This is what a good job market looks like

[BlondeDocteur]

If this is a money thing, shouldn't this be true for all fields and not just path? This board has **clearly** proven that it's easy to train more people by getting some of that government pork. All you have to do is ask for more spots and you get an extra 300k to play with. I guess the path folks were just smart enough to catch on first and get that easy money.

This board has, in fact clearly **disproven** that very conspiracy theory.

I'm still an outsider yet but I think there can be urgent, though not truly emergent, situations in pathology. Transfusion Med & blood banking have some very urgent scenarios (been on the other side of those ones-- massive traumas, urgent plasmapheresis, etc). STAT biopsies for something like invasive fungal sinusitis. Frozen sections where the patient is laying open on the table, or the donor liver is growing ever more ischemic laying on ice.

Many fields do admirably restrict their supply of trainees. Neurosurgery springs to mind as well. There seems to be a consensus here amongst people much more in the know that there's a bottom quartile or so of pathology residencies which should be shuttered. I wonder if you've met or interviewed any of the graduates of these programs? Are they truly incompetent? Do you think it is possible to meet the ABP's training requirements and pass the boards while still being unfit to practice? (Asking genuinely here. I don't think that was possible in surgery, but I do think it's possible in fields like internal medicine, with a huge pool of FMGs trained in workhorse, education-poor hospitals like I saw in New York).

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[2121115]

I wonder if you've met or interviewed any of the graduates of these programs? Are they truly incompetent? Do you think it is possible to meet the ABP's training requirements and pass the boards while still being unfit to practice?

It is not about whether they are competent or fit to practice. It is about whether they are needed. No one is claming that there are all these terrible pathologists out there who can't diagnosis a TA, etc. That isn't the point. There are just too many of us altogether. That is the point.

 

[turtle1966]

There seems to be a consensus here amongst people much more in the know that there's a bottom quartile or so of pathology residencies which should be shuttered.

It is not about whether they are competent or fit to practice. It is about whether they are needed.

During 1930 depression, highest unemployment rate was 25%.

Any discussion about the lack of jobs in Pathology, its causes and consequences, should be mindful of this fact. I would think that if even 5-10% of pathologists are unemployed/under-employed/unhappily-employed, given the job market in medicine at large, the situation should be deemed serious. Therefore, those reporting their distressing experience should not dismissed as "unqualified" or "outliers" or "whiners".

 

[malchik]

This board has, in fact clearly **disproven** that very conspiracy theory.

I don't think this is the correct interpretation of what this thread has shown. It seems to me that at worst, residents neither make nor cost money for a department. But they provide a service that otherwise costs the salary/benefits of a PA. Even if a PA does the work of 10 residents, 10 times zero cost is still zero and cheaper than a PA. There is a financial incentive for residency programs in pathology.

 

[BlondeDocteur]

If everyone more or less comes out competent then, how would you choose which residencies to close?

 

[2121115]

If everyone more or less comes out competent then, how would you choose which residencies to close?

That is the problem. They shouldn't have been opened to begin with. Everyone of them will say "look, we train competent residents". And the right answer, is "yeah, but so what?".

There is no way to determine which programs should be shut down. The only criteria for a shut down is not meeting the ACGME criteria, which of course they all do.

And of course they all will tell you, "our good trainees get jobs".

 

[BlondeDocteur]

OK, so what would you propose? How should the # of trainees be trimmed?

 

[pathstudent]

OK, so what would you propose? How should the # of trainees be trimmed?

Hunger games.

 

[deleted314957]

OK, so what would you propose? How should the # of trainees be trimmed?

They could significantly lower the pass rate on the boards.

 

[coroner]

That wouldn't change the number of trainees. It would just change the ratio of board eligible vs board certified pathologists scrapping for the same number of jobs.

 

[turtle1966]

OK, so what would you propose? How should the # of trainees be trimmed?

I think that people are kind of being facetious on this matter. Do you mean that PDs do not know the lowest twenty percentile programs? If so, we are in a deep hole.

 

[Johnny Sunshine]

OK, so what would you propose? How should the # of trainees be trimmed?

First, the CAP and similar organizations should publicly acknowledge the problem, and recommend a cut back in trainees.

