What can be done to decrease the disparity between academic pay and private?

[pathstudent]

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[Path or bust]

I know that there are people that work in academics that make more than 99% of all pathologists and that there are people in private practice that don't make that much, but I think it is safe to assume that on average people in private practice make more.

This is unfortunate as it will force some very talented people to choose private over academics. If you are living in the Bay Area or Boston or NY and are the "breadwinner" for your family with kids, then I think it is understandably difficult to choose to work for 180K versus 300K unless of course you are able to find the non-monetary rewards of being in academics of greater value. But let's face it, some people have to sacrifice.

The federal government should step in and slash physician pay via medicare cuts. People shouldn't getting rich off the public dole anyway. Alternately the government could give huge tax breaks to academic physicians and tax private ones at a higher rate to equal things out.

Less satisfying would be to have academics spend more time signing cases out to make more money but that would not be good as it would reduce time for research and teaching.

Thoughts on how to equalize academic and private pay?

Well I don't really think that slashing pay is an effective solution to anything. In academics, attendings technically are on service only about 6-7months out of the year and have at least one month vacation, this is quite cushy.

 

[yaah]

People in academia get paid less because of the perks of academia (which may be less than they used to be, however). Oftentimes you have better insurance, better malpractice, better support for travel, more time for your research interests, etc.

That being said, many academics make more than private physicians. Generally they are quite reknowned and have outside sources of income, however, or lucrative consult practices.

 

[rockit]

Well I don't really think that slashing pay is an effective solution to anything. In academics, attendings technically are on service only about 6-7months out of the year and have at least one month vacation, this is quite cushy.

This is a stupid idea and a stupid concept. Academic jobs have benefits beyond salary as was pointed out above. Private doctors, no matter what the field, work their asses off to make their money. Medicare already doesn't pay enough to fund a practice, so lets cut reimbursement more. I can't emphasize enough how terrible an idea this is. Remove all incentive for working harder...

 

[Nilf]

I know that there are people that work in academics that make more than 99% of all pathologists and that there are people in private practice that don't make that much, but I think it is safe to assume that on average people in private practice make more.

This is unfortunate as it will force some very talented people to choose private over academics. If you are living in the Bay Area or Boston or NY and are the "breadwinner" for your family with kids, then I think it is understandably difficult to choose to work for 180K versus 300K unless of course you are able to find the non-monetary rewards of being in academics of greater value. But let's face it, some people have to sacrifice.

The federal government should step in and slash physician pay via medicare cuts. People shouldn't getting rich off the public dole anyway. Alternately the government could give huge tax breaks to academic physicians and tax private ones at a higher rate to equal things out.

Less satisfying would be to have academics spend more time signing cases out to make more money but that would not be good as it would reduce time for research and teaching.

Thoughts on how to equalize academic and private pay?

Are you nuts?

 

[2121115]

Well, there are several factors affecting academic pay and also some academic centers are different than others in terms of how much they pay and where that money comes from.

One factor is that TC billing in academics goes right to the department and the physician sees none of it. This is a major source of revenue to the department and they use it for all sorts of purposes. That is one reason the pay is lower in academics. Another reason is that they sign out fewer cases than private pathologists because they have time off service for projects, travel and meetings, as well as teaching in some cases. Although, these days with the advent of "clinical track" faculty they are signing out cases almost 100% of the time and still getting paid less, which is basically a money making system for the department (or a scam, however you want to look at it). A third reason is that there are pathologists who can't wait to sign up for these "clinical track" positions so there is no incentive for the department to change. (I've heard countless times "sure you get paid less, but it gives you the opportunity to teach" and I'm like "what? you should get paid to teach" but whatever, to each his own). 🙂

Edit: Also, academic anatomic pathologists get no share of CP revenue for covering lab admin duties like some in private practice do.

