What makes someone leave a job?

[pathres9999]

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Kind of curious as to what makes pathologists leave one job for another. I am not sure if this is accurate, but I feel like turnover is quite high in our field. The main things I have seen are with toxic environments, but curious if there are other triggers.

Also, as a side note, have you ever seen anyone leave due to high case load. I know of some places where they see over 7000 surgicals a year, which seem like alot.

 

[KeratinPearls]

Toxic members in a group, short staffed and burnout, unfair treatment by other members of the group, low pay/high workload with no increase in pay to do the extra work. Senior pathologists doing little to no work but order you around like a fellow but get paid 4-5X as much as you. Moving to be closer to family, etc.

Getting asked to come in on weekends to do work but don’t get paid extra. Group being bought out by another entity and you don’t think it’s right but other partners do, so you leave for greener pastures. Lazy pathologists in your group. Crazy pathologists getting let go because they can’t work well with others.

Everyone should make sure you don’t get paid crap to deal with a lot of bs or get treated like crap by partners or your employer. Quit and find another job and let them find another poor soul/sucker to do the work. Working hard while someone is profiting off your work is the worst scenario you can get yourself into.

There are some good jobs out there guys and gals. It may require you to move father from a city. I know because I’m at one. Hospital treats you nice and compensates you well for your hard work. The best jobs are ones where you work in a department where everyone does their job and most everyone is nice, pleasant and honest. No egos. No personality problems. No screaming or yelling at staff. No drama. Just good people to work with.

Not every place is like that however.

 

[KeratinPearls]

Kind of curious as to what makes pathologists leave one job for another. I am not sure if this is accurate, but I feel like turnover is quite high in our field. The main things I have seen are with toxic environments, but curious if there are other triggers.

Also, as a side note, have you ever seen anyone leave due to high case load. I know of some places where they see over 7000 surgicals a year, which seem like alot.

7000 surgicals divided between how many pathologists?

 

[pathres9999]

7000 surgicals divided between how many pathologists?

7000 per pathologist

 

[pathres9999]

Toxic members in a group, short staffed and burnout, unfair treatment by other members of the group, low pay/high workload with no increase in pay to do the extra work. Senior pathologists doing little to no work but order you around like a fellow but get paid 4-5X as much as you.

Getting asked to come in on weekends to do work but don’t get paid extra. Group being bought out by another entity and you don’t think it’s right but other partners do, so you leave for greener pastures. Lazy pathologists in your group. Crazy pathologists getting let go because they can’t work well with others.

Everyone should make sure you don’t get paid crap to deal with a lot of bs or get treated like crap by partners or your employer. Quit and find another job and let them find another poor soul/sucker to do the work. Working hard while someone is profiting off your work is the worst scenario you can get yourself into.

There are some good jobs out there guys and gals. It may require you to move father from a city. I know because I’m at one. Hospital treats you nice and compensates you well for your hard work. The best jobs are ones where you work in a department where everyone does their job and most everyone is nice, pleasant and honest. No egos. No personality problems. No screaming or yelling at staff. No drama. Just good people to work with.

Not every place is like that however.

Also thanks for the input. Glad you made it at a good place!

 

[KeratinPearls]

7000 per pathologist

Hopefully most of those cases are GI and they are being paid fairly.

 

[pathres9999]

Hopefully most of those cases are GI and they are being paid fairly.

I would say not likely. It's a partnership track but it seems like they are a churn and burn operation.

 

[WEBB PINKERTON]

Lost business, toxic atmosphere, more money.

7000 per pathologists isn't anything. That would get you fired for not being productive where I am at.

 

[pathres9999]

Lost business, toxic atmosphere, more money.

7000 per pathologists isn't anything. That would get you fired for not being productive where I am at.

I always thought average was 4500 to 5000 surgicals. But I guess if churning for that money.

 

[KeratinPearls]

Lost business, toxic atmosphere, more money.

7000 per pathologists isn't anything. That would get you fired for not being productive where I am at.

7000 is a lot. Depends on your experience of course. The path at a gi heavy academic program told me he did 6,000 a year, so I wouldn’t say it “isn’t anything”. Sure you can always work harder and hit 7,000, but if those 7000 cases are mostly resections that sounds horrible. 7000 GI cases more manageable but it all depends on your experience, confidence and how fast you can read slides.

