Verbatim from CAP - the pathologist shortage

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It is definitely official now. CAP thinks we need more pathologists and that there is a shortage. Link included, but here is the copy/paste.

http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=statline%2Findex.html&_state=maximized&_pageLabel=cntvwr#Story3
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Addressing the Coming Pathologist Shortage

The country faces a significant shortage of pathologists in the near future at a time when pathologists will play essential roles in new care delivery paradigms. Donald Karcher, MD, FCAP, Chair of Pathology at George Washington University and President-Elect of the Association of Pathology Chairs (APC) delivered these twin messages on behalf of the CAP and the Association of Pathology Chairs (APC) on September 9 to the members of the federal Council on Graduate Medical Education (COGME).

COGME has statutory authority to advise the U.S. Department of Health and Human Services (HHS) and Congress on physician workforce policy. Dr. Karcher’s messages served to emphasize a joint statement signed by CAP, APC and eight other pathology associations. The statement complimented COGME on its recent report Improving Value in Graduate Medical Education for recognizing the need to increase funding for GME but expressed serious concerns that the report failed to include pathology as a “high-priority specialty” deserving of special attention in the GME funding paradigm.

Medicare funding for GME has essentially been frozen since 1997, with recent efforts to address shortages aimed mostly at primary care physicians. The joint pathology statement recognized the need to address primary care shortages but also pointed out that while other laboratory workers are vital, they—unlike nurse practitioners—cannot substitute for pathologists.

Dr. Karcher’s remarks and the joint pathology statement are part of CAP’s efforts to increase pathology’s presence in GME policy circles, so that policymakers will begin to understand the critical importance of pathologists in patient care and the need to address the pathology workforce.

 

[LADoc00]

Propagandist fiction. There is no shortage of pathologists literally ANYWHERE in the US I am aware of. Even recent openings in remote places such as Alaska received deluges of applicants. And from what Ive been told the U.S. Military branches arent even taking boarded Pathologists who arent willing to be primary care docs (although Im not sure how you could do that IF you were willing).

Pathology is the most underemployed medical speciality in all of medicine.

Of course that is very environment you would want if you had to fill up a medical school faculty roster with low compensated jr. faculty members who will never be on any sort of tenure path.

Curious huh?

 

[scienceguy19]

It seems that plenty of people had difficulty landing a job this year. How can there be a shortage?

 

[yaah]

Because it says "the coming" shortage. It doesn't say the current shortage. The "near future" is an undefined time. You're complaining about something they are not saying.

It's easy to say this is off base and a poor thing to focus on, etc. So refute it then. With data. Don't just say stuff like "everyone knows this is true" because clearly everyone doesn't know it's true. Use real data.

One has to come by an opinion like this with real data - Current # of pathologists is increased by X number each year, which should be fairly easy to measure based on number of training spots per year minus number who don't end up practicing in the US. Attrition is harder to get at but in 20 years it is probably somewhat easier to predict than it is to predict 2 years from now.

The challenging part of the equation is the anticipated need for pathologists - how many pathologists are needed? Will consolidation and efficiency increase? I hear a lot about how "obamacare" and aging population are going to INCREASE the need for pathologists due to increasing number of specimens and increasing health care utilization. But we also hear about DECREASING lab utilization being a cornerstone of future cost savings and cost management. What is the difference between the increase and the decrease? How can you project work force needs from this? What about how technology will play a role?

To me, looking at all of these trends I find it hard to believe that the absolute number of pathologists needed in the future is going to increase. I find it hard to believe it will need to even stay constant. But I would love to see the data.

 

[Path or bust]

. So refute it then. With data. Don't just say stuff like "everyone knows this is true" because clearly everyone doesn't know it's true. Use real data.

Where is this CAP data of which you speak?

 

[pathstudent]

God I hope they are right. A dire shortage of pathologists is the only hope that those of us who are willing to bust our asses will earn a decent living.

 

[Tissue issue]

I scrolled through the Archives article cited in the CAP link. I saw no discussion about the increased number of cases individual pathologists are signing out (or being forced to sign out, as the case may be). I didn't read every word of the article; somebody please correct me if I missed it.

 

[B***F*****]

Shortage or no shortage...debatable. What is more relevant is shortage/no shortage based on future needs.