 

[pathstudent]

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[2121115]

... once Obama learns that some docs make 500-600K or more a year (in path and other specialties), that won't be tolerated, kind of like the outrage from the AIG bonuses. People won't tolerate other people living high on the hog off the taxpayers money.

No doubt Obama already knows this. Its not like it is some secret. Hell, the Obamas made over 2 million last year and paid 800k in taxes. Its not just some docs that make money. Successful lawyers from top law school who are partners at big firms make more than that. Also successful small business owners. The banking sector folks were making millions each year. In fact, now that they've been "humbled" they are making like 1 million a year. 500k is chump change to these guys.

 

[pathstudent]

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[xanthines]

Not sure I agree with that sentiment.

-X

I know what you are saying. But you are comparing apples to oranges. Enterainment and cooperate lawyers are not paid out of public funds. Medicine is generally considered an unalienable right which is heavily funded by the government. If medicine get nationalized, docs making 400K would be equivalent to gov't attorneys and judges to makign 400K. That won't be accepted especially while most of the people in the country are hurting in these economic times. But this is a separate topic. I just believe that private practice pay and academic pay will come closer together after healthcare reform is enacte.d

 

[dl2dp2]

i'm planning on going into academics, and live in one of the three most expensive cities you just mentioned.

i find it very strange that you think it's not livable with 180k in these three cities, and instead need at least 300k. Do you know how many people make more than 300k in a city like New York, which has 8 millions people? Do you know how many people live on the upper east side, the most expensive zipcode in the US, makes more than 300k? NOT 100%. Not even close to 50%. It's very clear to me that people who get paid much less live and thrive there with children.

if your wife/husband works, then there'll be more than 180k. if she/he doesn't, then hopefully will be able to take care of the children. a reasonably sized apartment is certainly expensive in some neighborhoods, but i'd say 180k a year is MORE than MOST of the family's income in MOST of the neighborhoods. And you would be able to afford private school, even, with 180k.

The difference between academics and PP isn't one of "living comfortably". It's one of luxury vs. comfort.

 

[asmallchild]

Are you nuts?

 

[pathstudent]

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[Entgegen]

Not sure I agree with that sentiment.

-X

I'm not so sure I agree either, but that doesn't mean that the sentiment isn't widely felt, particularly by politicians and those who can't afford health care.

 

[rockit]

You seem to be assuming that academics is the superior career choice. Lots of people don't want an academic job for financial or personal reasons. I also take a ton of umbrage to your idea that privates should be paid less. No physician in this country deserves a pay cut.

Also, the academic pay disparity may be explained by this quote from an attending on an interview; "It's a pretty easy-going place, most of us try to leave by 4:30." Academic pathologists who generate more income get paid more money.

 

[Gyric]

If a big name academic program, which typically has deep pockets, wants you on the faculty, they can make their offer VERY hard to refuse, even in expensive cities. They want to recruit the best people just like any good private practice and there is more to a recruitment package than just salary. If you are AP/CP/Fellowship trained they know you have other options. That being said, the efficiency of a well-run private practice is hard to beat (which overall helps the bottom line of our medical system) and their profit should reflect that success imo.

 

[malchik]

Academic pathologists who generate more income get paid more money.

Not entirely. There may be a loose correlation, but academics are not paid based on the amount they bill.

 

[Dr. McDreamy]

I volunteer pathstudent to work pro bono for the rest of his or her career. That's after spending all of his/her 20s/early 30s slaving away in med school and then residency. Then pathstudent can get the satisfaction of not making money off the government's dole. You can do pathology for free and work as a professional basketball player, corporate lawyer, or movie star on the side to get that guilt free money. mmmmmmkay??

I know I'll sleep better at night.....🙄

 

[Thrombus]

The federal government should step in and slash physician pay via medicare cuts. People shouldn't getting rich off the public dole anyway. Alternately the government could give huge tax breaks to academic physicians and tax private ones at a higher rate to equal things out.

No wonder we are where we are. This guy could be straight out of Karl Marx or Vlad Lenin's school of thought.

