Yup, its bad.

[Dave CX]

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How are they gonna make her move?

They implied that she would lose her job. Wouldn't be much opportunity in my city. Had I known of her predicament I would have offered her work, I am busting my butt these days.

 

[rirriri]

They implied that she would lose her job. Wouldn't be much opportunity in my city. Had I known of her predicament I would have offered her work, I am busting my butt these days.

Can’t tell you how many emails I get from young un’s looking for jobs and there are none. Unless one enjoys South Dakota. Another issue is many have done 2 plus fellowships. I try to guide them the best I can.

It’s not negativity but the harsh reality of the march toward single payor ririrri. Academics may be fine for some, but this discussion Since 2012 is about business survival in a failing system.

When the newbies are coming out with 400k in loans plus cost of living for jobs that pay less than 150k, they need to know the struggle is real.

Wish I shared your optimism.

The whole philosophy behind “job hunting” in Pathology in 2019 is warped. Residents are blindly encouraged to do 2 or 3 fellowships as if there is some magic button that gets pressed if they do. I think there is a false notion of what constitutes a good Pathologist candidate. I think there are still very bright and able minds coming into Pathology but the lack of competitiveness has left it as a 2nd choice specialty for others; which leads to people landing Pathology not out of desire but out of circumstance. That in itself is never a good thing.

Yes I am wholly in the “academic bubble” as they say. That being said I think the best thing ALL of us can do regardless or whether we are academic, community, or private is to be elastic and prepared to deal with ANY change in the healthcare system.

If we approach the future with confidence rather than fear; the outcomes will certainly be better controlled and dealt with rather than If we scream and shriek like a horror film.

Medicine has changed a LOT over the past 50 years and will change a lot in the next 50 years. It will still be practiced though and will need us to be positive in the primary goal; which is patient care.

For all the impending doom and gloom I don’t know any residency graduate who has not gotten a job. There are jobs out there; some are better at navigating the market than others. Some take 2 weeks to find one some take 6 months.

 

[y2k_free_radical]

So much negativity here; primarily by private practice Pathologists from what I see.

The Path world isn’t going to run like a private practice; hate to break it to you. No we are not going to adhere to just a profit-making philosophy over the fine details of practicing Pathology. First and foremost you should care about patient care. The majority of Pathologists in this country are in hospital-based jobs and private practice factories are only a fraction of Path jobs. Private practice worry about every little financial change because the biggest part of that type of practice is the finances. Those of us who are focused on hospital or academic practice have different modes of funding. We aren’t solely concerned with policy or financial dynamics. Perhaps that’s why we’re not so negative.

Oversupply? Possibly. In big trouble? Nope. If you read SDN from 2012 you’ll find the same type of fear mongering and no those changes didn’t happen so instead of discouraging young Pathologists with fear; how about you contribute to solutions over time as well as offer constructive ideas rather than just point fingers and do nothing.

I am more excited than ever about Pathology and think we are at the epicenter of disease understanding just like Path was 50 years ago or more.

Worry about the science more than the RVUs. Worry about integrity more than $.

To med student hopefuls, trainees, or young attendings just KNOW there is a population of Pathologists who see things positively.

This place is called “STUDENT” Doctor Pathology not Angry Older Peeps Vent Room. Lol. Set a good example for young Doctors don’t fill up their minds with one sided negativity.

So it is unseemly for those of us pathologists who have to be both businessmen and scientists to care about remuneration ????

 

[rirriri]

So it is unseemly for those of us pathologists who have to be both businessmen and scientists to care about remuneration ????

Not saying don’t care; but surely there are other things to discuss here rather than the constant, incessant, one-dimensional financial doom and gloom parade I see being thrown down here.

This place is meant for people learning about the specialty, starting their training, contemplating the specialty, or people like some of us who have done those things in the past and are now advising as attendings.

Showing up to a cake tasting event and exhibition walking around screaming “sugar will kill you!” isn’t really my idea of a good time or optimal for a discussion.

 

[WEBB PINKERTON]

If people want to learn about the specialty, leave the computer and go out and job shadow. Don't take the word of anyone on the internet.

There is a lot of truth here and Al Gore-ish pathology will be dead in 12 years type of predictions as well. Which will be extinct first, polar bears or pathologists?

 

[rirriri]

If people want to learn about the specialty, leave the computer and go out and job shadow. Don't take the word of anyone on the internet.

There is a lot of truth here and Al Gore-ish pathology will be dead in 12 years type of predictions as well. Which will be extinct first, polar bears or pathologists?

Nah. Path will be fine...just like it has before. Will it be different? Of course. It’s very very different now than it was in 1984 and it will be very different in 2039 as compared to now.

