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Thus, the AAMC pathology workforce estimate does not include those whose principal work is in 11 subspecialty areas, such as blood banking or transfusion medicine, cytopathology, hematopathology, or microbiology. An additional discrepancy relates to the ACGME residency (specialties) and fellowship (subspecialties) training programs in which pathologists with training in dermatopathology appear as dermatologists and pathologists with training in molecular genetic pathology appear as medical geneticists.
 

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Does that mean tons of residency slots will now be closed since all these new pathologists suddenly appeared out of nowhere? Or will this be used to pump out tons more pathologists?
 
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Thus, the AAMC pathology workforce estimate does not include those whose principal work is in 11 subspecialty areas, such as blood banking or transfusion medicine, cytopathology, hematopathology, or microbiology. An additional discrepancy relates to the ACGME residency (specialties) and fellowship (subspecialties) training programs in which pathologists with training in dermatopathology appear as dermatologists and pathologists with training in molecular genetic pathology appear as medical geneticists.
Thanks for posting this
It basically completely debunks the Metter paper that claimed a huge drop of pathologists between 2007-19. The same paper oft quoted by academics to support the looming pathology shortage / justification for increasing path training spots.
 

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Confirms what we have all been seeing on the ground. No drop in pathologists. Bend the pathologist curve. Quit overtraining!
In my ( pretty f***ing long) experience, all these CAP officer/groupie types (ASCP and USCAP less-so) just , emphatically,do not represent “Joe Pathologist” that I dealt with for ages. It was always seen as the pathologists or the medical politicians.
 

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They reported this at a CAP meeting that I believe is still up on their Facebook page. Several months old news now, to me at least.

Edit: In case anyone wants the abridged version, it was a 40% undercount of the workforce that our leadership has been working off of until they figured out that AAMC wasn't counting the pathology subspecialities as "pathologists".
 
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They reported this at a CAP meeting that I believe is still up on their Facebook page. Several months old news now, to me at least.

Edit: In case anyone wants the abridged version, it was a 40% undercount of the workforce that our leadership has been working off of until they figured out that AAMC wasn't counting the pathology subspecialities as "pathologists".
Don't ascribe to malice what can be readily explained as incompetence
 

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Don't ascribe to malice what can be readily explained as incompetence
Never thought it was malicious by design. That being said, their wholly incongruent and dogmatic view of the workforce and job market coupled with their historic absolute unwillingness to even entertain the possibility that they could have been wrong didn't help matters.

The real question is now that they know they've been working off bad data and assumptions, what do they do now? Do they just go "Eh, more pathologists never hurt anyone" or do they starting pulling back spots and if so, how and from who?
 

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Never thought it was malicious by design. That being said, their wholly incongruent and dogmatic view of the workforce and job market coupled with their historic absolute unwillingness to even entertain the possibility that they could have been wrong didn't help matters.

The real question is now that they know they've been working off bad data and assumptions, what do they do now? Do they just go "Eh, more pathologists never hurt anyone" or do they starting pulling back spots and if so, how and from who?
I think Webb would agree with me that the best solution to this problem is Carousel.
 

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I think Webb would agree with me that the best solution to this problem is Carousel.
I like that idea. Any volunteers to be Sandmen?

More pathologists out there just equals more healthcare and waste. We have a false market that was created by this surplus.
 
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An online forum (for years, decades) brings the facts, truth, reality, honesty.

Academics, organizations, programs, journals not so much.

Reality won't stop the oversupply. No one is going to give up their program. It will never get better. Stay away people. The job market will always be complete crap and a pathologist is just a commodity. It is done/over.

Pathology needs to drain the swamp to see any improvement.
 

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An online forum (for years, decades) brings the facts, truth, reality, honesty.

Academics, organizations, programs, journals not so much.

Reality won't stop the oversupply. No one is going to give up their program. It will never get better. Stay away people. The job market will always be complete crap and a pathologist is just a commodity. It is done/over.

Pathology needs to drain the swamp to see any improvement.
Agree. There are still ppl out there who think the pathology job market is good sadly Or people who tell readers of this forum to not listen to the doom and gloom. It’ll just get worse now with covid.
 

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Imo this demonstrates how many academic pathologists (and some SDN forum posters, we know who they are) are either clueless or corrupt by spreading false information.
 
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Imo this demonstrates how many academic pathologists (and some SDN forum posters, we know who they are) are either clueless or corrupt by spreading false information.
I'm pretty sure there are some corrupt pathologists out there who benefit from an oversupply, but I think they're the minority. I will agree however that academia's and CAP's insistence that there is nothing wrong with a pathology fellow taking an average 3-6 months to land a job, let alone a good job with decent pay, is appalling. It shows a complete lack of empathy or understanding with the future standard-bearers of our field. It should be no surprise, least of all to them, that if you ignore your residents and fellows for no less than a decade and repeatedly tell them to be happy with a garbage job market in comparison to practically every other specialty, you'll eventually get garbage applicants.

Only now, when a third of incoming pathology residents are US medical graduates, are they at all concerned. And to add salt to the open festering wound that is our field, family medicine - the only field less competitive than pathology - is about to get a significant pay raise paid in part by a global 8% reimbursement cut to pathology. Oh, and family med doesn't have any trouble at all landing a job.
 

KeratinPearls

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Starting salaries in pathology of 180-210 are at the level of or below pediatricians in their first year.
 

