No Jobs!

[106174]

You never hear of a derm complaining, and I think that should be the case with ANY field in medicine, not just pathology. It really depends on who has the power to control the # of residents put out each year. If any field keeps the number of slots to a minimum, that field will def be that "elite" field.

I agree with you completely KeratinPearls. Here in Dallas alone, graduates of our Dermatology residency program have, for the most part, gotten jobs here in the metroplex. Most of them have chosen and have been able to stay in the area (and we have a relatively large Dermatology residency program here, with anywhere from 6-8 residents per year, so that is a lot of people being placed in jobs all over the metroplex).

Meanwhile, most of our Pathology graduates have had to leave Dallas (much to their disappointment because several of our graduates wanted to stay here) to get a job elsewhere. I am going to be a Dermatopathologist and even I am worried I will not be able to get a job in Dallas after I am done with fellowship training.

---

Members don't see this ad.

 

[2121115]

I agree with you completely KeratinPearls. Here in Dallas alone, graduates of our Dermatology residency program have, for the most part, gotten jobs here in the metroplex. Most of them have chosen and have been able to stay in the area (and we have a relatively large Dermatology residency program here, with anywhere from 6-8 residents per year, so that is a lot of people being placed in jobs all over the metroplex).

Meanwhile, most of our Pathology graduates have had to leave Dallas (much to their disappointment because several of our graduates wanted to stay here) to get a job elsewhere. I am going to be a Dermatopathologist and even I am worried I will not be able to get a job in Dallas after I am done with fellowship training.

When I was considering pathology as a medical student, one of the most important things I was told was that you CANNOT get set on living in a specific city. That is apparently a setup for FAIL. I agree with you that this is the reality reflecting the less than stellar state of the job market. However, it is the price we pay for doing the job we love. If we really cared that much we'd have gone into radiology or something else.

 

[KeratinPearls]

I would like to hear more from the OP in regards to his/her program and difficulty in finding jobs.

 

[Gyric]

We need a unified outcry from practicing pathologists (and the situation will probably worsen before this happens), but imo the best way to organize this is through the CAP. CAP is powerful, with its pacs etc, and could:

1. Exert pressure on government to cut residency position funding (something you would think they would like to do in the current economic climate).
2. Pressure ACGME to uphold higher standards, effectively eliminating the small community-based residency program.
3. Pressure the association of pathology chairs (APC) to not fill some percentage of spots at their programs. These people are the “voice of academic pathology.” All but the short sighted should recognize the benefits to their training programs of increasing pathology competitiveness.
4. Pressure the ABP to require a strict minimum number and diversity of surgical cases for AP certification, thereby preventing residents with insufficient training from gaining board certification.

I agree that for this to work, we will need data and leadership; this will probably have to wait until the current generation moves into leadership positions in CAP.

 

[HESC]

Actually, there are bad jobs in every field. I personally know of a group of cardiologists that dissolved becuase of infighting and bad blood and several members of the group had to move out of the area becuase of non-compete clauses. another case that I personally know of just like this one was a critical care-pulmonology group that basically did the same thing...

I can go on and on. Face it, there are bad jobs in all fields of medicine. I think any family medicine job would be worse than an average pathology job.... do we all agree??

Plus, when considering the derm thing, you must keep in mind that to get into a derm residency spot the applicant MUST BE WILLING TO DO RESIDENCY ANYWHERE THEY CAN GET IN!!!! that include back woods middle america and the most unattractive programs. It is a trade off that the applicant must be willing to make if he/she wants to be able to practice derm one day. Pathology may have a similiar trade off but just in reverse... do your residency at your top 3 rank but be prepare to go elsewhere when finished.

 

[106174]

Plus, when considering the derm thing, you must keep in mind that to get into a derm residency spot the applicant MUST BE WILLING TO DO RESIDENCY ANYWHERE THEY CAN GET IN!!!! that include back woods middle america and the most unattractive programs. It is a trade off that the applicant must be willing to make if he/she wants to be able to practice derm one day. Pathology may have a similiar trade off but just in reverse... do your residency at your top 3 rank but be prepare to go elsewhere when finished.

But Derm residency is only 3 years... The trade off for them is much sweeter...

 

[HESC]

But Derm residency is only 3 years... The trade off for them is much sweeter...

