Which programs should be shut down?

[path19]

I agree with you that limiting spots is the key. I just wanted to point out that we don't attract lesser candidates (on average) than a specialty like derm because we have a good lifestyle. On the contrary, if all residents graduating pathology programs actually could get 500K jobs off the bat working bankers hours, I think you would very quickly see the average quality of applicant skyrocket.

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[path19]

Radiology residents make calls independently all the time at night that if they are wrong could be clinically impactful. Head CTs for acute bleeding, etc. they don’t do it on day one but they do actually do these things prior to finishing training.

You're right, there for sure is some of this. I was just thinking of potential differences between radiology and path. But I bet there is still someone else on the other end looking at that head CT, be it the emergency docs, neurology or neurosurg. Although it certainly could be another resident on the other end.

 

[SunBakedTrash]

I truly believe we have become the path of least resistance for those with serious red flags and flagrant communication issues. it hasn’t helped us that specialties like psychiatry and emergency medicine have become much more competitive. They at least used to absorb some of the dregs of the system. Rad onc is increasingly seeming like it will be joining us in the toilet bowl. Same inept style of leadership! The fish stinks from the head.

 

[Unty]

As opposed to all those derm residents who enter the specialty because they're so passionate about the epidermis and dermis?

LOL what % of derm residents/dermatologists would do derm if it paid 210,000 a year like pathology jobs do?

 

[Alteran]

LOL what % of derm residents/dermatologists would do derm if it paid 210,000 a year like pathology jobs do?

If that was the starting salary for Derm, realistically you’d have a US med student interest at around what IM and Family Med currently are: 30-40%.

 

[Alteran]

I truly believe we have become the path of least resistance for those with serious red flags and flagrant communication issues. it hasn’t helped us that specialties like psychiatry and emergency medicine have become much more competitive. They at least used to absorb some of the dregs of the system. Rad onc is increasingly seeming like it will be joining us in the toilet bowl. Same inept style of leadership! The fish stinks from the head.

Perhaps, but at least they recognize there’s a stench (see below). We’re still sitting in our own filth with a Lysol can pretending everything is just great.

Summary of new ACGME program requirements (effective July 1, 2020)

Hadn't seen this posted. Here's a good summary of the changes to program requirements that will be put in place starting July 1. https://www.acgme.org/Portals/0/PFAssets/ProgramResources/RadiationOncology_Summary_PR-Changes2019.pdf?ver=2019-08-26-120824-023 There aren't any changes that are...

forums.studentdoctor.net

 

[pathslides]

Any program with less than 50k specimens should be closed. Programs with the following specimens per year should have the following max cap and the stipulation that all residency programs must have atleast 2 PAs:
50k-75k: 2 residents/yr
75k-100k: 3 residents/yr
>100k: 4 residents/yr.
No program allowed more than 4 residents/yr. No more cush programs or easy residency lifestyle. Residents need to work hard but all programs must have grossing comprise no more than 33% of a resident’s working time per current avg 80 hour week rule.
Increase competitiveness, increase quality, decrease supply, gain respect for the field.

 

[gbwillner]

	You're right, there for sure is some of this. I was just thinking of potential differences between radiology and path. But I bet there is still someone else on the other end looking at that head CT, be it the emergency docs, neurology or neurosurg. Although it certainly could be another resident on the other end. I can't speak for Rads, but IM and surgery aren't really any different than path on any fundamental level for the approach to training. The lack of independence for path is a result of the product we produce. In IM and surgery, the billing is in either the procedure (done by the attending) or in the time spent with the patient. The attendings round on all the patients and sign the notes. So they fulfill the billable components of the majority of the service. The residents also round and write notes, but they are duplicative and not billable. Residents in surgery only assist until the very end, and then there is always an attending around. Yes, minor procedures are done by residents, but these are also time sensitive whereas in path there are no such urgencies. To me this is not much different than reviewing a case, and then signing it out with attending supervision and review, which is how my program worked.

 

[hurrycane]

One of the biggest problems in my opinion is the laziness and lack of work ethic I see in pathology trainees, even those from fancy programs.

