To current Forensic path fellows

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Gorlum

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Hey guys, I have a question to everyone who started a forensic path this July (or a year before): what is the situation with medical insurance and a pay? I've been working for almost a month with no medical coverage and I haven't seen a single paycheck. I was told that it was a "county issue" since a fellowship is affiliated with a county rather than with a hospital or university. Nobody can answer WHEN I will get the above including county human resources. My fellowship director and a chief medical examiner are interested in me covering the autopsies and writing papers, and it seems like a dead end. Prior fellows were in the same boat - no insurance for as long as 3 months and no pay for as long as 6 months. They eventually were paid retrospectively but they had to use other sources to support themselves. Meanwhile, I ended up in ER getting stitches, X-rays and so on, and no I'm stuck either with a bill over a 1000 usd or with an option to get COBRA (446 usd). Again, nobody's gonna pay for that but me. I would like to know is it a "normal" situation? How does it work in your institution? Any advise on how to fight my rights?
Thanks!
 
I just started in July. I too have had some trouble with getting paid, but it sounds like my chief ME is more sympathetic than yours. He is working on getting us expedited checks tomorrow. I have been told that my health insurance will begin after being employed for 30 days, and I'm using COBRA until then.

My program is also a county funded program and I have heard of people having trouble getting paid or getting health insurance in other county programs. When you hear that it is a county issue they are probably right. You need to find out who your county Human Resources person is, there is usually one in the ME office. I advise getting them on your side. If that's not possible, the county has to have a Human Resources department to speak to. They theoretically should be able to help you or at least identify what the problem is.

Other than that I'm afraid there might not be much else to do, short of refusing to work until the situation gets worked out. Is the program ACGME certified? That might be another road to go down, contact them and start asking questions about your rights as a fellow.

I can't imgaine not getting paid for 3-6 months, there is no way I would be able to make it financially. I hope this info helps or at least gives you a few new ideas.
 
I started this July and haven't had any problem. I work for a county office, too. There was an issue with me starting in the middle of a pay period, but I worked with the office's HR/budget person, who worked with the county HR people to make it happen. I filled out the paperwork and received a packet for insurance, but not sure if it has started yet. I am currently still covered by my residency insurance for 30 days past residency.

I agree with the previous poster that you should talk with your office's HR/payroll person and figure things out. You can also try contacting the head of the county HR department directly if all else fails. Did you sign a contract?
 
I'm a year out, and my program was state administered. There was -maybe- a month delay for our first paycheck? 6 weeks? It's pretty common for there to be a little overlap. As I recall, between my final residency paycheck and the start of fellowship paychecks, it wasn't entirely unexpected or unmanageable. If your program has a history of several months of delayed first checks, that's a major problem and the program needs to either address it, publicize it to interested potential fellows, or drop the fellowship. If it's just a time problem, they should have been able to get you the proper paperwork 3-6 months ago and have everything already taken care of.

I know most government administrated offices -regardless- of the work being done have a reputation for this sort of foolishness, but it continues because people put up with it or only gripe within their own niche. All the while their bosses claim their hands are tied. (Never true, though the available options may not be very attractive ones, and even counter-productive, given the political and financial landscape.) Explaining to the county that they risk losing a cheap fellow possibly in exchange for a full-time pathologist at 4 times the cost to handle the long-term workload might work, though government officials are rarely accused of being forward thinking -- especially the non-elected staff doing most of this kind of day-to-day work. Addressing it with ACGME is a possible last resort, but remember the most they can really do is pull accreditation (is "getting paid" a requirement?) -- and it doesn't do you much good to be in an unaccredited fellowship, except getting paid for it of course, if you believe your chief is already doing the best possible for you short of risking their own job.

But, yes, starting small and politely harassing human resources on a daily basis until they bump you up the line is the better way to start.

For some of the other details, including health coverage, etc., if HR isn't forthcoming, clear, and fair in your estimation, find a contract/employment lawyer.
 
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When you hear that it is a county issue they are probably right. You need to find out who your county Human Resources person is, there is usually one in the ME office.
The country HR doesn't have my papers cause a person at ME, an "administrative assistant", didn't bother sending 'em till last Friday... This "assistant" knew I was coming a year in advance, and I kept reminding her to deal with my paper in order to avoid delays. As I said, a fellowship director and a chief ME do not care. So this is one side of the problem. Another side is a county with their "minimum 30 days insuranse delay". BTW, the county HR couldn't tell me WHEN a paycheck will come. They don't know. Actually, I did contact ACGME recently cause thier web-site policy says "a medical coverage should be provided from day 1" and asked whether this situation can be settled through 'em or not. I'm awaiting the reply.
 
