Thrombus concerns with supply-demand have some merit

[y2k_free_radical]

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Members do not see this ad.

He may be a bit over the top sometimes, but pathologists' marketplace value and leverage have been steadily deteriorating.

 

[Pathbusiness]

So?

 

[WEBB PINKERTON]

If you want to enjoy the pathologist lifestyle, you need to get used to it. There are major tradeoffs if you choose this career.

FREE THROMBUS!

 

[LADoc00]

I think this entire line of thinking is a massive logic trap. Let me explain.

The job market and pathologist leverage situation is not even remotely due to FMGs. FMGs were always there and in many ways are becoming the real persecuted population in the ever widening pathologist income disparity.

If we can step back from going "full Klansman" for a moment, let's take a snap shot of the entire history of the field:
1.) Medicare arises in 1965 under Pres. Johnson. That alone is worrisome given the elected president did NOT chose to create Medicare and was assassinated 2 years prior..

2.) Initially Pathology enjoys unprecedented halcyon days where each lab test represents insane sources of passive income. 1966-late 70s represents an almost robber-baron mindset in the field. The income levels at some of the top groups would match or exceed mid range NBA players today.

3.) 1980s Reagan elected and begins the largest post war military expansion ever. Money is taken from Medicare, now a successful and well loved social program for the elderly aka the Greatest Generation at this point to pay for the Cold War. Pathology is one of the losers of this, CP money nearly completely dies, large groups crumble and many of the robber barons sail off into the sunset between 1985-88 with their bags of loot.

4.) 90s situation for Pathology continues its decline. 1988 CLIA is crippling for labs trying to expand and comply. Groups that didnt depart with the "Grey Ships laden with loot" in 1988 are constantly scamming and scheming to get their business back to the pre-fall days but this is impossible, everything is totally different in pathology economics. Here you see the first of pathologists actually going to jail. Sink testers, Medicare scammers, etc. are created by pathologists who remember the Halcyon days too vividly.

5.) Finally in the mid 90s, the trickle down reaches pre-med and med students who turn their backs on Pathology in massive numbers. It is here that many Path training programs, unable to recruit solid trainees begin to fold, literally a first in American medical history (up to here Path programs only increased from 1904 on). Med school costs also begin skyrocketing due to back stopping of the Fed on student loans. Once schools realize there is no longer a cost sensitive consumer for their product and Uncle Sam is footing the bill in the short term, the sky became the only limit for med school tuition. Massive student loans cause many students to then choose guaranteed money with the greatest autonomy from a reliance on CMS payment, Dermatology begins historic ascent. Once the tides of fortune had turned, many in academia refused to make the appropriate shift. Other fields like Optho, Rads or Gas did change their residency ratios, but academic pathology had grown to love the free slave labor AND the matching dollar amounts that came from CMS to fund these positions. So many path training programs kept the staffing that been created based on the Halcyon days, in many ways operating like a for profit tech college. This decision alone created the FMG tidal wave that occurred into pathology in the 90s. This decision also inadvertently lead to dramatic change in the private practice business model from an "equal share ownership" to the "lord and fiefs" mode.

6.) 21st Century: A New Hope. Under this dark back drop there were unnamed heroic figures of pathology that began the long war to win back some of our lost respect. Billing for clinical lab test, at first almost heretical, began to pop up everywhere. Pathologists began asking for bigger and more appropriate payments for Medicare Part A. Pathology representation on the CMS RUC council less afraid of surgeons, became willing to speak up. Older pathologists who now have clung to power since the late 70s, early 80s begin to die off, literally dying at the scope. Younger pathologists arise from the ashes bringing new technology, new billing sources and better biz skills than ever before.

No where in that entire Saga is FMGs being the source of anything nefarious in modern Pathology folks.

 

[Pathbusiness]

It is same with internal medicine, FM, Psych, Anesthesia programs in inner city, non university, less desirable places. There are plenty of programs where almost 100% of residents, and faculty are IMG's. Does not mean it gives Thrombus to go ballistic and post almost racist(nationalistic is the new buzz word these days). He can do that by joining Harley Davidson, NRA etc forums.

 

[LADoc00]

It is same with internal medicine, FM, Psych, Anesthesia programs in inner city, non university, less desirable places. There are plenty of programs where almost 100% of residents, and faculty are IMG's. Does not mean it gives Thrombus to go ballistic and post almost racist(nationalistic is the new buzz word these days). He can do that by joining Harley Davidson, NRA etc forums.

Yes but it is far better to come back at someone online who is obviously hurting enough to post that with the facts I have laid out rather than jumping to the typical bandwagoneer SJW mode who just replies with a "you are a Nazi!" or "white oppressor!" or whatever the FOTW insult is on mainstream media/academics. No clue what Harley Davidson has to do with anything though and the main NRA spokeman at the moment is a black guy so...yah.

