Flee Pathology Now!!!

[jayceee]

Ishie.
Hang in there my friend. You'll get a job. Don't forget about Canada. It's not yet completely hopeless here, and you can get hired for a pretty decent wage (350-400k). The paperwork is not bad and takes about 3-6 months. Your U.S. credentials are good for 5 years. Bingo your working. Most of the jobs are close to the U.S border, so close to home.Worked well for me when I was absolutely at the end of my rope. Not even the stinking VA or military would give me a job. Just don't even think about Nova Scotia, 2016 combined tax rate of 59.7 percent. That's no typo, fifty nine point seven%

http://www.ey.com/CA/en/Services/Tax/Tax-Calculators-2015-Personal-Tax

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[27G]

Consultations are not primary diagnoses and often require hospital privileges and State liscences. Digital slides may be used for IHC, FISH, consults but have a long way to go before coming close to replacing straight up glass slapping diagnosis. This is inordinately more efficient, provides quick Z-plane assessment, fast low mag impression and has a tangible quality. All serious surgical pathologists like to hold and feel their slides.... Order deepers if necessary, and have a closer interface with the lab and gross room. The hot tub hanging crowd that envisions signing out from iPhones will destroy the field. Maybe you can triage cases digitally but if there ever is a technology that will replace having to cut slides... Pathology may be forever damaged and changed with every swinging Harry can sign out... Kinda like Family medicine, pulmonary, emergency medicine etc looking at films. Most non-rads primary care based fields and surgeons can read CT's, x-rays, MRI's etc. Put a cytology smear or a SP slide that's even remotely complicated and they will soil their shorts. These fields only understand pathology through crappy Med school classes where the best averaged photo of a disease is presented to them.

 

[yaah]

Those who claim digitization will destroy the field need to answer why this hasn't happened for radiology. Radiology images are orders of magnitude less complicated and orders of magnitude easier to manipulate through a computer. Almost all images are now viewed on the computer. The radiology group at our facility is bigger than ever and they are not employed by the hospital or health system. They are growing. And it certainly isn't all procedure based. It's imaging based. If it was so easy to take an image and outsource it to a competent but low paid radiologist why aren't more hospitals doing this? And why would they do it for pathology but not radiology? The radiology job market isn't wonderful either. They have an oversupply also, again not due to declining in specimens but more related to increasing specialization and efficiencies.

 

[Autopsy101]

A little off the current topic, but thought this belonged here.
Apparently they are hiring physicians to do transcription now...

 

[Johnny Sunshine]

Heh. Got an "offer" similar to that last week. The month before, some poor lab informed me they needed a histotech...

Crickets otherwise.

 

[Sulfinator]

Heh. Got an "offer" similar to that last week. The month before, some poor lab informed me they needed a histotech...

Crickets otherwise.

Hey, Johnny. Last I heard you hadn't taken boards. Any change on that front? If not, do you have any plans to become board certified?

 

[WEBB PINKERTON]

A little off the current topic, but thought this belonged here.
Apparently they are hiring physicians to do transcription now...

View attachment 199484

Anderson, Indiana is one of the worst towns in the midwest. Crime and drug ridden. A great example of what happens when your town relies on factory work and they leave town for asian countries/mexico. If you are a fan of the show Teen Mom on MTV, one of the original girls from season 1 is from there.

 

[Pathwrath]

There is more than one wise pathologist who have told me the field does not have more than 10-12 years left in it. From massive payments cuts to changing screening recommendations designed to ration care to disruptive technology, there are simply too many factors arrayed against our discipline to not face the reality at this point. Im not being super negative, Im literally just relaying what many of the smartest business types in the field of Pathology are thinking and saying in whispers to each other.

If you are planning to generate any quality income beyond say 2025, I would rethink that and plan your career accordingly.

Pushing glass for actionable diagnoses is still extremely cost effective. In this era of federal bean counting, expensive disruptive technologies that would ordinarily supplant more primitive but cheaper methods will not be covered.

Now, rationed care is another thing altogether. We are going to continue to suffer cuts, and not only that--we are going to be told how to practice, down to what stains we may order or face charges of fraud. Whatever fat that remains in pathology is going to be carved away, leaving a heavily-regulated, barebones operation.

But there will still be pathology. Less of a medical specialty and more of a glorified medical technology. Less income but less scope of practice and less responsibility.

 

[pathmonkey]

>>Pushing glass for actionable diagnoses is still extremely cost effective. In this era of federal bean counting, expensive disruptive technologies that would ordinarily supplant more primitive but cheaper methods will not be covered. ​

This.