As with anything; if you’re scared about something then it will certainly scare you. If you’re searching for new answers within uncertainty you will certainly find answers....as it unfolds.

 

[y2k_free_radical]

Not saying don’t care; but surely there are other things to discuss here rather than the constant, incessant, one-dimensional financial doom and gloom parade I see being thrown down here.

This place is meant for people learning about the specialty, starting their training, contemplating the specialty, or people like some of us who have done those things in the past and are now advising as attendings.

Showing up to a cake tasting event and exhibition walking around screaming “sugar will kill you!” isn’t really my idea of a good time or optimal for a discussion.

Tell all the art,history and other liberal arts majors that the love of the subject is all that matters.Compensation or ability to get a job are trivial matters.

 

[deleted978973]

Too bad pathology is in this state of affairs. Looking inward as an M2 it really looked like it would be my dream specialty. Though when I started looking at programs I noticed that almost all of them are filled with FMGs, even the top-rated ones. I took that as an enormous red flag and came to other sites like this one for more info. It seems my suspicion was right.

 

[rirriri]

Tell all the art,history and other liberal arts majors that the love of the subject is all that matters.Compensation or ability to get a job are trivial matters.

Not trivial but not the whole story. Not everyone has difficulty getting a job. Not everyone’s sole priority is compensation. It can be an issue; but not worth sabotaging a good forum meant for students and trainees for.

 

[rirriri]

Too bad pathology is in this state of affairs. Looking inward as an M2 it really looked like it would be my dream specialty. Though when I started looking at programs I noticed that almost all of them are filled with FMGs, even the top-rated ones. I took that as an enormous red flag and came to other sites like this one for more info. It seems my suspicion was right.

If you like a specialty you shouldn’t care whether there are FMGs or not. And no the “truth” told here often isn’t the entire truth. If you’re interested in Path, make that decision on your own with electives and communication with Pathologists. Don’t buy into all the fear mongering.

Path is a wonderful specialty. Full of smart people who are dedicated and full of fascinating work. 8 years into academic practice there’s nothing else I’d rather be doing.

 

[y2k_free_radical]

If you like a specialty you shouldn’t care whether there are FMGs or not. And no the “truth” told here often isn’t the entire truth. If you’re interested in Path, make that decision on your own with electives and communication with Pathologists. Don’t buy into all the fear mongering.

Path is a wonderful specialty. Full of smart people who are dedicated and full of fascinating work. 8 years into academic practice there’s nothing else I’d rather be doing.

I concur that the scientific side of pathology has never been better.However,the business side has never been worse since the mid sixties.Recently,the seemingly inexorable slide in reimbursement and influence has speed up exponentially.Please reply to the severe cuts by private payers to 50-70 % medicare.How much free care do you provide ?????Do you really think your colleagues in other specialties or ADMINISTRATORS consider you their equal???Pathology will endure but we will be CHILDREN OF A LESSER GOD.

 

[deleted978973]

I concur that the scientific side of pathology has never been better.However,the business side has never been worse since the mid sixties.Recently,the seemingly inexorable slide in reimbursement and influence has speed up exponentially.Please reply to the severe cuts by private payers to 50-70 % medicare.How much free care do you provide ?????Do you really think your colleagues in other specialties or ADMINISTRATORS consider you their equal???Pathology will endure but we will be CHILDREN OF A LESSER GOD.

Ya I think after all I've researched, the only way I'd choose Path now is if I had rich parents and was going to graduate med school debt free.

 

[Merely]

You realize at the “going rate” rad onc is still almost twice path.

Stop trolling us. There are many pathologists apparently that would not only cover the work but also perform degrading sexual favors for 1200 a day haul....

This is absolutely a disaster

LOL wtf is happening with medicine..this is so sad yet kinda funny too..

 

[FourCandles]

So much negativity here; primarily by private practice Pathologists from what I see.

The Path world isn’t going to run like a private practice; hate to break it to you. No we are not going to adhere to just a profit-making philosophy over the fine details of practicing Pathology. First and foremost you should care about patient care. The majority of Pathologists in this country are in hospital-based jobs and private practice factories are only a fraction of Path jobs. Private practice worry about every little financial change because the biggest part of that type of practice is the finances. Those of us who are focused on hospital or academic practice have different modes of funding. We aren’t solely concerned with policy or financial dynamics. Perhaps that’s why we’re not so negative.

Oversupply? Possibly. In big trouble? Nope. If you read SDN from 2012 you’ll find the same type of fear mongering and no those changes didn’t happen so instead of discouraging young Pathologists with fear; how about you contribute to solutions over time as well as offer constructive ideas rather than just point fingers and do nothing.

I am more excited than ever about Pathology and think we are at the epicenter of disease understanding just like Path was 50 years ago or more.