It is not surprising at all since nowadays all you have to do to match to path is to be able to walk and talk. Sometimes I even feel like the latter is optional.

 

[Unty]

It is not surprising at all since nowadays all you have to do to match to path is to be able to walk and talk. Sometimes I even feel like the latter is optional.

Yup one of the issues. Slides sitting around to be looked at after the fellow has previewed them but no one takes the initiative to look at them. Attendings don’t make it a requirement for residents to look at them either. So residents graduate and pick it up in a fellowship or never learn it well enough to be confident in a job. Thus explaining the weak candidate talk here on SDN.

Some programs have low volume (hemepath) as well. They don’t do a fellowship in that particular area and aren’t confident at it in practice and can’t sign out a bone marrow in practice if they have to. Another reason for weak candidates.

 

[tensoranalysis]

Any program with less than 50k specimens should be closed. Programs with the following specimens per year should have the following max cap and the stipulation that all residency programs must have atleast 2 PAs:
50k-75k: 2 residents/yr
75k-100k: 3 residents/yr
>100k: 4 residents/yr.
No program allowed more than 4 residents/yr. No more cush programs or easy residency lifestyle. Residents need to work hard but all programs must have grossing comprise no more than 33% of a resident’s working time per current avg 80 hour week rule.
Increase competitiveness, increase quality, decrease supply, gain respect for the field.

50k specimens per year /365 days = 136 specimens / day

split between two residents. 68 cases per day working 7 days per week?!?!

 

[Guest8]

50k specimens per year /365 days = 136 specimens / day

split between two residents. 68 cases per day working 7 days per week?!?!

That doesn't include PA's, which larger programs should have regardless of the number of residents.

 

[deleted314957]

That doesn't include PA's, which larger programs should have regardless of the number of residents.

Attendings used to play a VERY minor role in resident education for the first 3 years. I was a surgical intern, generally supervised by a 3rd yr resident. I almost never saw an attending .


Sent from my iPad using Tapatalk

 

[DoctorCancer]

I can think of 3 reasons. First, what we do really is more important. An incorrect pathology report will lead to all sorts of negative consequences, usually far beyond what happens when a medicine or surgery resident messes something up. Secondly, our mistakes are there to be seen and reviewed for years after the fact. The majority of specialties, when a resident (or attending) screws something up, there is no record set in stone that documents said mistake like there is in pathology. So our mistakes are noticed and amplified. And lastly, no one else can do what we do. This is what distinguishes us from radiology residents. Not many surgeons (or oncologists, etc) will act upon a radiology report without actually reviewing the films themselves. The same is not true of pathology. And radiology reads are typically less definitive in the first place, so there is a lot of wiggle room for radiology residents who aren't entirely comfortable with a case, and this helps them to stay out of trouble.

Many people have raised these points about Pathology being so much more important than other specialties. Sadly, it is reflected neither by the job market and salaries nor by attitudes of other physicians towards pathology. This is something that only us pathologists say to each other For everyone else, we are just glorified laboratory technologists.

So, If someone trains AP only and gets board certified, you will feel comfortable if they are signing out independently but if the same person is AP/CP PGY4, you won't let them operate independently. As far as I am aware, they do not give those magic pills with broad certification anymore!Nobody is advocating here that PGY1s should sign out independently from the first day. This discussion is about the higher residents who can make out benign from malignant in most cases and the staff will have only slightly better chance of catching it if they missed it. And if we have PGY3s who are not confident in calling benign vs malignant in most cases, shut down all of the above programs

 

[kchan99]

In IM and surgery, the billing is in either the procedure (done by the attending) or in the time spent with the patient.

Time based billing is not always used in non-procedural patient contact specialties. Billing is often based on note elements for level of service, with a higher level requiring more extensive documentation of exam details and test review. Both inpatient and outpatient H&P's and new consults are billed higher than daily rounding and follow up appointments. The alternative is time based billing. It is advantageous to use time based billing if there is a high rate for time, such as in critical care situations, or if considerable time is spent with the patient. Time based billing is a lot easier in terms of documentation as long as there is sufficient documentation on the amount of time spent with the patient.

