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Warning. Do not go into pathology

Discussion in 'Pathology' started by average, Aug 1, 2006.

  1. average

    average Member
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    Spoke with a pathologist today who showed a very gloomy picture of path's future. He seems to think that "assembly-line" type jobs are becoming more and more common, and warned me about going into pathology.

    Is path doomed to become a bunch of large companies with an industrial mentality? That is, is it enevitable that the majority of pathologist jobs will become all about production--how many slides can you get through in X amount of time?

    He also warned of groups forcing people to see a vary narrow scope of practice while making a minimal salary and watching the "partners" rake in millions. To bad if you don't like it, we will just let you leave and hire another.

    He claims that in general pathologists are an unethical bunch that will take advantage of you if possible. Spoke of groups keeping two financial books so that other non-partners will not gripe about salary and forcing employees to sign no competition clauses. Said he has friends who were promised partnerships after 3 years but still haven't after 5 but don't want to leave because family is settled down in area. Said this stuff is a rampant problem in pathology but that the major governing baords won't even talk about it because they are governed by the owners of these large companies.

    Would like to hear some pathologists perspectives on these claims. Has anybody else heard similar stories?
     
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  3. dermpathlover

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    I think there was once a golden age of medicine known as the 70s and 80s when most all people had insurance and all doctors made good money.

    In the 90s the "for profit" mentality took over with lots of other business people trying to take a slice of the pie. This resulted in more cut-throat behavior amongst the specialties and within the specialties.

    I think we will see a lot more of the US Labs taking over. But on the other hand, if a pathologist knows his **** and gives good service, he will always be able to work and have the upper hand in the local market over US Lab, Ameriapath etc. Doctors are putting their ass on the lines based on what a pathologist reads into the slides. If they know you and trust you, that means a lot more than all the slick advertising and claims of specialized subservices.

    The market will be more and more ruthless the next few decades, but I think there is still hope.
     
  4. LADoc00

    LADoc00 There is no substitute for victory.
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    [​IMG]

    Why would a single thing you stated ONLY pertain to pathology. HELLO. That is all of medicine!! At least pathology doesnt have turf wars over stuff like angio procedures.

    And by the way:
    [​IMG]
     
  5. yaah

    yaah Boring
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    There are always going to be naysayers. I think the best way I can respond to the above is that people should not take the word of one person over the word of others. And seek out many opinions before you make your mind up.

    Pathology, like everything else in medicine, is ultimately about patient care. Those that provide the best service for the best cost will ultimately get the most business. Doing things cheaply or efficiently isn't necessarily good if it doesn't come with quality. The market chooses which forces it will adhere to - if the future is one in which pathologists become glorified assembly line workers, the market will likely support this. But I doubt this will happen to the extent people worry about. I do believe subspecialization will continue to become more important, but this is because subtleties are becoming more recognized, and something that only a pathologist who sees prostate cores every day would notice may become more significant, whereas in the past it was a curiosity.

    In general, I would avoid any dire predictions of the future, and especially anyone who is definitive. The thing of it is this: Patients are still going to get sick, and need a diagnosis. Almost every pathologist will tell you that the volume of cases they see continues to go up every year - it doesn't go down. Ancillary tests are getting better but they are not replacing pathologists. Certain types of biopsies are becoming less common (like endometrial biopsies for infertility purposes - i.e. date the endometrium) but these are in the minority. Most things are increasing.
     
  6. average

    average Member
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    Dermpathlover- very good point. This was an older doc, and he probably was a bit bitter because of the glory days of 70's and 80's.

    LADoc00- Not much class in how you approached your post but a reasonable point nonetheless.

    Yaah- TY, this is exactly why I am posting this questions on this site. I want to see what others think so that I can form my own opinion.
     
  7. deschutes

    deschutes Thing
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    What did he suggest as a favoured alternative?
     
  8. drPLUM

    drPLUM Got your tickets?
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    Didn't you hear? Market forces and supply/demand don't apply in other fields. Everyone who trains in a field other than pathology gets a promised ideal job in the exact city they want, guarenteed.
     
  9. yaah

    yaah Boring
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    Complaining!

    ;)
     
  10. deschutes

    deschutes Thing
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    Huh? You mean I actually have to work??
     
  11. juddson

    juddson 3K Member
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    I'm afraid I don't understand how Ameripath and US Labs can drive salaries down. Don't they have to hire pathologists too? Don't these pathologists have the same salary demands as everybody else? Don't they also complain about slide volume, etc.

    Judd
     
  12. b&ierstiefel

    b&ierstiefel Guest

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    Oh no! God forbid we have to work for our money!
     