Worry about the science more than the RVUs. Worry about integrity more than $.

To med student hopefuls, trainees, or young attendings just KNOW there is a population of Pathologists who see things positively.

This place is called “STUDENT” Doctor Pathology not Angry Older Peeps Vent Room. Lol. Set a good example for young Doctors don’t fill up their minds with one sided negativity.

Your moral compass is set correctly. However, if the ship is sailing towards financial ruins, what's the point boarding the ship in the first place? Morality alone can not save humanity.

 

[Vicinal]

Well stated and thanks

 

[Alteran]

The whole philosophy behind “job hunting” in Pathology in 2019 is warped. Residents are blindly encouraged to do 2 or 3 fellowships as if there is some magic button that gets pressed if they do. I think there is a false notion of what constitutes a good Pathologist candidate. I think there are still very bright and able minds coming into Pathology but the lack of competitiveness has left it as a 2nd choice specialty for others; which leads to people landing Pathology not out of desire but out of circumstance. That in itself is never a good thing.

Yes I am wholly in the “academic bubble” as they say. That being said I think the best thing ALL of us can do regardless or whether we are academic, community, or private is to be elastic and prepared to deal with ANY change in the healthcare system.

If we approach the future with confidence rather than fear; the outcomes will certainly be better controlled and dealt with rather than If we scream and shriek like a horror film.

Medicine has changed a LOT over the past 50 years and will change a lot in the next 50 years. It will still be practiced though and will need us to be positive in the primary goal; which is patient care.

For all the impending doom and gloom I don’t know any residency graduate who has not gotten a job. There are jobs out there; some are better at navigating the market than others. Some take 2 weeks to find one some take 6 months.

I’m not disputing anything you’re saying. I just find it unsettling that no other speciality I can think of has this difficulty in finding a job. Virtually any other speciality can just make a phone call and be Anywhere, USA in 24 hours, quite literally.

 

[rirriri]

I’m not denying that the job market for initial applicants out of training is challenging because I’m sure many people have encountered prolonged searches with problems—-but it’s more a case of negative stories overshadowing positive ones. I have guided residents and helped them figure out what they want to do and where they want to work—-and have not yet encountered anyone who has had prolonged difficulty finding a good job.

FYI the radiology job market is also tough these days (diagnostic radiology) in a pretty similar way to Path. Path and Rads are very different to say, Peds. Of course the dynamics of the job market will be difficult as well. We require infrastructure, machines, reporting, licensure, etc in a non-patient setting. It’s the nature of the specialty rather than a ‘problem’, per se.

 

[rirriri]

Your moral compass is set correctly. However, if the ship is sailing towards financial ruins, what's the point boarding the ship in the first place? Morality alone can not save humanity.

Finances of any healthcare industry evolve and twist based on so many factors such as public policy, guidelines, social and infrastructural parameters—-we have never had full control of these things and likely never will. Pathology is not heading into ruin; we are heading into a different era of Path where our strategical priorities and dynamics will have to be adjusted that’s all.

The number of surgical pathology specimens is increasing all the time and the amount of information we can provide to a patient about disease is increasing exponentially with molecular/ancillary testing. It means we still have to provide answers and our answers are hitting new levels of higher importance.

True financial ruin only happens when demand for a specialty wanes; in our case it’s more about surmounting regulatory and strategic challenges rather than the actual work we do. That in itself makes me very very optimistic about our field.

 

[tensoranalysis]

rirriri

Thanks for being brave enough to share your perspective. This place can be hostile to prospective candidates and current trainees.

 

[AZpath]

South Dakota is full up... try North Dakota.

 

[rirriri]

rirriri

Thanks for being brave enough to share your perspective. This place can be hostile to prospective candidates and current trainees.

Thank you! Really appreciate that. That is so unfortunate if true. We have to help and guide others who share their love of Path! I went through a lot of effort and perseverance to get where I am today and am grateful to the many people who supported me. One of my goals now is to help others find their own road...

 

[deleted314957]

Too bad pathology is in this state of affairs. Looking inward as an M2 it really looked like it would be my dream specialty. Though when I started looking at programs I noticed that almost all of them are filled with FMGs, even the top-rated ones. I took that as an enormous red flag and came to other sites like this one for more info. It seems my suspicion was right.

Good. Just avoid the field.

 

[y2k_free_radical]

Finances of any healthcare industry evolve and twist based on so many factors such as public policy, guidelines, social and infrastructural parameters—-we have never had full control of these things and likely never will. Pathology is not heading into ruin; we are heading into a different era of Path where our strategical priorities and dynamics will have to be adjusted that’s all.