 

[Scania]

The current war over reimbursements heavily favors primary care, and the perception of a massive FP/GP shortage helps their cause (in theory)... Convince the "hand that feeds you" that we're an underappreciated specialty on the verge of a major shortage, maybe that helps our cause... ... I'd like to think our leaders are simply cunning old bastards and trying to solidify the fear of a "mass pathology shortage" (with no real intention of increasing the training programs) to leverage their lobbying efforts when the proverbial $hit hits the fan...but.... I'm afraid I can't give them that much credit...I know that's not the case.

 

[LADoc00]

Shortage or no shortage...debatable. What is more relevant is shortage/no shortage based on future needs.

There is no debate: there is no manpower shortage in pathology. this is simple fact. You can chat up CompHealth who DOES track real data on this and they will tell you point blank: they have a TON of Pathologists they simply cant place and the gigs that pay they do have open want to you LESS than the payrate a travelling NP is making (and consequently like 1/2 what other subspec earn).

There is NO data the CAP folks or their cheerleaders will accept. You want data the sky is blue too? How about data that 1+1 = 2 or maybe data that the weather in Maui is nice??

Once you realize the farce of the manpower shortage myth, you then just need to ask yourself: who has the most to gain from continuing the fiction? Why would they press it so hard?

Follow the trail and make your own judgements..

 

[Tissue issue]

From the COGME report:

Recommendation 2:
GME funding should be prioritized to accelerate physician
workforce alignment with population and health delivery needs.
Recommendation 2.1:
Increases in GME funding should be directed toward the
following high priority specialties:
•
Family
medicine
•
Geriatrics
•
General
internal
medicine
•
General
surgery
•
High priority pediatric subspecialties
•
Psychiatry

 

[B***F*****]

There is no debate: there is no manpower shortage in pathology. this is simple fact. You can chat up CompHealth who DOES track real data on this and they will tell you point blank: they have a TON of Pathologists they simply cant place and the gigs that pay they do have open want to you LESS than the payrate a travelling NP is making (and consequently like 1/2 what other subspec earn).

There is NO data the CAP folks or their cheerleaders will accept. You want data the sky is blue too? How about data that 1+1 = 2 or maybe data that the weather in Maui is nice??

Once you realize the farce of the manpower shortage myth, you then just need to ask yourself: who has the most to gain from continuing the fiction? Why would they press it so hard?

Follow the trail and make your own judgements..

My point was that the "debate" for the current state of things is irrelevant. The specialty is slowly hemorrhaging. So in future state, the current workforce will be even more of a surplus.

IMHO, I don't buy into the whole shortage BS either. I never thought we had a shortage and I certainly don't believe this will be the case in the future (quite the opposite).

The good days are over. We are going to have to work more for less.

 

[yaah]

Where is this CAP data of which you speak?

I don't know, I didn't say I agreed with their position. But I suspect they have more data than most people on this forum. That's the problem. You can't argue data with anecdotes and rhetoric unless you're in congress or talk radio. What I THINK their data is is mostly actuarial - pathologist average age is increasing so while there may not be a shortage currently, the projections suggest declining numbers in the future. I think the projections probably also show declining GME funding and thus declining residency positions overall. Thus, a simple look at the evidence suggests that there will be fewer pathologists and fewer graduates. Combine this with an aging population which (apparently) is going to be consuming more health care (this is debatable I think) and it looks like a perfect storm.

However, I doubt that there will be significant acknowledgement of the fact that this is probably a GOOD trend for pathologists in general.

To me the major problems on the horizon are not pathologist numbers but declining reimbursement and changing payor models. Technology will also present challenges as well as opportunities, but the challenges may outweigh the opportunities for most.

 

[yaah]

From the COGME report:

Recommendation 2:
GME funding should be prioritized to accelerate physician
workforce alignment with population and health delivery needs.
Recommendation 2.1:
Increases in GME funding should be directed toward the
following high priority specialties:
•
Family
medicine
•
Geriatrics
•
General
internal
medicine
•
General
surgery
•
High priority pediatric subspecialties
•
Psychiatry

Yeah I don't disagree with these recommendations at all. Especially psychiatry. Pathologist organizations would be MUCH better suited to focusing on stuff that is more critical, like reimbursement, regulations that disfavor pathologists, and pathologist place in the future of care.

