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Tissue issue

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When they sold they had something like 8-10 dermpaths seeing 160-250 specimen containers a day. High volume.
 
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no wonder so many people want to do dermpath!!! $$$$

Yes, but those people won't be receiving the high-paying jobs anymore. My program director is actually deterring path-trained candidates from applying because the job market is terrible. Derm-trained fellows will always get a job and can fall back on doing clinical derm. There are jobs that are surg path + derm path, but those aren't the ones that are offering $$$ that everyone wants. There are experienced dermpaths that have been recently "let go" because there aren't sufficient cases to justify their salary. Graduating dermpath fellows are now competing with such folks. In the NYC metro area, dermpath labs are fighting for contributors. At least the dermpath training programs are seeing the problem and are cutting back on the number of positions that are offered. However, this only makes getting the fellowship more cut throat than it already has been.
 
People are strange! If I was able to sell my business for $40 million cash, I would just retire and disappear. I guarantee you I would not care one iota about any potential conflicts of my previous employment contract or whatever. (Hell, if I suddenly came into $4 million with no outstanding debts, I'd probably do the same thing...)
 
Yes, but those people won't be receiving the high-paying jobs anymore. My program director is actually deterring path-trained candidates from applying because the job market is terrible. Derm-trained fellows will always get a job and can fall back on doing clinical derm. There are jobs that are surg path + derm path, but those aren't the ones that are offering $$$ that everyone wants. There are experienced dermpaths that have been recently "let go" because there aren't sufficient cases to justify their salary. Graduating dermpath fellows are now competing with such folks. In the NYC metro area, dermpath labs are fighting for contributors. At least the dermpath training programs are seeing the problem and are cutting back on the number of positions that are offered. However, this only makes getting the fellowship more cut throat than it already has been.

Funny how dermpath training programs are cutting back as you say but not path training programs in general.
 
Funny how dermpath training programs are cutting back as you say but not path training programs in general.

They are smart. Plus, it's a smaller subset of pathology so things can be accomplished more efficiently. Half, if not more, of the fellowship training programs are run by dermatology-trained DPs. To my experience, the AAD, as opposed to the CAP, has a more powerful say, but that's a different topic all together. Several of the larger fellowship programs are affiliated with a lab (i.e. Dermpath Diagnostics/Quest) and once the $$ went slightly south and the competition soared, they rightfully cut back on the number of spots they had. One DP director said, "Why would I train a pathologist when all he would do is take away my business? At least with a dermatologist, he would do some biopsies and contribute somehow." A director at a program that is about to close specifically wanted to open the program so that he could train fellows who would ultimately see patients in clinic and help out with the DP caseloads. Now a few years later, he has those folks so he's shutting down the program. It's all about politics and money. Yes, the DPs are reacting to this oversupply with haste and proper timing.
 
They are smart. Plus, it's a smaller subset of pathology so things can be accomplished more efficiently. Half, if not more, of the fellowship training programs are run by dermatology-trained DPs. To my experience, the AAD, as opposed to the CAP, has a more powerful say, but that's a different topic all together. Several of the larger fellowship programs are affiliated with a lab (i.e. Dermpath Diagnostics/Quest) and once the $$ went slightly south and the competition soared, they rightfully cut back on the number of spots they had. One DP director said, "Why would I train a pathologist when all he would do is take away my business? At least with a dermatologist, he would do some biopsies and contribute somehow." A director at a program that is about to close specifically wanted to open the program so that he could train fellows who would ultimately see patients in clinic and help out with the DP caseloads. Now a few years later, he has those folks so he's shutting down the program. It's all about politics and money. Yes, the DPs are reacting to this oversupply with haste and proper timing.

Dermatologists really have good business sense. Pathologists depend on cheap labor (gross monkeys) so there is no need to shutdown a program.
 
When they sold they had something like 8-10 dermpaths seeing 160-250 specimen containers a day. High volume.

That's a good volume... for 2 derm paths. At our training institution each pathologist signed out over 100 cases a day 5 days a week.
 
They are smart. Plus, it's a smaller subset of pathology so things can be accomplished more efficiently. Half, if not more, of the fellowship training programs are run by dermatology-trained DPs. To my experience, the AAD, as opposed to the CAP, has a more powerful say, but that's a different topic all together. Several of the larger fellowship programs are affiliated with a lab (i.e. Dermpath Diagnostics/Quest) and once the $$ went slightly south and the competition soared, they rightfully cut back on the number of spots they had. One DP director said, "Why would I train a pathologist when all he would do is take away my business? At least with a dermatologist, he would do some biopsies and contribute somehow." A director at a program that is about to close specifically wanted to open the program so that he could train fellows who would ultimately see patients in clinic and help out with the DP caseloads. Now a few years later, he has those folks so he's shutting down the program. It's all about politics and money. Yes, the DPs are reacting to this oversupply with haste and proper timing.