Why the heck would anyone try to pursue medicine as a career with this plan? What is wrong with success? What is wrong with making money and going out to eat so waitstaff can make a living. What is wrong with having money so car dealerships can make money. What is wrong with having money so resorts in this country can make money? Etc. Etc.

You people won't stop until everyone in this country is poor and on their knees begging the left wing administration for another handout. That seems to be utopia for nearly half the country these days.

Then no one will work. No one will acheive and we can all get to the back of the breadline.

 

[pathstudent]

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[LADoc00]

I know that there are people that work in academics that make more than 99% of all pathologists and that there are people in private practice that don't make that much, but I think it is safe to assume that on average people in private practice make more.

This is unfortunate as it will force some very talented people to choose private over academics. If you are living in the Bay Area or Boston or NY and are the "breadwinner" for your family with kids, then I think it is understandably difficult to choose to work for 180K versus 300K unless of course you are able to find the non-monetary rewards of being in academics of greater value. But let's face it, some people have to sacrifice.

The federal government should step in and slash physician pay via medicare cuts. People shouldn't getting rich off the public dole anyway. Alternately the government could give huge tax breaks to academic physicians and tax private ones at a higher rate to equal things out.

Less satisfying would be to have academics spend more time signing cases out to make more money but that would not be good as it would reduce time for research and teaching.

Thoughts on how to equalize academic and private pay?

Its fascinating to read this as it perfectly illustrates the cluelessness of lay people in modern medicine.

The foundation assumptions of the above are so completely out of whack with reality I dont know where to begin so I will start at the first paragraph:
1.) No, it is NOT safe to say academic pathologists make less than private practice. Those that spend a vast majority of their s/o'ing subspec areas can make quite a pretty coin. A rare academic can even make a fortune pirates of old can envy.
Fact: the highest paid employee of the great state of California is a Pathologist, income over 2 million per year when royalities are considered. Fat off the government dole you say?? It is occurring but in academics NOT in private practice. There is no asset risk, there is no worry about making payroll and there is no stress about market competition when you are safely pulling down 2 million bucks a year at UCSF. There is when you are in the private sector.

2.) It is NOT unfortunate talented people choose private prac over academics. Im baffled why you think community hospitals should automatically have less skilled physicians than academic centers. This assumption is both incredibly ignorant and insulting.
In addition, your statement assumes some additional magical/intellectual value to being an academic when for the most part there is NONE. Many academics simply sign out meat, some are good teachers and we have MORE than enough good teachers already. In fact we have more good teachers of pathology than pathologists the workforce needs trained! LESS people should be going into academics, not more.

3.) Moving on to the next paragraph, the absolute height of idiocy. First off, if you plan is to slash medicare how the hell would that increase the number of academics, their pay would suffer MORE than those in private prac! At this point, I honestly think you are a troll....
The biggest issue in slashing medicare is not decreasing physician payments, which if you had ANY clue account for a MINORITY of total medicare expenditures but in doing so you force more physicians to drop medicare coverage...once enough physicians drop it in a community, these elderly patients get charged full tilt and medicare is WORTHLESS (and this has already happened in some places and is getting worse).

Basically, insurance is only as good as the number of providers who accept it.
Decrease payments from medicare--->providers opt out and full charge patients--->patients look for covered providers in their area but there are none--->patients cant move because of housing crisis--->patients either go broke paying out of pocket or die--->Patients suffer, numbnuts, not providers when you cut medicare

In conclusion, never start a thread again here. You are a serious waste of space.

 

[docbiohazard]

Academics in this day and age seems like the best fit for DINKS, single people, etc....

I know a lot of academic pathologists who find the flexibilities and lifestyle of academics to be more conducive to a happy family life...

 

[rockit]

Not entirely. There may be a loose correlation, but academics are not paid based on the amount they bill.