If you have 20-30 years experience 7000 surgicals not as bad versus someone with 1-5 years of experience.

 

[Med Director New England]

7000 per pathologist

Assuming 200 days working (or ~ 42 weeks when you factor in holidays) in the lab - that’s 35 cases / day (With typical mix of biopsies and larges)…. And 10 weeks vaca

Sounds quite nice actually

 

[Sawback3]

Everyone should make sure you don’t get paid crap to deal with a lot of bs or get treated like crap by partners or your employer.

This. All pathology jobs have crap to deal with. It’s for you to decide what premium you’re paid for said crap, which may depend on your own values. If there is high turnover and increased workload, then expecting increased pay (lots of $$, not 10-20K) for your efforts is not unreasonable.

This doesn’t always happen. You are told to “pitch in” for the good of the team, help is on the way, “We appreciate you and all you do”, etc. while someone takes home the majority of the bacon. Then, time to start looking, especially if you’ve been there for a few years. The cycle may or may not repeat itself.

7000 per pathologist

The number I hear often is 5000- for a “ready-to-hire” pathologist to be able to handle. This is often in addition to cytology, ROSE, frozens, and medical directorship responsibilities. I can see 7000 (or more) being reasonable for a high-flyer with a lot of biopsies/GI. Need the right setup and a brain that doesn’t perseverate.

 

[cmz]

What is "7000" cases in terms of wRVU?

 

[Sawback3]

What is "7000" cases in terms of wRVU?

Doesn’t get mentioned a lot in this context and probably depends (and is also the most important). Where I am, 3500-4000 turns out to be 10000-11000 wRVUs, for me. It’s a broad mix of cases.

 

[ChicagoPath]

What’s a good conversion factor for pathology? Anyone know? I’m asking about the $/RVU your hospital may pay you if you are in a RVU system?

 

[cmz]

Doesn’t get mentioned a lot in this context and probably depends (and is also the most important). Where I am, 3500-4000 turns out to be 10000-11000 wRVUs, for me. It’s a broad mix of cases.

Thanks for the information. I think mentioning "cases" without proper context can be misleading. Each "case" can have multiple parts and a plethora of ancillaries. Slide number is also misleading. I don't think wRVU is the best measure by any means, but it is what translates the best into so-called "value" (i.e. how much you $$$ can you generate).

On a side note, what do you think a pathologist is worth if they produce only 5,000 wRVU/year? 5,000 wRVU seems to sit at the 50th percentile (unless I have outdated data).

 

[mike-sheree]

Just always make sure you generate more money (in all capacities/med directorships/rvu’s, etc) than you personally are remunerated EVEN AS A PARTNER. Yes, that does mean you may be “carrying “ some folks but they usually get fired( even partners). Kept me in the same (non academic) job for >25 years and everyone was sorry to see me go. Work ethic means a lot.

 

[Sawback3]

On a side note, what do you think a pathologist is worth if they produce only 5,000 wRVU/year? 5,000 wRVU seems to sit at the 50th percentile (unless I have outdated da

Agree on “cases” - usually worded as “surgicals” per year in job ads and interviews. wRVU is what it comes down to.

5000 is a little low, average is more like 6000-6500.

Depending on what the value is per rvu - which can vary:
5000 (slides, some frozen coverage and/or ROSE, rotating call, minimal medical directorship activity) for a mid-career is worth 350-400, I think.

6200, a little closer to the median, 400-450 This is “worth” also defined as independently practicing and not showing every other case to someone else, showing up to frozens, etc.

Someone less than 5 years, 350-375 for both. Right out of fellowship: 300-350.

 

[HeyDalaron]

The factors that inspire an individual to leave a job for another are myriad. You probably already know what they may be.

Observing others around me, I have seen people leave jobs because: they didn't like the locale for whatever reason, be it weather, distance from family or amenities etc.; didn't like their colleagues; didn't like the duties of the job; didn't think they were being paid enough; wanted to leave academia; wanted to enter academia; the promises in their contact weren't held up; they were fired; their contractual obligation to a particular health authority had ended.