The attendings round on all the patients and sign the notes. So they fulfill the billable components of the majority of the service. The residents also round and write notes, but they are duplicative and not billable.

Resident notes are partially billable as long as there is sufficient documentation that the attending performed the key components of the history and relevant portions of the exam, and wrote something about the assessment and plan.

 

[gbwillner]

Time based billing is not always used in non-procedural patient contact specialties. Billing is often based on note elements for level of service, with a higher level requiring more extensive documentation of exam details and test review. Both inpatient and outpatient H&P's and new consults are billed higher than daily rounding and follow up appointments. The alternative is time based billing. It is advantageous to use time based billing if there is a high rate for time, such as in critical care situations, or if considerable time is spent with the patient. Time based billing is a lot easier in terms of documentation as long as there is sufficient documentation on the amount of time spent with the patient.



Resident notes are partially billable as long as there is sufficient documentation that the attending performed the key components of the history and relevant portions of the exam, and wrote something about the assessment and plan.

Thanks for the added detail. I continue to maintain the approach is no different in Path to training, but the billing is different. A report is only billable if signed out by the attending. Residents are welcome to preview cases and create a draft report, but the liability is on the physician that signs the report. So they really can't do much truly independent sign out, unless the reimbursement is so low it's not worth it or it is really inconvenient for the attending. That's why I signed out autopsies (no billing), low-paid services with low risk (reviews/consults for established DX), and calling in frozens to the OR (hassle for the attending some times). All other cases I previewed I wrote a prelim report that was dictated and then reviewed by the attending for final sign-out. Not that different, IMO.

 

[kchan99]

A report is only billable if signed out by the attending. Residents are welcome to preview cases and create a draft report, but the liability is on the physician that signs the report. So they really can't do much truly independent sign out, unless the reimbursement is so low it's not worth it or it is really inconvenient for the attending.

Billing is the more or less the same for direct patient care. Residents can't bill, but attendings are allowed to "borrow" parts of their notes for their billing.

Liability is shared amongst residents and attendings. For example, if a resident orders the wrong medication and there is a lawsuit because of the medication's effect, then both the resident and the attending would be named.

In my residency program, as a senior resident, I had some independent experience overnight and on weekends. I could see patients in the ED, and then admit the patient to my service or recommend admission to another service, or discharge from the ED without attending presence. Often, I didn't discuss with the attending. Of course, my attending could not bill. I heard that this type of experience is program-dependent.

 

[KeratinPearls]

It'd still be competitive because it has a 9-5 lifestyle.

LMAOOOOO

 

[YH5]

This is directly from the University of South Alabama website:



View attachment 296816

And it is incorrect.

 

[urbancowboydoc]

Here's all the residencies with volumes listed and arranged by boards pass rates:

​

How do people feel about Allegheny Health Network's pathology program? I know several pathologist mentors who trained here and have been excellent. I'm sure it's hard to compete next to a top path program, but outcomes appear pretty decent. Thoughts?

 

[SunBakedTrash]

How do people feel about Allegheny Health Network's pathology program? I know several pathologist mentors who trained here and have been excellent. I'm sure it's hard to compete next to a top path program, but outcomes appear pretty decent. Thoughts?

The second best in Pittsburgh and like the fifth best in Pennsylvania (maybe)? Pass. Just go to UPMC.

 

[YBNJay]

Billing is the more or less the same for direct patient care. Residents can't bill, but attendings are allowed to "borrow" parts of their notes for their billing.

Liability is shared amongst residents and attendings. For example, if a resident orders the wrong medication and there is a lawsuit because of the medication's effect, then both the resident and the attending would be named.

How does this jive with FM residents who moonlight? I knew of one person who did extra shifts at an urgent care clinic as a PGY3, and had 0 attending supervision whatsoever. They were presumably allowed to bill insurance for their services, even though they had not passed FM boards.

 

[Drifter76]

The second best in Pittsburgh and like the fifth best in Pennsylvania (maybe)? Pass. Just go to UPMC.

Programs I have some personal knowledge of.. East Tennessee State, University of Florida Jacksonville, Vidant/East Carolina, UMKC, Creighton should all be closed.

