What's going on . . .in Pathology

[juddson]

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One of the major pathology residency programs in my town (which has anywhere from three to five programs depending on how you define "town") is increasing its number of first year incoming residency positions rfom 6 to 9next year. It has been suggested that one of the major reasons for doing this is an increase in specimen census at the institution.

If this reason played even a tiny part in this decision, it demonstates the extraordinary lengths academic pathology is willing to go to ritualistically disembowel the profession going forward. If true, this institution (and perhaps all the institutions that have and will increase spots in the coming years) is mortgaging the future of its graduating pathologists and the future of pathology as a profession generally for the forseable future in order to secure short-term, cheap surgical pathology labor. The idea that a program would increase training spots for the sole purpose of staffing its academic pathology services with NO view to the market supply and demand of community pathology services (let alone the professional prospects of its graduates) enrages me.

Judd

 

[LADoc00]

One of the major pathology residency programs in my town (which has anywhere from three to five programs depending on how you define "town") is increasing its number of first year incoming residency positions rfom 6 to 9next year. It has been suggested that one of the major reasons for doing this is an increase in specimen census at the institution.

If this reason played even a tiny part in this decision, it demonstates the extraordinary lengths academic pathology is willing to go to ritualistically disembowel the profession going forward. If true, this institution (and perhaps all the institutions that have and will increase spots in the coming years) is mortgaging the future of its graduating pathologists and the future of pathology as a profession generally for the forseable future in order to secure short-term, cheap surgical pathology labor. The idea that a program would increase training spots for the sole purpose of staffing its academic pathology services with NO view to the market supply and demand of community pathology services (let alone the professional prospects of its graduates) enrages me.

Judd

Write a letter to CAP, ABP and that program's Chairman expressing these ideas in a succint professional manner. I completely agree with you. This has to end.

 

[yaah]

Well, I think the change needs to come not from major med centers reducing their resident load, but from all the small practices and med centers not interested in teaching that get to have them. A lot of graduates come out of training unprepared.

 

[deleted113029]

I now know how to answer the potential interview question:

What makes you 😡 ?

 

[juddson]

And what the hell is with the reduction of the residency from five to four years? No fewer than three residents have insisted to me that the change has meant only that a fellowship is, more or less, required in order to practice (or at least find a job).

Judd

 

[juddson]

Well, I think the change needs to come not from major med centers reducing their resident load, but from all the small practices and med centers not interested in teaching that get to have them. A lot of graduates come out of training unprepared.

Yea, not sure about this. But I think some of the unpleasantness the whole profession is experiencing - and this may go for the practice of medicine as a whole - has something to do with the fact that major medical centers are buying up community practices and hospitals. In my town of 15 or so hospitals, there is precisely ONE independant hospital left. Are these giant, voracious medical centers responsible for the general decline in practice satisfaction?

Judd

 

[tsj]

It would be great for them to reduce the number of path residents by about 50-60%, but that would never happen as they are too important to pathology depts in terms of the work they do.

 

[Gut Shot]

And what the hell is with the reduction of the residency from five to four years? No fewer than three residents have insisted to me that the change has meant only that a fellowship is, more or less, required in order to practice (or at least find a job).

I think it has been a positive change, overall. Five years to practice = four years + fellowship year. It offers flexibility in terms of where one does a fellowship, since you're not necessarily trapped doing your credentialling at the same institution where you spent the previous four years.

 

[tsj]

I think it has been a positive change, overall. Five years to practice = four years + fellowship year. It offers flexibility in terms of where one does a fellowship, since you're not necessarily trapped doing your credentialling at the same institution where you spent the previous four years.

Isn't that kind of how it was before anyway? I thought a lot of people used their 5th year to do a fellowship (or at least something called a fellowship like a surg path fellowship), but I don't really know what the rules were.


One thing I wonder about is when is it possible to do just 2 years AP and one year fellowship? Too me it seems impossible, but I know of people that have done it. For instance I have seen people to 2 years of AP and then go right into board certfied fellowships like neuropath and hemepath.

 

[Gut Shot]

Isn't that kind of how it was before anyway? I thought a lot of people used their 5th year to do a fellowship (or at least something called a fellowship like a surg path fellowship), but I don't really know what the rules were.

The fifth year was the so-called "credentialling year." It was glorified elective time, from what I've heard, but you couldn't really get additional certification from it. Way back when path residency was four years, and they added the extra year to try and encourage people to do a clinical internship, but they never designated the year for that purpose. Virtually nobody did that, so it became 12 months of limp, dead weight projecting from the end of your residency.

 

[LADoc00]

Well, I think the change needs to come not from major med centers reducing their resident load, but from all the small practices and med centers not interested in teaching that get to have them. A lot of graduates come out of training unprepared.

Major med centers are the ones churning out an insane INSANE number of trainees for already locked markets. Boston alone is probably churning (MGH 10+BWH 8+BID 6+BU 4=28 pathologists!!!!!!!!) for a town that can absorb *maybe* 1-2 a year. WTF?!!!!! Seriously. This is totally out of control.

You want to close down Oregon 3 slots which supplies the state but leave places like MGH, Mich, UCLA and Stanford flooding the flipping urban market? that doesnt make sense. There should be a total of 6 residents in the ENTIRE Harvard system each year, thats what the market can absorb.

And for people still in training, I dont want to hear how none of your residents had a hard time finding a job...I had 17+ offers, the point is the QUALITY sucks. If we ever had a dream of starting of lab you practically have to do it mafia-style because even asscrack Kansas has big commericial enterprises that have permeated the market.