To answer your question, I've seen people leave when there's a high case load without appropriate compensation.

 

[ChicagoPath]

To answer your question, I've seen people leave when there's a high case load without appropriate compensation.

Yup pathologists especially the younger ones should be wary of groups that look to take advantage of them. Low pay, low vacation for years before partnership, being micromanaged by bosses that get paid much more than you, lower fixed salaries over five years before you eventually become partner.

Be wary of the groups you apply to and interview at. You may be in the lions den before you know it.

 

[caffeinegirl]

+1 to ChicagoPath's comments above. This was exactly my situation - I was geographically limited and took what I could get and it was devastating in the long run. Be extremely weary of practices with partners vs non-partner situations, such a few partners who always hire employee pathologists, or even those with a five year path to partnership. And, if you can do the homework, find out the turnover beforehand. It's quite telling which practices have a "revolving door." After all the work you've done to finish your training, job security shouldn't be something you should be worried about.
In my experience, job stability comes at the expense of "take home pay" at the end of the day. These partnership practices dangle the carrot of high pay, but at the expense of job security (because you likely won't make it to partner, or they won't offer you partnership in the first place). In my experience, a steady income offers more security in the long run. In my neck of the woods, such jobs are in larger organizations such as HMO (Kaiser), academia, and employees in large health systems. There is a lot of instability about market share in larger metropolitan areas, and being in a traditional private practice is quite a gamble - especially if you're right out of training.

 

[KeratinPearls]

Low pay for a lot of overwhelming, high volume work is modern slavery. Especially if your boss does nothing except for collecting a phat paycheck.

I don’t think docs in more competitive fields are as submissive and put up with that crap.

Do you see ortho bros and dermies working for pennies busting their butts off?

 

[mike-sheree]

Low pay for a lot of overwhelming, high volume work is modern slavery. Especially if your boss does nothing except for collecting a phat paycheck.

I don’t think docs in more competitive fields are as submissive and put up with that crap.

Do you see ortho bros and dermies working for pennies busting their butts off?

That’s because you are not a commodity. There are pathologist coming out of the woodwork . It is the default specialty for anybody. Can’t say the same about ortho and derms. You can’t be a lazy/poorly productive, orthopedic surgeon who needs to “show around his knee replacements“. Also, by the time they finish their residency, they can actually do, and have done, knee replacements on their own. A new pathologist has never put his or her name on anything that meant anything. So how much do you think you’re worth in that situation? You are a 100% unproven performer upon initial employment. 100%. But you sure want iron-clad guarantees and the same money as the boss who has been there 25 years and built the practice. Anybody who goes into path is in the wrong field for instant post residency/fellowship gratification.

 

[KeratinPearls]

That’s because you are not a commodity. There are pathologist coming out of the woodwork . It is the default specialty for anybody. Can’t say the same about ortho and derms. You can’t be a lazy/poorly productive, orthopedic surgeon who needs to “show around his knee replacements“. Also, by the time they finish their residency, they can actually do, and have done, knee replacements on their own. A new pathologist has never put his or her name on anything that meant anything. So how much do you think you’re worth in that situation? You are a 100% unproven performer upon initial employment. 100%. But you sure want iron-clad guarantees and the same money as the boss who has been there 25 years and built the practice. Anybody who goes into path is in the wrong field for instant post residency/fellowship gratification.

Posted on Reddit:

“I'm a practicing academic pathologist.

Yes, I like the intellectual challenges of our field. But yes, I also regret going into pathology as a profession. Watching your fellow US medical school graduates in radiology or anesthesiology being spammed with highly lucrative job offers out of the blue, having their pick of where they want to practice, while you as a US pathologist still have to go out on a limb to get a good job that doesn't abuse you (a lowly paid academic job, an abusive "partnership-track" private practice job), is bittersweet. The field is also dragged down by a disturbingly high number of suboptimal performers- both US and foreign graduates- who don't have the technical chops or the emotional skills and shouldn't be practicing medicine on live people in the first place, but who give the field a bad rap and drags down pathology job applicants' collective leverage in the job market.