Then, someone should start reporting simple numbers: The ratio of resident and fellow spots to an institution's specimen numbers.

Peer pressure may be sufficient to do the rest.

 

[deleted314957]

That wouldn't change the number of trainees. It would just change the ratio of board eligible vs board certified pathologists scrapping for the same number of jobs.

if you are not boarded you are essentially not in the employable pipeline. I mean, really, how many non-boarded paths are are in the competition.
The ones I have heard of are in really marginal ( or none) positions.

 

[path24]

Lowering the board pass rate would go along with pathology principles:
We need more of your money.
We don't care that you wasted half a decade of your life.
We don't care if you can't get a job.

 

[turtle1966]

if you are not boarded you are essentially not in the employable pipeline. I mean, really, how many non-boarded paths are are in the competition.
The ones I have heard of are in really marginal ( or none) positions.

Well, possibly not quite like that. The sweatshops and POLs could view the excess, non-Boarded pathologists as a God given bonanza to their practice and find a way to exploit them.

If you look at Medicare payment data, POLs are making a killing. Those POLs are significantly staffed by those inexperienced recent trainees and those that could not find a traditional job in pathology groups.

THE ONLY SOLUTION IS THE ACADEMIC DONS TO BECOME ETHICAL AND STOP THIS SELFISH MADNESS, RATHER THAN BABBLING ABOUT FUTURE SHORTAGE!

I WISH THERE WERE A WAY TO PUBLICLY SHAME THE ACADEMIC DONS FOR OUR SITUATION!

 

[BlondeDocteur]

Then, someone should start reporting simple numbers: The ratio of resident and fellow spots to an institution's specimen numbers.

This is an interesting proposal. What is an optimal ratio of annual surgical specimens to trainees? Minor specimens? CP cases in micro, chemistry, transfusion, etc?

And if we can establish an optimal ratio, what's the minimum ratio?

Any other thoughts on making pathology residency more rigorous, and therefore shutting down the 20% of positions/programs you claim is necessary to protect job prospects?

 

[deleted314957]

That wouldn't change the number of trainees. It would just change the ratio of board eligible vs board certified pathologists scrapping for the same number of jobs.[

 

[Pollux]

And along similar lines, perhaps they can consider retracting the grandfather clause, and make pathologists who got boarded before 2006 subject to the MOC exam requirement too. It's only fair for everyone to take the exam every 10 years, right?

 

[Johnny Sunshine]

What is an optimal ratio of annual surgical specimens to trainees? Minor specimens? CP cases in micro, chemistry, transfusion, etc?

Yeah, that's pretty difficult to say. Even if two places have similar numbers, all sorts of factors may lead to their residents getting different levels of exposure to specimens. But they such numbers could used to provide general impressions.

If programs A and B have 8 residents each, while A has 20,000 annual surgicals and B has 27,000, I'm not sure you could conclude anything. B may have more PA's, for example. And what if most of Program A's cases are hernia sacs and lipomas? Then their "real" specimen number in regards to training utility would be even lower.

But if most programs have similar resident/case ratios as the above, and then program C is noted to have 12 residents but only 23,000 surgicals, that can be useful info. There may be special circumstances going on at program C; one bit of data alone isn't sufficient to condemn them. But having such data can at least provide a starting point on identifying places that may deserve scrutiny.

(The above numbers are just random examples for illustrative purposes. I do not mean to suggest any specific numbers or ratios as good or bad.)

 

[deleted314957]

And along similar lines, perhaps they can consider retracting the grandfather clause, and make pathologists who got boarded before 2006 subject to the MOC exam requirement too. It's only fair for everyone to take the exam every 10 years, right?

Agree. I got voluntarily recertified in 2007. Either everyone takes it or no one takes it--only fair.

 

[yaah]

5-10% unemployed is an incredibly high and generous estimate for unemployment amongst pathologists. I would say it's less than 5% if not less than 2%. And many of the unemployed are unemployed by choice or for legal reasons.

Note that this does not mean the job market is wonderful. It's just that if you start floating around guesses like this without any hint of real data your arguments are going to be completely dismissed because they aren't based in reality.