 

[Pathbusiness]

I made HD or NRA comment in a humor, since he would find way more people agreeing to the kind of posts he makes.
"So I have been censored for writing about the overflow of foreign nationals flooding and destroying our profession!
IF YOU FOREIGNERS DONT LIKE FREE SPEECH GO BACK TO YOUR 3rd WORLD HELLHOLE!!"

 

[LADoc00]

I made HD or NRA comment in a humor, since he would find way more people agreeing to the kind of posts he makes.
"So I have been censored for writing about the overflow of foreign nationals flooding and destroying our profession!
IF YOU FOREIGNERS DONT LIKE FREE SPEECH GO BACK TO YOUR 3rd WORLD HELLHOLE!!"

I honestly know nothing about Harley Davidson, I suspect you dont either. But the NRA is fairly diverse from an ethnic pov and even a cultural one. Much more than outsiders think. Im a life long NRA member so the knee jerk racist association you seem to be throwing out in humor isnt that humorous to me.

This is the internet and I think people post or say crazy stuff they would never say in person if they were actually properly communicating with someone so I will give you and I guess Thrombus the benefit of the doubt since its Christmas.

 

[Pathbusiness]

I own more than 10 of both brother! Give me a little break..

 

[deleted314957]

I think this entire line of thinking is a massive logic trap. Let me explain.

The job market and pathologist leverage situation is not even remotely due to FMGs. FMGs were always there and in many ways are becoming the real persecuted population in the ever widening pathologist income disparity.

If we can step back from going "full Klansman" for a moment, let's take a snap shot of the entire history of the field:
1.) Medicare arises in 1965 under Pres. Johnson. That alone is worrisome given the elected president did NOT chose to create Medicare and was assassinated 2 years prior..

2.) Initially Pathology enjoys unprecedented halcyon days where each lab test represents insane sources of passive income. 1966-late 70s represents an almost robber-baron mindset in the field. The income levels at some of the top groups would match or exceed mid range NBA players today.

3.) 1980s Reagan elected and begins the largest post war military expansion ever. Money is taken from Medicare, now a successful and well loved social program for the elderly aka the Greatest Generation at this point to pay for the Cold War. Pathology is one of the losers of this, CP money nearly completely dies, large groups crumble and many of the robber barons sail off into the sunset between 1985-88 with their bags of loot.

4.) 90s situation for Pathology continues its decline. 1988 CLIA is crippling for labs trying to expand and comply. Groups that didnt depart with the "Grey Ships laden with loot" in 1988 are constantly scamming and scheming to get their business back to the pre-fall days but this is impossible, everything is totally different in pathology economics. Here you see the first of pathologists actually going to jail. Sink testers, Medicare scammers, etc. are created by pathologists who remember the Halcyon days too vividly.

5.) Finally in the mid 90s, the trickle down reaches pre-med and med students who turn their backs on Pathology in massive numbers. It is here that many Path training programs, unable to recruit solid trainees begin to fold, literally a first in American medical history (up to here Path programs only increased from 1904 on). Med school costs also begin skyrocketing due to back stopping of the Fed on student loans. Once schools realize there is no longer a cost sensitive consumer for their product and Uncle Sam is footing the bill in the short term, the sky became the only limit for med school tuition. Massive student loans cause many students to then choose guaranteed money with the greatest autonomy from a reliance on CMS payment, Dermatology begins historic ascent. Once the tides of fortune had turned, many in academia refused to make the appropriate shift. Other fields like Optho, Rads or Gas did change their residency ratios, but academic pathology had grown to love the free slave labor AND the matching dollar amounts that came from CMS to fund these positions. So many path training programs kept the staffing that been created based on the Halcyon days, in many ways operating like a for profit tech college. This decision alone created the FMG tidal wave that occurred into pathology in the 90s. This decision also inadvertently lead to dramatic change in the private practice business model from an "equal share ownership" to the "lord and fiefs" mode.

6.) 21st Century: A New Hope. Under this dark back drop there were unnamed heroic figures of pathology that began the long war to win back some of our lost respect. Billing for clinical lab test, at first almost heretical, began to pop up everywhere. Pathologists began asking for bigger and more appropriate payments for Medicare Part A. Pathology representation on the CMS RUC council less afraid of surgeons, became willing to speak up. Older pathologists who now have clung to power since the late 70s, early 80s begin to die off, literally dying at the scope. Younger pathologists arise from the ashes bringing new technology, new billing sources and better biz skills than ever before.

No where in that entire Saga is FMGs being the source of anything nefarious in modern Pathology folks.

To my mind the “sea change” came with TEFRA 1982.

 

[LADoc00]

To my mind the “sea change” came with TEFRA 1982.

to those that dont know TEFRA changed the way Medicare paid out. Of course this was huge, perhaps the biggest legislation ever other than the actual passage of Medicare itself.

pre-TEFRA: if you charged medicare X amount, they paid X amount
post-TEFRA: implementation of the concept of a modern "take or leave" fee schedule

Honestly I dont enough to intelligently comment on because the pre-TEFRA period sounds insane. It would create an environment so rife with scoundrels and thieves, Im shocked the whole government didnt collapse from 1965-1982.