Even for people who luck out in pathology, the quality of their financial arrangements are nothing compared to radiology or rad onc. You are entwined in page after page of no-compete clauses, convenant agreements and outside income limitations, all that in 1 contract in practically UNHEARD OF in almost any other professional field.

If residents are happy about their post-training jobs, then its predominantly because they are clueless and hell IGNORANCE IS BLISS right?

The sad thing is in general young pathologists are some of the most clueless professionals out there, any 25 year old attorney has a better head on their shoulders.

50% cuts in trainees is not even close to enough, try 80%+. Some programs need to be eliminated altogether but everyone EVERYWHERE needs to seriously shave. SF Bay area is producing some insane 20ish boarded people a year, for a job market where there were maybe 4 openings last year. LA is even worse! Its total chaos.

 

[1Path]

The sad thing is in general young pathologists are some of the most clueless professionals out there, any 25 year old attorney has a better head on their shoulders.

I've said many times that people should have intimate knowledge of terms like 401K, term life insurance, ect BEFORE they matriculate into med school. But that's the subject for another thread.....

50% cuts in trainees is not even close to enough, try 80%+. Some programs need to be eliminated altogether but everyone EVERYWHERE needs to seriously shave..

Welcome to the world of the PhD scientist.🙄 It's hard to read threads like this without sensing "entitlement" oozing from the posts. I still say if people, in general weren't so motiovated by MONEY, the future wouldn't seem so bleak.

 

[ermonty]

I still say if people, in general weren't so motiovated by MONEY, the future wouldn't seem so bleak.

Well if it wasnt money that motivated people it would be SEX, I can't imagine that....Oh, nevermind, I just turned on the TV. 😛

E-Mo

 

[LADoc00]

I've said many times that people should have intimate knowledge of terms like 401K, term life insurance, ect BEFORE they matriculate into med school. But that's the subject for another thread.....

Welcome to the world of the PhD scientist.🙄 It's hard to read threads like this without sensing "entitlement" oozing from the posts. I still say if people, in general weren't so motiovated by MONEY, the future wouldn't seem so bleak.

Im confused. Isnt that like saying if people werent so motivated by air, drowning wouldnt seem so bleak??

Or, if people werent so motivated by hunger, famine wouldnt seem so bleak.

Or, if people werent so motivated by sex, being a priest wouldnt seem so bleak...okay! that isnt a good example.

 

[1Path]

Im confused. Isnt that like saying if people werent so motivated by air, drowning wouldnt seem so bleak??

YOU would be!

So tell me, how much house is enough, 2000 sq ft, 3500 sq ft, 10K sq ft.??? Even if you have 7 bathrooms you can only poop in them one at a time .

So, how much boobs are enough?........... Ok for you, that probably isn't a fair question!🙄

BTW, air we NEED to live, a 10K house is ONLY needed to feed your ego.

 

[rirriri]

that really sucks.

but have you noticed in that other thread that the qualifications for PAs are increasing to holding a Master's Degree? Do you think this means that in the future they WILL be reducing the number of Path residency positions and hiring more PAs? assuming that there will be a larger supply of PAs.

if the specimens all get grossed and processed by well qualified and trained PAs, then less residents might be needed to handle the load.

 

[Med_Leviathan]

50% cuts in trainees is not even close to enough, try 80%+. Some programs need to be eliminated altogether but everyone EVERYWHERE needs to seriously shave. SF Bay area is producing some insane 20ish boarded people a year, for a job market where there were maybe 4 openings last year. LA is even worse! Its total chaos.

Yet in another thread you claimed that it was (apparently) normal for a 7th year partner to make $500K/year. Please explain how it is possible for a pathologist to earn that kind of money when you arm-wavingly state that there are five times the number of pathologists there should be.

 

[LADoc00]

Yet in another thread you claimed that it was (apparently) normal for a 7th year partner to make $500K/year. Please explain how it is possible for a pathologist to earn that kind of money when you arm-wavingly state that there are five times the number of pathologists there should be.

I will explain, try to follow me. See I work with a guy who has a humble abode worth around 10 million bucks. He has built this massive fckin estate on the bones and dust of the dreams of 23+ pathologists. I had to be literally pulled off his fence by my GF I was so pissed....

Every time he brings a new sucker in, he turns and burns them, meaning he brings them in at a low low salary, makes a ton of money off em(around 400K per associate per year by my estimate in addition to his own take which is around 500K) and churns em out without ever making someone partner. Luckily for me this one guy is simply too old to do this again.

But he was able to do this because academics fed him fresh new pathologists desperate for employment for the better part of 20 years. By my calculation he has banked in excess of 8 million doing this.

MAKE SENSE NOW?

pathology is seriously screwed up. I can tell you honestly women and IMGs are getting COOKED big time out there. This shiat is the killing fields. I had a Harvard trained pathologist call me last me week because she got cooked off after a mere 4 months on the job in Cali.

Think of it like Mexico, there is HUGE divide between rich and poor. All the result of the greed of a few and the poor leadership of academic pathology.

 

[MacGyver]

Now do you guys understand that residency slots have NOTHING to do with real population demand?

Its a money grab pure and simple. Think about it. I'm a director of a university hospital based pathology program. I get 100k from Medicare per year for each resident I get.

More residents = $$$$$

Dont ever tell me again that it costs more money to train residents than what Medicare pays out. Thats an absolute bald faced lie. Hospitals make HUGE sums of money with residency slots funded at 100k per slot per year.