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I'm pretty sure there are some corrupt pathologists out there who benefit from an oversupply, but I think they're the minority. I will agree however that academia's and CAP's insistence that there is nothing wrong with a pathology fellow taking an average 3-6 months to land a job, let alone a good job with decent pay, is appalling. It shows a complete lack of empathy or understanding with the future standard-bearers of our field. It should be no surprise, least of all to them, that if you ignore your residents and fellows for no less than a decade and repeatedly tell them to be happy with a garbage job market in comparison to practically every other specialty, you'll eventually get garbage applicants.

Only now, when a third of incoming pathology residents are US medical graduates, are they at all concerned. And to add salt to the open festering wound that is our field, family medicine - the only field less competitive than pathology - is about to get a significant pay raise paid in part by a global 8% reimbursement cut to pathology. Oh, and family med doesn't have any trouble at all landing a job.
But if the small minority controls all the contracts and wealth, isn’t that awful for the average pathologist? If the small minority can get lots of pathologists to work for $100-$200k less than they are worth due to desperate candidates competing against each other for any kind of work, Then of course they would want that over supply. Multiply $150k profit by 10 pathologists and you have quite the life of you’re the chief!
 

Alteran

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But if the small minority controls all the contracts and wealth, isn’t that awful for the average pathologist? If the small minority can get lots of pathologists to work for $100-$200k less than they are worth due to desperate candidates competing against each other for any kind of work, Then of course they would want that over supply. Multiply $150k profit by 10 pathologists and you have quite the life of you’re the chief!
Again, I don't disagree with that sentiment. This why most US medical students who can do basic math are not at all interested in pathology. The numbers just don't add up in comparison to any of the other specialties you could do. It wasn't this bad 10 years ago when I got into pathology, but it really has gotten worse. Except CAP of course keeps telling me it's still all good.

As an aside, someone remind me again what CAP is supposed to be doing for us exactly? It seems like every year we keep getting reimbursement cuts but the party line is "it could have been worse were it not for us". Last time I checked, successive losses of reimbursement every year running is nothing to brag about.
 
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Could not agree more with you alteran...

would be interested to hear some of the academics chime in on this one.

hopefully academia will at least now consider the possibility that we may be saturated and over training.
 

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Starting salaries in pathology of 180-210 are at the level of or below pediatricians in their first year.
I just got a headhunter ad for an M.E. job in the New Mexico state lab. By reputation, it is one of the better and modern/ progressive ME facilities. This was for 220k and typical municipal benefits and NOT the CME position. It looks like supply and demand are moving the football.
 
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I am in academics. I can't speak for the entire enterprise of academic pathology, but I have some observations.

I think we have to look closely at the incentives at play. The unit of decision making in academics is at the department level. Academic departments are incentivized to make money, or at least not lose money, for the medical school. Financially, trainees are beneficial because they come attached with CME money and they get a lot of work done. Some have tried to argue that trainees may in fact be a loss. I do not believe this for a second. Has any department ever said, "let's cut some of our training slots because we can't afford it." No surprise, more departments want to open training programs, and individual departments want as many trainees as possible.

The incentives are the bottom line. Academic departments have no incentive to manage the long term health of the private practice market. As long as there are more trainees available, and there seems to be an endless supply of international trainees, why would a department care? Academic departments don't even really have an incentive to worry about the quality of the trainees either, because the work they are doing is not particularly highly skilled.

I'm actually a little surprised that people expect academics to work for lower pay and gross more so that the market for private practice improves and pays better. Academics is not in it for altruism any more than private practice is. You want fewer and better trainees? Remove the financial incentive to train. This responsibility is all on CAP, not academics, to manage the field.
 

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I am in academics. I can't speak for the entire enterprise of academic pathology, but I have some observations.

I think we have to look closely at the incentives at play. The unit of decision making in academics is at the department level. Academic departments are incentivized to make money, or at least not lose money, for the medical school. Financially, trainees are beneficial because they come attached with CME money and they get a lot of work done. Some have tried to argue that trainees may in fact be a loss. I do not believe this for a second. Has any department ever said, "let's cut some of our training slots because we can't afford it." No surprise, more departments want to open training programs, and individual departments want as many trainees as possible.

The incentives are the bottom line. Academic departments have no incentive to manage the long term health of the private practice market. As long as there are more trainees available, and there seems to be an endless supply of international trainees, why would a department care? Academic departments don't even really have an incentive to worry about the quality of the trainees either, because the work they are doing is not particularly highly skilled.

I'm actually a little surprised that people expect academics to work for lower pay and gross more so that the market for private practice improves and pays better. Academics is not in it for altruism any more than private practice is. You want fewer and better trainees? Remove the financial incentive to train. This responsibility is all on CAP, not academics, to manage the field.
I am not in academics but was for some time, and I agree with some, but not all your sentiments.

The argument of academic departments making or losing money with trainees is nuanced. I don't believe most departments approach this as a financial win/lose as you describe in the decision to have trainees or how many. Academic departments have a mission to have trainees. Academic pathologists in part take jobs there to train trainees. It is not as simple as a calculated "how can we make more money" decision and describing it as such does not ring true to me.

the argument that pathology departments "lose" money with trainees is true from a certain perspective- one that is aligned with your description of how you think the department operates- namely, in an effort to make money for the university (rather than fulfilling research and clinical objectives for the university). If there were no trainees, they could argue according to your model, their staff could focus on signing out cases rather than providing lectures to residents and students, mentoring residents, and spending time reviewing each case with a resident to teach them something. They would not have to correct residents' bad diagnosis or reports. They could effectively spend their entirety of their FTEs signing out cases (basically like private practice). With this in mind, the department, assuming a stable amount of volume, could hire fewer pathologists to do the work. Each pathologist would certainly, in this scenario, generate far more revenue for the department at lower cost than what they can do with trainees. Having trainees from this perspective COSTS the department money as trainees cannot perform any billable duties. The amount of money the department gets from CME for a resident does not cover the amount of POTENTIAL revenue lost by having to deal with them; I think this is even true when you substitute trainees with PAs.