Actually its an intern year plus 3 years so it equals that of a 4 year ap/cp path residency.
But i would argue that most of those derm applicants probably work way harder than the average path resident.... derm is crazy to get into.

 

[106174]

Actually its an intern year plus 3 years so it equals that of a 4 year ap/cp path residency.
But i would argue that most of those derm applicants probably work way harder than the average path resident.... derm is crazy to get into.

Yes, it is 4 years but most of them do their internships in very cush programs in very, very nice cities.

 

[Gut Shot]

CAP is predicting the retirement of 6,000 pathologists over the next ten years. Even with the current number of training slots, we can't fill that number. And that's assuming zero growth in demand.

I know that the great pathologist retirement/die-off has been heralded for years, but it simply has to happen. These people cannot practice in the afterlife. They will retire. They will die. They will leave vacancies even if their desiccated husks continue to occupy space.

 

[milkytooth]

Pathologists are probably one of the least unified specialties. The opinion is still divided even if the evidence is in front of our eyes. Soon, there will be a critical job shortage.

 

[yaah]

CAP is predicting the retirement of 6,000 pathologists over the next ten years. Even with the current number of training slots, we can't fill that number. And that's assuming zero growth in demand.

I know that the great pathologist retirement/die-off has been heralded for years, but it simply has to happen. These people cannot practice in the afterlife. They will retire. They will die. They will leave vacancies even if their desiccated husks continue to occupy space.

Yes - and it is this point that will make CAP, ASCP, etc more likely to discount the "there are no jobs" argument. That is why, as I said, anyone who presents such an argument for consideration would be advised to get more evidence than anecdotal evidence. We have some, but I don't think we have enough. As I have also said, it is not me that needs to be convinced.

From personal experience it is definitely true that there are a lot of older pathologists still working. Some are actually starting to be forced out by hospital admins in some places (either for being too old, too old fashioned, or whatever).

 

[Sulfinator]

Pathologists are probably one of the least unified specialties.

I wonder if this is, in part, due to the fact that the day-to-day practice among pathologists is so diverse.

 

[Sulfinator]

CAP is predicting the retirement of 6,000 pathologists over the next ten years. Even with the current number of training slots, we can't fill that number. And that's assuming zero growth in demand.

I know that the great pathologist retirement/die-off has been heralded for years, but it simply has to happen. These people cannot practice in the afterlife. They will retire. They will die. They will leave vacancies even if their desiccated husks continue to occupy space.

Call it unfounded and blinded optimism, but I'm inclined to believe that en mass retirement of more senior pathologists will soon open things up a bit in the job market.

At any rate, Gut Shot, I found your post hilarious.

 

[djmd]

CAP is predicting the retirement of 6,000 pathologists over the next ten years. Even with the current number of training slots, we can't fill that number. And that's assuming zero growth in demand.

I know that the great pathologist retirement/die-off has been heralded for years, but it simply has to happen. These people cannot practice in the afterlife. They will retire. They will die. They will leave vacancies even if their desiccated husks continue to occupy space.

I am sure that eventually pathologist retire/die but...
I still don't buy the mass exodus theory, they keep claiming 6k pathology will retire in 10 years.. but they are clearly basing this on the # of pathologist over X age...
But somepathologist keep working well past 55 or even 65...

See what I said this thread

From that article also
Pathology at a glance

• Average salary: $183,000 to $359,000
• Residency slots: 525
• Residency requirement: four years for combined clinical/anatomic program
• Number of U.S. practitioners: 13,936

Sure 45% are over 55... but as alot of people point out, pathologists work past 65... lets say that 75% retire per decade after 55...
That's ~4800 pathologist retiring in the next decade...

Oh but wait in one decade 5250 new pathologist will be trained...

Every year we add enough people to be ~ 4% of the workforce...
If 90% of the pathologist over 55 retire, then we would be just about even...

Not factoring in the one double class year... that generated ~1000 new pathologist in one cycle...

The other hard fact is in ten years we train ~5000 new pathologist. If there are ~14,000 pathologist that means in any ten year block there are ~30% of pathologists...
So 35-45 = 30%
45-55 = 30%
55-65 = 30%
65-75 = 10%

 

[LADoc00]

We need a unified outcry from practicing pathologists (and the situation will probably worsen before this happens), but imo the best way to organize this is through the CAP. CAP is powerful, with its pacs etc, and could:

1. Exert pressure on government to cut residency position funding (something you would think they would like to do in the current economic climate).
2. Pressure ACGME to uphold higher standards, effectively eliminating the small community-based residency program.
3. Pressure the association of pathology chairs (APC) to not fill some percentage of spots at their programs. These people are the “voice of academic pathology.” All but the short sighted should recognize the benefits to their training programs of increasing pathology competitiveness.
4. Pressure the ABP to require a strict minimum number and diversity of surgical cases for AP certification, thereby preventing residents with insufficient training from gaining board certification.