 

[y2k_free_radical]

I think this entire line of thinking is a massive logic trap. Let me explain.

The job market and pathologist leverage situation is not even remotely due to FMGs. FMGs were always there and in many ways are becoming the real persecuted population in the ever widening pathologist income disparity.

If we can step back from going "full Klansman" for a moment, let's take a snap shot of the entire history of the field:
1.) Medicare arises in 1965 under Pres. Johnson. That alone is worrisome given the elected president did NOT chose to create Medicare and was assassinated 2 years prior..

2.) Initially Pathology enjoys unprecedented halcyon days where each lab test represents insane sources of passive income. 1966-late 70s represents an almost robber-baron mindset in the field. The income levels at some of the top groups would match or exceed mid range NBA players today.

3.) 1980s Reagan elected and begins the largest post war military expansion ever. Money is taken from Medicare, now a successful and well loved social program for the elderly aka the Greatest Generation at this point to pay for the Cold War. Pathology is one of the losers of this, CP money nearly completely dies, large groups crumble and many of the robber barons sail off into the sunset between 1985-88 with their bags of loot.

4.) 90s situation for Pathology continues its decline. 1988 CLIA is crippling for labs trying to expand and comply. Groups that didnt depart with the "Grey Ships laden with loot" in 1988 are constantly scamming and scheming to get their business back to the pre-fall days but this is impossible, everything is totally different in pathology economics. Here you see the first of pathologists actually going to jail. Sink testers, Medicare scammers, etc. are created by pathologists who remember the Halcyon days too vividly.

5.) Finally in the mid 90s, the trickle down reaches pre-med and med students who turn their backs on Pathology in massive numbers. It is here that many Path training programs, unable to recruit solid trainees begin to fold, literally a first in American medical history (up to here Path programs only increased from 1904 on). Med school costs also begin skyrocketing due to back stopping of the Fed on student loans. Once schools realize there is no longer a cost sensitive consumer for their product and Uncle Sam is footing the bill in the short term, the sky became the only limit for med school tuition. Massive student loans cause many students to then choose guaranteed money with the greatest autonomy from a reliance on CMS payment, Dermatology begins historic ascent. Once the tides of fortune had turned, many in academia refused to make the appropriate shift. Other fields like Optho, Rads or Gas did change their residency ratios, but academic pathology had grown to love the free slave labor AND the matching dollar amounts that came from CMS to fund these positions. So many path training programs kept the staffing that been created based on the Halcyon days, in many ways operating like a for profit tech college. This decision alone created the FMG tidal wave that occurred into pathology in the 90s. This decision also inadvertently lead to dramatic change in the private practice business model from an "equal share ownership" to the "lord and fiefs" mode.

6.) 21st Century: A New Hope. Under this dark back drop there were unnamed heroic figures of pathology that began the long war to win back some of our lost respect. Billing for clinical lab test, at first almost heretical, began to pop up everywhere. Pathologists began asking for bigger and more appropriate payments for Medicare Part A. Pathology representation on the CMS RUC council less afraid of surgeons, became willing to speak up. Older pathologists who now have clung to power since the late 70s, early 80s begin to die off, literally dying at the scope. Younger pathologists arise from the ashes bringing new technology, new billing sources and better biz skills than ever before.

No where in that entire Saga is FMGs being the source of anything nefarious in modern Pathology folks.

 

[y2k_free_radical]

Good overview.I stated supply-demand,not number of FMGs.Fewer new graduates would make us all more valuable over time.

 

[y2k_free_radical]

to those that dont know TEFRA changed the way Medicare paid out. Of course this was huge, perhaps the biggest legislation ever other than the actual passage of Medicare itself.

pre-TEFRA: if you charged medicare X amount, they paid X amount
post-TEFRA: implementation of the concept of a modern "take or leave" fee schedule

Honestly I dont enough to intelligently comment on because the pre-TEFRA period sounds insane. It would create an environment so rife with scoundrels and thieves, Im shocked the whole government didnt collapse from 1965-1982.

It waited until 2000 and the FED induced bubbles which enriched the top 1% inordinately as well as many a miscreant and no one went to prison

 

[Pathbusiness]

If total residency spots are less than or equal to number of med school graduates(as in most other countries), all fields will become competitive. Pathology will be still at the bottom unfortunately! It is the nature of the field we chose.

 

[y2k_free_radical]

If total residency spots are less than or equal to number of med school graduates(as in most other countries), all fields will become competitive. Pathology will be still at the bottom unfortunately! It is the nature of the field we chose.

There is an imbalance of needed numbers in specialties and number of graduates

 

[LADoc00]

There is an imbalance of needed numbers in specialties and number of graduates

This.

You realize this once you head out into private practice and see most hospitals:
~Staff pathologists at 1:3-4 with Radiologists, yet most academic pathology training programs are nearly the same size as radiology classes

~Staff path 1: 5-6 General Surgery yet most training programs in surgery are barely larger than path classes

and so on and so on.