However, this scenario above is and can only be hypothetical. Academia is NOT private practice; their mission is to do research and to train residents. So to assume both that they make decisions to hire trainees or not hire them for purely economic ones is flawed. Academia will have trainees. They will leverage their use for their mission AND for economic reasons, and there is no one approach that will be true for all academic departments. From my experience, the rationale to hire more trainees is far more practical and a result of departmental budgets than anything to do with raising revenue for the department or university from CME. I actually believe that departments do not get any tangible economic benefit from trainees; but that does not mean that they do not actively pursue them for entirely selfless reasons. The decision to have or increase the number of residents is proportional to the amount of pathology services being rendered. The consideration may be whether a PA or a trainee should be brought in (or less likely, additional staff). I think far more relevant to the decision making (over how much revenue will come from CME) is where the money will come from. Hiring another PA means having enough money in the departmental budget to be able to afford it. This budget is tightly controlled. This means likely cutting costs in the staff budget or asking for more money from the university or being allowed to use more of your revenue for this purpose- revenue that other departments and research initiatives are dependent on. There is no guarantee that it will be allowed, and even if enough money is available within control of the Chair, the decision must be to prioritize these funds for a PA when there are many other projects within scope of the department's responsibilities that will compete for those funds. However, another trainee usually comes from another bucket of resources entirely. So even though the gestalt of having a trainee may cost the department (or really, the university) money, from a practical perspective, this is seen as free labor to the department because it comes from another bucket entirely- the CME office. Some departments will consider only this when they apply for positions- substituting trainees for PAs- while others (the good ones) will consider more trainees when there is more volume than their current residents can handle and they determine more trainees can be trained at their facility with proper oversight and training. Notice that while subsequent employment opportunities are a consideration and very important to the department for their trainees- the department itself has NO oversight over the total number of positions available or the larger marketplace. All they know is they could train one more.

It is understood that some departments make money for the university, while others lose money. The university will take money from the departments that make money to make up for those that lose money. Pathology, in general, makes money for the university. The departments that lose money- like endocrinology- still have these same issues, If the department and university ran on the principles many of you ascribe to academia, these departments would not exist.
 
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"From my experience, the rationale to hire more trainees is far more practical and a result of departmental budgets than anything to do with raising revenue for the department or university"

I did not mean to imply that academic departments' only goal is to make money, or that all departments do in fact make money. That is quite obviously not the case. But that margin of budget - revenue is critical and departmental leadership is charged with maintaining it. My point is that with respect to training residents, the financial incentive is in the direction of pro-training, as you seem to agree. If X amount of work performed by a PA costs more than X amount of work performed by a trainee, that is a tangible economic benefit in favor of the trainee.

And with respect to the effects that the numbers of trainees in a program might have on the long term health of the larger field of pathology, there is no incentive for that to affect a department's local, immediate decision making. And in 7 years of meetings I've attended at 2 different large institutions regarding the residency or fellowship programs, that issue has not once been raised.
 

HeyDalaron

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I am not in academics but was for some time, and I agree with some, but not all your sentiments.

The argument of academic departments making or losing money with trainees is nuanced. I don't believe most departments approach this as a financial win/lose as you describe in the decision to have trainees or how many. Academic departments have a mission to have trainees. Academic pathologists in part take jobs there to train trainees. It is not as simple as a calculated "how can we make more money" decision and describing it as such does not ring true to me.

the argument that pathology departments "lose" money with trainees is true from a certain perspective- one that is aligned with your description of how you think the department operates- namely, in an effort to make money for the university (rather than fulfilling research and clinical objectives for the university). If there were no trainees, they could argue according to your model, their staff could focus on signing out cases rather than providing lectures to residents and students, mentoring residents, and spending time reviewing each case with a resident to teach them something. They would not have to correct residents' bad diagnosis or reports. They could effectively spend their entirety of their FTEs signing out cases (basically like private practice). With this in mind, the department, assuming a stable amount of volume, could hire fewer pathologists to do the work. Each pathologist would certainly, in this scenario, generate far more revenue for the department at lower cost than what they can do with trainees. Having trainees from this perspective COSTS the department money as trainees cannot perform any billable duties. The amount of money the department gets from CME for a resident does not cover the amount of POTENTIAL revenue lost by having to deal with them; I think this is even true when you substitute trainees with PAs.