I meant this in a more general sense. Academics who truly are top of the top generate huge amounts of money thru consults and make an amount of money that reflects that.

As for academics being better and smarter than private docs, this is just laughable. There are TONS of private docs in every field who practice privately because they're really really good and make more money that way. Academic departments have more than their fair share of filler docs.

 

[Psychopathology]

A little while ago, my close relative in Small City, USA needed surgery and checked into Small City Hospital, where surgery was performed by a superstar surgeon who trained at one of the best programs in Boston. The surgery went well and my relative was satisfied with the care she received. I hope that surgeon is paid well. He is an asset to his community and I would not wish to see his salary "slashed" because he decided to leave the ivory tower behind to take care of my family, friends, and neighbors.

I respect everyone's opinion, but I strongly disagree with those of you who feel that some physicians deserve less than they're earning. It's not easy to get rich in medicine 🙂 One's income potential does not correlate with the calibre or duration of their medical training. People get rich in every business, but most salaried employees do not. Same thing in medicine. We make out well, but not so well that I feel guilty or undeserving. There are other players in the healthcare industry that make out much, much better than the salaried doctor.

It's one thing to say that academics deserve higher salaries, but you're not going ot garner favoritism (or even much of a discussion) by implying that individuals in private practice deserve less.

 

[mcfaddens]

I know that there are people that work in academics that make more than 99% of all pathologists and that there are people in private practice that don't make that much, but I think it is safe to assume that on average people in private practice make more.

This is unfortunate as it will force some very talented people to choose private over academics. If you are living in the Bay Area or Boston or NY and are the "breadwinner" for your family with kids, then I think it is understandably difficult to choose to work for 180K versus 300K unless of course you are able to find the non-monetary rewards of being in academics of greater value. But let's face it, some people have to sacrifice.

The federal government should step in and slash physician pay via medicare cuts. People shouldn't getting rich off the public dole anyway. Alternately the government could give huge tax breaks to academic physicians and tax private ones at a higher rate to equal things out.

Less satisfying would be to have academics spend more time signing cases out to make more money but that would not be good as it would reduce time for research and teaching.

Thoughts on how to equalize academic and private pay?

this thread is a waste of time and brain power, Im Smelling TROLL big time

 

[pathstudent]

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[HolyCowpers]

1. Academics and privates both get paid exactly what they're worth, thanks to market forces.
2. Whom do you want covering frozens and left-field clinical consultations for a large private hospital on a weekend? The subspecialist who has spent years cultivating expertise in one organ? Or the private practicioner who works diligently to maintain skills in all areas and boldly incurs the implied risk?
3. The academic who reclines in the luxury and protection of academia has just that for his compensation. How common are the cases where the "talented" eyes of the uber-specialist is needed? Not very. And how much sympathy is generated by your derision of the un-talented private pathologist? Not much.

 

[Ale]

But I do think that some talented people might choose private practice over academics based on remunerative reasons. I do think academics does and deserves to have the superior physicians. If anyone doubts this, I ask you "who sends who the consults". Where patients are really sick, where do they go for a "higher level of care"? Lastly, I believe the pay difference between academics and private will narrow as medicine under goes reform. There will obviously be a lot more government funding and the taxpayers/congress will not tolerate making 500,000 let alone 2,000,000 off taxpayer money.

Talented people choosing private over academics is the whole point. Getting better trained physicians all around the country so you don't have to move or pay $200 a night in hotels fees to get the treatment you deserve.
<O😛
Pay less to people that do more, hhmm. Why should you get paid the same amount of money to s/o 10,000 cases a year than a super pathologist in a top academic institution that only sees 500 cases? Are you going to see a case for an average of $18. My haircut costs more than that.

<O😛And by the way, the taxpayers aren't paying diddly squat for anything. Medicare and Medicaid is charity for laboratories (and for most physicians). You get reimbursed less than what the tests actually cost.