  13. DarksideAllstar

    DarksideAllstar you can pay me in bud
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    f*@k! I didn't get into this in order to have to work for my money. Give me your paycheck bitch. Better yet, LADoc, hook a brotha up.
     
  14. b&ierstiefel

    b&ierstiefel Guest

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    :laugh:
     
  15. LADoc00

    LADoc00 There is no substitute for victory.
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    Hey, have you ever been to Treasures in LV?? There is the hottest German-Asian chick I have ever seen there, like about 5'8"...crazy hot. Dunno why I mentioned other than your tag says strip club in vegas...if you are in city of course check out Deja Vu on Broadway(I think you can get a pass for all the strip clubs in North Beach for like 30 bucks now) or O'Farrells.
     
  16. yaah

    yaah Boring
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    German-Asian? That's odd. Kind of like Indian-Irish. Would be interesting to see.
     
  17. pathdawg

    pathdawg Senior Member
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    Not much class? Do you want class or truth? He is 1000% right. How that pathologist characterized our field can be applied to medicine as a whole. Assembly-line mentality: check. Unscrupulous older generation taking advantage of the younger generation: check. Everyone making less money: check. This is happening in EVERY SINGLE FIELD, KIDS!!!!! What makes pathlogy unique? This is the deal: medicine sucks. Thats the harsh reality. Pathology by no means stands out.
     
  18. yaah

    yaah Boring
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    People are always going to idealize the past and fear the future. Even if the past sucked for the most part, people will talk about how wonderful it was, because they are transferring the aspects of the past that sound good to them to the present, while leaving behind the objectionable aspects. You can't do that. You have to work in the present. Are there crappy jobs out there with people in charge that take advantage of their underlings? Of course. There always have been. There have also always been great jobs, and there probably always will be.

    Some people look at one incident and see an isolated incident. Others look at it and see a trend. Some people look at 500 isolated incidents and still see isolated incidents. Others see a trend. There is a lot of complaining on these forums about how things aren't what they used to be, etc etc. And a lot of it comes from hearsay and from listening to people who may or may not know what they are talking about. Is medicine different from in the past? Yes it is, because medical costs are insane now, and this country is probably headed towards a crisis when medical costs will exceed our gross national product.

    You have to do what you want in life. If you spend your career idealizing the past and reminiscing about what once was, or you see a few lucky individuals who happened to catch a break and say, "Why can't that be me," you are never going to be happy. You will always be looking over your shoulder.


    By the way you can't possibly be 1000% right.
     
  19. pathdawg

    pathdawg Senior Member
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    The extra 900% was hyberbolic inflation.
     
  20. deschutes

    deschutes Thing
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    I thought it was just their age showing.
     
  21. b&ierstiefel

    b&ierstiefel Guest

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    What I would recommend is to go to other parts of this forum and see who's moaning and groaning about the job situation. I, personally, have not heard as much gripe about the job situation in other fields than pathology. There is something going on when you hear stories about connections that set people up with jobs or stories where people got jobs but not in the geographical areas of preference. Just throwing that out there.

    Keep discussing...this is entertaining.
     
  22. pathER

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    :smuggrin: This thread gives me an idea. I'll just post a bunch of crap about how path sucks and try to scare people out of it. I'm bound to land my spot in path then.

    Genius!!!!

    Yeah path really sucks huh. Probably one of the better lifestyles. Decent money, I'm mean I guess not if you want to get rich, but if you want to get rich maybe you should be considering something other than medicine anyhow.

    Yeah, Path Sucks. No one go into path............
     
  23. DarksideAllstar

    DarksideAllstar you can pay me in bud
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    I am in Vegas now (left San Francisco about a month ago). Haven't been to Treasures in a couple of years. Most recently was at Scores in October (they had recently opened at that time). I have been to my share of clubs and that was far and away the classiest one, and had the most per capita hot women. I'm talking like their worst looking girl would be headlining at another decent club (ie Cheetahs or OG) in Vegas .

    Anyway, your german-asian woman might look like the one in the middle, but with less prominent sclerae.
    LADoc's Dreamwoman

    PS- Where's my fat ends biatch?
     
  24. DarksideAllstar

    DarksideAllstar you can pay me in bud
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    I heard that pathologists pack huge cocks. Is there any truth to that? How does it impact the job search? I mean, I heard about this guy who was like 13" and only got ONE OFFER and it was in Kansas as the state prison cornholer? Anyone have any insight?
     