 

[Kilgoretrout 65]

I don't know, I didn't say I agreed with their position. But I suspect they have more data than most people on this forum. That's the problem. You can't argue data with anecdotes and rhetoric unless you're in congress or talk radio. What I THINK their data is is mostly actuarial - pathologist average age is increasing so while there may not be a shortage currently, the projections suggest declining numbers in the future. I think the projections probably also show declining GME funding and thus declining residency positions overall. Thus, a simple look at the evidence suggests that there will be fewer pathologists and fewer graduates. Combine this with an aging population which (apparently) is going to be consuming more health care (this is debatable I think) and it looks like a perfect storm.

However, I doubt that there will be significant acknowledgement of the fact that this is probably a GOOD trend for pathologists in general.

To me the major problems on the horizon are not pathologist numbers but declining reimbursement and changing payor models. Technology will also present challenges as well as opportunities, but the challenges may outweigh the opportunities for most.

The recent ASCP data about the number of fellowships people do and the number of job offers they get and how long it takes to find a job is a clear indication that there is no shortage of pathologists. Why would people do 2 or 3 fellowships if employers were offering them jobs after there first heme or cyto fellowship? That being said, of course the APC/CAP is trying to be heard at the table because the specialty keeps having to remind others we still exist - for a little while anyway.

 

[scienceguy19]

50% reduction in reimbursements in pathology....

pathologists are getting thrown under a bus...

and lack of respect from patients and other doctors

 

[yaah]

The recent ASCP data about the number of fellowships people do and the number of job offers they get and how long it takes to find a job is a clear indication that there is no shortage of pathologists. Why would people do 2 or 3 fellowships if employers were offering them jobs after there first heme or cyto fellowship? That being said, of course the APC/CAP is trying to be heard at the table because the specialty keeps having to remind others we still exist - for a little while anyway.

Look, I am not sure how many times this is going to be said, but I'll say it again: The current situation is not the issue CAP is talking about. It is the future (undefined time period). The CAP thing referenced above is talking about the future potential job market. Not the current. Not the present. It doesn't reference the present at all as far as I can tell.

It will probably take about 2 posts before we get another "the CAP is crazy, there is no current shortage" post but there we are. There are 8 billion other threads about the current job market situation. This was not supposed to be one of them as far as I can tell.

 

[pathstudent]

This is ridiculous. As we move away from "volume" based care to "value" based care pathology specimens will decrease. Docs will incentivized to perform less tests and to utilize specialties less

 

[yaah]

This is ridiculous. As we move away from "volume" based care to "value" based care pathology specimens will decrease. Docs will incentivized to perform less tests and to utilize specialties less

I agree with that. In a sense that is the whole point of ACOs and bundling.

 

[scienceguy19]

future shortage as in 30 years from now.... we'll be dead by then lol

 

[yaah]

future shortage as in 30 years from now.... we'll be dead by then lol

Believe it or not I think that's kind of the point of the whole argument.

 

[Kunu]

IF not when old pathologists retire the overall net effect will just be an offset of income lost from lower reimbursements but everyone will be just working more to push back toward salary equilibrium.

 

[LADoc00]

I think that ACGME priority mission list is interesting, who other than me thinks we will see a mad explosion in the the popularity of Psych as a residency??

Government psych workers in my state are making a FORTUNE and I can only see this going higher.

I graduated from very highly rated US medical school (like perma top 5) and there were NO psych. bound students. None. And 1 one into pathology🙂

I bumped into a Psych. M.D. who pulled down near 700K last year and literally did a double take...it sort of blows up the paradigm that procedures=$ and time with patients=loss.

Anyone else think that with all these shootings and mental health focus, psych. might be a goldmine?? Like the hidden gem for the next 2-3 decades??

 

[TMZ2007]

I bumped into a Psych. M.D. who pulled down near 700K last year and literally did a double take...it sort of blows up the paradigm that procedures=$ and time with patients=loss.

Was he actually seeing patients himself or was he "merely" supervising a whole herd of mid-levels? Are there some lucrative lesser known billing codes for psych or something? Curious.

 

[MOHS_01]

This is ridiculous. As we move away from "volume" based care to "value" based care pathology specimens will decrease. Docs will incentivized to perform less tests and to utilize specialties less

I agree with that. In a sense that is the whole point of ACOs and bundling.

...and the real winners will be the insurance companies, trial lawyers, and politicians, for how easy will it be to argue that Doc McScrooge was looking out for his bottom line rather than pay for that test the he used to order routinely -- prior to entering into a shared cost arrangement. If only Dr. M was not so greedy, this innocent mother of three would still be here to see her granddaughter get married....

Funny how this **** always works out in favor of those crafting the rules, huh.