The number of surgical pathology specimens is increasing all the time and the amount of information we can provide to a patient about disease is increasing exponentially with molecular/ancillary testing. It means we still have to provide answers and our answers are hitting new levels of higher importance.

True financial ruin only happens when demand for a specialty wanes; in our case it’s more about surmounting regulatory and strategic challenges rather than the actual work we do. That in itself makes me very very optimistic about our field.

True that the number of surgicals are increasing ,but not as fast as the reduction in payment, increase in the numbers read /pathologist and the increased supply of pathologists.Your new technology may actually lessen the need for biopsies.Most of the pathologists i know would welcome more work and we are fighting big labs and others to save our livelihood.Surgicals are the backbone of a viable pathology practice for most.

 

[deleted314957]

Not trivial but not the whole story. Not everyone has difficulty getting a job. Not everyone’s sole priority is compensation. It can be an issue; but not worth sabotaging a good forum meant for students and trainees for.

When you have to meet a payroll for >100 employees, the cash flow becomes a MAJOR concern. Employed folks can just stick their head in the sand until their employer goes broke.

 

[rirriri]

When you have to meet a payroll for >100 employees, the cash flow becomes a MAJOR concern. Employed folks can just stick their head in the sand until their employer goes broke.

Good. Just avoid the field.

I get it that you are upset about some part of your career or don’t feel that Path is heading in the right direction; but it’s very unfortunate you keep posting vague, hateful comments like “avoid the field”. There’s no place for that kind of negativity here when there are med students, residents, and young attendings looking for support.

Cash flow is a concern; but any large laboratory or employer should be well ahead of the curve in anticipation and adaptation. Scaling services, staff, and faculty are something that are not emergencies but should be looked at in advance. Changes in medicine move slowly with time and at least *some* degree of predictability. The whole profession of medicine is a slow-to-change industry and anyone advertising drastic sudden changes is likely dealing in propaganda rather than reality.

 

[rirriri]

True that the number of surgicals are increasing ,but not as fast as the reduction in payment, increase in the numbers read /pathologist and the increased supply of pathologists.Your new technology may actually lessen the need for biopsies.Most of the pathologists i know would welcome more work and we are fighting big labs and others to save our livelihood.Surgicals are the backbone of a viable pathology practice for most.

Private medicine is not only impacted in Pathology but across many specialties so don’t think you are alone. This is a cultural shift in medical employment gravitating towards larger institutions running more like businesses while previously large institutions worked separately from private ones. I have watched a large hybrid academic/community health system completely annihilate local small private labs in the past; and unfortunately for private labs this trend will continue as people consolidate services.

There are certainly challenges as you pointed out; but those who adapt actively always fare better than those paralyzed in fear.

 

[Dave CX]

My son will probably be attending medical school next year. When the time comes, I will strongly discourage him from entering this field, despite the success that I have experienced. Although I have nothing to complain about, I view myself an being as lucky as I am good. The structural problems with Pathology extend far beyond an over supplied job market. In my opinion, the best medical specialties in the future will be any where the practitioner can earn most of his money outside of a hospital, with procedure codes. Med-onc, GI, Vascular surgery, cardiology, Optho, Derm, pain management to name a few.

 

[rirriri]

My son will probably be attending medical school next year. When the time comes, I will strongly discourage him from entering this field, despite the success that I have experienced. Although I have nothing to complain about, I view myself an being as lucky as I am good. The structural problems with Pathology extend far beyond an over supplied job market. In my opinion, the best medical specialties in the future will be any where the practitioner can earn most of his money outside of a hospital, with procedure codes. Med-onc, GI, Vascular surgery, cardiology, Optho, Derm, pain management to name a few.

For every one of you who feel that about Path there is someone from each one of those specialties who would discourage others to go into THEIR specialties. Your thoughts about your specialty are echo’d by many people in many specialties. Every specialty has issues and problems. I have tons of friends in clinical specialties and many have expressed massive concerns to be about their specialties many saying “I wish I went into something like Path”.

That old, overused, tired cliche about green grass comes to mind 😉

Congrats to your son about getting into med school!

 

[y2k_free_radical]

I get it that you are upset about some part of your career or don’t feel that Path is heading in the right direction; but it’s very unfortunate you keep posting vague, hateful comments like “avoid the field”. There’s no place for that kind of negativity here when there are med students, residents, and young attendings looking for support.

Cash flow is a concern; but any large laboratory or employer should be well ahead of the curve in anticipation and adaptation. Scaling services, staff, and faculty are something that are not emergencies but should be looked at in advance. Changes in medicine move slowly with time and at least *some* degree of predictability. The whole profession of medicine is a slow-to-change industry and anyone advertising drastic sudden changes is likely dealing in propaganda rather than reality.