I did the back of the napkin math once, but from what I remember we need around 1/3 to 1/2 the number of path training slots that currently exist to meet coming demand and probably need to close programs almost entirely for 3-4 years just to clear out current manpower excess.

Look at this:

there are currently 43 General Surgery residents at UCLA med center. This is a SEVEN year program, meaning 5.85 FTEs per year on average being churned.

UCLA Pathology is training FIVE residents a year! Nearly at a 1:1 with general surgery! This is totally insane if you went to a traditional community healthcare facility ANYWHERE on Earth.

This is the equivalent of setting a table with each place setting having 4-5 spoons. You would look at that & say "WTF does everyone have so many spoons?!"

THIS is the real issue in Pathology.

 

[y2k_free_radical]

This.

You realize this once you head out into private practice and see most hospitals:
~Staff pathologists at 1:3-4 with Radiologists, yet most academic pathology training programs are nearly the same size as radiology classes

~Staff path 1: 5-6 General Surgery yet most training programs in surgery are barely larger than path classes

and so on and so on.

I did the back of the napkin math once, but from what I remember we need around 1/3 to 1/2 the number of path training slots that currently exist to meet coming demand and probably need to close programs almost entirely for 3-4 years just to clear out current manpower excess.

Look at this:

there are currently 43 General Surgery residents at UCLA med center. This is a SEVEN year program, meaning 5.85 FTEs per year on average being churned.

UCLA Pathology is training FIVE residents a year! Nearly at a 1:1 with general surgery! This is totally insane if you went to a traditional community healthcare facility ANYWHERE on Earth.

This is the equivalent of setting a table with each place setting having 4-5 spoons. You would look at that & say "WTF does everyone have so many spoons?!"

THIS is the real issue in Pathology.

Yet CAP,aka BIG LABS and ACADEMIA, persist with the impending pathologist shortage BS because of the financial rewards to them.CAP and ACADEMIA don't really care about community pathologists any more than our SENATORS or REPRESENTATIVES care about the average citizen.CAP and ACADEMIA are driven by money as much as any community pathologist.I would like to be proven wrong by their spokespeople such as DR. REMICK

 

[CDX-2]

This.

You realize this once you head out into private practice and see most hospitals:
~Staff pathologists at 1:3-4 with Radiologists, yet most academic pathology training programs are nearly the same size as radiology classes

~Staff path 1: 5-6 General Surgery yet most training programs in surgery are barely larger than path classes

and so on and so on.

I did the back of the napkin math once, but from what I remember we need around 1/3 to 1/2 the number of path training slots that currently exist to meet coming demand and probably need to close programs almost entirely for 3-4 years just to clear out current manpower excess.

Look at this:

there are currently 43 General Surgery residents at UCLA med center. This is a SEVEN year program, meaning 5.85 FTEs per year on average being churned.

UCLA Pathology is training FIVE residents a year! Nearly at a 1:1 with general surgery! This is totally insane if you went to a traditional community healthcare facility ANYWHERE on Earth.

This is the equivalent of setting a table with each place setting having 4-5 spoons. You would look at that & say "WTF does everyone have so many spoons?!"

THIS is the real issue in Pathology.

Soup spoon, salad spoon, dinner spoon, dessert spoon?

Joke aside, that sounds excessive.

I don't get why the US trains so many AP residents if they can just cut down the numbers and use the pathologist assistants for grossing?

I thought it'd make sense coz pathologists assistants are cheaper to hire than AP residents surely?

I think Australia is overtraining as well.
This year, ~50 people total graduated from AP alone.

I believe the largest hospital in Sydney has like 10 AP registrars (albeit not all of them are final year).
I'd be surprised if that hospital had any more than 10 radiology registrars...

Certainly on the RCPA job listings website, I don't see 50 AP consultant / attending vacancies. I know some of the job openings will be through word of mouth, but I still doubt the public / private sector will be able to accommodate all of them, nor will there be 50 senior pathologists retiring this year.
I think some of them will be doing a PhD or a fellowship to keep occupied, and so the College won't count them as being "unemployed".

It sounds like the US will be just as hard to break into as Canada considering the local oversupply...😕

I find it interesting that US AP training is shorter (3 years) than Australia (5 years),
yet US General Surgery training is longer (7 years vs 5 years).

But for Australia, the 5 years of General Surgery doesn't include the prevocational Internship and (general) resident years,
I suppose if you included them the total would be 7+ years as well...

I'm being a bit "mean" here, but maybe in addition to slashing the resident spots, they could also lengthen the US AP training to 4 (or 5) years to slow down the numbers that graduate?

 

[yaah]

This is an interesting bit - quite accurate, I think. Our hospital system and outreach (4 hospitals, 90,000 surgicals), for example, thrives on about 12-14 pathologists. But the radiology group has 40+. In all the surgical specialties there are also probably close to 100. But we had a similar number of pathologists 20 years ago when surgical numbers were half that. I am not sure how many radiologists there were back then.

