yaah

[LADoc00]

Quick ?: Is your GI fellow getting a job doing ONLY GI, general surg path or academics?

Does Appleman have an opinion the rise of these GI doc owned path pod operations? Does this spell the end of hospital based pathology in his opinion?

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[yaah]

I don't know what his opinion is on GI pod labs - he is basically an academic at heart though, but likes general path people too. I have a feeling he isn't a big fan of pod labs. He does not think hospital based path is going anywhere though - the expertise is key, and clinicians will demand it and many will not stand for pod labs, especially at academic centers. He is a big fan of clinician-pathologist interaction.

As for the fellow, I dunno. He is AP only, I think his goal is to get an academic job, but he is convinced that with AP only and GI fellowship, he can get a great private job. But I don't think that is his goal.

(I deleted his name from your post since it's a privacy issue)

 

[pathstudent]

With regards to the pod labs, it has nothing to do with wanting specialty based pathology. It has to do with making money. The truth is that the people that will take these jobs reading 10-15K cases a year for 200K-300K a year will be rubes right out of training or flunkees from real private practice outfits or academic drop-outs who lack the tact, work ethic and/or humility to go to private practice. Fortunately I think there are a lot more aspiring pod labs than there are available rubes, so I think a lot of these enterprises will fold. Pathology really needs its leadership to sort this out and put an end to it.

A lot of GI groups hire nurses to deliver the gas and then they bill for the anesthesia and pocket the rest rather than using real MDs. This is not exactly the same thing but its similar. They want to make money off physician services that they are not providing.

 

[yaah]

I agree to some extent - the pod labs don't want to hire just anyone (particularly specialty based pod labs) - they want to hire people who have sufficient credentials. And people with these credentials are less likely to take these jobs.

 

[pathstudent]

I agree to some extent - the pod labs don't want to hire just anyone (particularly specialty based pod labs) - they want to hire people who have sufficient credentials. And people with these credentials are less likely to take these jobs.

Well sure, ideally they would like to hire "GI-pathologists" if they are are GI group. But is someone who is just out of fellowship going to be a better GI pathologist than someone who has seen 20,000 biopsies and all the pitfalls in 20 years of general practice? There is already outstanding quality in any group with experienced pathologists.

Plus I have met a few community pathologists from a group whose GI clients have informed them that they are going to build their own lab and hire a pathologist. The community path group has young GI fellowshiped people in it as well as pathologists with 20-25 years of experience, so the gastroenterologists won't be getting anything they don't already have except for a cut of the pathologist's income.

Yeah yeah, of course they would say they would like the best most experienced people to read their stuff, but if they can't ressurect Haggitt, they'll take anybody off the street. I bet a lot of them will settle for people right out of training that haven't done a GI fellowship. These new phenomenon is soley based upon greed and nothing else.

And I do agree with you that no one any good will take these jobs. The best people will get good jobs in private practice or persue an academic tract.

 

[yaah]

I agree with this - I am just saying that they would would have a bit of trouble getting outside business unless they post credentials of those that work there. Now, maybe they don't need to do this, I don't know, but I would expect it would help. They know and we know that someone in practice for 25 years is likely to be just as good as many people who have a "fellowship," but a lot of people who make decisions don't know this.

 

[djmd]

Well sure, ideally they would like to hire "GI-pathologists" if they are are GI group. But is someone who is just out of fellowship going to be a better GI pathologist than someone who has seen 20,000 biopsies and all the pitfalls in 20 years of general practice? There is already outstanding quality in any group with experienced pathologists.

And I do agree with you that no one any good will take these jobs.

You summed it all up with that last line.

The lawsuit potential (or the lawsuit eventual) might put a stop to this. A mistaken Dx, and you could sue the whole group. The pathologist because of the mistake, and the whole group for not sending the slides to an actual pathology practice, rather than their little caged GI monkey.