Sadly, we have overtrained in derm, too - particularly the subspecialties. It has been a raging debate for a decade, and the wrong side got their way. The increase in trainees on a relative basis from 2000 to now has been ridiculous - from around 200 then to 270 something now (more, really - those are just the ones offered through the match. The actual number of pgy2 spots has increased to 329 :eek:). A relative increase of that size will play hell with equilibrium dynamics, a point I made as a resident in a dermatology workforce symposium at the AAD... right before being scolded as a child and instructed to sit down by some asshat program director who shall remain unnamed.
 
That's a good volume... for 2 derm paths. At our training institution each pathologist signed out over 100 cases a day 5 days a week.

You misunderstood - that is 180-250 specimen containers a day EACH. This is a very, very high volume lab. They have accessioners, histo staff, and support staff working almost around the clock. The regular joe dermpaths get paid very well, but as you can see the owners made huge money when they sold. Plus I don't think there's anything along the lines of a partner track or the like, especially now that it's owned by an investment company.
 
Dermatologists really have good business sense. Pathologists depend on cheap labor (gross monkeys) so there is no need to shutdown a program.

Well this is no surprise. Smart people go into derm. Average/below-average +/- avoidant personality disorders go into path.
 
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Well this is no surprise. Smart people go into derm. Average/below-average +/- avoidant personality disorders go into path.

Substance, I can't really argue with the fact that derm is more competitive than pathology - based off of the latest available "charting outcomes in the match" data, U.S. seniors matching into derm do have higher step scores (244 and 253) than U.S. seniors matching into path (226 and 235). However, the average U.S. senior pathology scores are almost identical to the average scores of U.S. seniors matching into ALL specialties - so I don't think that our residents are in any way "below average."

https://www.aamc.org/students/download/62400/data/chartingoutcomes.pdf

Also, as someone who has been told repeatedly that my personality/people skills would have made me a great ____ physician (whatever 3rd year rotation I was on) and as someone with higher than average step scores, I find your comment rude.
 
Well this is no surprise. Smart people go into derm. Average/below-average +/- avoidant personality disorders go into path.

You should probably focus on your own personality disorder before lumping many folks under those labels.
 
Substance, I can't really argue with the fact that derm is more competitive than pathology - based off of the latest available "charting outcomes in the match" data, U.S. seniors matching into derm do have higher step scores (244 and 253) than U.S. seniors matching into path (226 and 235). .

That is a massive difference, like over 1 s.d. difference.
 
You should probably focus on your own personality disorder before lumping many folks under those labels.

I was a little harsh with the personality disorder comment, and I do redact that. However, your field has a huge problem which your governing bodies fail to rectify, and a lot of it has to do with the ethics of people in your field and the standards of practice/practitioner competence.

To accept mostly average people into your field is to accept average practice results. Furthermore, the academic leaders are more concerned about CV buffing than about providing adequate training for patient care, and community PDs want to stay within budget, so both of these things cause them to relax the standards of admission(to get research and gross monkeys). I understand from reading here that pathology residency prepares one very little for practice. This is the only residency I know of that generally cannot produce competent practitioners, and that is entirely unacceptable.

The fact that derm controls the market for dermpath is a boon to path trained dermpaths because derm will absolutely balance supply with demand, ensuring that those that practice the field are competent, ensuring good patient care, and also well-rewarded, ensuring that competent people fill their ranks. Path should have taken a similar approach, if patient care was the primary incentive. But it is not: budgets and academic masturbation are.

Your standards as a field are too lax, and there are far too many ulterior motives for recruiting residents beyond patient care, which was the point of my first comment. Until this is changed, your field will still be seen as a commodity and as the destination for unfit, incompetent clinical students.

The recruitment problem was a factor in 1986, and it hasn't changed much as far as can be gleaned:
http://www.ncbi.nlm.nih.gov/pubmed/3679185
 
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You misunderstood - that is 180-250 specimen containers a day EACH. This is a very, very high volume lab. They have accessioners, histo staff, and support staff working almost around the clock. The regular joe dermpaths get paid very well, but as you can see the owners made huge money when they sold. Plus I don't think there's anything along the lines of a partner track or the like, especially now that it's owned by an investment company.

:eek:
 
If they sold for 40m, their EBITA was in the range of 8m. That is roughly 80,000 specimens per year.
 
I understand from reading here that pathology residency prepares one very little for practice. This is the only residency I know of that generally cannot produce competent practitioners, and that is entirely unacceptable. [/url]

I would suggest that this comment is complete crap. I think that good path programs produce good pathologists and bad programs produce poor pathologists. I would further suggest that this is true of many other disciplines in medicine too. In the case of family practice for example, There are plenty of mediocre FP doctors and I'm sure that anyone living in the USA could attest to that.

The fact that derm controls the market for dermpath is a boon to path trained dermpaths because derm will absolutely balance supply with demand, ensuring that those that practice the field are competent, ensuring good patient care, and also well-rewarded, ensuring that competent people fill their ranks. Path should have taken a similar approach, if patient care was the primary incentive. But it is not: budgets and academic masturbation are. [/url]
I'd like to think that dermpath training programs are decreasing in number but I know of only a few examples where this is true. Can someone provide a list of programs that are reducing the number of trainees or shutting down completely?
 