  25. yaah

    yaah Boring
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    Personally, I think there are too many residency programs training too many residents. I know I am not alone in this view. There are too many subpar programs who really have no business training residents. I really don't know what all these people do after they finish training every year - as I have said, I haven't personally heard of any residents having trouble finding jobs in or close to the area the want, in the subspecialty they want (if applicable), and with adequate compensation.

    Someone tried to ask this question to Dr Silva at USCAP last year, but I think his response was that there were plenty of jobs, and the number was increasing (and when asked specifically about assembly line/path mill type jobs, he said those were likely to remain a small minority of jobs). So I can't figure out what the real truth is at all.

    My conclusions, as I have posted before: There are lots of jobs out there, and qualified applicants shouldn't have much trouble finding a good one. Less qualified applicants may have more trouble, and as I say, when one person bitches, it sounds like more. The people who are satisfied often don't say anything, shut up, and go about their business. Does anyone really hear about people not finding good jobs, or is it all just hearsay? (I heard from a friend who knows this pathologist who was working with this guy who had to work at burger king because he couldn't find a job!) And are the people complaining really in trouble? And WHY can't they find a job? 5-10 years ago, path wasn't very competitive, and lots of marginal candidates got in. So now these people are in the job market. Is it really realistic to compare yourself to someone who is a marginal candidate? There are lots of reasons why someone can't find a job - some people have a drug problem, some people have personal issues, some refuse to move, some have preconceived false notions about reality.

    Now, if you're CP only and you don't do research or have grants, you're ****ed unless you get lucky or are willing to move anywhere you can find a job.
     
  26. rirriri

    rirriri easy
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    really well said, Yaah. I am not sure about the "too many residents" position, as I just started and have yet to see how the number of current residents impacts the field.

    i have never heard any complaints about the (CURRENT) job market in Pathology. Like you said, when someone falls into a trap of not finding a job---it is completely unknown what the reasons are. For all we know, it could be any number of things involved (personal, location, lack of sufficient preparation during residency). Most people who finish their residency these days subspecialize with a fellowship, this wasn't necessarily the case 10 years ago....the market is more specific now, with different needs and different changes taking place as compared to before.

    the bottom line, in my opinion, is that IF one is dedicated to the field of Pathology and has taken sufficient care to learn his/her material and progress through residency; then there should be no problem in finding a suitable and satisfying job. There should always be flexibility in mind as well....as should be for ANY job.

    Of course people shouldn't expect to find opportunities as abundant as say...IM or FP or even Surgery....but Pathology is already a 'smaller' field with less residents and less staff as compared to those fields, so the job market will be relative to those numbers. Perspective is the most important knowledge in the evaluation of THIS job market as compared to other physicians.

    All of the information i've heard is consistent and persistent. There are a HUGE number of physicians retiring in the next 5 years or so, and Pathology is no different.....It remains to be seen if those positions become renewed OR if they become removed/altered; however all signs point to a healthy demand for pathologists in the medical system.
     
  27. pathdawg

    pathdawg Senior Member
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    That quote can be dated 2006, or 1996, or 1986.
     
  28. LADoc00

    LADoc00 There is no substitute for victory.
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    Yep, they had been talking about a huge wave of retirement for pathology as far back as 1993-5 that was to begin in the late 90s...NEVER materialized. trust me, that is all B.S.
     
  29. yaah

    yaah Boring
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    Anecdotal experience from around this area says it is actually happening here though. People are starting to phase out. Although that brings up another point - when pathologists phase out, what do they do? To some, that means being full time anyway.
     
  30. LADoc00

    LADoc00 There is no substitute for victory.
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    Exactly, pathologists are practicing into their late 70s, it is absurd and frankly dangerous, I would LOVE to put forward legislation to mandate physician retirement at 70, after that they can do a bit of locums or admin work but not work FT.
     
  31. yaah

    yaah Boring
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    If I am still working at 70, it is either because

    1) I am senile, but people can't tell, or they are afraid to tell me.
    2) I had too many kids and am broke.
    3) I forgot to save any money.

    2 & 3 are unlikely. I don't know why people can't just give up and quit. I'll be damned if I work any longer than I have to, even if I do love what I do.
     
  32. pathdawg

    pathdawg Senior Member
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    If I am still working at 70, you all hereby have permission to euthanize me.
     
  33. dermpathlover

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    Another thing that the old-timers ruin for us is that when they are finally ready to get out, the'll sell their practice to US Labs/Ameripath. So after years of making great money they get a nice windfall of 1.5 million or so as they are going out the door to help pay for that waterfront home in Laguna Beach or Hawaii or that condo in Aspen or for their kids medical school tuition or for their hot second wife.