I agree that for this to work, we will need data and leadership; this will probably have to wait until the current generation moves into leadership positions in CAP.

QFT
Ive actually been saying this since the early 90s.

 

[Path_Anon]

The specialty any field should model is Derm. The field is so competitive because of the $$$ involved and derms (if not metropolitan due to competition) can set up shop pretty much anywhere. There are waitlists of months to see a dermatologist. If anything, slots in derm could be increased to meet the demand out there, so that patients dont have to wait months to see their derm. But, no....like BigD said, the powers to be have kept slots down to a minimum. The field is so elite because of this well controlled supply (which results in a shortage) of dermies going out into the workforce each year. I am sure derm residents out there have no problem finding GOOD jobs. You never hear of a derm complaining, and I think that should be the case with ANY field in medicine, not just pathology. It really depends on who has the power to control the # of residents put out each year. If any field keeps the number of slots to a minimum, that field will def be that "elite" field.

If derm increases the # of slots to meet patient demand, do you think the field would be as competitive as it is now? No way. Those who go into derm for the love of it will stay. Those who go into it for the $$$$ will leave and that's the truth.

Amen to that. I wish path would take a page out of derm's book and reduce, not increase, the # of pathology residency spots (which after meeting applicants for the past several years, seems like are increasing EVERYWHERE).

Also, while I do agree that most folks coming out of medium to large quality programs with 0-1 fellowships are getting quality jobs (private, not nec. academic), in my opinion the next few years for folks coming out will be much harder than those who've landed jobs during the past few years.... reason being the sh*tty economy. While we all know how pathologists despite being super freaking old, keep signing out and don't retire, from my experience interviewing and interaction with community folks these same oldies that were basically ready to hang up their scopes are gonna stick around for a few more years and attempt to get back some of their retirement $$ they lost in the market/etc.

 

[Gut Shot]

Sure 45% are over 55... but as alot of people point out, pathologists work past 65... lets say that 75% retire per decade after 55...
That's ~4800 pathologist retiring in the next decade...

Okay, considering you just pulled 75% out of your sigmoid, sure... why not?

Oh but wait in one decade 5250 new pathologist will be trained...

Yeah, if you take the number of training spots present in one year (2006, the second highest in recent years) times ten, and assume 100% program filling, 100% completion and 100% of trainees staying in the US to practice as full time pathologists.

What if 80% retire, and "only" 5,000 new pathologists are trained? Then we're operating at parity, assuming zero change in demand.

Tricky, eh?

 

[Gut Shot]

I wish path would take a page out of derm's book and reduce, not increase, the # of pathology residency spots (which after meeting applicants for the past several years, seems like are increasing EVERYWHERE).

Match data:

2005 - 526 positions, 481 filled
2006 - 525 positions, 480 filled
2007 - 513 positions, 467 filled
2008 - 508 positions, 466 filled

Anybody know what's on tap for 2009?

 

[djmd]

Okay, considering you just pulled 75% out of your sigmoid, sure... why not?



Yeah, if you take the number of training spots present in one year (2006, the second highest in recent years) times ten, and assume 100% program filling, 100% completion and 100% of trainees staying in the US to practice as full time pathologists.

What if 80% retire, and "only" 5,000 new pathologists are trained? Then we're operating at parity, assuming zero change in demand.

Tricky, eh?

I will grant that my 75% was only vaguely reasonable number...
But to assume that 90-100% retire is foolish.

The end result is that a 6000 pathologist retiring is about what we need just to maintain parity...

If there is growth then it will mean there is a demand for pathologist, but if market forces conspire to cause a contraction (less surgeries/cut reimbursement).. then we will have a real over supply problem..

My point is just to point out that this great flood of retirement (the great 6,000) is pretty much the number of pathologist that should retire in a 10-15 year period anyways... And will not cause some great demand for pathologists..