Regarding your comment about the consults, no one cares who signs the case as long as it has a "brand name" sticking in the report. If famous Joe leaves to private practice, you are not going to send him the consults anymore. The consult is about what will make the regular Joe more comfortable with the dx. The "brand name” does that.
<O😛
Finally, instead of making fun of a pathologist that misses a diagnosis, you should be learning of that mistake. Why did a guy with 5-15 yrs of experience that has seen 100 of "that" missed the case? That should be the question. Remember, it will be you in a couple of years. EVERYONE MAKES MISTAKES.<O😛

 

[pathstudent]

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[mcfaddens]

Regarding #2 I don't think have a frozen section done at UCSF or BWH on a weekend will be any less hazardous to the patient than if done at a community hospital. While an expert in GI may not be as good at GYN pathology as a community pathologist, he or she doesn't need to make a diagnosis and just needs to determine reactive vs. neoplastic, benign vs. malignant.

Regarding #3 It is not just me. Academic pathologists and clinicians don't accept any diagnosis made "in the community" until it is reviewed by an academic pathologist. Do community pathologists question and go against a DX made by David Page, Robin Young, Peter Burger, Odze, etc.... I seriously doubt it.

Dear Pathstudent,

Although for the record you are a f***ing ( i suprise myself sometimes with restraint) idiot and have no idea, you have already won in getting a response out of me, dude my hat is off to you. the path forum in sdn officially sucks now thanks to your blind efforts. Your posting of miles long of copied internet articles and a rigid pure lack of insight has astonished me. In the fantasy world you reside in my opinion makes you a great fit for something like politics or prostitution (unless you are horrid to look at, you may have a shot in the field). Five years ago when I stumbled on this site I thought it was great, lots of great info, funny hijinks, and good debate. Even the good old "Dermpathlover" couldnt stop the great info on this site, but in my opinion you have, thats awesome. I would like to meet you some day and shake your hand, (hopefully its not when im passing you change from my car for washing my windows at a stop light)

 

[pathstudent]

Dear Pathstudent,

Although for the record you are a f***ing ( i suprise myself sometimes with restraint) idiot and have no idea, you have already won in getting a response out of me, dude my hat is off to you. the path forum in sdn officially sucks now thanks to your blind efforts. Your posting of miles long of copied internet articles and a rigid pure lack of insight has astonished me. In the fantasy world you reside in my opinion makes you a great fit for something like politics or prostitution (unless you are horrid to look at, you may have a shot in the field). Five years ago when I stumbled on this site I thought it was great, lots of great info, funny hijinks, and good debate. Even the good old "Dermpathlover" couldnt stop the great info on this site, but in my opinion you have, thats awesome. I would like to meet you some day and shake your hand, (hopefully its not when im passing you change from my car for washing my windows at a stop light)

I don't see how these posts "stop information" and the internet articles I think are interesting, but I will quit posting them.

 

[yaah]

Whatever our opinions, let us please keep our comments and disagreements civil. As easy as it is to be rude on anonymous forums, it doesn't really add much to an argument.

 

[KluverB]

... In the fantasy world you reside in my opinion makes you a great fit for something like politics or prostitution...

Actually, I think it makes him a perfect fit for some of the academic circles out there. He may actually thrive there.

 

[BierstiefelAndy]

First of all, I find this thread laughable and almost offensive. I agree with these points below, especially the first point.

Patients deserve the best care they can get regardless of where they are and patients in need of this care far outnumber the number of pathologists who quibble about money matters.

And the whole notion that academic physicians are somehow better than and should look down on private practice physicians is simply absurd. Admittedly, I used to think that way. I quickly realized how ignorant that was. Now, after several years in this business, I know plenty of smart folks who go into private practice over academics. Conclusion: there are plenty of talented people in both the private and academic sectors.

I hear some academicians say, "He's really smart. I wish he would have stayed in academics because he would have really contributed to the field." I can only imagine the vast knowledge that the private practice pathologists possess that never get shared via publications. Quite humbling and scary.