So yes, I regret going into pathology. If you want a diagnostic specialty, go for radiology. Anesthesiology is also a good field. Go into a field where you are working alongside high performers, not people who went into the field because they have nothing else they can match into.”

First of all, Academic pathology is terrible. Especially the high volume mediocre pay ones.

You can still get some good private jobs in pathology out of the gates (I mean out of fellowship) but you may have to move out in the sticks or away from large cities where demand>supply for a pathologist not large metropolitan cities where your chances of being taken advantage of are higher. I speak from experience.

 

[cmz]

That’s because you are not a commodity. There are pathologist coming out of the woodwork . It is the default specialty for anybody. Can’t say the same about ortho and derms. You can’t be a lazy/poorly productive, orthopedic surgeon who needs to “show around his knee replacements“. Also, by the time they finish their residency, they can actually do, and have done, knee replacements on their own. A new pathologist has never put his or her name on anything that meant anything. So how much do you think you’re worth in that situation? You are a 100% unproven performer upon initial employment. 100%. But you sure want iron-clad guarantees and the same money as the boss who has been there 25 years and built the practice. Anybody who goes into path is in the wrong field for instant post residency/fellowship gratification.

You put the nail on the head. Prove your worth and then re-negotiate. If you don't like what you're given, then find another job that is willing to pay for your talents. The market is good right now. Explore the wild.

 

[pathres9999]

I appreciate all the good discussion, despite me giving a relatively generic question. I was curious too since I have been asking around, do any of you notice a problem with retaining pathologist? Especially with recent grads?

 

[KeratinPearls]

I appreciate all the good discussion, despite me giving a relatively generic question. I was curious too since I have been asking around, do any of you notice a problem with retaining pathologist? Especially with recent grads?

Not that I’ve noticed or heard of but people do change jobs 2-3 times before landing at their final job.

The key is to build good surgpath experience that you can leverage into getting a better job if you choose later. You don’t want to start at a low volume place.

 

[mike-sheree]

I appreciate all the good discussion, despite me giving a relatively generic question. I was curious too since I have been asking around, do any of you notice a problem with retaining pathologist? Especially with recent grads?

The ONLY way you will REALLY know is thru word-of-mouth by folks who HAVE been there ( not current denizens) or via others in the community, including paths, SURGEONS, GI’s. THIS is why connections are CRITICAL.For example, I practiced for almost 27 yrs in the same non- academic hospital in a ~ 1.5 M urban area and if you asked damned near any path at the two “big” hospitals with training programs they would not know s***. Mind you, this is > a quarter century of practice at the same hospital. Ask the people who use(d) my services and they would fill your ear.

 

[Alteran]

That’s because you are not a commodity. There are pathologist coming out of the woodwork . It is the default specialty for anybody. Can’t say the same about ortho and derms. You can’t be a lazy/poorly productive, orthopedic surgeon who needs to “show around his knee replacements“. Also, by the time they finish their residency, they can actually do, and have done, knee replacements on their own. A new pathologist has never put his or her name on anything that meant anything. So how much do you think you’re worth in that situation? You are a 100% unproven performer upon initial employment. 100%. But you sure want iron-clad guarantees and the same money as the boss who has been there 25 years and built the practice. Anybody who goes into path is in the wrong field for instant post residency/fellowship gratification.

This is what sets Pathology apart from every other specialty in medicine, bar none. ACGME in its infinite wisdom has handicapped our specialty by not allowing residents to successfully mature and perform during their training. The ability to make independent decisions that directly impact patient care is the ENTIRE POINT of residency and fellowship, but we as pathology trainees are allowed to do so - because it might affect patient care according to AGMCE

Which ultimately is ironic because if we are soooo special as a specialty that even our trainees are not allowed to meaningfully participate in patient care because our decisions are soooo important to patient care, why is our reimbursement and status in the field such hot garbage these days……

 

[KeratinPearls]

This is what sets Pathology apart from every other specialty in medicine, bar none. ACGME in its infinite wisdom has handicapped our specialty by not allowing residents to successfully mature and perform during their training. The ability to make independent decisions that directly impact patient care is the ENTIRE POINT of residency and fellowship, but we as pathology trainees are allowed to do so - because it might affect patient care according to AGMCE

