone else to make something illegal. If we want to take something back, we need to find a way to simply do so. Granted, doing so might include, but not be limited to, creating the waves to make certain things illegal. The point is to get active and involved.
Specialties are where they are because they either demanded to be there or allowed themselves to drift there. Occasionally one gets lucky by blindly drifting, but..not often.
Side note: I see 23 lurkers and no new posters. The same people keep posting time and again. Say something, lurkers! Contribute to this batsh*t crazy discussion!
Sorry to hijack the thread, but I completely agree with the highlighted statement, and I think that 'Blink' is a must-read for pathologists.
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Indeed I have read both of those, and enjoyed them immensely. They probably deserve a reread by now.
