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The hammer will come soon for dermies...
Started by LADoc00
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This whole CJV thing is new to me. Why would a dermpath want to work for such a "pod lab" if remuneration were less than they can make currently in PP? The way I understand it, unless they paid similarly, pathologists would not want to work for them, and the pod lab would not survive.
If your claim that the "hammer is going to fall" is true, would this not then hurt all general pathologists, not just dermies?
I can't actually figure out why dermpath is so sweet. 90% of derm path is easy diagnosis. The tough diagnoses (some inflammatory rashes, atypical nevi, CTCL) could be farmed out. People need to stop assuming that a dermpath needs to look at every BCC and SK.
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yaah said:
To whom would the tough diagnoses be farmed out to? A high-profile faculty specialist on the subject?
Is it common that if a group disagrees on a call that they ship out the slides/specimen to another group? That way the first group forfeits the compensation while the second group charges the patient? How does this work?
I think both get compensated, it's just that there is an extra fee for consultation. Who pays for this fee is the question - and I am not sure. Does it get charged to the patient as an additional fee, or does the bill go to the people who sent it? Interesting question to ask...
But yes, consults generally go to a tertiary care facility expert, although sometimes experts are in private practice somewhere - like Dr Bostwick who is a urologic path expert and formed his own group.
But yes, consults generally go to a tertiary care facility expert, although sometimes experts are in private practice somewhere - like Dr Bostwick who is a urologic path expert and formed his own group.
It's a different billing code though. A consult charges less than the standard pathology fee, which of course also includes processing the specimen, something the consultant doesn't have to do.
pathdawg said:
Oh, of course. I know this. It's just that I find it weird that many people go into dermpath only practice and they spend most of their time on BCCs and SKs. This is why there is a "shortage" of dermpaths, IMHO, or at least part of the reason.Maybe I'm wrong.
yaah said:
There is a shortage of dermpath folks, because of the small number of fellowship programs. There are not enough dermpath graduates each year to fill the number of jobs. This is with every fellowship being full for years ahead of time.
Academic institutions have a hard time setting up programs because they cannot pay a dermpath person 3-5 times more than the rest of the path staff. Which would be competitive to the private sector.
Derm path is so lucrative because specimens generally bill as 88305 with is around $100 bucks a case. And, since the majority of cases take about one min. to have the answer that adds up to alot of money.
Same goes for gi biopsies, breast, prostate etc.. and is why you see specialty labs who do nothing but these things. Much to the frustration of the general pathologist.
Oh I agree with the small number of programs being the key factor. When Dr Silva was here (USCAP) he told us about how there were a lot of programs that had (apparently) approval for dermpath fellowships but were not filling their spots. He didn't know why. That didn't make any sense to any of us, and we kind of had to move on. Maybe they just don't have the training staff for it? But then why would they be approved?
Dermpath staff here make additional money beyond the comparable level for a surgical pathologist in general.
Dermpath staff here make additional money beyond the comparable level for a surgical pathologist in general.
LADoc00 said:
Isn't fee splitting illegal?
Man, pathologists are turning into everyone's bitch. First the surgeons, then the MBAs, now the dermies, uros and gastros. When are we gonna have the nuts to stand our ground or is it way too late?
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GreatPumpkin said:
I agree there are a ton of easy 88305 skins that I can sign out in a minute but I have cases there are very tough, especially all the inflammatory stuff. The number of people being trained in dermpath is being kept artifically low, bascially if there was any real free market competition, their little scam (maybe wrong word) would collapse. There is serious collusion of $ interests and resident/fellowship training from lots of different angles. I think I posted a thread about how residency programs bilk huge amounts from social security for path trainees. One day things will change which is why its best to pick something you like, but for the short term dermpath is golden indeed.
pathstudent said:
It is never too late, the problem is that we are not unified. Everyone else protects their intrests (lawyers, industry) and even medicine like the uro dermies and gi. We have been taking it in the a$$ and saying "thanks" to everyone who does it. Pathology needs to grow some balls and putting our heads together (instead of constantly fighting) to come out on top. We are supposed to be more intelligent the the rest of them, so why are we stuck in a losing situation.
We need to get off our A$$ put down the cash and time to get the right decision makers on our side work together on a plan so that we arent treated like second class physicians and do something instead of hiding behind the scope. We hold a tremendous ammount of power (the most important cases rely heavily on us) we need to use it to make our situation and healthcare delivery better.
I think part of the problem (I may be wrong) is that there are a number of pathologists who like the situation, because they control it, and are the ones buying out practices and profitting off of others. These are often the prominent ones who aren't going to do much to change the situation.
Im not quite sure about that
I would think in general commercial large labs would be the ones doing the buying out. But if there is this sort of oligarchy amongst us, the fact remains that there is no overwhelming reason that this would influence us all, or that the situation could be changed or even used as a model for the rest of us. Again its not like we are a large community (how many IM docs are out there?), theres less to organize, which in essence would make it easier. Plus I have a hard time believing that small prominant groups are buying out other groups in such a small national community, I could understand a common merge but to me I feel that there are bigger problems out side the path community that are regulating it.
I would think in general commercial large labs would be the ones doing the buying out. But if there is this sort of oligarchy amongst us, the fact remains that there is no overwhelming reason that this would influence us all, or that the situation could be changed or even used as a model for the rest of us. Again its not like we are a large community (how many IM docs are out there?), theres less to organize, which in essence would make it easier. Plus I have a hard time believing that small prominant groups are buying out other groups in such a small national community, I could understand a common merge but to me I feel that there are bigger problems out side the path community that are regulating it.
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