I don't believe you run your department,at least the business end.You have that smug outlook of a tenured professor.Most of your students will face the realities of the real world outside of the hallowed halls of academia.Furthermore,the financial changes will negatively affect large hospitals and academia in time.I know of several groups that are not going to replace a retiring colleague because of their drop in income.That will affect your students job market.You are not in a vacuum. P.S.-The severe reduction by ANTHEM in reimbursement to MISSOURI pathologists and threats to those in seventeen other states happened suddenly,not gradually.How does one plan for that.

 

[rirriri]

I don't believe you run your department,at least the business end.You have that smug outlook of a tenured professor.Most of your students will face the realities of the real world outside of the hallowed halls of academia.Furthermore,the financial changes will negatively affect large hospitals and academia in time.I know of several groups that are not going to replace a retiring colleague because of their drop in income.That will affect your students job market.You are not in a vacuum. P.S.-The severe reduction by ANTHEM in reimbursement to MISSOURI pathologists and threats to those in seventeen other states happened suddenly,not gradually.How does one plan for that.

Changes like this affect ALL specialties. We have been hiring Pathologists like crazy over the past few years where I am; but I know that it’s not like this everywhere. Yes some places will shrink or even shut down, others will grow and prosper. Welcome to Medicine in general this happens all the time across specialties. Not sure if you are in private practice or community or academia but just know that there are, in general, a wide assortment of things happening across the country. For every 1 lab falling apart there is 1 growing solidly.

I am academia but I am not smug or tenured. I don’t know what the future will bring but I do know that approaching it with severe negativity certainly isn’t the answer.

 

[bauber]

I'm mostly with ririri here...many of y'all post platitudes and statements with lack of nuance about how the house of cards is going to topple...My group hired myself and another pathologist to replace the 2 that are retiring. Using anecdotes to justify your argument is a little silly. Is pathology the best field in medicine to go into right now...maybe not if you want to buy a lambo...are there pathology specific problems now and in the future....yeah....Is all of medicine facing big questions and issues going forward...yes....should we tell people to stay away because the sky is falling? No.

 

[WEBB PINKERTON]

People in academia shouldn't be lecturing private practice docs. Totally different realities.

 

[y2k_free_radical]

I'm mostly with ririri here...many of y'all post platitudes and statements with lack of nuance about how the house of cards is going to topple...My group hired myself and another pathologist to replace the 2 that are retiring. Using anecdotes to justify your argument is a little silly. Is pathology the best field in medicine to go into right now...maybe not if you want to buy a lambo...are there pathology specific problems now and in the future....yeah....Is all of medicine facing big questions and issues going forward...yes....should we tell people to stay away because the sky is falling? No.

I see more platitudes from ACADEMIA and the CAP with no discussion of the sordid subject of filthy lucre

 

[126230]

I’m not denying that the job market for initial applicants out of training is challenging because I’m sure many people have encountered prolonged searches with problems—-but it’s more a case of negative stories overshadowing positive ones. I have guided residents and helped them figure out what they want to do and where they want to work—-and have not yet encountered anyone who has had prolonged difficulty finding a good job.

FYI the radiology job market is also tough these days (diagnostic radiology) in a pretty similar way to Path. Path and Rads are very different to say, Peds. Of course the dynamics of the job market will be difficult as well. We require infrastructure, machines, reporting, licensure, etc in a non-patient setting. It’s the nature of the specialty rather than a ‘problem’, per se.

Umm this isnt 2011 anymore. The radiology job market is pretty good right now. In the fall of 2013 there were 185 jobs on the ACR jobs board, now there are just under 950. Of course the best jobs are passed through word of mouth. But here are some examples in the pacific northwest near and within 1.5 hr drive of seattle.

POSITION Job Opening in LOCATION - American College of Radiology Career Center

A new

jobs.acr.org

"We are a democratic and equitable practice and welcome pre-partner participation and collaboration in practice building and operational management.
We offer a competitive starting salary with 2 years to partnership and a personal commitment to mentorship and professional development. We offer a comprehensive benefits package including generous profit sharing and 9-10 weeks of vacation yearly in addition to an average 4.5 work day/week."

2 hours outside of seattle on the coast will get you this General-Body with Procedures Olympic Peninsula Job Opening in Port Angles, Washington - American College of Radiology Career Center
"Ideal work schedule: 3 weeks on and 1 week off with 1 in 4 weekend call. Evening/overnight diagnostic interpretations are covered remotely via our internal network. There is limited procedural call shared among the group.
Radia offers a competitive compensation package including up to a $50K signing bonus. Potential first year W-2 income is $474K (base + incentive)."

We are seeking physicians to join Radia in our partnership track.