    It is hard to blame them, but once US Labs owns a group everyone in that group becomes a US lab employee, their work load goes up, they start making less, and that little nook of private practice pathology is ruined.
     
  34. LADoc00

    LADoc00 There is no substitute for victory.
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    Not any more really. Private pathology practices have been so devalued, that aside from property a rare prac might own and depreciating assets, what are you buying? Sort of brings up what a biz IS. Most of the value of a biz is the PEOPLE, in this case the pathologists, what is the point for an Ameripath to buy group X, when superstar young doc Andy can merely go to the admin and get the contract which expires in a mere 2 years. If they dont have the contract, Ameripath just bought a big piece of crap, some aging equipment and the legal responsibility to save specimens for 10 years as well as the liability...they have really lost their corporate shirts on many such deals which is why you dont see Ameripath, Dianon and the like coming west. Meanwhile Quest has really changed its strategy, it is now contracting with path groups rather than buying them outright.

    A great example, lets say you were in a small group of 2-3 people, community hospital practice. And as the young guy you are facing having to buy out the two geezers you work with. Now, they want "goodwill", say 100 grand. In turn, you get...what? Their aging equipment? Assume that their technical staff is all hospital employees and your group is only billing for professional components. Now you can pay that if you are a nice guy...but you could also merely go to the hospital as your own LLC and bid on the contract. You essentially just picked up a "pathology practice" for free (well minus the time you invested making the hospital connections).

    That is called "contract raiding" and is the way to go. Its a form of biz guerilla warfare that is becoming more and more prevalent AND large groups like Ameripath are powerless to prevent.
     
  35. 1Path

    1Path Membership Revoked
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    :laugh:
     
  36. juddson

    juddson 3K Member
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    I'm afraid I don't understand this. Ameripath has huge economies of scale, which is precisely why they are in the business in the first place. How can a small group compete with them in price, particularly if it is a "start-up" group that must invest in equipment?

    Judd
     
  37. LADoc00

    LADoc00 There is no substitute for victory.
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    You are a tad confused here: THERE IS NO ECONOMY OF SCALE for pathology. Typically hospitals grab the TC portion, pay the histotechs, secretaries and lab assts and you bill for the PC. Whether it is you with your trusty Olympus microscope or the Exxon Corporation, doesnt matter. There is no start up or investment, the hospital already has everything, the business IS the pathologist. That is point, Ameripath is a business built on illusionary crap, the second the pathologists decide to take the contracts for themselves, they are over. Over. Commericial AP stuff is by and large a total illusionary house of cards biz model. Sh!t, Ken Lay would be proud.
     
  38. juddson

    juddson 3K Member
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    If there's no economy of scale, then you are hard pressed to explain why the business model works. "houses of cards" don't have long term viability. This makes no sense. What "illusory" advantage do the large labs offer the groups who send them cases if not lower prices?
    Judd
     
  39. LADoc00

    LADoc00 There is no substitute for victory.
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    Good question!! There is no discoount whatsoever with large labs like Quest, in fact for a simple pap smear, they charge almost DOUBLE what my lab does. Their overhead is insane, think about it, the CEO of Quest Diagnostics made 60 million last year!! Hahahaha...Sounds like they got the consumer in mind doesnt it? This is like the anti-Walmart biz model: move into an area, set up shop and charge twice what the local docs are charging. So why does it suceed? Because by and large, clinicians dont really care about cost to the patient, which is often covered by insurance contracts anyway. These dimwitted fools respond to marketing....see a company like Ameripath is pure marketing, it has no substance.
     
  40. juddson

    juddson 3K Member
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    Oh come on. I know you aren't suggesting that some of the private groups (includinng yours) leaves money on the table. Your group (and Ameripath, etc.,) would be moronic to not try and collect on the highest contract rate possible (and, of course, would negotiate the highest contract rates possible). Ameripath is no different. You are right that docs aren't price sensitive (and god knows, neither are patients), but payors ARE - and no large groups is going to be able to get away with uncompetitive rates in the marketplace. Now, unless you are able to convince me that Ameripath can negotiate better rates with payors than the privates can, I'm guessing there is no differential in collections (case for case) between your group and the big dogs. Tell me I'm wrong.

