Dermatopathology remuneration

[FlourWaterSaltYeast]

How does compensation work in dermatopathology? Is there a set amount earned per slide read? I'd imagine you earn more in PP than academics, provided you were a partner. I couldn't find MGMA data in the charts I looked at for dermpath.

Philip Leboit is a pathology trained dermatopathologist who's the director of the dermpath program at UCSF.
He's also known to have one of the highest non-athletic coach salaries in the UC system (search Googles for articles on that). Here's a brief snapshot - 1.8MM recently.
He has a base pay of 265k, within the realm for an academic pathologist. But then he has 1.5MM in payments in the "other" category -- presumably from his clinical work. Another faculty member makes a similar amount > 1MM. One of the highest paid positions at Yale is a dermpath.

What's determining these salaries?

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[asmallchild]

Volume: the more you read, the more you'll make.

The caveat, of course, is that obtaining the kind of volume that Leboit (or others) reads is not easy.

 

[Skindoc83]

They are major academic centers and therefore get higher reimbursements than is possible in private practice. They also have incredible volume since derms across the country send them specimens. Ackerman had such high volume that he developed repetitive Use injuries in his wrist to the point that he used to have his fellows put the slides on and off the microscope stage. Those guys are insane outliers and not representative of the field as a whole

 

[PhillyMed777]

You are pointing out the true best in the field.
Even with the hardest of efforts it’s nearly impossible for anyone to get to the level.

 

[Dral]

Yes, these are folks that typically have a robust consult service.

I work with someone who is a specialist who gets a good number of outside consults. She has all of her consults to do during the day on top of the case load that the rest of us have to do as well.

 

[kwyjibo]

How does compensation work in dermatopathology? Is there a set amount earned per slide read? I'd imagine you earn more in PP than academics, provided you were a partner. I couldn't find MGMA data in the charts I looked at for dermpath.

Philip Leboit is a pathology trained dermatopathologist who's the director of the dermpath program at UCSF.
He's also known to have one of the highest non-athletic coach salaries in the UC system (search Googles for articles on that). Here's a brief snapshot - 1.8MM recently.
He has a base pay of 265k, within the realm for an academic pathologist. But then he has 1.5MM in payments in the "other" category -- presumably from his clinical work. Another faculty member makes a similar amount > 1MM. One of the highest paid positions at Yale is a dermpath.

What's determining these salaries?

Volume of slides (or specimens) certainly plays a role. Most places will have a base + production or pure production arrangement. The actual details of this arrangement will vary.

For example, there is a large corporate group that has a base pay with production of a fixed amount of dollars that kicks in after the 100th specimen. Another non-corporate private practice job was offering a fixed dollar amount per slide. Most practices will pay a percent of collections (whether that be global or PC only).

As for how the money is actually generated, each specimen (doesn't matter if its a skin tag or a large, multi-slide excision, it's still one specimen (per jar) for billing purposes) reimburses a global payment (professional component (PC) + technical component (TC) fees) per specimen. Large academic centers/hospitals also have facility fees that they can draw from that private/in-house labs cannot. Special stains and immunos also generate additional global fees (to a point, some insurance plans have stipulations that they will only cover an X number of stains).

There is a wide variability in production agreements. On the lower end you have groups paying 40% or less of PC only, usually these are corporate groups/PE who rely on path revenues (in addition to midlevel and Mohs collections) to keep their operations profitable. Other labs may offer percent of global (I've seen 25-35%). Of course, what you get paid is based on what you ACTUALLY collect. Lots of patients who are self pay, have high deductible plans, or are out-of-network never end up paying. Currently, I feel there is an oversupply of pathologists, thus there is always someone willing to take the lower paying, predatory jobs.

Aside from that, volume and payor mix are the other drivers of compensation. Dermpath (and path in general) has seen reductions in payments over the years and many private plans now pay considerably less than medicare (60-80% of medicare fees). Also, in many areas, certain insurance plans have exclusive contracts with large corporate labs (often by accepting a global way less than medicare rates), which effectively cuts volume for other private practice pathologists. If you are an in-house derm/dermpath, your employment status with the practice may limit what cases you can read (per Stark Law regulations).