Biopsy stained with H&E and interpreted by a trained physician gives a definitive and generally highly reliable diagnosis for a wide variety of diseases, in one business day for a cost of about $75. In terms of pure testing cost-effectiveness, its one of the best bargains in all of medicine. H&E is 110+ years old, there are good reasons we're still using it, and its not going away any time soon.

>>Now, rationed care is another thing altogether. We are going to continue to suffer cuts, and not only that--we are going to be told how to practice, down to what stains we may order or face charges of fraud. Whatever fat that remains in pathology is going to be carved away, leaving a heavily-regulated, barebones operation. ​

Not sure we're going to be told what stains to order or not order, but stain reimbursement will probably be cut further, and possibly even capped. You can get as many stains as you like, but you're only going to be reimbursed for the first "X" of them, and not much at that. If you need more stains, you eat the cost. Some payers already do it this way.

>>But there will still be pathology. Less of a medical specialty and more of a glorified medical technology. Less income but less scope of practice and less responsibility.

Well, many individuals already consider pathology to be not more than a lab tech. That view is hardy new, though its simply not correct. A good pathologist does more than just look at slides and note (like a tech with a blood smear) what's on there. They have to correlate with clinical findings, and use medical judgment to make clinically relevant diagnoses. It simply can't be done by individuals without significant training and medical background.

So long as human beings are physically reading slides, making substantial diagnoses (like cancers), and actually being held accountable for getting the DXs right, then they're necessarily going to have physician-level responsibility. I don't see any way around that.

At the end of the day, pay is dependent on volume and reimbursement levels. Volumes aren't going anywhere but up. Reimbursements, unfortunately, aren't. Pathologists who don't insist on being paid for the work they actually do, won't be. That's also, nothing new, and the corporate/hospital physician-employee model is now prevalent in many other medical specialties, including internal medicine.

But I agree pathology isn't going anywhere. People still get diseases that, at least of now and the foreseeable future, can only be diagnosed by tissue evaluation. No molecular test is going to evaluate margins or make important surgical diagnostic based decisions in real time. As I said in the thread on oncotype, wake me up when there is some molecular based blood test that can determine intraoperative margins on a basal cell carcinoma on someone's eyelid.

 

[narvanation]

Okay listen to this. I get a phone interview from a prominent hospital in a major city that is 3 hr flight away. After three weeks, they ask i come for in-person interview ASAp. I choose a date the following week. The in person interview is only 2 hours long, so I get suspicious and ask about reimbursement of travel expenses, they say sorry, we only reimburse if you get the position! Not to add, that this is the first of other possible in person interviews. and this is not some shady hospital, a prominent one! OMGggggggg
Oh off course i was like, to hell with you and your interview

 

[path24]

Sounds to me like you are a bad pathologist and unworthy. No job for you.

Don't worry the 99+ other people that applied will be happy to pay the travel expenses for a remote chance at a job.

Pathology, where fellows beg for jobs!

 

[deleted314957]

Okay listen to this. I get a phone interview from a prominent hospital in a major city that is 3 hr flight away. After three weeks, they ask i come for in-person interview ASAp. I choose a date the following week. The in person interview is only 2 hours long, so I get suspicious and ask about reimbursement of travel expenses, they say sorry, we only reimburse if you get the position! Not to add, that this is the first of other possible in person interviews. and this is not some shady hospital, a prominent one! OMGggggggg
Oh off course i was like, to hell with you and your interview

I think that was rather naive of you to not have had a clear understanding of the financial arrangements prior to travel.

 

[medgator]

I think that was rather naive of you to not have had a clear understanding of the financial arrangements prior to travel.

It's naive of you to not understand the customs when interviewing for a job, especially at a hospital. Generally expected to cover travel expenses

 

[icpshootyz]

It's naive of you to not understand the customs when interviewing for a job, especially at a hospital. Generally expected to cover travel expenses

In this market why would you bother? You know enough applicants will be throwing themselves at you just for the opportunity of an interview, so the employer holds all the cards. Why hand out perks you don't need to?

 

[medgator]

In this market why would you bother? You know enough applicants will be throwing themselves at you just for the opportunity of an interview, so the employer holds all the cards. Why hand out perks you don't need to?

That's a fair point in pathology I guess. Unfortunately, I see rads, and now even rad onc, heading in that direction.

 

[AZpath]

You guys are being a bit hard of Narvanation

Travel expenses is a fair question to ask. I guess this now a question to ask up front.
Most hospitals and labs do still reimburse for travel expenses.

In the past this was a sign of a real bad job.
I had this happen to me once. It was only a day drive and 100 buck hotel that I booked. They said "send us the bill". I did twice but they never paid it.
Not a big deal but a bad sign. Glad I did not take the job.