However, this scenario above is and can only be hypothetical. Academia is NOT private practice; their mission is to do research and to train residents. So to assume both that they make decisions to hire trainees or not hire them for purely economic ones is flawed. Academia will have trainees. They will leverage their use for their mission AND for economic reasons, and there is no one approach that will be true for all academic departments. From my experience, the rationale to hire more trainees is far more practical and a result of departmental budgets than anything to do with raising revenue for the department or university from CME. I actually believe that departments do not get any tangible economic benefit from trainees; but that does not mean that they do not actively pursue them for entirely selfless reasons. The decision to have or increase the number of residents is proportional to the amount of pathology services being rendered. The consideration may be whether a PA or a trainee should be brought in (or less likely, additional staff). I think far more relevant to the decision making (over how much revenue will come from CME) is where the money will come from. Hiring another PA means having enough money in the departmental budget to be able to afford it. This budget is tightly controlled. This means likely cutting costs in the staff budget or asking for more money from the university or being allowed to use more of your revenue for this purpose- revenue that other departments and research initiatives are dependent on. There is no guarantee that it will be allowed, and even if enough money is available within control of the Chair, the decision must be to prioritize these funds for a PA when there are many other projects within scope of the department's responsibilities that will compete for those funds. However, another trainee usually comes from another bucket of resources entirely. So even though the gestalt of having a trainee may cost the department (or really, the university) money, from a practical perspective, this is seen as free labor to the department because it comes from another bucket entirely- the CME office. Some departments will consider only this when they apply for positions- substituting trainees for PAs- while others (the good ones) will consider more trainees when there is more volume than their current residents can handle and they determine more trainees can be trained at their facility with proper oversight and training. Notice that while subsequent employment opportunities are a consideration and very important to the department for their trainees- the department itself has NO oversight over the total number of positions available or the larger marketplace. All they know is they could train one more.

It is understood that some departments make money for the university, while others lose money. The university will take money from the departments that make money to make up for those that lose money. Pathology, in general, makes money for the university. The departments that lose money- like endocrinology- still have these same issues, If the department and university ran on the principles many of you ascribe to academia, these departments would not exist.
A select few top level academic departments are probably more akin to what you described.

I would argue that many if not the majority of academic pathology departments produce very little in the way of actionable, relevant research, and the staff are signing out with all of their time and are expected to write papers in their off time, which they have their residents do the bulk of the work on.

Residents in pathology perform mostly clerical work or grossing, and thereby are unlikely to harm patients. In combination with GME money, it makes taking in residents of any perceived quality or lack thereof a financially beneficial choice for most departments. Were pathology residents able to report independently, even on a preliminary basis, departments would be a lot more careful about adding residents for monetary gains, as the liability issues could surpass them.

I think that regardless of the job market, the training standards in pathology must be raised significantly, either for opening programs or sitting for board exams. Departments should be required to have a sufficient number and variety of specimens, and enough experts, in addition to sufficient technical resources (including PAs) before they are allowed to open a program. The current sole determinant of being able to sit for the ABP is 50 autopsies. That is like saying the only prerequisite for taking the radiology boards is 50 barium enemas.
 

msnbc2020

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Liars or idiots. 21292 active pathologists. ~600 residents graduating per year = 6000 pathologist every 10 years, 21000 pathologists every 35 years. Not surprising to see 21000 pathologists since many pathologists work for 35+ years.
 

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I just got a headhunter ad for an M.E. job in the New Mexico state lab. By reputation, it is one of the better and modern/ progressive ME facilities. This was for 220k and typical municipal benefits and NOT the CME position. It looks like supply and demand are moving the football.
So Mike, 220K is good or bad for this position?
 

mikesheree

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So Mike, 220K is good or bad for this position?
I think in this day and age, particularly to be able to work in a modern, N.A.M.E. accredited facility with a great forensic reputation and (for many) great geography/ urban terrain and a decent cost of living, it is ok. I am assuming “full” and generous benefits( not a 1099 job). much much better if your situation allows for your testimony to be considered “expert” testimony, which it is (unless their only question is “ did you do an autopsy on this dude on june first”), and that ain’t why they are calling you. they SPECIFICALLY want your expert opinion. and if some jackass of a defense lawyer says that is not constitutional because of the right to confront your accuser, just remind her the second she asks for your opinion that she is trying to elicit expert testimony and the court must deem you as an expert. then start billing. noobs can start at $500/ hr count all prep waiting time and travel and time on the stand. quote an up front retainer of $1500 for local cases minimum.
 
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doctor313

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Maybe I'm thinking about this the wrong way, but to me, this actually sounds like GOOD news in terms of job market prospects, not bad news.

The way I see it, getting ready to enter a market where X% of 21000 pathologists are getting ready to retire is MUCH better than entering a job market where X% of 13000 pathologists are getting ready to retire.

Why are people interpreting a larger pathologist workforce that previously thought as a bad thing? This means that our workforce is actually much bigger than we initially thought, so more jobs are going to potentially become available as people retire... right?
 

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Maybe I'm thinking about this the wrong way, but to me, this actually sounds like GOOD news in terms of job market prospects, not bad news.

The way I see it, getting ready to enter a market where X% of 21000 pathologists are getting ready to retire is MUCH better than entering a job market where X% of 13000 pathologists are getting ready to retire.

Why are people interpreting a larger pathologist workforce that previously thought as a bad thing? This means that our workforce is actually much bigger than we initially thought, so more jobs are going to potentially become available as people retire... right?
Congratulations. I think you have a future as a pathologist. Pathology is scraping the bottom of the barrel as the least competitive non-primary care field in medicine. Somehow you think that having more pathologists makes for a better job market. Absolutely ridiculous.
 
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Maybe I'm thinking about this the wrong way, but to me, this actually sounds like GOOD news in terms of job market prospects, not bad news.

The way I see it, getting ready to enter a market where X% of 21000 pathologists are getting ready to retire is MUCH better than entering a job market where X% of 13000 pathologists are getting ready to retire.