I have long thought pathology training should be limited to large institutions who see and do everything at high volume. That would ensure quality graduates. Lots of smaller programs do a good job at training, however.

There are what, like 600 path residency spots in the US (about 2400 total residents)? And about 4500 total radiology residents? Does seem out of whack! Here is data on number of residents per specialty: https://apps.acgme.org/ads/Public/Reports/ReportRun?ReportId=3&CurrentYear=2015&AcademicYearId=2015

This.

You realize this once you head out into private practice and see most hospitals:
~Staff pathologists at 1:3-4 with Radiologists, yet most academic pathology training programs are nearly the same size as radiology classes

~Staff path 1: 5-6 General Surgery yet most training programs in surgery are barely larger than path classes

and so on and so on.

I did the back of the napkin math once, but from what I remember we need around 1/3 to 1/2 the number of path training slots that currently exist to meet coming demand and probably need to close programs almost entirely for 3-4 years just to clear out current manpower excess.

Look at this:

there are currently 43 General Surgery residents at UCLA med center. This is a SEVEN year program, meaning 5.85 FTEs per year on average being churned.

UCLA Pathology is training FIVE residents a year! Nearly at a 1:1 with general surgery! This is totally insane if you went to a traditional community healthcare facility ANYWHERE on Earth.

This is the equivalent of setting a table with each place setting having 4-5 spoons. You would look at that & say "WTF does everyone have so many spoons?!"

THIS is the real issue in Pathology.

 

[y2k_free_radical]

This is an interesting bit - quite accurate, I think. Our hospital system and outreach (4 hospitals, 90,000 surgicals), for example, thrives on about 12-14 pathologists. But the radiology group has 40+. In all the surgical specialties there are also probably close to 100. But we had a similar number of pathologists 20 years ago when surgical numbers were half that. I am not sure how many radiologists there were back then.

I have long thought pathology training should be limited to large institutions who see and do everything at high volume. That would ensure quality graduates. Lots of smaller programs do a good job at training, however.

There are what, like 600 path residency spots in the US (about 2400 total residents)? And about 4500 total radiology residents? Does seem out of whack! Here is data on number of residents per specialty: https://apps.acgme.org/ads/Public/Reports/ReportRun?ReportId=3&CurrentYear=2015&AcademicYearId=2015

It is partly the refusal of CAP-ACADEMIA to acknowledge this increase in number of surgicals done per practicing pathologist now versus 20 years ago that leads to their massive over estimation of the number of pathologists needed in the market place.Your practice would be deemed to be in dire need of more pathologists

 

[LADoc00]

Yaah, so this has been my premise since I started creeping on SDN when it first appeared (like around 2000?) and then registered officially on the site a few years after that.

Pathology-anatomic and clinical 2,362 total residents
vs.
Radiology-diagnostic 4,693 total residents
from these numbers, we should be training around 1000 residents in Pathology BUT I think the numbers for Radiology are hyperinflated and excessive now.

Looking at this is the 'staffing reference" is a better guide:
Surgery 8,793 total residents
from this, Pathology should be around 700-730 residents total of all years and my feeling is now Radiology is overtraining to the tune of around 600 residents, bringing their maintenance numbers near 4000 total.

If you look at the Dermatology numbers, which I believe are the most tightly controlled and hyper-monitored of all medical specialties, there are only 1500 of them total. Go out into any community and do the research on the number of Dermatologists: Pathologists...should be at least around 3-4:1. That is terrifying.

This would indicate at any time in the Pathology pipeline there are at least around 1500 excessive trainees. That is beyond insane. If I took my own top tier academic journey as a reference, basic science research careers capture less than 2-3% of that excess. Teaching another 2-3% of the excess. Leaving over 1400+ trainees to be doomed to be underemployed for the bulk of the career.

But it's even worse than that for many. Once you get sidelined into an underemployed position or a position with high degree of specialization (say only signing out prostate biopsies), you are at a massive increase risk to tracking that route for life.

 

[CDX-2]

But it's even worse than that for many. Once you get sidelined into an underemployed position or a position with high degree of specialization (say only signing out prostate biopsies), you are at a massive increase risk to tracking that route for life.

It sounds like doing combined AP / CP (General Pathology) would be a bit more protective against being underemployed / turned into a "one-trick pony" than AP alone.

Still, the numbers for US sound ridiculous and are quite worrying.

I'm surprised I don't see more US AP graduates applying overseas just for the sake of having a job!

I imagine Canada would be inundated with job applications from US graduates...

Is there some sort of loan forgiveness scheme, or do the unemployed / undereployed AP graduates declare bankruptcy if the SHTF?

If the employment situation is that bad and lots of graduates can't find jobs and pay off their loans, then surely the government would consider cutting down numbers coz the AP residents spots are federally funded?

 

[tensoranalysis]

What data are you guys using, if any, other than personal experience?