Physicians will be reviewed by the Board of Directors for partnership recommendation to the shareholders 12- 24 months from joining, based on experience.
Shift Compensation

• Sign-on bonus of $50,000
• First year guaranteed compensation (12-13 weeks off) is $433,200.
• First year compensation (10 weeks off) with maximum performance pay is $474,000.
• 2018 Shareholder compensation for this schedule is $493,000.
• Profit sharing, malpractice, health insurance, and generous CME.

 

[Dro133]

Umm this isnt 2011 anymore. The radiology job market is pretty good right now. In the fall of 2013 there were 185 jobs on the ACR jobs board, now there are just under 950. Of course the best jobs are passed through word of mouth. But here are some examples in the pacific northwest near and within 1.5 hr drive of seattle.

POSITION Job Opening in LOCATION - American College of Radiology Career Center

A new

jobs.acr.org

"We are a democratic and equitable practice and welcome pre-partner participation and collaboration in practice building and operational management.
We offer a competitive starting salary with 2 years to partnership and a personal commitment to mentorship and professional development. We offer a comprehensive benefits package including generous profit sharing and 9-10 weeks of vacation yearly in addition to an average 4.5 work day/week."

2 hours outside of seattle on the coast will get you this General-Body with Procedures Olympic Peninsula Job Opening in Port Angles, Washington - American College of Radiology Career Center
"Ideal work schedule: 3 weeks on and 1 week off with 1 in 4 weekend call. Evening/overnight diagnostic interpretations are covered remotely via our internal network. There is limited procedural call shared among the group.
Radia offers a competitive compensation package including up to a $50K signing bonus. Potential first year W-2 income is $474K (base + incentive)."

We are seeking physicians to join Radia in our partnership track.

Physicians will be reviewed by the Board of Directors for partnership recommendation to the shareholders 12- 24 months from joining, based on experience.
Shift Compensation

• Sign-on bonus of $50,000
• First year guaranteed compensation (12-13 weeks off) is $433,200.
• First year compensation (10 weeks off) with maximum performance pay is $474,000.
• 2018 Shareholder compensation for this schedule is $493,000.
• Profit sharing, malpractice, health insurance, and generous CME.

Honest question because I'm a naive millenial; is that kind of money necessary? Like what I mean is, does making $400,000 make a significant difference in one's quality of life compared to making, say, $250,000? I'm asking because I'm genuinely curious.

 

[126230]

Honest question because I'm a naive millenial; is that kind of money necessary? Like what I mean is, does making $400,000 make a significant difference in one's quality of life compared to making, say, $250,000? I'm asking because I'm genuinely curious.

When you start taking call and finish a busy saturday shift having read 200+ studies knowing that you have to do the same s*** tomorrow your tune will change.

Not to mention that if you aren't making that money I can guarantee you someone else is mooching off your hard work. People like this Mednax Inc (MD) Q2 2019 Earnings Call Transcript

Mednax is a large corporation that has bought many radiology, anesthesiology and neonatology groups.

Here is a snippet from that conference call regarding radiology in particular.

"we will give our physician a percentage of the revenue and so instead of a guaranteed salary which is what our physicians on the anesthesia side have, they get a pool depending upon what percentage they get 60% of revenue.

They get that pool and from there they manage all of their direct expenses, salaries, etc. The advantage to that is that they then become responsible for any additional expenses. So if they decide they would like to have an additional clinical resource and additional physician or an additional nurse etc, then that becomes their responsibility. The flip side of that is they get the first whatever $0.60 -- $0.70 out of any additional dollar that comes in the door. So they're are very incentivized to go out and bring additional dollars in the door. But just as importantly of any additional physicians or nurses that they -- that are no longer a member of their team, they get 100% of those savings.”

“So the idea is to incentivize them A, to grow because they are going to get a significant percentage of the additional dollar that comes in the door or B, to run or both to run their practices more efficient.”

You are 100% a cog in their medical machine.

Get paid for your hard work.

And why choose 250,000 as a comfortable amount? That is still WAY above the "average" american. Why do you hate the poor? Why do you want sooo much money. Why can't you be happy with 200k or 150k? Take a paycut for the common good comrade. /s

 

[rirriri]

@126230

That’s great for radiology if true.

I work with radiology residents and fellows often and that’s not what they tell me; they have been telling me it’s an unpredictable job market here. Perhaps this is regional (NYC/Northeast) dependent.

 

[FourCandles]

Changes like this affect ALL specialties. We have been hiring Pathologists like crazy over the past few years where I am; but I know that it’s not like this everywhere. Yes some places will shrink or even shut down, others will grow and prosper. Welcome to Medicine in general this happens all the time across specialties. Not sure if you are in private practice or community or academia but just know that there are, in general, a wide assortment of things happening across the country. For every 1 lab falling apart there is 1 growing solidly.