Why are people interpreting a larger pathologist workforce that previously thought as a bad thing? This means that our workforce is actually much bigger than we initially thought, so more jobs are going to potentially become available as people retire... right?
Academics and our professional societies have been lamenting “the shortage” for decades and increasing training slots with the expectation that there would be both mass retirement and expansion of the workforce. I think pathologists today are working both longer and harder than they did 40 or 50 years ago and I doubt there will be a shortage of labor in our careers. The continuation of consolidation paired with automation, AI advances and/or other disruptive technologies will exacerbate this trend. Whatever abundance of jobs that may have been available will be taken by the masses of trainees crammed into the training pipeline. This is especially problematic due to those within pathology who are willing to settle for insulting salaries like the person in the other thread, which ultimately undercuts the rest of us.
 
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Academics and our professional societies have been lamenting “the shortage” for decades and increasing training slots with the expectation that there would be both mass retirement and expansion of the workforce. I think pathologists today are working both longer and harder than they did 40 or 50 years ago and I doubt there will be a shortage of labor in our careers. The continuation of consolidation paired with automation, AI advances and/or other disruptive technologies will exacerbate this trend. Whatever abundance of jobs that may have been available will be taken by the masses of trainees crammed into the training pipeline. This is especially problematic due to those within pathology who are willing to settle for insulting salaries like the person in the other thread, which ultimately undercuts the rest of us.
lol people settle for insulting salaries (180/190k) because it’s the only job we could get or because it’s the only offer they got in their desired location. I got a higher offer but I could have been lowballed and I still probably would’ve took it because it was the only job I could get in my desired location. Thank god they didn’t low ball me (based on the volume I’ve been signing out). I live near a city pumping out 20+ grads a year and I only saw 5 or 6 jobs in a one hour radius lol. I personally am grateful for this job.
 
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Maybe I'm thinking about this the wrong way, but to me, this actually sounds like GOOD news in terms of job market prospects, not bad news.

The way I see it, getting ready to enter a market where X% of 21000 pathologists are getting ready to retire is MUCH better than entering a job market where X% of 13000 pathologists are getting ready to retire.

Why are people interpreting a larger pathologist workforce that previously thought as a bad thing? This means that our workforce is actually much bigger than we initially thought, so more jobs are going to potentially become available as people retire... right?
I’m guessing basic economics isn’t your forte. When it takes 3-6 months to find a job, let alone one in an area you want, there‘s a problem with over saturation. Moreover, the low salaries exist because of this saturation. In this musical chairs of a job market we got, you often take the first chair you see open- at any price - because you don’t want to be left standing holding >$200K med school debt and no way to make ends meet. And no, pathology is the rare field where you can actually still be reading slides the week you die. We’ve been told about this retirement cliff for decades but it’s never materialized in a meaningful way.
 

doctor313

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Your points are all valid about the job market currently being bad, and I do not deny that an over-supply of pathologists is at the root of the current job situation. However, no one actually spoke to the point I was trying to make.

Again, I am not denying that the job market is currently undesirable for pathologists compared to other that of many other specialties.

The point I am trying to make is that the "discovery" that there are really closer to 23,000 pathologists in the current job market as opposed to the previously-reported 13,000 means that the number of "chairs" in the "musical chairs" analogy that was given earlier is actually much larger than we were initially being told. That means there could be up to 40% more potential jobs out there than was previously predicted for the 600+ trainees/year being released into the workforce to fill as people retire / die at their microscopes.

In other words, that there are suddenly "more" pathologists out there than we previously thought does not in and of itself make the job market worse than it already is. These extra 10,000 people didn't just enter the workforce when that paper was published, they are already there, working tirelessly to fill SDN up with horror stories about the job market in their free time between signing out cases.

To me, the updated numbers mean that the assumptions underlying the previously predicted deficit in pathologists that was expected in the next few years due to our aging pathologist workforce may have been underestimating the true future need, as a greater number of jobs will probably become vacant than was predicted with 13,000 as the denominator compared to 23,000.

You are welcome to insult me if it makes you feel good about yourself (it's easy for me to discount the personal attacks people make in the guise of anonymity), but if anyone wishes to genuinely address my point, I'd be interested in reading your response.
 

gbwillner

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I’m guessing basic economics isn’t your forte. When it takes 3-6 months to find a job, let alone one in an area you want, there‘s a problem with over saturation. Moreover, the low salaries exist because of this saturation. In this musical chairs of a job market we got, you often take the first chair you see open- at any price - because you don’t want to be left standing holding >$200K med school debt and no way to make ends meet. And no, pathology is the rare field where you can actually still be reading slides the week you die. We’ve been told about this retirement cliff for decades but it’s never materialized in a meaningful way.
Let's not be overly harsh. There is a definite point here that is not incorrect. If the assumed total positions outstanding has been undercounted, it is not improper to question what effects this may have on the market and what assumptions we have about the way the market even works. Knowing that there was an undercount does not make the current market conditions worse or better; it merely helps us understand it more. As it is, the market is not like in other similar specialties (if there even are any), but it is also not so dire that there are lines of unemployed pathologists. Your economic rationale for a response to Doctor313's comment is at best a red herring and in no way actually addresses his point.
 
