Yes. Your idea to increase residency to 5 years (5th year being a fellowship) is a good one. But this would obviously be contingent on the ACGME NOT increasing the number of overall spots to account for an extra 20% of residents. That would be the easiest to implement, although it would still be expensive and quite difficult.
However, your points about deciding which programs to eliminate, while a good start, aren't really practical. I tend to agree with the criticisms which yaah layed out. Getting 90% of your residents to pass the boards is a little too subjective. It is immensely hard to create something objective that would allow elimination of programs or positions, because unfortunately once the cat is out of the barn, so to speak, by granting these programs residency positions it becomes much harder to eliminate them. All of these programs could probably present data and metrics that demonstrate they are producing competent pathologists, even if they arne't.
So how do we reduce the pool of graduating pathologists? We have to find some way to eliminate programs. The solution, as you say, is very easy, it is the implementation that is difficult. There should be some coordination with the ACGME, as well as residency program reviews. Right now, these evaluations (I am talking about when pathologists come and evaluate the training programs) are basically rubber stamps. They ensure that the program does things that are necessary, like providing enough surgicals and study time, etc. But they create criteria that are easy to meet if the program puts enough effort in it. What we truly need to do is create a culture shift where getting accreddited as a residency program becomes a difficult task, and requires evaluation of not only the program characteristics but how the graduates fare when they finish. This would make programs uncomfortable but it would force them to get better because they could lose their accreditation at least for a time. I do not know who should be responsible for this - ACGME? Path organiations? The ABPath? It would be immensely difficult to implrement but I do not know of many easier solutions. I wish I did. Do you?
The only other way to combat the job market is to come at it from the job angle - somehow create more desirable jobs. But this is far too dependent on market dynamics and non-controllable factors and is essentially impractical. You can't limit practicing pathologists to a certain amount of work. You can't force people to hire someone.
Your post is beyond absurd. If you search the job market threads I have not hidden my view that having residents complete training and not be able to get a job in pathology is unacceptable. The deniers here always say there are lousy residents and lousy programs and these people basically don't deserve jobs. I have news for you, there are lousy IM/Peds/FP/etc. programs, etc and lousy IM/Peds/FP/etc. residents but they still all manage to find jobs. How about closing or fixing the bad programs and properly training residents rather than letting significant numbers of people endure the trauma of unemployment after all the years of training? When you have the occasional resident who turns out to be a bad fit for pathology how about helping them transfer to another field rather than stringing them along for 4 years and giving them a rubber stamp residency completion certificate?
This is a ludicrous response! At least, the first part of it is. The second part is spot on. Almost everyone who posts these opinions that there are lousy residents and programs is not denying that the job market is weak! Of course all graduates of pathology programs who pass the boards should be able to get jobs. But that assumes that all graduates of pathology programs are qualified - which they are NOT!! These unqualified folks are rare, but they exist. Are you really serious that lousy graduates in other specialties still manage to get great jobs? There are unemployed people in every specialty who just can't hack it. Just because you can name a bad clinician who has a job doesn't make this untrue. I can list off dozens of pathologists who have jobs who I wouldn't want to work with, but they still have jobs! I have a relative who ran an ER for 20 years and he knew of ER physicians who couldn't find jobs because their skills were poor.
I TOTALLY agree that programs need to be more responsible for finding these poor residents. Pathology is at a disadvantage because residents have far less autonomy than those in other specialties. Because the other specialties allow autonomy, unqualified practitioners can be easier to spot and removed from the training process (or transferred to something that fits them better). This is a VERY IMPORTANT point! Programs do an AWFUL job of preparing residents for practice in many aspects. There are far too many residents who don't perform yet still are allowed to graduate. Obviously the program has responsibilities to create a training environment that allows different types of individuals to succeed, but there is only so much they can do. I know that sounds tough, but life is tough. Peoples' lives are at stake. As a (presumably) capitalist I would think you would agree with this.