Then, I always wonder if the flip side is true...if people in private practice say, "Gosh, that academic is a really awesome guy who publishes a lot. He's authored 4000 papers. I gotta get him to join my practice." Maybe this happens but I haven't observed this yet in my lifetime.

As for consults, many consults are a direct consequence of the litigious culture of medicine...simply a cover your arse tactic so that lawyers can't sue you and allege that you were a negligent pathologist..."but your honor, I sent this case to this really famous guy who wrote this textbook and he agreed 🙂"


And I can't agree more with your last statement. Everybody makes mistakes. One established attending once told me, "You spend all this time establishing your career and expertise. Eventually, you gain more respect as time goes along. And then you f*** up and then people stop believing what you say anymore because you're remembered much more for the mistakes you made than the diagnoses you got right."

Talented people choosing private over academics is the whole point. Getting better trained physicians all around the country so you don't have to move or pay $200 a night in hotels fees to get the treatment you deserve.
<o>😛</o>
Pay less to people that do more, hhmm. Why should you get paid the same amount of money to s/o 10,000 cases a year than a super pathologist in a top academic institution that only sees 500 cases? Are you going to see a case for an average of $18. My haircut costs more than that.

<o>😛</o>And by the way, the taxpayers aren't paying diddly squat for anything. Medicare and Medicaid is charity for laboratories (and for most physicians). You get reimbursed less than what the tests actually cost.

Regarding your comment about the consults, no one cares who signs the case as long as it has a "brand name" sticking in the report. If famous Joe leaves to private practice, you are not going to send him the consults anymore. The consult is about what will make the regular Joe more comfortable with the dx. The "brand name" does that.
<o>😛</o>
Finally, instead of making fun of a pathologist that misses a diagnosis, you should be learning of that mistake. Why did a guy with 5-15 yrs of experience that has seen 100 of "that" missed the case? That should be the question. Remember, it will be you in a couple of years. EVERYONE MAKES MISTAKES.<o>😛</o>

 

[yaah]

Then, I always wonder if the flip side is true...if people in private practice say, "Gosh, that academic is a really awesome guy who publishes a lot. He's authored 4000 papers. I gotta get him to join my practice." Maybe this happens but I haven't observed this yet in my lifetime.

I have talked to a few academic attendings who routinely get contacted by private groups (or large reference labs) asking about their interest in leaving academia. Some actually do leave academia but continue to publish/take consults/etc.

 

[LADoc00]

I have talked to a few academic attendings who routinely get contacted by private groups (or large reference labs) asking about their interest in leaving academia. Some actually do leave academia but continue to publish/take consults/etc.

Its rare and limited to specific subspec areas..namely dermpath (as expected).

The issue is even large private groups require true generalist skill sets that academia, generally speaking, lacks. In addition, there can be a culture clash when academics enter the private sector and realize 25%+ of their time is spent dealing with HR issues, budgeting, marketing and host of other activities that are likely totally foriegn to them.

A more interesting issue might be the entire Academic-Private subculture of Path in general, the back and forths, the consult culture etc that doesnt exist in Radiology. Frankly, if all academic centers never saw consults in path again starting tommorrow and closed, my research/experience shows only minimal if any impact on actual patient outcomes. I actually spent time trying to find a case over the last 10 years in my file that would have had an OUTCOME difference due to a consult from academia and couldnt find a single one. Yes they catch things, change the names from DCIS to ADH, but the outcomes are seemingly unchanged. Makes me wonder in the age of decreasing health care costs, Pathology academic consultations may actually go away (save for specific things like Renal path, immunoderm etc). Im now thinking yes and I never ever imagined that before.

 

[2121115]

I know a lot of academic pathologists who find the flexibilities and lifestyle of academics to be more conducive to a happy family life...