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Alteran

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Let's not be overly harsh. There is a definite point here that is not incorrect. If the assumed total positions outstanding has been undercounted, it is not improper to question what effects this may have on the market and what assumptions we have about the way the market even works. Knowing that there was an undercount does not make the current market conditions worse or better; it merely helps us understand it more. As it is, the market is not like in other similar specialties (if there even are any), but it is also not so dire that there are lines of unemployed pathologists. Your economic rationale for a response to Doctor313's comment is at best a red herring and in no way actually addresses his point.
In my brevity I failed to illustrate the illusion of our workforce arising out of the oversupply. The question that should be asked is how many pathology jobs are redundant and can be eliminated? We have on prior forums discussed the "false economy" of pathology. If all the work were to be consolidated and done efficiently by competent pathologists, how many of those 23,000 jobs can be eliminated without anyone noticing? I'll give you an example that played out here locally with our sister diagnostic field - radiology.

One local radiology group here was a juggernaut. It was privately owned with multiple facilities where they owned all the equipment with 60+ radiologists and about a dozen or so partners. The partners decided it was a good idea to sell out to the radiology equivalent of quest or labcorp. When COVID hit, over 20 radiologists were let go and their work was consolidated with the remaining radiologists with no intent to hire them back. Effectively, 20+ radiologists jobs were vaporized forever. In the final analysis, these radiologist positions were created out of convenience for coverage and vacation- they were not necessary for the essential functions of the practice. No referring physician has even noticed their absence because they still get their reports in the timely manner.

Pathology has the same issue. I would bet good money that a double digit percentage of those 23,000 jobs are created simply because they can be. That is to say that if it comes to hiring a well trained pathologist starting at $275K+ (or just simply absorb and redistribute amongst the remaining pathologists), you could instead hire 2 for about $150K each (positions that will be filled by the way) and get double your return in work distribution and vacation time coverage. And I would go so far as to say that the most egregious contributors of the false economy of pathology are the academic centers that seem to materialize low paid positions like "clinical instructorships" out of thin air simply for their convenience and as a method to out compete the local groups in work capacity and turn around time.

While I'm frank and blunt in my delivery, I'm not out to deliberately insult anyone. I do however want to make the point that a great many pathology jobs exist simply because what would've been one good FTE is now split multiple ways. And because of this there’s no guarantee what so ever that if a position opens up it’ll be filled again.
 
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doctor313

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In my brevity I failed to illustrate the illusion of our workforce arising out of the oversupply. The question that should be asked is how many pathology jobs are redundant and can be eliminated? We have on prior forums discussed the "false economy" of pathology. If all the work were to be consolidated and done efficiently by competent pathologists, how many of those 23,000 jobs can be eliminated without anyone noticing? I'll give you an example that played out here locally with our sister diagnostic field - radiology.

One local radiology group here was a juggernaut. It was privately owned with multiple facilities where they owned all the equipment with 60+ radiologists and about a dozen or so partners. The partners decided it was a good idea to sell out to the radiology equivalent of quest or labcorp. When COVID hit, over 20 radiologists were let go and their work was consolidated with the remaining radiologists with no intent to hire them back. Effectively, 20+ radiologists jobs were vaporized forever. In the final analysis, these radiologist positions were created out of convenience for coverage and vacation- they were not necessary for the essential functions of the practice. No referring physician has even noticed their absence because they still get their reports in the timely manner.

Pathology has the same issue. I would bet good money that a double digit percentage of those 23,000 jobs are created simply because they can be. That is to say that if it comes to hiring a well trained pathologist starting at $275K+ (or just simply absorb and redistribute amongst the remaining pathologists), you could instead hire 2 for about $150K each (positions that will be filled by the way) and get double your return in work distribution and vacation time coverage. And I would go so far as to say that the most egregious contributors of the false economy of pathology are the academic centers that seem to materialize low paid positions like "clinical instructorships" out of thin air simply for their convenience and as a method to out compete the local groups in work capacity and turn around time.

While I'm frank and blunt in my delivery, I'm not out to deliberately insult anyone. I do however want to make the point that a great many pathology jobs exist simply because what would've been one good FTE is now split multiple ways. And because of this there’s no guarantee what so ever that if a position opens up it’ll be filled again.

Thanks for the detailed and thoughtful reply. Makes a lot of sense. But regarding the splitting of jobs and false economy, if two pathologists are doing the work of one, that means each one is doing "half" the work of a "true" FTE. Why should two "half" pathologists expect to get paid $275,000 for doing half the work of someone who does one "true" FTE? It seems to me like there is more to it than that, because people on these forums don't seem to complain about not having enough cases to sign out in a given day.

I wonder if part of the economic problems comes from the trend towards subspecialization in pathology. People who get really good at a narrow area likely are becoming much more productive then general pathologists who sign out a little bit of everything (especially specialists in high-volume areas like derm, GI, etc). A subspecialist who gets really good at a narrow area of pathology can probably crank through 2-3 FTEs worth of work in their specialty, and whoever is employing them is pocketing the profits from that productivity. One productive specialist at an academic center doing the work of 2-3 general pathologists may be earning about half the pay of one of FTE general pathologist in private practice. However, they are also offsetting the lower productivity of other subspecialists in lower-volume specialties like bone/soft tissue, head/neck, etc who are doing maybe a quarter or half an FTE of sign-out, and spending the rest of their time doing teaching/research.