Addressing it with ACGME is a possible last resort, but remember the most they can really do is pull accreditation (is "getting paid" a requirement?) -- and it doesn't do you much good to be in an unaccredited fellowship, except getting paid for it of course, if you believe your chief is already doing the best possible for you short of risking their own job.
My chief cares only about looking good on TV. He made it clear that he doesn't give a damn about my bills and so on. I asked what would happen if I cut myself or have any other job-related accident. He simply answered "it never happened before". I called the county HR and asked same question. They didn't know and had to consult someone. The answer was I would probably be eligible for a woker's compensation, but since they don't have my papers, it will be hard to arrange. If ACGME answers something sensible, I'm gonna give chief a choice: he either gets my COBRA paid or I will proceed to filing an official complaint. As for a lawyer, one of regular MEs offered me a free legal help - his wife is a lawyer. I might use it if I need. I've been doing my job properly since day one and I don't want anything but what was entitled to me.
 
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I probably wouldn't use that particular word in a public forum, though I would probably perform similar actions -- lay out what perfectly legal recourse I might take and let the chief make a decision. What you're saying sounds pretty woeful, and if/when the time is right I'm sure potential forensic fellows (and attendings) out there would like to know where & who to avoid. Is the office currently NAME accredited?

Having a protocol for handling on-the-job injury is a pretty basic standard requirement. The absence (not just lack of knowledge of the existence) of something like that wouldn't go over well in any forum.
 
Sorry for the complete hi-jack, but since there are some forensics in here.... Are forensic pathologists experiencing the same problems finding jobs as the "other" pathologists. I worked as a county employed path tech for a few years and some of the of the fellows seemed to find jobs quickly, but a few either went back to hospital based path or claimed not to have any "good" offers.


Sorry to go off topic... thanks for any replies!
 
Sorry for the complete hi-jack, but since there are some forensics in here.... Are forensic pathologists experiencing the same problems finding jobs as the "other" pathologists. I worked as a county employed path tech for a few years and some of the of the fellows seemed to find jobs quickly, but a few either went back to hospital based path or claimed not to have any "good" offers.


Sorry to go off topic... thanks for any replies!

im interested in this, too... maybe KC can give us his opinion/experience if he gets a few minutes
 
Is the office currently NAME accredited?
He's dreaming about getting it, and NAME people are supposedly coming in January. It's not gonna fly - a fellow does 250 autopsies in 6 month, and NAME requires no more than that in a year, as I remember.
 
Are forensic pathologists experiencing the same problems finding jobs as the "other" pathologists.
I can tell you about my friend's experience. She just finished a fellowship in NYC. She started looking for a job in early spring, attended 4 interviews and chose a position in Boston.
 
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I don't know that NAME starts calling it a deficiency until the workload is such that on average the pathologists must go over 325 (there's a calculation to include externals), but the "recommended" maximum number is lower. The NAME inspection checklist and autopsy standards are downloadable here, you can interpret for yourself:

http://thename.org/index.php?option=com_docman&task=cat_view&gid=45&Itemid=26

ACGME starts dinging programs if a fellow does more than 300, at least when I was a fellow not so long ago, but again recommends substantially fewer (I seem to recall at least 200 so you see enough but not more than 250? I'd have to look it up. Most programs advertise that a fellow is expected to do about 250; at the big busy offices most will approach 300, but only a few go over that because of ACGME coming down on them).

The job hunt for me, and those I've spoken to from my year and the year or two before me, wasn't bad. I believe one or two didn't really get what they wanted, but still had a properly paying job on time. The annual NAME meeting, annual AAFS meeting, their associated websites, and your own office's pathologists seemed to be the primary sources for finding job opportunities. I chose about a dozen to contact, all but perhaps one returned contact, we spoke by phone, and they asked for my CV +/- a short and simple application (some of the state/county administrated positions require you step through some hoops before they'll bring you for interview). I don't recall anyone not offering an interview, though I only went to..er..three locations I think, two of them second interviews so I could bring my fiance. Most of the jobs advertised at $140k+ (but as low as ~$95k to as high as ~$190k; it may be higher in some expensive cities, but not that I saw advertised) straight out of fellowship, board eligible with expectation of getting AP & FP within 2 years. I was also coming from a "bigger" fellowship program. Most people have indicated that if one is just a little ambitious, in ~5 years or so the opportunity to land a deputy chief or chief position is very attainable.

