What subspecality is best overall.

[Dave CX]

I agree with that. I used to practice community AP and the derm cases were more nuanced than the GI ones, in which the variables are predominantly binary.

Of interest, are you aware of what kind of histo processing protocols these big labs employ? I can only assume they are very efficient with all that volume, so I was wondering if I could learn them and compare them to what we do at my institution.

Lots of GI labs are crooked, with H.Pylori stains on multiple stomach biopsies. PAS/AB on all duodenums as well as CD3. PAS on all esophagus biopsies. Trichromes on all inflamed colons. I refuse to practice that way.

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[Dave CX]

I think my arms would fall off if i was looking at 250-300 GI biopsies/day [but i'd probably go insane before that].

The key is the reporting system. If you can build a library of your 90 or so most common diagnoses and enter with keystrokes, then you can be efficient. I can do 5 or 6 trays per hr. and do it well.

 

[Dave CX]

He's referring to professional. A pathologist doesn't generate the global unless they own the lab/equipment/reagents, etc. and he said he works for a slide mill.

The numbers add up: (250 accessions/d) (~$40/accession) = $10K/d x 5d/wk = $50K/wk x 46wks/yr (e.g. 6wks vacay/yr) =$2.3m/yr, throw in IHC, and it's around $2.5 mil/yr. From my discussions with various pathologists employed in similar settings, their cut is usually 40% of the PC. Greater than 50% is almost unheard of. So, in his case 850K/2.5m = 34%, which comes out to roughly $13.60 to sign out a tubular adenoma. To some, this may seem low, but that is the going rate for our skillset and within range of current market value. F.Y.I., there are some greedy outpatient labs where the pathologist's cut is even less, as well as some of our colleagues who will take any offer thrown at them to scrape the bottom of the barrel.

Hence, the term "slide mill". It's all about volume and this setting is certainly not for everybody. But if you can crank it out and it makes you happy, more power to you. I do know some of these pod labs limit the number of accessions per day a pathologist is permitted to look at before they hit their max. DermPath diagnostics is one such outfit. Can't remember what their max was, but I knew a histotech who used to work there and I believe she said it was somewhere around 150/d, not sure though. That being said, she told me most of the pathologists, if not all of them tried to hit their daily max (for more cash-o-la)...haha.

Not a slide mill per se. 2 large GI groups 60 miles apart. One with histo lab, one TC26. I am wiped at the end of the day.

 

[gbwillner]

Not a slide mill per se. 2 large GI groups 60 miles apart. One with histo lab, one TC26. I am wiped at the end of the day.

I simply cannot imagine having a daily volume like that. Kudos to you for being able to handle it.

 

[Dave CX]

I simply cannot imagine having a daily volume like that. Kudos to you for being able to handle it.

I have hit the wall though. Ditching the practice thats further away. 8 yrs is enough. Big pay cut coming.

 

[coroner]

I would also be bored to death

...No meetings, autopsies, call, tumor boards or hospital administrators. If you get off on all of that then you are a better man than me.

Everything is relative in the eye of the beholder. I remember when I was a resident I was having lunch with a dental resident and we were talking about Pathology in general. She asked, "Don't you get tired of looking through a microscope all day?" To which I replied, "Don't you get tired of looking into people's mouth all day?" To each their own...

Lots of GI labs are crooked, with H.Pylori stains on multiple stomach biopsies. PAS/AB on all duodenums as well as CD3. PAS on all esophagus biopsies. Trichromes on all inflamed colons. I refuse to practice that way.

I can one up that: My ex-boss did a CD117 on every colon bx to rule out mast cell colitis...

I have hit the wall though. Ditching the practice thats further away. 8 yrs is enough. Big pay cut coming.

PM me so I can take that job...I'm getting burnt out from grossing during weekend call and placenta conferences

 

[Dave CX]

Everything is relative in the eye of the beholder. I remember when I was a resident I was having lunch with a dental resident and we were talking about Pathology in general. She asked, "Don't you get tired of looking through a microscope all day?" To which I replied, "Don't you get tired of looking into people's mouth all day?" To each their own...


I can one up that: My ex-boss did a CD117 on every colon bx to rule out mast cell colitis...


PM me so I can take that job...I'm getting burnt out from grossing during weekend call and placenta conferences

There is already a replacement.

 

[TrojanRaggy]

Slide mills sound amazing!

 

[deleted314957]

The key is the reporting system. If you can build a library of your 90 or so most common diagnoses and enter with keystrokes, then you can be efficient. I can do 5 or 6 trays per hr. and do it well.

That is exactly what we did. BIG time ( money) saver.

 

[KeratinPearls]

That is exactly what we did. BIG time ( money) saver.

Yeah sounds pretty awesome if you want to move quick.

Is there a program that you use to set this up Dave or can it be programmed on any regular computer?

 

[cmz]

Lots of GI labs are crooked, with H.Pylori stains on multiple stomach biopsies. PAS/AB on all duodenums as well as CD3. PAS on all esophagus biopsies. Trichromes on all inflamed colons. I refuse to practice that way.

Good. If you did, you might see yourself wearing orange one day. It's best to steer clear of these outfits. The labs that do these kind of things won't go unnoticed...

Also since you're assigning your right to bill over to someone else, do you have a mechanism to audit how things are being billed?

 

[Dave CX]

Good. If you did, you might see yourself wearing orange one day. It's best to steer clear of these outfits. The labs that do these kind of things won't go unnoticed...

Also since you're assigning your right to bill over to someone else, do you have a mechanism to audit how things are being billed?

No, but I enter the codes myself

 

[Dave CX]

Yeah sounds pretty awesome if you want to move quick.

Is there a program that you use to set this up Dave or can it be programmed on any regular computer?

Its part of the reporting software.

 

[Dave CX]

This is an example. One of my docs asked me to review an outside case, which was a straight forward case of UC. In addition to the "diagnoses" being completely unreadable wishy washy descriptive garbage, there were 6 88342s and 6 88313s billed. Shameful, but these labs/pathologists seem to get away with it.

 

[Guest8]

Derm is more complex, but lots of pathologists miss GI diagnoses. Amazing how many can't diagnose autoimmune gastritis, despite a 2% prevalence.

True. I think I was inferring more the amount of dictating/typing that derm biopsy cases can involve compared to GI biopsies. My notes on GI cases are usually a sentence or two and most have canned text I can insert in a second. My notes on inflammatory derm can be paragraphs long and aren't always amenable to canned text. Synoptic reports on all melanoma biopsies, plus outpatient offices do fairly large excisions that take added time to go through. But yes, there are still plenty of obscure GI findings that could easily be missed if going too fast.

 

[coroner]

This is an example...the "diagnoses" being completely unreadable wishy washy descriptive garbage...

Guess they never heard of a comment section/microscopic description...

 

[WEBB PINKERTON]

Those diagnoses looks like the work of Jack Torrance from the Shining.

 

[Dral]

If you use an interface that uses Word (like Copath), just make a 'dot phrase' list using the spelling autocorrect function. Otherwise, Phrase Express works well.

I'd be lost without my dot phrases. I sign out most basal cell carcinomas with no more than 7 key strokes.

 

[chooks]

+1 to PhraseExpress. I used to use another phrase expander but was having problems with having my (paid for) unlimited license being recognized so ditched that in favor of PhraseExpress.