 

[106174]

Match data:

2005 - 526 positions, 481 filled
2006 - 525 positions, 480 filled
2007 - 513 positions, 467 filled
2008 - 508 positions, 466 filled

Anybody know what's on tap for 2009?

This downward trend in the number of positions offered in the match does not necessarily mean the ACTUAL number of spots is decreasing. Many programs prematch applicants, and most of these programs are small community ones that are not confident they can fill their slots through the match. And these are the same programs that ought to be cut.

 

[djmd]

Match data:

2005 - 526 positions, 481 filled
2006 - 525 positions, 480 filled
2007 - 513 positions, 467 filled
2008 - 508 positions, 466 filled

Anybody know what's on tap for 2009?

Looks like improvement until you look further back...

2004 - 477 positions, 438 filled
2003 - 443 positions, 399 filled
2002 - 398 positions (dont have #)
2001 - 383 positions

 

[Gut Shot]

Looks like improvement until you look further back...

2004 - 477 positions, 438 filled
2003 - 443 positions, 399 filled
2002 - 398 positions (dont have #)
2001 - 383 positions

I was only addressing the assertion that the number of positions is still increasing.

 

[Gut Shot]

I will grant that my 75% was only vaguely reasonable number...
But to assume that 90-100% retire is foolish.

The end result is that a 6000 pathologist retiring is about what we need just to maintain parity...

If there is growth then it will mean there is a demand for pathologist, but if market forces conspire to cause a contraction (less surgeries/cut reimbursement).. then we will have a real over supply problem..

My point is just to point out that this great flood of retirement (the great 6,000) is pretty much the number of pathologist that should retire in a 10-15 year period anyways... And will not cause some great demand for pathologists..

So you grant that 75% was something you pulled from the air, and then proceed to state, with great confidence, that 6,000 is the magic number.

This is why we can't have nice things.

Seriously, this is a very complex topic, and we can't even agree on the current state of the job market, much less what it will be like in 10 years.

 

[LADoc00]

Folks: to reiterate among the very first posts I did here 4 years ago:

 

[listeriaismfb]

The industry of cranking out recent-trainees is where the problem is, everyone knows this except for the people making the decisions. I agree with previous posts that the emphasis should shift to quality, not quantity & that they should close half the programs in the country to make pathology competitive.

Anyway, those of you that think that there will be (or even could be) a mass exodus due to retirement have been hitting the mother load of crack. None of the old farts are going anywhere. As for death creating opportunities - are you kidding?

 

[exPCM]

During the mid and late 1990's in the days when the tripod group formed there was a stock market boom and yet there was no wave of pathologists retiring and massive unemployment of pathology graduates. Now we have a stock market bust and it is incomprehensible to me that people believe we will now see a massive wave of pathologists retiring. Pathologists are now more likely to keep working since many have had their retirement savings depleted. Basically the leaders in pathology have done nothing to address resident oversupply and pathology workforce issues despite the disaster of the mid to late 1990s in pathology. Unfortunately unemployed pathology residency graduates are less likely to be able to retrain into other fields now that hospitals are under financial pressure and therefore less likely to take people for second residencies (because residents are not fully funded by Medicare for a second residency: http://www.amsa.org/pdf/Medicare_GME.pdf )

 

[yaah]

Yeah, people really never do retire unless they are forced to. I don't think it has anything to do with the stock market. When it's down people don't retire because they lost their savings. When it's up they don't retire because they want to put more in and have it grow. A lot of it probably has to do with being unable to stop working. I would like that think that when I reach my mid 60s I have more to life than my job, but who knows. Maybe it will fascinate me so much I will want to continue.

I know of one older pathologist (I am guessing >65 if not >70) who was forced out of his group, I think mostly due to pressure from the hospital because he was way behind the times, who started looking for a new job. Give it up, man!

 

[Patholo-gyst]

At our program, we do get info from our attendings on academic jobs. There seem to be a lot of academic spots out there, but several of us are looking for private jobs, and we are seeing very little out there. We go to places like the CAP site and Medhunters, and when we contact the places, often they aren't really seriously looking--or else they are places that we have been warned about as either 1. A place that dangles partnership but never (or very rarely) comes through with their promises, or 2. A hothouse type of spot where they just feed you cases until you explode, with no greater compensation for greater numbers of cases (commercial lab companies). The few places that have jobs outside of these types seem to be in crapy locations or have some benefits problem or both, for example:

*Work near the airport in an unpopular city in the northeast, a few hours' drive to some big cities, get only 3 weeks of vacation per year, but the pay seems okay. But you are stuck there except for 3 weeks a year.