 

[IDPathDoc]

How does this jive with FM residents who moonlight? I knew of one person who did extra shifts at an urgent care clinic as a PGY3, and had 0 attending supervision whatsoever. They were presumably allowed to bill insurance for their services, even though they had not passed FM boards.

You don’t need to be board certified to work in an urgent care. It’s more rare but you can do it after completing an intern year and getting full licensure. It depends on the state laws your working in if insurance can deny a claim based on lack of BE/BC.

How does this jive with FM residents who moonlight? I knew of one person who did extra shifts at an urgent care clinic as a PGY3, and had 0 attending supervision whatsoever. They were presumably allowed to bill insurance for their services, even though they had not passed FM boards.

 

[fecalith]

Programs I have some personal knowledge of.. East Tennessee State, University of Florida Jacksonville, Vidant/East Carolina, UMKC, Creighton should all be closed.

Omg you are my hero... I would say ETSU could sort of stay but the others are completely BASURA aka TRASH. Especially that Jacksonville place....an abomination...17K specimens...Most residents barely speak english....Also, UMKC is equally as bad.... their only kind of saving grace is the Mercy Children's hopsital..

 

[SunBakedTrash]

Programs I have some personal knowledge of.. East Tennessee State, University of Florida Jacksonville, Vidant/East Carolina, UMKC, Creighton should all be closed.

I would also add every program on the west coast except UCSF, Stanford and UW. Add the garbage places in New York and Texas and that alone is probably 100 residents.

 

[fecalith]

I would also add every program on the west coast except UCSF, Stanford and UW. Add the garbage places in New York and Texas and that alone is probably 100 residents.

Also, The St. Barnabas place in NJ, Ascension in MI, Allegheny in PA, Metro Health and Summa Health in OH, Baylor University in TX, Howard in DC, HCA in FL, Hosftra-Lenox hill and staten island in NY, Baystate in MA, Danbury in CT to name a few more

 

[KeratinPearls]

Also, The St. Barnabas place in NJ, Ascension in MI, Allegheny in PA, Metro Health and Summa Health in OH, Baylor University in TX, Howard in DC, HCA in FL, Hosftra-Lenox hill and staten island in NY, Baystate in MA, Danbury in CT to name a few more

Howard has less than 10,000 surgicals I heard. Anyone can confirm????

Basura?!? LMAO!!!! First time I’ve seen that on Pathology SDN.

 

[fecalith]

Howard has less than 10,000 surgicals I heard. Anyone can confirm????

Basura?!? LMAO!!!! First time I’ve seen that on Pathology SDN.

lol I can't find a better word to describe some of these 'programs'

I have heard the same about Howard.....

I will also add to the above list some more: LSU-Sheverport in LA, University of Chicago (NorthShore)in IL, Westchester Medical center in NY and the list goes on.....!

 

[KeratinPearls]

lol I can't find a better word to describe some of these 'programs'

I have heard the same about Howard.....

I will also add to the above list some more: LSU-Sheverport in LA, University of Chicago (NorthShore)in IL, Westchester Medical center in NY and the list goes on

lol I can't find a better word to describe some of these 'programs'

I have heard the same about Howard.....

I will also add to the above list some more: LSU-Sheverport in LA, University of Chicago (NorthShore)in IL, Westchester Medical center in NY and the list goes on.....!

I truly believe these residency programs exist due to gross mismanagement by the ACGME, CAP and ABP.

 

[Allegri]

I truly believe these residency programs exist due to gross mismanagement by the CAP and ABP.

Isn't the ACGME the organization that accredits residency programs and thus controls numbers? How do CAP and ABP affect this?

 

[KeratinPearls]

Isn't the ACGME the organization that accredits residency programs and thus controls numbers? How do CAP and ABP affect this?

Edited and Corrected. Don’t think the big organizations/those in power have a say.

 

[KeratinPearls]

Decrease in US and IMG applications to Pathology (2015-2020) although total applications to residencies have been increasing.

 

[deleted314957]

Edited and Corrected. Don’t think the big organizations/those in power have a say.