Which ultimately is ironic because if we are soooo special as a specialty that even our trainees are not allowed to meaningfully participate in patient care because our decisions are soooo important to patient care, why is our reimbursement and status in the field such hot garbage these days……

Agree. Then you go into general practice and have to sign out everything. Bone marrows, lymph nodes, thyroids, gi, bladder, blah blah and hopefully you don’t make a mistake and kill a patient. To make matters worse you get thrown a pile of slides and you got to meet “turnaround times”. You did two months of cytology? Doesn’t matter…here you go read these slides and don’t miss hsil on a pap. You did two months of derm in residency? Well our practice has a lot of dermpath. Here’s a bunch of slides. Don’t miss a melanoma.

Sometimes I wonder if some of the people that go the academic route do so because they want to avoid “being a jack of all trades, master of none.” In academics you can just focus on two subspecialties and cover frozens. You’d get really good at two areas but then lose all your skills in everything else over time but you’d at least avoid being clueless in a general private practice setting where you’re expected to sign out most everything.

 

[caffeinegirl]

Agree. Then you go into general practice and have to sign out everything. Bone marrows, lymph nodes, thyroids, gi, bladder, blah blah and hopefully you don’t make a mistake and kill a patient. To make matters worse you get thrown a pile of slides and you got to meet “turnaround times”. You did two months of cytology? Doesn’t matter…here you go read these slides and don’t miss hsil on a pap. You did two months of derm in residency? Well our practice has a lot of dermpath. Here’s a bunch of slides. Don’t miss a melanoma.

Sometimes I wonder if some of the people that go the academic route do so because they want to avoid “being a jack of all trades, master of none.” In academics you can just focus on two subspecialties and cover frozens. You’d get really good at two areas but then lose all your skills in everything else over time but you’d at least avoid being clueless in a general private practice setting where you’re expected to sign out most everything.

A side effect of this is that in many general private practices, several oncology groups "know" which pathologists have no clue, and ask for second opinion academic consults on pretty much all their cases. Or you have pathologists who send every malignant or "maybe malignant" case for academic consult because they can't make up their mind (or have been burned and don't want to get sued).

 

[HeyDalaron]

Agree. Then you go into general practice and have to sign out everything. Bone marrows, lymph nodes, thyroids, gi, bladder, blah blah and hopefully you don’t make a mistake and kill a patient. To make matters worse you get thrown a pile of slides and you got to meet “turnaround times”. You did two months of cytology? Doesn’t matter…here you go read these slides and don’t miss hsil on a pap. You did two months of derm in residency? Well our practice has a lot of dermpath. Here’s a bunch of slides. Don’t miss a melanoma.

Sometimes I wonder if some of the people that go the academic route do so because they want to avoid “being a jack of all trades, master of none.” In academics you can just focus on two subspecialties and cover frozens. You’d get really good at two areas but then lose all your skills in everything else over time but you’d at least avoid being clueless in a general private practice setting where you’re expected to sign out most everything.

With the digital revolution on the horizon, how we practice pathology will markedly change.

I think, were our leadership forward thinking, we'd split off the subspecialties into their own programs like internal medicine did and apply directly into them. Those who chase two rabbits catch neither. The trend for all fields, not just medical ones, is for specialization.

Independent sign out in residency is sorely required. I wonder if it's been prohibited because it allows the cheap labor international pipeline to stay open. There's zero risk for programs to recruit low quality applicants because of this.

We'd also benefit from significantly reducing the number of residents we're presently training. This could be easily done by raising the bar and only accepting those with potential, not every FMG or underachiever that applies as seems to be the case now.

The accreditation bodies could also raise the standards by which programs are allowed to remain open. Of course, by switching to an entirely subspecialized training model, many of these poor quality programs would be required to close, because as far as I know, there is no demand for a fellowship in gallbladders and osteoarthritic knees and hips.

We could also use to dispel with the corporate-coded language like 'turnaround time'. I never heard a surgeon talk about their 'turn around time'.

The CAP has been a suboptimal advocacy organization. Which leads me to my next question: why do pathologists agree to take part in their lab accreditation teams for free?