I one of the "benefits" of pumping out lots of trainees is to generate bodies who can fill up subspecialty fellowship positions. The subspecialists themselves become more productive at a narrow area than generalists overall, but they are dependent on large labs/academic departments for employment, because they don't have the confidence to work in a smaller hospital and do general sign-out. The large labs/departments capitalize on the increased productivity of their specialist employees, benefit from being recognized as having experts in each subspecialty, and while the generalist pathologists are marginalized and their positions gradually get eliminated by consolidation into larger labs who employ the specialists.
 

msnbc2020

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Thanks for the detailed and thoughtful reply. Makes a lot of sense. But regarding the splitting of jobs and false economy, if two pathologists are doing the work of one, that means each one is doing "half" the work of a "true" FTE. Why should two "half" pathologists expect to get paid $275,000 for doing half the work of someone who does one "true" FTE? It seems to me like there is more to it than that, because people on these forums don't seem to complain about not having enough cases to sign out in a given day.

I wonder if part of the economic problems comes from the trend towards subspecialization in pathology. People who get really good at a narrow area likely are becoming much more productive then general pathologists who sign out a little bit of everything (especially specialists in high-volume areas like derm, GI, etc). A subspecialist who gets really good at a narrow area of pathology can probably crank through 2-3 FTEs worth of work in their specialty, and whoever is employing them is pocketing the profits from that productivity. One productive specialist at an academic center doing the work of 2-3 general pathologists may be earning about half the pay of one of FTE general pathologist in private practice. However, they are also offsetting the lower productivity of other subspecialists in lower-volume specialties like bone/soft tissue, head/neck, etc who are doing maybe a quarter or half an FTE of sign-out, and spending the rest of their time doing teaching/research.

I one of the "benefits" of pumping out lots of trainees is to generate bodies who can fill up subspecialty fellowship positions. The subspecialists themselves become more productive at a narrow area than generalists overall, but they are dependent on large labs/academic departments for employment, because they don't have the confidence to work in a smaller hospital and do general sign-out. The large labs/departments capitalize on the increased productivity of their specialist employees, benefit from being recognized as having experts in each subspecialty, and while the generalist pathologists are marginalized and their positions gradually get eliminated by consolidation into larger labs who employ the specialists.
I think you are clueless about how pathology groups operate. The partners often do far less work than the non-partners.
 

doctor313

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Sep 24, 2016
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Thanks for taking the time to tell me what you think of me, but just out of curiosity - why do you spend your time on and donate money to "student-doctor network?" Is it so you can have a platform for insulting trainees, or so that you can mentor those who wish to learn from you?

How should a trainee be expected know how pathology groups operate if they have never worked in one?

If you have knowledge to share, share it. There is no need to insult someone who is genuinely trying to learn from those who are more experienced than them.
 

KeratinPearls

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Thanks for taking the time to tell me what you think of me, but just out of curiosity - why do you spend your time on and donate money to "student-doctor network?" Is it so you can have a platform for insulting trainees, or so that you can mentor those who wish to learn from you?

How should a trainee be expected know how pathology groups operate if they have never worked in one?

If you have knowledge to share, share it. There is no need to insult someone who is genuinely trying to learn from those who are more experienced than them.
Young lad. Listed to Webb, LADoc and meddirector, mikesheree, Alteran they know about private practice. If you want to do academics listen to BUPathology but I think we all scared him away lol.
 
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So the Metter paper should be retracted at this point. I would be embarrassed If I had my name attached to something published so far from the truth.

to me the number of practicing paths reported out in that paper was not as important as the trend. The authors claimed a huge reduction in practicing pathologists in about a 10 yr time. When in fact it looks like the numbers of paths were at least holding steady and likely increasing a little bit. It never made sense to me, paths esp since I started practice never seem to retire. I know a ton of 70+ and quite a few 80+ in practice full or part time. The number in practice, is important to know but it still doesn’t really inform on the future need for pathologists. I still think a better proxy on demand for the newly minted pathologist is to look at the offer (salary and sign on incentives), the number of offers, etc. talk to any MD recruiter / headhunter and ask them what fields they get hired to fill and which fields are in demand. I guarantee you will not hear them include pathology in this list. talk to your good friends who are moving onfrom training - see what kind of offers they are getting. See if you can find someone getting a sign on bonus of 50k or loan forgiveness. You want find this in path, but it is common in many fields.
 

msnbc2020

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So the Metter paper should be retracted at this point. I would be embarrassed If I had my name attached to something published so far from the truth.

to me the number of practicing paths reported out in that paper was not as important as the trend. The authors claimed a huge reduction in practicing pathologists in about a 10 yr time. When in fact it looks like the numbers of paths were at least holding steady and likely increasing a little bit. It never made sense to me, paths esp since I started practice never seem to retire. I know a ton of 70+ and quite a few 80+ in practice full or part time. The number in practice, is important to know but it still doesn’t really inform on the future need for pathologists. I still think a better proxy on demand for the newly minted pathologist is to look at the offer (salary and sign on incentives), the number of offers, etc. talk to any MD recruiter / headhunter and ask them what fields they get hired to fill and which fields are in demand. I guarantee you will not hear them include pathology in this list. talk to your good friends who are moving onfrom training - see what kind of offers they are getting. See if you can find someone getting a sign on bonus of 50k or loan forgiveness. You want find this in path, but it is common in many fields.
So true.
 