The ABP leadership ( this assumes they have some balls) could have a nice luncheon with a couple folks from the
ACGME. Some CAP toadys could come along for the drinks
and to maybe learn how to develop a voice. The nice ABP folks would then tell the ACGME that they would be informing certain programs that their residency graduates did not meet their standards ( make up whatever standards/bs they want) and would not be eligible to sit for the exam they administer.

 

[Drifter76]

Omg you are my hero... I would say ETSU could sort of stay but the others are completely BASURA aka TRASH. Especially that Jacksonville place....an abomination...17K specimens...Most residents barely speak english....Also, UMKC is equally as bad.... their only kind of saving grace is the Mercy Children's hopsital..

A couple of those programs may have been semi-decent at some point in the past, but they are now nothing more than diploma mills for FMGs, funded with our tax dollars.

 

[Mad Jack]

Crying is healthy.

Crying often because of work isn't

 

[KeratinPearls]

Isn't the ACGME the organization that accredits residency programs and thus controls numbers? How do CAP and ABP affect this?

Here’s your answer:

“ACGME accreditation is overseen by a Review Committee made up of volunteer specialty experts from the field that set accreditation standards and provide peer evaluation of Sponsoring Institutions and specialty and subspecialty residency and fellowship programs.”

I’m assuming volunteer specialty experts have a voice in CAP or ABP or are connected. If you are a specialty expert, I am assuming you know other players in the field.

 

[Allegri]

Nice work. Now the big question: who are the volunteer specialty experts? These people appear to hold enormous power over the specialty.

 

[KeratinPearls]

Nice work. Now the big question: who are the volunteer specialty experts? These people appear to hold enormous power over the specialty.

That’s the million $ question. I’m sure they are well connected to the leaders of our Pathology societies or are even one of them.

Sometimes I wonder if there is corporate influence in terms of increasing the number of grads to supply these large entities who benefit financially ($$$$$) by hiring minions aka young Pathology grads for cheap. But this is just speculation/a theory on my part.

I would not be surprised if HCA had a role in opening that program. There are large healthcare entities in primary care/internal medicine that have their own residency programs as well. Pump out graduates to supply their hospitals. Win-Win!

Does anyone think we need that HCA residency? Are we really in dire straits that we need 2 more pathologists a year? 5 faculty? Really?

HCA has two Pathology residencies. One in Florida and Tulane. They apparently have many residencies in every field.

Money controls everything in medicine y’all.

 

[SunBakedTrash]

My guess is the authors of papers about the robust pathology job market and their minions.

 

[KeratinPearls]

My guess is the authors of papers about the robust pathology job market and their minions.

Im sorry but the conclusion the job market is strong in that paper is complete BS.

 

[HeyDalaron]

Im sorry but the conclusion the job market is strong in that paper is complete BS.

Wasn't there an admission that all of those job market papers were underestimating the current pathology workforce by 40% because they didn't include any subspecialists (e.g. cytopathologist, dermatopathologist) in their counts?

 

[KeratinPearls]

Wasn't there an admission that all of those job market papers were underestimating the current pathology workforce by 40% because they didn't include any subspecialists (e.g. cytopathologist, dermatopathologist) in their counts?

No idea but I think the sample size was small. I highly doubt an academic will conclude in a paper the job market is “mediocre” or anything less than “strong”.

 

[SunBakedTrash]

Wasn't there an admission that all of those job market papers were underestimating the current pathology workforce by 40% because they didn't include any subspecialists (e.g. cytopathologist, dermatopathologist) in their counts?

Yes, it was buried, but they only counted those categorizing themselves as practicing “anatomic pathology, clinical pathology, and anatomic/clinical pathology.” It excluded any sub-specialists (and even the term “pathologist” I believe).

 

[deleted314957]

Ages ago, we had a boat load ofHCA contracts. None of those places can realistically support any kind of residency.
You are there to do the scut work for all the PP docs and employed docs. It is shameful that the ABMS lowers themselves to this (non)standard. Now with hospitalists ((vs. your own physician(s))you really wonder and worry about all the marginally trained physicians out there and which ones are reading your slides, films, scoping you, sleeping you, etc. Your personal physician is only peripherally involved, if at all, with any in patient care. Just not a fan of these community hospital “pop-up” residencies.