 

[KeratinPearls]

We'd also benefit from significantly reducing the number of residents we're presently training.

Lol….We’ve been talking about that for 15 years now on SDN. Sorry to break the news to you but to them we have a pathologist shortage and we need more pathologists.

Yeah agree independent signout is needed. I mean I’m not saying you have to sign out every case you preview during training but at least a few here and there to develop the confidence and by confidence I mean pushing the sign out button. The more you push that signout button the more confidence you develop and the more independent you will be once you hit the job market. First years sign out gallbladder and easy junk cases or biopsies. Second to 4th years sign out more and more complex cases of course with attending supervision.

Sometimes I wonder if it’s a scheme by the powers to be to graduate trainees who lack confidence/signout experience so that large academic centers and corporate overlords can take advantage of young pathologists by way of crappy primary care level salaries. Corruption. I mean why not get trainees well trained so they can hit the ground running by giving them the skills needed to succeed on day one (by signing out a lot of cases during training)?
Why not get trainees prepared and ready to sign out 40-50 gi cases a day by the time they finish residency or fellowship? Because large corporations and academic centers want to pay you crap to do those 40-50 cases. They don’t want to pay you off of productivity because it would mean less money for them.

I’ll say this. I don’t trust our pathology society. I have colleagues who said they were worried about getting a job when they finished 30 years and 10 years ago. If you have an inept society who cannot manage the workforce numbers for the past 30 years, i don’t think you cannot trust them for anything else.

Never forget the crap job market we had in path in the past. I almost cried when my colleague recently told me she was paid $150k as a first year attending when she started 10 years ago.

Luckily, we are in the golden age of pathology. The best job market in a long time. I’m not saying the market is great but better than the crap we had before.

Young grads should get a job asap and start getting signout experience before and if, this market tanks again.

 

[Sawback3]

Sometimes I wonder if it’s a scheme by the powers to be to graduate trainees who lack confidence/signout experience so that large academic centers and corporate overlords can take advantage of young pathologists by way of crappy primary care level salaries. Corruption.

This. I couldn’t put this into the right words. It was a pyramid scheme, until very recently. This field cannot look out for itself. Even fresh graduates are somewhat hostile to their peers, behind their backs. I’ve seen this in academia during training but I’m sure it’s in many practices (not where I work as much - a few of us call that stuff out). At the same time, there’s a good amount of hostility directed at clinicians, especially oncologists. This is from younger and middle aged pathologists, as well. This is a customer service field. They have to get patients to trust them, and we have to get clinicians to trust us. Reputation is important. Communication is important. I don’t call in such and such results, I’m not sending a block for this test, I’m not doing this frozen because it’s stupid and doesn’t change this or that. Not a good look. But it’s baked in..

 

[shikimate]

Many good points above, I will just add my 2c:
1) we have pathologist here complaining of high workload doing 2K per year, if any of you want a cushy job doing 2K per year and getting paid well please come to Canada.
2) Academic places purposely make you think you need fellowship and need a consult to sign out anything that's not a TA or BCC. They always talk about "what if it's something else". That's called gaslighting.
3) I don't see often people leaving jobs because of higher pay. It seems to be mostly burn-out related, family reasons related, or incompatible personality related.

 

[MifflinDunder]

Agree. Then you go into general practice and have to sign out everything. Bone marrows, lymph nodes, thyroids, gi, bladder, blah blah and hopefully you don’t make a mistake and kill a patient. To make matters worse you get thrown a pile of slides and you got to meet “turnaround times”. You did two months of cytology? Doesn’t matter…here you go read these slides and don’t miss hsil on a pap. You did two months of derm in residency? Well our practice has a lot of dermpath. Here’s a bunch of slides. Don’t miss a melanoma.

Sometimes I wonder if some of the people that go the academic route do so because they want to avoid “being a jack of all trades, master of none.” In academics you can just focus on two subspecialties and cover frozens. You’d get really good at two areas but then lose all your skills in everything else over time but you’d at least avoid being clueless in a general private practice setting where you’re expected to sign out most everything.

This is very common in my field as well (heme-onc). I guess being a generalist in any specialty isn't for everyone.