I am academia but I am not smug or tenured. I don’t know what the future will bring but I do know that approaching it with severe negativity certainly isn’t the answer.

Your paragraph seems inherently contradicting. On the one hand, you say 'hiring Pathologists like crazy over the past few years ". That, my friend, you are probably referring to replacing expensive, older, retiring pathologists with cheaper, younger pathologists (probably very good ones). On the other hand, you say "I don’t know what the future will bring" which reflects your uncertainty about the future prospect. So a frenzy of hiring combined with uncertainty, what does that tell you? The filed of pathology lacks confidence. This is only addressing the business aspect, not the scientific progress which is totally unrelated to the woes and plight experienced by possibly many practitioners. Medicine and science will progress, no matter what. Even half of the board certified pathologists can not find adequate jobs, this great discipline of medicine will march on. That's not the point. We were all in academia at some point in our career. Academia is great but not sacred. People chose private practice for various reasons. But my personal view is the academic leadership of the field and the professional organizations (which we contributed annual membership fees for a long time) failed us miserably. We sorely miss an effective and wise leadership in our specialty.

 

[deleted314957]

I get it that you are upset about some part of your career or don’t feel that Path is heading in the right direction; but it’s very unfortunate you keep posting vague, hateful comments like “avoid the field”. There’s no place for that kind of negativity here when there are med students, residents, and young attendings looking for support.

Cash flow is a concern; but any large laboratory or employer should be well ahead of the curve in anticipation and adaptation. Scaling services, staff, and faculty are something that are not emergencies but should be looked at in advance. Changes in medicine move slowly with time and at least *some* degree of predictability. The whole profession of medicine is a slow-to-change industry and anyone advertising drastic sudden changes is likely dealing in propaganda rather than reality.

I really should not post, as you say, “vague” comments like “avoid the field”.

 

[deleted314957]

Honest question because I'm a naive millenial; is that kind of money necessary? Like what I mean is, does making $400,000 make a significant difference in one's quality of life compared to making, say, $250,000? I'm asking because I'm genuinely curious.

Yes.

 

[path24]

Sounds like BU Pathology 2.0. Go into path. There are good jobs for good pathologists (vague meaningless comment). Ignore the 50-100+ applicants per job. Don't worry about your 6 figure debt. Follow your heart. If it doesn't work out, we will set up a gofundme for you.

The job market is bad. Every insurance company will follow what blue cross is trying/going to do. Huge oversupply, they can cut reimbursement. They want all specimens sent to path mills. More consolidation is coming. How long will this take (or how quick)? A career is a long time. Pathology is not a good choice.

 

[Dave CX]

Honest question because I'm a naive millenial; is that kind of money necessary? Like what I mean is, does making $400,000 make a significant difference in one's quality of life compared to making, say, $250,000? I'm asking because I'm genuinely curious.

When you start earning you start spending. When I was 32 I started my first job making 185K. Thought it was a lot until I started paying a mortgage, student loans, having more kids, and wanting more, like a beach house. 20 yrs later, I am making 4x that and Iove it. At these levels, dropping 200$ on a dinner for 2 or 3K on a new heat pump, or 6k for silicone implants for the gf, or 20K for new roof or college tuition feels easy.

 

[HeyDalaron]

Honest question because I'm a naive millenial; is that kind of money necessary? Like what I mean is, does making $400,000 make a significant difference in one's quality of life compared to making, say, $250,000? I'm asking because I'm genuinely curious.

I do not think the issue is deciding what money is necessary. If that were the case, then most of us could subsist comfortably on even 100k/yr. The issue is obtaining fair value for services rendered. If you are an employee of a large corporate conglomerate or hospital system, the managers of such will skim money off the top of your work without lifting a finger to earn it, and there is no justice in that, at least not with the effort and skill it required for us to reach the point to safely practice this field.

 

[Guest8]

I do not think the issue is deciding what money is necessary. If that were the case, then most of us could subsist comfortably on even 100k/yr. The issue is obtaining fair value for services rendered. If you are an employee of a large corporate conglomerate or hospital system, the managers of such will skim money off the top of your work without lifting a finger to earn it, and there is no justice in that, at least not with the effort and skill it required for us to reach the point to safely practice this field.

^^^This.

It doesn't matter what money is "necessary". We provide a service, and that service is billed at certain levels that we do not directly control. What you receive in compensation depends on how much of that billing goes to overhead costs, fixed costs, and whatever portion goes to your superiors (if you have them). If two pathologists do the same amount of work and one gets $250K and one gets $400k, the difference in salary was still billed, the extra money is just going to someone else (boss, partners, hospital administration, etc) rather than the pathologist doing the work. THAT is what should worry you.