    Judd
     
  41. LADoc00

    LADoc00 There is no substitute for victory.
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    No sh!t payors are sensitive. Certaintly Quest may give some HUGE whale contracts discounts, while keeping their costs on things like pap smear vials/filters low due to volume BUT there really is no free market in medicine. There is no menu at the Gyn office that says: pap smears...market price
    today's market:
    Quest $110.00
    UCSF $65.00
    Average Joe's $60.00

    See regardless of what rate your group and Ameripath might negotiate with payors, WHERE the specimens end up is completely dependant on the Gyns or the dermies or the GIs. Private pay patients dont even have the OPTION to see what the difference in price might be...
    for example I recently had a lab tech go to a private dermatologist who sends his specimens to a buddy. First they stop at a histo lab and generate a bill, the TC, which for this patient was $140, then off to the dermy who read it, another separate $200 charge, for a whopping $340 per case. Now a global bill from Average Joe's is only $145 for everything! The patient wasnt even aware there was such a difference until I told him.
     
  42. mrjames

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    :smuggrin:
     
  43. Rippey

    Rippey Senior Member
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    why did you resurrect a four-and-a-half year old thread

    idiot
     
  44. 2121115

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    Again, low-post-count disease.
     
  45. mrjames

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    Hi, you idiot, it is still the same,

     
  46. KeratinPearls

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    Apparently, you didn't enjoy Pathology enough to even want to enter the field to begin with and now you're complaining about the job market? I'm not saying the job market is great but dude, do you even like Pathology?
     
  47. purplecolor

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    My opinion is that the US Pathology Job Market is terrible; and there are a few nationwide surveys that support my opinion. One is an ASCP Resident Survey from 1996 available on the Internet at:

    http://ascp.ais.net/member/rps/surveys/surwi96.asp

    An important quote from that article: "Almost half (49%) had received no job offer, 30% one offer, 13% two offers, and 4% three offers."

    Another article about residents from all medical specialties was published in JAMA (JAMA, 275(9):708-12 1996 Mar 6). To quote from this article: "Of those seeking employment, the percentage who did not find a full-time position in their specialty or subspecialty ranged between none in urology to 10.8% in pathology."

    These articles suggest that pathologists graduating from training in the US stand a 10.8% chance of being unemployed and a 49% chance of being underemployed and going from Fellowship to Fellowship while searching for an attending level position.

    The experience of the people who graduated from Residency at about the same time I did seems to confirm that the job market is terrible.

    Does anyone know of any additional information available on the Pathology job market?

    Subject: Pathology Job Market
    In my opinion pathologists will be in surplus relative to the job supply for at least the next 10 years. Anyone who begins training in Pathology now stands maybe a 50% chance of never finding work in their chosen field.

    I agree you that there may be more work in Anatomic Pathology as the US population increases and ages. However, that will not be enough to offset the losses of jobs that are occuring as a result of laboratory and hospital mergers and acquisitions of practice groups, and reassignment of workload to non-MD technical and administrative staff.

    Here are some estimates I have of the numbers involved:

    Let's say that the US population is about 270,000,000 (latest census estimate). If there are roughly 6,000 surgical specimens per 100,000 population per year then there are 16,200,000 surgical specimens examined in the US per year. A Pathologist working full-time doing only Surgical Pathology would average about 4,000 specimans/yr. Therefore the entire Surgical Pathology load of the US could be done by 4050 pathologists.

    I'm going to guess that the US Cytopathology load could be done by 2,000 pathologists, Autopsy by 1,000 and Clinical Pathology by 1,000.

    There is a need for a minimum of 8,050 pathologists (an educated guess). HOWEVER THERE ARE CURRENTLY ABOUT 14,000 PATHOLOGISTS IN THE USA, AN OVERSUPPLY OF 73%. If every Pathology training program were shut down today this oversupply would last at least 10 years
     
  48. KeratinPearls

    10+ Year Member

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    Purplecolor is your second screename, mrjames? LOL. Someone ban this troll already.

     
    #47 KeratinPearls, Feb 5, 2011
    Last edited: Feb 5, 2011
  49. JPR22

    JPR22 New Member
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    As much as I hate to feed a troll, I do like the use of objective evidence, such as population, workload and biopsy rate to determine the need for pathologists.
    The ASCP survey for hemepath fellows suggested that there is overtraining, at least for hemepath.
     
  50. Circumflex

    Circumflex Junior Member
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    You posted 2 years ago that you liked IM and picked pathology for the lifestyle. It's never too late to do something different. If you are this unhappy, then move on.
     
  51. LADoc00

    LADoc00 There is no substitute for victory.
    10+ Year Member

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    Why are we doing threadnecromancy to revive post where I claim to know something about strip clubs...suspicious...

    Im not running for office, no need to publically embarass LADOC:) (that I do well on my own)
     

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