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WEBB PINKERTON

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I have CAP inspected and know of many labs that have way too many pathologists. I have no clue why they don't privatize the VA labs in this country. I inspected an operation a few years ago with TWO pathologists and around 2000 surgicals. Each of them does less work in a year than I do in a month. Like others said, we have a false market that lead to creation of in-office labs and other exploitation. Those places would not exist if not for the surplus. Insultingly low client pricing would not exist. Derms wouldn't be forcing the paths in my area to do skins for 5 dollars on the TC. We probably could furlough 25 percent or more of the pathologists in this country and be fine. Hopefully unnecessary procedures and specimens would disappear and our health care costs would go down.
 

KeratinPearls

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I have CAP inspected and know of many labs that have way too many pathologists. I have no clue why they don't privatize the VA labs in this country. I inspected an operation a few years ago with TWO pathologists and around 2000 surgicals. Each of them does less work in a year than I do in a month. Like others said, we have a false market that lead to creation of in-office labs and other exploitation. Those places would not exist if not for the surplus. Insultingly low client pricing would not exist. Derms wouldn't be forcing the paths in my area to do skins for 5 dollars on the TC. We probably could furlough 25 percent or more of the pathologists in this country and be fine. Hopefully unnecessary procedures and specimens would disappear and our health care costs would go down.
Sadly this has been discussed ad nauseum by Experienced pathologists in the trenches for the past 10 years but nothing has changed. Our voice is only on SDN.
 
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y2k_free_radical

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So the Metter paper should be retracted at this point. I would be embarrassed If I had my name attached to something published so far from the truth.

to me the number of practicing paths reported out in that paper was not as important as the trend. The authors claimed a huge reduction in practicing pathologists in about a 10 yr time. When in fact it looks like the numbers of paths were at least holding steady and likely increasing a little bit. It never made sense to me, paths esp since I started practice never seem to retire. I know a ton of 70+ and quite a few 80+ in practice full or part time. The number in practice, is important to know but it still doesn’t really inform on the future need for pathologists. I still think a better proxy on demand for the newly minted pathologist is to look at the offer (salary and sign on incentives), the number of offers, etc. talk to any MD recruiter / headhunter and ask them what fields they get hired to fill and which fields are in demand. I guarantee you will not hear them include pathology in this list. talk to your good friends who are moving onfrom training - see what kind of offers they are getting. See if you can find someone getting a sign on bonus of 50k or loan forgiveness. You want find this in path, but it is common in many fields.
The upside to this is the increased removal of older physicians by the CORONA VIRUS thereby creating new openings.
 

Alteran

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Thanks for the detailed and thoughtful reply. Makes a lot of sense. But regarding the splitting of jobs and false economy, if two pathologists are doing the work of one, that means each one is doing "half" the work of a "true" FTE. Why should two "half" pathologists expect to get paid $275,000 for doing half the work of someone who does one "true" FTE? It seems to me like there is more to it than that, because people on these forums don't seem to complain about not having enough cases to sign out in a given day.
They shouldn't expect to be paid a high sum of money for little work. But that's not often what happens in the real world. In the real world, depending on your possible future employers, you'll be a commodity sold and traded at the lowest price point possible while maximizing the employer's gain. In predatory private practice groups, you're hired at the $150-180K range for 3-5 years with the expectation that you'll produce more than your salary (which they will pocket) and then you'll either be made partner or dumped at the end of your contract for another pathologist to be hired once again at the low salary range to begin the cycle once gain (so called "churn and burn" operation). The same goes with the megalab (i.e. labcorp, quest, etc.) practice model with the exception that there is no expectation of ownwership/partnership in such a practice - you're an employee forever. From the employer's perspective the oversupply is a total boon. It allows them quick and effective modulation of their workforce and profit margins basically at will without any consequence to their work flow. They hire low-paid FTEs that generate profit in the good times and then dump them in the rough times just as easily.

In a market where supply was more tightly controlled, a pathologist could basically tell such an employer to shove it and those positions would either remain unfilled until the salary matched productivity more closely or be consolidated into the existing pathologist workforce.
 

KeratinPearls

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They shouldn't expect to be paid a high sum of money for little work. But that's not often what happens in the real world. In the real world, depending on your possible future employers, you'll be a commodity sold and traded at the lowest price point possible while maximizing the employer's gain. In predatory private practice groups, you're hired at the $150-180K range for 3-5 years with the expectation that you'll produce more than your salary (which they will pocket) and then you'll either be made partner or dumped at the end of your contract for another pathologist to be hired once again at the low salary range to begin the cycle once gain (so called "churn and burn" operation). The same goes with the megalab (i.e. labcorp, quest, etc.) practice model with the exception that there is no expectation of ownwership/partnership in such a practice - you're an employee forever. From the employer's perspective the oversupply is a total boon. It allows them quick and effective modulation of their workforce and profit margins basically at will without any consequence to their work flow. They hire low-paid FTEs that generate profit in the good times and then dump them in the rough times just as easily.

In a market where supply was more tightly controlled, a pathologist could basically tell such an employer to shove it and those positions would either remain unfilled until the salary matched productivity more closely or be consolidated into the existing pathologist workforce.
Great post Alteran. Some ppl in academics or those without business/economic sense will never understand what you just wrote and I don’t think they ever will because it doesn’t affect them. Just as long as they have a steady flow of young trainees, that’s all they care about. How that flow of trainees affects pathologists in the private sector they have no worries about and why should they? Academics teach, mentor, some supposedly do research, order residents/fellows around. Do you think they give a rats [email protected] what’s happening in private practice? No!

The winners are academics, predatory groups and corporate labs. I forgot the urologists and gastroenterologists.

The best thing about all this ranting is that the higher ups in Path are starting to take notice of this forum.
 
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