 

[octopusprime]

^^^This.

It doesn't matter what money is "necessary". We provide a service, and that service is billed at certain levels that we do not directly control. What you receive in compensation depends on how much of that billing goes to overhead costs, fixed costs, and whatever portion goes to your superiors (if you have them). If two pathologists do the same amount of work and one gets $250K and one gets $400k, the difference in salary was still billed, the extra money is just going to someone else (boss, partners, hospital administration, etc) rather than the pathologist doing the work. THAT is what should worry you.

EXACTLY--it's not that everyone's' sense of "financial comfort" is variable, it's that our compensation for the same work performed is variable, and it's not inherent to skill set or innate ability.

The REASON for that variability is other people skimming off the top, re-allocating your revenue to someone/something, and that someone/something else isn't inherently tied to the "cause" of medicine, and is usually a "business cost". Pathology laboratories generally have lots of overhead / equipment costs, but our skill set has been reduced to a highly-reproducible commodity on the cheap. Rirriri--aside from the "why", ever wonder "how" your dept is able to hire massive numbers of new people?

For those in academics--are you privy to the finances of your department? Do you even know how much you bill, how much revenue you're generating?
Maybe you don't care, maybe you are fine being a martyr for whatever department has pumped your ego with egalitarian notions of what it means to be a physician in 2019...but I guarantee you that the universities, chairs, CFOs, CEOs, Presidents, countless admins, executive boards, et al, couldn't pay themselves what they do if it weren't for the selfless academicians & national lab employees willing to sacrifice their livelihood for the sake of the company/university.

I don't consider myself any less committed to patient care because I get paid closer to what I'm actually generating in revenue, and I wouldn't think taking a pay cut would make me more entitled to a larger claim of such a commitment.

 

[octopusprime]

Honest question because I'm a naive millenial; is that kind of money necessary? Like what I mean is, does making $400,000 make a significant difference in one's quality of life compared to making, say, $250,000? I'm asking because I'm genuinely curious.

an emphatic YES, especially if you KNOW you're generating well north of $400k but are only seeing $250k of that.
1.) taxes take a massive chunk--including state...don't forget state taxes.
2.) property taxes are exceedingly high is many states.
3.) kids are expensive
4.) that $150k less of income should be at least $90k in take home--tell me $90k/yr doesn't make a difference in your retirement/investment/529 scheme (or in life in general) and i call BS.
5.) med school is insanely expensive, and the rates for loans are so high most people need to start making interest only payments during residency. remember when residents were able to defer their loans AND avoid interest accumulation in residency??
6.) health insurance, malpractice insurance, life insurance, and disability insurance add up to alot, and is on top of car, home and whatever insurance you're paying.
would go on but have a procedure to go on.

 

[deleted314957]

EXACTLY--it's not that everyone's' sense of "financial comfort" is variable, it's that our compensation for the same work performed is variable, and it's not inherent to skill set or innate ability.

The REASON for that variability is other people skimming off the top, re-allocating your revenue to someone/something, and that someone/something else isn't inherently tied to the "cause" of medicine, and is usually a "business cost". Pathology generally has lots of overhead / equipment costs, but our skill set has been reduced to a highly-reproducible commodity on the cheap. Rirriri--aside from the "why", ever wonder "how" your dept is able to hire massive numbers of new people?

For those in academics--are you privy to the finances of your department? Do you even know how much you bill, how much revenue you're generating?
Maybe you don't care, maybe you are fine being a martyr for whatever department has pumped your ego with egalitarian notions of what it means to be a physician in 2019...but I guarantee you that the universities, chairs, CFOs, CEOs, Presidents, countless admins, executive boards, et al, couldn't pay themselves what they do if it weren't for the selfless academicians & national lab employees willing to sacrifice their livelihood for the sake of the company/university.

I don't consider myself any less committed to patient care because I get paid closer to what I'm actually generating in revenue, and I wouldn't think taking a pay cut would make me more entitled to a larger claim of such a commitment.

[emoji122]well said

 

[dukeresident]

As a second year pathology resident this thread scares me.

It should scare you away from Path

 

[dr.weiner]

I see why some may be anxious and/or disgruntled, but those who are may not want to completely telegraph their identity on an anonymous forum based on their username and/or signature. Doesn't help matters.

Anyway, path worked for me! My job is awesome.

 

[deleted314957]

I see why some may be anxious and/or disgruntled, but those who are may not want to completely telegraph their identity on an anonymous forum based on their username and/or signature. Doesn't help matters.

Anyway, path worked for me! My job is awesome.

The problem is that path “doesn’t work” for too damned many young doctors today. IM, PEDS, GS, PSYCH, OB-GYN
“work” for ~98% of their grads. NOT path, most assuredly.