 

[Zarniwoop]

You guys are being a bit hard of Narvanation

Travel expenses is a fair question to ask. I guess this now a question to ask up front.
Most hospitals and labs do still reimburse for travel expenses.

In the past this was a sign of a real bad job.
I had this happen to me once. It was only a day drive and 100 buck hotel that I booked. They said "send us the bill". I did twice but they never paid it.
Not a big deal but a bad sign. Glad I did not take the job.

Agreed. Hospitals will always pay for interview expenses because doctors in other specialties would never consider something as absurd as paying for their interview. To make only pathology candidates pay would mean a hard to stomach change in HR's policies.
Private groups (those that are still left) are making candidates pay more and more. The incentive isn't there. Regardless of their need and incentive, it is not a good sign.

 

[path24]

"We had a very good response (more than 100 applicants)! I would recommend your service." C. Lee, Alaska, 3 May 2016

There is a current "published" shortage of pathologists. 100+ applicants for a job in Alaska!!!

Is there a shortage? no. Will there be a shortage? no. Do you still believe in a shortage???? It will only get worse.

 

[WEBB PINKERTON]

88305tc about to reach levels we haven't seen since the late 90s after the upcoming 15 percent cut. Flee pathology now!

http://www.laboratoryeconomics.com/frontpage/Laboratory_Economics_1112_sample.pdf

 

[postbacpremed87]

88305tc about to reach levels we haven't seen since the late 90s after the upcoming 15 percent cut. Flee pathology now!

http://www.laboratoryeconomics.com/frontpage/Laboratory_Economics_1112_sample.pdf

This makes me sad. You have convinced an academically strong student to avoid Pathology (I wanted to go into it). I think it is the most fascinating field in medicine and would have truly loved practicing it and making the diagnoses. Some will say that I should not let an online forum deter me - but there are too many people saying negative things.

 

[omn]

This makes me sad. You have convinced an academically strong student to avoid Pathology (I wanted to go into it). I think it is the most fascinating field in medicine and would have truly loved practicing it and making the diagnoses. Some will say that I should not let an online forum deter me - but there are too many people saying negative things.

I agree, I had no idea about this before reading this post. I don't question it, but we could say that it "begs explanation" (go figure that one out) ...

Sent from my SM-N900V using SDN mobile

 

[postbacpremed87]

I agree, I had no idea about this before reading this post. I don't question it, but we could say that it "begs explanation" (go figure that one out) ...

Sent from my SM-N900V using SDN mobile

My question is why do academically strong students still match in Pathology? I look at the mid to upper tier programs and they are almost all AMGs or extremely talented IMGs. If there are no jobs, then they must be doing it for the fun of it?

 

[knightmare3000]

Flee Pathology now...and do what?

Do you mean "Flee Pathology now!", because I might "only" make $150,000/year and will have to live in a less than ideal location? Because I will take that any day over making $200,000 as a Family doc in the best place in the world, or even $500K as an Orthopedic Surgeon.

On the other hand if you mean "Flee Pathology Now!" because I will make $50,000/year working 60+ hours a week after being without a job for a year post residency. Then you might have a point. I mean, you have to draw the line somewhere.

I love Pathology and do not want to do anything else. It was the specialty that as soon as I was exposed to it I felt at home. It took me a little time to get over the fear of the job market and giving up seeing patients. But after doing rotations I KNEW this is what I wanted to do. I haven't looked back. I'm willing to make less money than the average Pathologist does today and work in a less than ideal location as long as I get to do what, so far, I love doing. Pathology has been the only rotation I have had that i LOVE going to! I mean I wake up in the morning looking forward to it.

I know before you get into something there is a tendency to wear "rose colored glasses." Med school was like that. I thought being a doc was going to be WAY different before medical school. Pathology may be like that too. In fact I expect to have a somewhat more sober and less enthusiastic view as a 3rd year resident or an attending with 10 years under me. Certain realities that I am unaware of will no doubt rear their ugly head.

On the flipside, however...what is my alternative? I actually love pathology. I wish I would have known about it earlier. I feel no hesitation at all about becoming a Pathologist. In the end, I'm still doing Path no matter what. My priorities aren't money, location, etc. I'm going into what I love.

Maybe that is naive, but what is the alternative? I think it would be stupid to going into something I know I don't enjoy just to have a little better job security and make more money.

Right Now if you look at a job at Quest or lab Corp and put down desired salary any amount over 100K get an automatic rejection. Most academics make about 80K with an R O 1 research grant. top salary with extra service work and/or teaching is about 120K . so with cut backs in CMS ( i.e. Medicare) forget pathology only those that do not speak English shall be left. get into internal medicine.