Really? Many of the attendings at my program work a lot, sign out a lot of cases, and get paid less than they would for doing the same work in private practice, all for the added bonus of getting to say they are an instructor/assistant professor at our medical center (brand name institution prestige, etc). It is a big screw job and I would never do it in a million years. Sure after they sucker a few residents into writing some papers for them, they get a few pubs under their belt and they get some time off service to do more... but at the beginning it seems like they get dumped on. I see virtually no way that working in a private practice or a corporate lab would provide a worse lifestyle. At least in those situations you are getting paid better.

[/quote] With respect to academics. It seems that universities have no trouble filling positions so the salary seems to be sufficient to induce people to work in academia. [/quote]

I agree they have no trouble filling positions, but its not because of the salary.

 

[pathstudent]

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[Pathwrath]

A more interesting issue might be the entire Academic-Private subculture of Path in general, the back and forths, the consult culture etc that doesnt exist in Radiology. Frankly, if all academic centers never saw consults in path again starting tommorrow and closed, my research/experience shows only minimal if any impact on actual patient outcomes

You'd never know it during residency, but after five, ten years in a busy practice, the academic consults are largely reduced to CYA BS or trivial pursuit. Patient impact is negligible. If I were forced to justify my consults on the basis of patient care decisions, they would disappear.

 

[LADoc00]

You'd never know it during residency, but after five, ten years in a busy practice, the academic consults are largely reduced to CYA BS or trivial pursuit. Patient impact is negligible. If I were forced to justify my consults on the basis of patient care decisions, they would disappear.

Yep..Consults will be the first thing to go when Obamanomic Healthcare Cost cuts come to town. Mark my words, the time will come when people look back at Pathology 2nd opinion consults as a vestige of a past time. To keep the CYA aspect up, expect to see community pathology groups creep toward more and more hedge Dx's.

Crazy because I seriously never imagined this would happen as late as 2005.

Those who have practices built on consults will have to find a new source of income, ouch.

 

[yaah]

That's interesting, because I always assumed consults would become more and more common as lawyers took over medicine. But that's an interesting way to look at it - hedge, and let the lawyers or clinicians order the second opinion consult on their own dime.

 

[LADoc00]

That's interesting, because I always assumed consults would become more and more common as lawyers took over medicine. But that's an interesting way to look at it - hedge, and let the lawyers or clinicians order the second opinion consult on their own dime.

A smart academic pathologist would directly market his/her second opinion to patients, but as of yet no one has done this on any sort of large scale. I did a small market analysis of this just for Southern California about 6-7 years ago and was told it was not pratical (although the year after some USC people went on to do exactly this).

But, to address your other point, clinicians if they had to pay for it themselves would NEVER order a 2nd opinion. Clearly IF payments to providers do get bundled, as Obama is planning, then consults will die off very very quickly. I predict a general die off in academic pathology beginning in 4-5 years due to this.

Im starting to outline what I think Pathology will be like in 5-10 years, inpatient vs. outpatient, academic vs. public vs. private vs. corporate and frankly it is not looking good. I do predict one aspect to prosper: non-hospital based biopsy groups, people like DP, Prostate Bx businesses and GI path. If I was a trainee, I would look SOLELY at one of those 3 areas.

 

[Pathwrath]

I do predict one aspect to prosper: non-hospital based biopsy groups, people like DP, Prostate Bx businesses and GI path. If I was a trainee, I would look SOLELY at one of those 3 areas.

But who is doing the prospering, the pathologist or the clinician who owns the lab? As long as the in-housing of surgical pathology services remains legal and new pathologists continue to be cranked out in grotesque excess, it is difficult for me to see anything good in this.

 

[LADoc00]

But who is doing the prospering, the pathologist or the clinician who owns the lab? As long as the in-housing of surgical pathology services remains legal and new pathologists continue to be cranked out in grotesque excess, it is difficult for me to see anything good in this.

your average run of the mill no-personality employee-4-life pathologist will never prosper doing almost anything.