 

[Napoleon1801]

More fuel to the fire:

http://finance.yahoo.com/news/-1-million-mistake--becoming-a-doctor-180452276.html

 

[KluverB]

More fuel to the fire:

http://finance.yahoo.com/news/-1-million-mistake--becoming-a-doctor-180452276.html

Actually, quite the opposite. The grass is not greener on the other side. Checkmate.

 

[WEBB PINKERTON]

The grass is dying on all sides.

Everyone better get used to making less. The gravy train is over. Face it most of the "growth" in this sector of the economy has been waste that created a false market. There is no doctor shortage. There is too much healthcare.

Thank the "entrepreneurs" who gave us cadillac insurance plans, hospital systems on every corner, robotic surgery, client billing, in-office labs, etc that jacked the costs up with little to no benefit.

If your math is strong, actuary school seems like a good option if anyone needs to change careers.

 

[LADoc00]

Was he actually seeing patients himself or was he "merely" supervising a whole herd of mid-levels? Are there some lucrative lesser known billing codes for psych or something? Curious.

nah just punching a clock at a government job. And the pension numbers for this person was insane. Like retire at 55 with 250K/yr for life and free health insurance..

there are some gems out there just need to shop it around.

 

[Surge2pathMD]

I'm a US grad applying to Pathology this year, and this discussion is quite worrisome... Losing sleep over getting a residency spot, boards scores and grades wasn't scary enough that now I have to worry about having a job in the future, even if I get a spot. Honestly, I love pathology for the science and academia behind it, and would not rethink my choice no matter what the future pays.
Besides, I thought one of the perks of being a Pathologist was job security, thinking that there is very little territorial threat from other specialties... am I wrong?

 

[yaah]

One of the perks of medicine in general is job security. Doctors are very rarely fired, and when they are it is typically for major issues like inability to do the job (drugs, personal issues, true incompetence). Pathology is at somewhat more risk because theoretically hospitals or groups could eliminate or lose contracts. But it is rare for pathologists (but possible) to lose a job they want to keep.

The threat for pathologists is not so much threat of other specialties taking patients from you, it is either other specialties insourcing their pathology or hospitals outsourcing their business to a national lab.

The point is you can always scare yourself. If it's not the job market it's reimbursement cuts or lifestyle concerns or the stress of doing the job or malpractice or whatever. It is quite hard to actually find an involuntary unemployed pathologist if that is what you are truly worried about. Despite what people on the forum say, no one really knows what the situation is going to be like in 5 years when you would finish and be looking. They will say they know, but they don't.

 

[Leukocyte]

It is quite hard to actually find an involuntary unemployed pathologist if that is what you are truly worried about.

Me too I am extremely worried. But if what you are saying is right, then I would be less worried. Reading the posts on this forum and the ASCP report gives people the idea that there are unemployed pathologists sitting around in their homes. If one is willing to work in a rural area, are there jobs there? Or you still have to "compete" for jobs.

This is very different from what I am used to in FM. In the FM job market, there is no such thing as "competition" But it all depends on who signs the job contract first. For example, if there are 2 FM docs who apply to the same job. They both will get an interview, and a contract offer, but who gets the job depends on who signs the contract first. The idea that you have to actually "compete" with a fellow docs for jobs in Pathology is very un-settling.

 

[scienceguy19]

Let's just say that in other specialties like internal medicine, practices will be begging for you to work for them, whereas it's the opposite in pathology.

In pathology, you will be putting in lots of effort looking for a job. For every pathology job posting on the internet, there are tons of people who send in their CVs. So yes it does feel like you are competing.

After speaking to several recent graduates in pathology, they said that the job market is tough. You should also ask graduating residents and fellows in the area you desire to practice their experience.

Me too I am extremely worried. But if what you are saying is right, then I would be less worried. Reading the posts on this forum and the ASCP report gives people the idea that there are unemployed pathologists sitting around in their homes. If one is willing to work in a rural area, are there jobs there? Or you still have to "compete" for jobs.

This is very different from what I am used to in FM. In the FM job market, there is no such thing as "competition" But it all depends on who signs the job contract first. For example, if there are 2 FM docs who apply to the same job. They both will get an interview, and a contract offer, but who gets the job depends on who signs the contract first. The idea that you have to actually "compete" with a fellow docs for jobs in Pathology is very un-settling.

 

[scienceguy19]

and ask graduating residents/fellows how many job offers they got...

compare that to an internal medicine graduate, who gets like 10 job offers.