 

[Drifter76]

I had a previous job that was based at a large HCA hospital, working for a group whose biggest contract was with HCA, and I learned a bit about the direction their corporate leadership is wanting to go with their pathology services. They are wanting to terminate contracts with all private groups across their 200+ hospitals and internalize their pathology services under their IRL/FPS subsidiary. They have done this in the Florida, Denver, and Kansas City markets and a few others. The last I heard, their IRL/FPS cronies were working on some places in Texas. They come in, announce they are terminating the contract, and start advertising nationally but let you know that they would love for you to stay on as their employee, as long as you are willing to have your vacation time cut in half, retirement benefits cut to nothing and future compensation cut significantly. They offer salaries in the uppers 200s for experienced pathologists, and I believe it is low 200s for those with less than 5 years experience. Most people who can, walk away. They don't seem to have a lot of trouble filling positions because of the horrendous job market/oversupply combined with their very low standards (basically just looking for warm bodies). These standards, from what I can tell, are a reflection of their overall standards system wide. There is a degradation of services when they take over the pathology, but it may be no worse than the overall degradation that occurs hospital wide after they buy a hospital. I would not want to be a patient in an HCA hospital. I also would be wary of joining any groups that depend largely on HCA contracts, as those contracts seem to be at very high risk of being terminated in the near future.
I believe the HCA residencies are part of some pipeline initiative, trying to give themselves a continual supply of minions in support of their pathology services subsidiary. Since they don't care much about quality to begin with, I doubt they'd be too concerned about the quality of education in their program or quality of the pathologists they are turning out.

 

[path24]

I had a previous job that was based at a large HCA hospital, working for a group whose biggest contract was with HCA, and I learned a bit about the direction their corporate leadership is wanting to go with their pathology services. They are wanting to terminate contracts with all private groups across their 200+ hospitals and internalize their pathology services under their IRL/FPS subsidiary. They have done this in the Florida, Denver, and Kansas City markets and a few others. The last I heard, their IRL/FPS cronies were working on some places in Texas. They come in, announce they are terminating the contract, and start advertising nationally but let you know that they would love for you to stay on as their employee, as long as you are willing to have your vacation time cut in half, retirement benefits cut to nothing and future compensation cut significantly. They offer salaries in the uppers 200s for experienced pathologists, and I believe it is low 200s for those with less than 5 years experience. Most people who can, walk away. They don't seem to have a lot of trouble filling positions because of the horrendous job market/oversupply combined with their very low standards (basically just looking for warm bodies). These standards, from what I can tell, are a reflection of their overall standards system wide. There is a degradation of services when they take over the pathology, but it may be no worse than the overall degradation that occurs hospital wide after they buy a hospital. I would not want to be a patient in an HCA hospital. I also would be wary of joining any groups that depend largely on HCA contracts, as those contracts seem to be at very high risk of being terminated in the near future.
I believe the HCA residencies are part of some pipeline initiative, trying to give themselves a continual supply of minions in support of their pathology services subsidiary. Since they don't care much about quality to begin with, I doubt they'd be too concerned about the quality of education in their program or quality of the pathologists they are turning out.

Lots of truth to this post. HCA will be starting more path residency programs. This is the future of pathology. Corporate or academic mill.

Good to see all med students are starting to stay away. The quality of jobs are only going to get worse.

 

[deleted314957]

I had a previous job that was based at a large HCA hospital, working for a group whose biggest contract was with HCA, and I learned a bit about the direction their corporate leadership is wanting to go with their pathology services. They are wanting to terminate contracts with all private groups across their 200+ hospitals and internalize their pathology services under their IRL/FPS subsidiary. They have done this in the Florida, Denver, and Kansas City markets and a few others. The last I heard, their IRL/FPS cronies were working on some places in Texas. They come in, announce they are terminating the contract, and start advertising nationally but let you know that they would love for you to stay on as their employee, as long as you are willing to have your vacation time cut in half, retirement benefits cut to nothing and future compensation cut significantly. They offer salaries in the uppers 200s for experienced pathologists, and I believe it is low 200s for those with less than 5 years experience. Most people who can, walk away. They don't seem to have a lot of trouble filling positions because of the horrendous job market/oversupply combined with their very low standards (basically just looking for warm bodies). These standards, from what I can tell, are a reflection of their overall standards system wide. There is a degradation of services when they take over the pathology, but it may be no worse than the overall degradation that occurs hospital wide after they buy a hospital. I would not want to be a patient in an HCA hospital. I also would be wary of joining any groups that depend largely on HCA contracts, as those contracts seem to be at very high risk of being terminated in the near future.
I believe the HCA residencies are part of some pipeline initiative, trying to give themselves a continual supply of minions in support of their pathology services subsidiary. Since they don't care much about quality to begin with, I doubt they'd be too concerned about the quality of education in their program or quality of the pathologists they are turning out.