They sold for 80M with 40M going to each of the two owners.

I don't know if the same formula applies for that type of lab with that type of volume but back in the day when large companies would purchase small pathology practices the going rate was 4-5 times annual revenue minus expenses, which for a small hospital based pathology practice is basically 4-5 times the dollars paid out in salary.
 
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I'd like to think that dermpath training programs are decreasing in number but I know of only a few examples where this is true. Can someone provide a list of programs that are reducing the number of trainees or shutting down completely?

If anything dermpath fellowships increased significantly in the last ten years. In the Boston area where I did residency Tufts added two spots at this DP lab, Caris/Cohen (now Miraca), Umass added a spot, and there was already the Harvard fellowship and BU fellowships. So basically every program now had dermpath. I know from experience that the dermpath job market is very tight these days and people fresh out of fellowship are having trouble finding DP jobs, often settling for other fields and waiting until something opens up. Hopefully some programs close because it seems like they did over shoot the market.
 
I would suggest that this comment is complete crap. I think that good path programs produce good pathologists and bad programs produce poor pathologists. I would further suggest that this is true of many other disciplines in medicine too. In the case of family practice for example, There are plenty of mediocre FP doctors and I'm sure that anyone living in the USA could attest to that.


I'd like to think that dermpath training programs are decreasing in number but I know of only a few examples where this is true. Can someone provide a list of programs that are reducing the number of trainees or shutting down completely?

Here are the ones I can think of off hand:

UTSW/Cockerell: from 4 to 2 (starting now)
UCSF: from 2 to 1 (happened already)
NYU: from 2 to 1 (starting soon)
Drexel: from 1 to 0 (closing soon)
Thomas Jefferson: from 1 to 0 (in its last year)
Ackerman Academy/SUNY Downstate: used be ~5 but now 3 ACGME fellows a year unless some really bizarre situation came up (like taking a rejected Cockerell fellow)
 
They sold for 80M with 40M going to each of the two owners.

hahaha. What a scam. Caris must be filled with idiots to have drank an 80M single practice Kool Aid deal.

The derm people should have left town, why the heck would you be working after an 80M sale?

LEAVE. vanish into the jungle somewhere.
 
hahaha. What a scam. Caris must be filled with idiots to have drank an 80M single practice Kool Aid deal.

The derm people should have left town, why the heck would you be working after an 80M sale?

LEAVE. vanish into the jungle somewhere.

Right

knock off 15% for capital gains and you still got a cool 34 million.

Per Mikesherre's formula that would mean you could live off 1.28 million a year for the rest of your life and not touch the principal.

BUt if I had 34 million, I'm touching the principal. I'm sure the kids wouldn't mind a measly 5 million each if they also inherited my NYC west village apartment, my aspen ski house, and my yacht.
 
$40 million? I wonder what their volume was?
My estimation is as follows:

1-The purchase price must have been between 6-7 time the EBITDA (earning before interest, taxes, depreciation and amortization). I presume this because
a-the year of sale, 2007 was about the peak of bubble before stock market crash.
b-Caris purchased this as their flagship Lab
c-It is unusual for a purchase to be all cash, therefore, either the multiple must have been toward the low range or Caris must have thought very highly of Lab

2-The usual derm lab's ebitda is between 50 to 65% of the net gross revenue.

3-I do not know the insurance mix nor reimbursement schedule in Boston area, however, I would presume an average net gross revenue of 100.00 per bottle (including, special stains). I could be wrong on this assumption.

4-Given the foregoing, the math (for sale price of 80 million) would work out as follows
a- the best sale price scenario of 7 times ebitda + ebitda = 65% + 100.00 per bottle, would give an annual volume of 176K bottle or biopsies,

b-the worst sale price scenario of 6 times ebitda + ebitda = 50% + 100.00 per bottle, would give an annual volume of 267K bottle or biopsies

c-the mid range amount would be 221K bottles.

5-since a dermatopathologist in a commercial lab usually does 20k-25k per year, the above figures would agree with another poster's information that the lab had 8-10 pathologists.
 
Here are the ones I can think of off hand:

UTSW/Cockerell: from 4 to 2 (starting now)
UCSF: from 2 to 1 (happened already)
NYU: from 2 to 1 (starting soon)
Drexel: from 1 to 0 (closing soon)
Thomas Jefferson: from 1 to 0 (in its last year)
Ackerman Academy/SUNY Downstate: used be ~5 but now 3 ACGME fellows a year unless some really bizarre situation came up (like taking a rejected Cockerell fellow)

You can add:
UVA: decreasing from 3 to 2 spots (starting next year)
UMDNJ: Don't have funding for their fellowship spot (heard this last year from a UMDNJ resident during Osler)

Any more, anyone?
 
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