One key factor you are omitting in comparing radiology vs pathology is the overall size and the rate of change of the number of active physicians.

As of 2018 according to AAMC 2018 Physician Specialty Data Report - Data and Reports - Workforce - Data and Analysis - AAMC:
Radiology: ~27,000
Pathology: ~13,000
(a 1:2 ratio vs your 1:3-4 quoted above)

The number of physicians in Radiology has remained stable from about 2010-2018, but Pathologists have been consistently decreasing (~10% total so far from 2010, or about 1% per year). Data and Reports - Workforce - Data and Analysis - AAMC

In fact we are the second fastest shrinking specialty!

So what we can say is at the current rate of training, we are shrinking as a specialty. I won't speculate as to why we are, but you cannot argue with the fact that the number of pathologists is actually decreasing despite the claims that there are too many training spots. You might argue the field could or should be shrinking faster, but we have no way of judging demand for services on a national scale, do we ?

 

[tensoranalysis]

By the way there are currently 12,000 dermatologists , and the specialty has been increasing in size by 8%. So clearly they are training at a rate to increase the size of their practitioner pool.

Also the ratio of dermatologists to pathologists in patient care is 11338:9130 , so about 1.2:1 , or more or less 1:1...

 

[Dro133]

What data are you guys using, if any, other than personal experience?

One key factor you are omitting in comparing radiology vs pathology is the overall size and the rate of change of the number of active physicians.

As of 2018 according to AAMC 2018 Physician Specialty Data Report - Data and Reports - Workforce - Data and Analysis - AAMC:
Radiology: ~27,000
Pathology: ~13,000
(a 1:2 ratio vs your 1:3-4 quoted above)

The number of physicians in Radiology has remained stable from about 2010-2018, but Pathologists have been consistently decreasing (~10% total so far from 2010, or about 1% per year). Data and Reports - Workforce - Data and Analysis - AAMC

In fact we are the second fastest shrinking specialty!

So what we can say is at the current rate of training, we are shrinking as a specialty. I won't speculate as to why we are, but you cannot argue with the fact that the number of pathologists is actually decreasing despite the claims that there are too many training spots. You might argue the field could or should be shrinking faster, but we have no way of judging demand for services on a national scale, do we ?

Could it be that the AAMC numbers reflect the actual pathology workforce, and that there are just simply fewer pathology jobs than there used to be while the number of graduates stays mostly stable, meaning more unemployed pathologists? Just speculating here.

 

[tensoranalysis]

Could it be that the AAMC numbers reflect the actual pathology workforce, and that there are just simply fewer pathology jobs than there used to be while the number of graduates stays mostly stable, meaning more unemployed pathologists? Just speculating here.

Sure. In that case they would have to be graduates who chose not to maintain their license and/or are working less than 20 hrs/week in any capacity ( clinical , research, academic, and non-patient care related capacities).

“Active physicians: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working more than 20 hours per week. Physicians who are retired, semi-retired, temporarily not in practice, not active for other reasons, or have not completed their graduate medical education are excluded. Active physicians include those working in direct patient care, administration, medical teaching, research, or other non-patient care activities. “

 

[Euchromatin]

I find it interesting that US AP training is shorter (3 years) than Australia (5 years),

It sounds like doing combined AP / CP (General Pathology) would be a bit more protective against being underemployed / turned into a "one-trick pony" than AP alone.

The vast majority of pathology residents in the U.S. do combined AP/CP training (which is 4 years) and at least one year of fellowship - so pathology training in the U.S. is effectively at least 5 years. Not many programs offer AP only training. Those that do (a few of the biggest academic centers) might offer 1 spot per year or so, if they even find anyone interested, and it is usually used by someone who knows at the time they are applying to residency that they want to do NP fellowship - so they set up a combined AP/NP program over 4 years (not sure, but I think some NP fellowships might be 2 years due to extra research time, so could be 5 at times too).

As evidenced by the difficulty that yaah and others have noted in other threads discussing the job market from a hiring perspective, the simple fact that most graduates get their CP boards doesn't really mean that they are willing/comfortable actually acting as laboratory medical directors or doing other CP-related duties.

 

[CDX-2]

The vast majority of pathology residents in the U.S. do combined AP/CP training (which is 4 years) and at least one year of fellowship - so pathology training in the U.S. is effectively at least 5 years. Not many programs offer AP only training. Those that do (a few of the biggest academic centers) might offer 1 spot per year or so, if they even find anyone interested, and it is usually used by someone who knows at the time they are applying to residency that they want to do NP fellowship - so they set up a combined AP/NP program over 4 years (not sure, but I think some NP fellowships might be 2 years due to extra research time, so could be 5 at times too).

As evidenced by the difficulty that yaah and others have noted in other threads discussing the job market from a hiring perspective, the simple fact that most graduates get their CP boards doesn't really mean that they are willing/comfortable actually acting as laboratory medical directors or doing other CP-related duties.