This is 100% accurate.

 

[fecalith]

Lots of truth to this post. HCA will be starting more path residency programs. This is the future of pathology. Corporate or academic mill.

Good to see all med students are starting to stay away. The quality of jobs are only going to get worse.

Don't worry! They are going to be filled with graduates from the prestigious Spartan and Xavier University in no time!

 

[octopusprime]

I had a previous job that was based at a large HCA hospital, working for a group whose biggest contract was with HCA, and I learned a bit about the direction their corporate leadership is wanting to go with their pathology services. They are wanting to terminate contracts with all private groups across their 200+ hospitals and internalize their pathology services under their IRL/FPS subsidiary. They have done this in the Florida, Denver, and Kansas City markets and a few others. The last I heard, their IRL/FPS cronies were working on some places in Texas. They come in, announce they are terminating the contract, and start advertising nationally but let you know that they would love for you to stay on as their employee, as long as you are willing to have your vacation time cut in half, retirement benefits cut to nothing and future compensation cut significantly. They offer salaries in the uppers 200s for experienced pathologists, and I believe it is low 200s for those with less than 5 years experience. Most people who can, walk away. They don't seem to have a lot of trouble filling positions because of the horrendous job market/oversupply combined with their very low standards (basically just looking for warm bodies). These standards, from what I can tell, are a reflection of their overall standards system wide. There is a degradation of services when they take over the pathology, but it may be no worse than the overall degradation that occurs hospital wide after they buy a hospital. I would not want to be a patient in an HCA hospital. I also would be wary of joining any groups that depend largely on HCA contracts, as those contracts seem to be at very high risk of being terminated in the near future.
I believe the HCA residencies are part of some pipeline initiative, trying to give themselves a continual supply of minions in support of their pathology services subsidiary. Since they don't care much about quality to begin with, I doubt they'd be too concerned about the quality of education in their program or quality of the pathologists they are turning out.

We've gotten to the point that upper 100s / low 200s is the expectation for the majority of one's career. Even in areas with poor reimbursement, a group with healthy/normal volumes should be double those salaries. Graduating residents think this is the standard and/or are willing to take it for the convenience of not moving or adhering to geographic restrictions for family or personal reasons, which--coupled with the ACGMEs ability to continually crank out an endless supply of newly minted pathologists--an effort bolstered by our professional organization through a combination of ignorance, self-interest and simply being out-of-touch--perpetuates the problem on an endless loop.

I am glad I went into pathology--but that decision was almost 2 decades ago, and the profession has changed alot since then. I would still potentially make the same decision now (assuming I'd be equally ignorant now as I was then) but only because I'm driven; I would wholeheartedly urge folks not to enter the field now UNLESS said person is extremely flexible with geographic location, extremely savvy, or simply willing to get paid a fraction of what they should be getting paid while hospital systems like HCA, large corporate labs, and academic institutions siphon off the majority of your earnings.

People always rebut that other fields are similarly disadvantaged when employed by a hospital system or large institution...but if we're talking specialists (derm, ENT, anesthesia, radiology, 5-year-training specialties...) those specialists almost invariably are salaried at MUCH higher levels than similarly employed pathologists. You could argue that in the private practice setting, those specialties reimburse more anyway, which may be marginally true but is somewhat variable, but the difference between corporate/hospital/academic pathology and private practice pathology is much more drastic, both in terms of income potential and "hourly wage".