Here's the catch.

Even though there are jobs out there (or were within the last 2 years), they're scattered. You won't be able to pick a city then find a job. You'll have to find a job and move where it's at. And, most of the jobs seem to be at smaller offices (2 or 3 FP's). Most of the advancement in title and pay (after you get AP & FP boards) is minimal, or will require moving again to take that deputy chief/chief job. If you want to work at a big place doing thousands of autopsies with a dozen other pathologists around you either need to do a fellowship there and hope a job opens up (many of the jobs at such places are filled internally like that) OR be willing to go to a body mill to be overworked and underpaid. The reason some people are willing to do this is that it's generally considered easier to go from a peon at a body mill to a deputy chief or chief anywhere than it is to go from a peon at a smaller office back to mere survival at any big-time office -- though I don't believe that's an accurate assumption.

All of that is possibly why you've heard people say they didn't get "good" offers, or moved from forensic back to surgical pathology before they really even got started.
 
Sorry for the complete hi-jack, but since there are some forensics in here.... Are forensic pathologists experiencing the same problems finding jobs as the "other" pathologists. I worked as a county employed path tech for a few years and some of the of the fellows seemed to find jobs quickly, but a few either went back to hospital based path or claimed not to have any "good" offers.


Sorry to go off topic... thanks for any replies!

Although I am in fellowship and haven't started the search, I hear that many fellows move into positions where they train (providing an open position). So, you won't see postings for some positions that may be available. Interestingly, FPs seem to move around quite a bit.
 
... I hear that many fellows move into positions where they train (providing an open position). So, you won't see postings for some positions that may be available. Interestingly, FPs seem to move around quite a bit.

I'd say this is pretty accurate. I have little doubt a significant number of positions are never nationally advertised, or only briefly advertised solely due to HR requirements despite knowing who they're hiring. This is where having good contacts in the field really help, as does talking to your chief & other FP's in your office. As a fellow, I -highly- recommend going to at least one of either the NAME or AAFS meetings, both if you can, if only for a couple of days (most programs build in time off for at least one). Even better if you can go to one or the other a time or two during residency.

-Some- FP's do seem to move around, meaning jobs tend to pop up here and there year round. (Don't be discouraged if the NAME & AAFS job listings only have a few FP advertisements on any given day -- they -always- have at least a few; I've seen as many as the high teens or maybe low twenties posted, and as low as maybe three? in watching it over three or so years from mid residency.) Unsurprisingly, this is partly due to good people climbing the ladder of success, partly due to certain stresses in certain offices ("not a good fit"), partly due to local politics related to the position, and partly due to not-so-good people trying to stay in business -somewhere-. But despite the sense that there is a reasonable amount of moving around in the field, most offices seem to have a core of individuals who've been there since the stone age. Makes for some interesting stories, but sometimes also some bad old habits.
 
to the OP: you are getting royally shafted. i'm very sorry.

i expect things to be occasionally screwed up since i am now working for a city government ie my health insurance info went to my previous address which is 100 mi away. fortunately i had already switched to my spouse's insurance so no big deal. also, there is also a delay sometimes with paychecks depending on what part of the pay period they're in when you start working. but people are saying 6 weeks? that's just plain wrong.

as for the job hunt... nope. rather not think about it right now.
 
But, yes, starting small and politely harassing human resources on a daily basis until they bump you up the line is the better way to start.

I use this technique for all sorts of things like this, and I find it works pretty well. If someone knows that they will get a call from you almost daily, they will be inspired to "oil" the squeaky wheel and actually push to get something fixed. And if you are always very polite and friendly about it, they can't really get too angry with you. Although they may be annoyed or frustrated, how can they rage at you or complain about you if you only say:

"Hi, I just wanted to check in again on my paycheck. It's been about 3 months and my kids are pretty hungry (ok don't say that part maybe). No, it's not ready yet? Ok, well thanks so much for looking into to it. I'll call again later to check on it. Have a great day!"

Polite but unrelenting persistence usually work very well. And it is easier and cheaper than legal proceedings (although that may be worth looking into to see your options).

Publicizing the issue via the media (esp if it has been months since you started but no paycheck yet...news channels would love that kind of story I imagine) might fix things quickly (since you mention that public image is important to your Chief), but I would seek legal counsel before going that route as it also has the potential to backfire and get you in trouble.
 
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