Interesting...In Australia it's the opposite, the vast majority do AP, with only a handful in each state opting to do General Pathology (combined AP / CP). 20+ years ago, General Pathology was a lot more popular, but I suspect the amount to learn in each pathology subspecialty has significantly increased, which makes exam preparation more stressful...

There's also the option to do AP, and then swapping to General Pathology or Forensics once you passed the AP Part 1 exams (in 3rd year).

 

[cmz]

The vast majority of pathology residents in the U.S. do combined AP/CP training (which is 4 years) and at least one year of fellowship - so pathology training in the U.S. is effectively at least 5 years. Not many programs offer AP only training. Those that do (a few of the biggest academic centers) might offer 1 spot per year or so, if they even find anyone interested, and it is usually used by someone who knows at the time they are applying to residency that they want to do NP fellowship - so they set up a combined AP/NP program over 4 years (not sure, but I think some NP fellowships might be 2 years due to extra research time, so could be 5 at times too).

As evidenced by the difficulty that yaah and others have noted in other threads discussing the job market from a hiring perspective, the simple fact that most graduates get their CP boards doesn't really mean that they are willing/comfortable actually acting as laboratory medical directors or doing other CP-related duties.

I recall back to when I was a fellow, there were a good number of residents at UTSW that suddenly decided AP-only is the best strategy and our program director allowed it. I am pretty sure everyone found a job; however, I have to say that you're nowhere near as marketable as being AP/CP.

 

[deleted314957]

I cannot understand why someone would do only straight AP ( not intending to
do NP or FP later) only given the job market. There is a huge percentage of
employers who will not even consider such an applicant.

 

[terriermed]

I cannot understand why someone would do only straight AP ( not intending to
do NP or FP later) only given the job market. There is a huge percentage of
employers who will not even consider such an applicant.

Typically people who know they want to be in academics.

 

[path24]

The oversupply has been going on for decades. The lie of a future shortage has been going on for decades. It is a poor decision to go with pathology no matter an amg, img, fmg. You won't get an honest answer about the job market from a program director, dept chair, organizational leadership...etc.

Flee pathology is the best advice you will get here. Don't become a commodity. It sucks constantly fighting to keep your work. No security/stability. You need to become financially independent as quick as you can.

 

[jupiterianvibe]

By the way there are currently 12,000 dermatologists , and the specialty has been increasing in size by 8%. So clearly they are training at a rate to increase the size of their practitioner pool.

Also the ratio of dermatologists to pathologists in patient care is 11338:9130 , so about 1.2:1 , or more or less 1:1...

There is some influence from VC and private equity to pump out more grads to lower their independence and fuel their biopsy mill business model.


Kind of reminds you of another specialty, doesn't it...


One pathologist could handle the work of 20 dermatologists.

Our current model overtrains pathologists and does not take into account efficiencies in scale that have occurred over time.

LADOC is right about the crux of the problem being the consistent overavailability of residency spots for decades and the ACGME's disinterest in evaluating each residency on the merits of modern practice standards.FMGs are merely taking advantage of an opportunity that should never have existed. It boggles the mind that the only requirement is for a resident to have done fifty postmortems, in a time where autopsies are basically ancient relics of practice.

Some pathology residencies have zero exposure to soft tissue and bone pathology, or significant dermatopathology beyond basal cell carcinomas. This is untenable.

Someone mentioned putting together a discussion at the next USCAP, with hard data. This is a great idea. Comparing the output to similar fields like radiology, and then comparing the number of radiologists per community vs pathologists, and THEN comparing the billings, would serve to argue the point that our job market is nowhere near as rosy as once thought.

 

[LADoc00]

Yup, I dont even want to ponder how technology has and will increase individual pathologist efficiency to the point we can all down 10000 accessions per year per FTE....(shiver..) 🙁

 

[Pathbusiness]

Actually technology has slowed us down. There are so many bottlenecks in new EMR's and accessioning systems that slow down everything.

 

[deleted314957]

LA, that’s only ~40/d. Half bx’s, the other half from the OR. That is not that
much. I did that or more for ages.
As I have posited before, I really believe most pathologists are cranking out
many fewer CPT’s than they could, particularly in academia. When I see
institutions with 40 staff and a gaggle of residents dealing with 150000 cases/yr
it makes me very unsympathetic. I can see why their income is so crappy.

 

[CDX-2]

LA, that’s only ~40/d. Half bx’s, the other half from the OR. That is not that
much. I did that or more for ages.
As I have posited before, I really believe most pathologists are cranking out
many fewer CPT’s than they could, particularly in academia. When I see
institutions with 40 staff and a gaggle of residents dealing with 150000 cases/yr
it makes me very unsympathetic. I can see why their income is so crappy.

My current private lab has 2 full-time pathologists, and the histology caseload for 2018 calendar year is ~8000 cases, so it's ~4000 cases / pathologist, or maybe ~4500 : 3500 cases (coz one of them is more junior).