My reference is purely to the balls to the wall, risk taking, entreprenurial types who I think will find it nearly impossible in 5 years to turn any sort of real coin from hospital based work, technical component capture or not!

 

[Gyric]

As a counter point, the academic pathologists I work with are far from “no personality employee-4-life” types. In fact, most are smart, aggressive and motivated; it would be relatively easy for them to take biopsies away from our local community pathologists (especially if they started hedging); the main reason they don’t … consults.

It is true that the CarisDx types will be going after this market as well, but I would not count academics out of the fight when it becomes every pathologist for themselves.

 

[pathstudent]

But, to address your other point, clinicians if they had to pay for it themselves would NEVER order a 2nd opinion. Clearly IF payments to providers do get bundled, as Obama is planning, then consults will die off very very quickly. I predict a general die off in academic pathology beginning in 4-5 years due to this.
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Bundling of payments will be a disaster for hospital pathologists. They will have to fight for money with the same people who give them the contract to be there. That is a tough spot to be in.

Also, whose to say that outpatient reimbursement won't be affected by this. The gov't could just as easily bundle a payment for a prostate biopsy, GI biopsy or a bone marrow biopsy.

 

[LADoc00]

As a counter point, the academic pathologists I work with are far from “no personality employee-4-life” types. In fact, most are smart, aggressive and motivated; it would be relatively easy for them to take biopsies away from our local community pathologists (especially if they started hedging); the main reason they don’t … consults.

It is true that the CarisDx types will be going after this market as well, but I would not count academics out of the fight when it becomes every pathologist for themselves.

Hmm dont know where you got that connection but I didnt mean to imply academics are no personality losers. I meant this in reference to success and all pathology spheres. Certainly by sheer numbers there are far far more no personality losers in the private sector.


To address the other post, yes BUNDLED payments for services would essentially spell the end of Pathology as we know it. I cannot emphasize this enough. We would essentially be put out of business overnight with little to no warning. Folks, Im NOT exaggerating here, this is the "Terminator: Salvation" level of epic sh-tfest.

I would advise a few books to prepare specifically from Amazon.com:

 

[Pathwrath]

My reference is purely to the balls to the wall, risk taking, entreprenurial types who I think will find it nearly impossible in 5 years to turn any sort of real coin from hospital based work, technical component capture or not!

As the biopsies fly out the door, the hospital-based income is going to stagnate, agreed.

The question is how to hold on to those biopsies. It used to be as simple as setting up your own independent lab with aggressive marketing and clinician customer service, maybe a couple of nice joint ventures. We did that years ago, and it has served us very well.

But with Medicare cuts forcing clinicians to troll after pathology tech and prof fees, even Ameripath-type labs are feeling the crunch. It's dog against dog, and the dogbowl is going to get even smaller with anticipated cost cutting.

I am perhaps even more pessimistic than you! I don't think even aggressive entrepreneurs are a match for our poor political clout and excess supply. I hope I am wrong, but in the meantime, I still cannot recommend this specialty as a future career.

When you start hoping that maybe our reimbursements will become so pissant that clinicians won't bother going after them anymore, I think you've reached the endgame of a profession.

 

[LADoc00]

I am perhaps even more pessimistic than you! I don't think even aggressive entrepreneurs are a match for our poor political clout and excess supply.

Realize this, Castro and Che took over Cuba with an initial landing force of a mere 40 guerillas, 1/2 of which were killed by Bautista's forces in the first few weeks of fighting for the island.

George C. Fremont and Kit Carson took over the entire STATE of California during the Bear Flag Revolt with a raiding band of 20 guys.

Never underestimate what a small handful of highly motivated, highly intelligent men/women can accomplish.

 

[LADoc00]

Whew...At first I thought you were talking about the Tea Baggers, but then you said "highly intelligent". That was a close one.

Jesus..what?!

No, you are correct, my point did not revolve around dunking my scrotum into someone's oral orifice..

can I get some what you are smoking?