It doesn't sound like much compared to your figure, but they also have to deal with frozen sections, FNAs, and preparing for various MDMs (multidisciplinary meetings, "tumour boards"). They often stay at work until 8 PM, and sometimes come in on the weekends to validate cases. Atm the reports are still transcribed with actual typists, not Dragon Naturally.

Given their peripheral duties, I can't imagine the 2 of them reporting much more than 8000 cases / year unless all of the big cases were magically converted into tubular adenomas, and if the IT system didn't crash so often...

 

[deleted314957]

My current private lab has 2 full-time pathologists, and the histology caseload for 2018 calendar year is ~8000 cases, so it's ~4000 cases / pathologist, or maybe ~4500 : 3500 cases (coz one of them is more junior).

It doesn't sound like much compared to your figure, but they also have to deal with frozen sections, FNAs, and preparing for various MDMs (multidisciplinary meetings, "tumour boards"). They often stay at work until 8 PM, and sometimes come in on the weekends to validate cases. Atm the reports are still transcribed with actual typists, not Dragon Naturally.

Given their peripheral duties, I can't imagine the 2 of them reporting much more than 8000 cases / year unless all of the big cases were magically converted into tubular adenomas, and if the IT system didn't crash so often...

The efficiency of necessity. Did it for years and years.

 

[Med Director New England]

Somehow missed much of this thread until now. This discussion ought to be sticky.

If you are currently considering entering pathology and have questions about the job market in the US this thread is a good synopsis.

 

[pathslides]

My current private lab has 2 full-time pathologists, and the histology caseload for 2018 calendar year is ~8000 cases, so it's ~4000 cases / pathologist, or maybe ~4500 : 3500 cases (coz one of them is more junior).

It doesn't sound like much compared to your figure, but they also have to deal with frozen sections, FNAs, and preparing for various MDMs (multidisciplinary meetings, "tumour boards"). They often stay at work until 8 PM, and sometimes come in on the weekends to validate cases. Atm the reports are still transcribed with actual typists, not Dragon Naturally.

Given their peripheral duties, I can't imagine the 2 of them reporting much more than 8000 cases / year unless all of the big cases were magically converted into tubular adenomas, and if the IT system didn't crash so often...

2 FTE should be able to hit 9k-10k no problem. I do all the peripheral things you mention your guys do and still hit about ~5000 yearly. However I get home by 5-5:30 and I don’t go in on weekends to work on cases. Get your peeps to be more efficient.

 

[gbwillner]

# of surgicals is heavily dependent on the type of services being rendered. True, 4-5K/ year is no big deal if you are doing Bxs as a large percentage of your work. What if you are on a GI service handling Whipples and CRC resections? What if you are ENT and handling laryngectomies? Mastectomies? If you cover a cancer hospital and have to deal with these, then those numbers may be totally unrealistic.

 

[jupiterianvibe]

# of surgicals is heavily dependent on the type of services being rendered. True, 4-5K/ year is no big deal if you are doing Bxs as a large percentage of your work. What if you are on a GI service handling Whipples and CRC resections? What if you are ENT and handling laryngectomies? Mastectomies? If you cover a cancer hospital and have to deal with these, then those numbers may be totally unrealistic.

This is why the present system for valuing work is incredibly inaccurate. Specimen numbers and the 88-modifiers have such low fidelity from a value perspective that they're essentially worthless and encourage cherry-picking of easy biopsy cases like GI to the exclusion of complex breast and head/neck cases.

 

[path24]

Can we just lock every thread. Just have one saying every pathologist is highly recruited to their dream job and they get a unicorn. Ok make it two unicorns let's keep it honest. What a joke.

 

[Wantnosmoke24]

Please, AMG medical students, stay away from this field. It's not worth it. If you don't like clinical medicine, there's plenty other fields to pick from that either don't deal with patients or are removed from the day to day grind of hospital medicine yet promise a secure, well-paid future. Radiology, Anesthesiology, Dermatology, Ophthomology, ENT, IR, etc.

 

[WEBB PINKERTON]

Guess we won't be hearing from Thrombus for awhile. Looks like he is in trouble again.

 

[gbwillner]

Guess we won't be hearing from Thrombus for awhile. Looks like he is in trouble again.

He'll be back in a few months to energize his fan base...

 

[deleted314957]

The mods must think we’re all snowflakes who will be offended
by free speech. Unpopular speech these days has been removed
from its protected status in this era. We are all adults over here.
You know, sticks and stones...........

 

[y2k_free_radical]

This is why the present system for valuing work is incredibly inaccurate. Specimen numbers and the 88-modifiers have such low fidelity from a value perspective that they're essentially worthless and encourage cherry-picking of easy biopsy cases like GI to the exclusion of complex breast and head/neck cases.

Like a $ 35 payment for diagnosing breast carcinoma

 

[y2k_free_radical]

Guess we won't be hearing from Thrombus for awhile. Looks like he is in trouble again.

MAIS OUI-the DONALD of pathology