*Work in a southwestern city, pay is okay, but the job is corporate and you probably will never make more than $250 your whole career. Bonuses are 'stock options' that seem questionable. Beholden to the owners of the company, who are business people. They can give you as many cases as they want per day, no caps, and there is nothing you can do but complain if you have to stay 15-16 hours a day to finish it all.

*Work in the midwest in a private practice, pay is okay, but the last five people who were in 'partnership track' left after 1-5 years, nobody has made partner for 8 years. But it will be different for you!! You will make partner after 2 years! Also, pay is just okay until you make partner, and you only get 4 weeks of vacation until you make partner (you are a 2nd class employee until you are a partner, and that just isn't going to happen . . .)

*Work in a city you hate (for example, a city in Wisconsin if you hate the cold, or in Texas if you love to ski and hate the heat). The pay is just okay.

I am wondering how much leverage you have once you get an offer. Say you get an offer from a corporate-type company, and they offer you X dollars a year and Y days of vacation. Can you say, Um, I'd like X+P dollars per year and Y+M days of vacation instead . . . is there bargaining? I wonder if they would just say, "forget you" and move in in this climate, or if they would say, well, let's see what we can do to meet you halfway . . .

Other similar experiences?

 

[listeriaismfb]

The title of the thread should be "No good jobs".

Tons of terrible jobs are out there... boatloads of 'em! One of the previous posts outlined the lowlights nicely.

At a minimum, I believe that we should be paid what we're worth, work in a place we like, and have no less vacation time than we did as residents.

Then I wake up....

 

[djmd]

Yeah, people really never do retire unless they are forced to. I don't think it has anything to do with the stock market. When it's down people don't retire because they lost their savings. When it's up they don't retire because they want to put more in and have it grow. A lot of it probably has to do with being unable to stop working. I would like that think that when I reach my mid 60s I have more to life than my job, but who knows. Maybe it will fascinate me so much I will want to continue.

I know of one older pathologist (I am guessing >65 if not >70) who was forced out of his group, I think mostly due to pressure from the hospital because he was way behind the times, who started looking for a new job. Give it up, man!

I think the lack of drive to retire is that it is easy to see how a pathologist could practice up to 70...
It is hard to see how Surgeons, and even Internal medicine specialties would/could do that...

As long as they keep up their knowledge... The job is not very physically demanding... (maybe on the the eyes)...

Still people on the whole are more likely to retire when they feel their retirement will be well paid for.. so a big market downturn is likely to make some people put off retiring.. (assuming they are in the Stock market and not say, pencil futures )

 

[Gut Shot]

Pathologists are now more likely to keep working since many have had their retirement savings depleted.

If you are over 60 and still have significant exposure to the stock market, you are an idiot. That's not to say there aren't plenty of idiots out there.

 

[Path_Anon]

I am wondering how much leverage you have once you get an offer. Say you get an offer from a corporate-type company, and they offer you X dollars a year and Y days of vacation. Can you say, Um, I'd like X+P dollars per year and Y+M days of vacation instead . . . is there bargaining? I wonder if they would just say, "forget you" and move in in this climate, or if they would say, well, let's see what we can do to meet you halfway . . .

Other similar experiences?

While I want assert myself during the post-interview/near-hiring period with a group and ask a bunch of detailed job-related questions (call/tail coverage/etc etc), I always worry in the back of my mind that I'm coming off shrewd. I know of a person that after receiving his/her contract, he/she proceeded to follow-up with a bunch of questions (perhaps overkill) about call..."So how much call, how many days, what exact I do, what's the policy if I can't be on call/who's gonna cover me, do call duties decrease with seniority, how is call spread out, how/what's the policy on swapping around call...." and additional similar questions. The group head basically ripped up the contract in front of him/her (apparently fed up with such a overkill of questions related to one particular issue). While I agree with the group that you wouldn't nec. want a person like this working with you, I do worry about how much leverage we have particularly in this competitive job market.

In the offers/pseudooffers I've received, I feel like if they snap their fingers I've got to come running [well, my story is biased b/c the groups I'm seeking out are super awesome with great pay/cases/workload/vacation/location]. And I should edit that people really don't "seek" them out; rather, they will hand-pick folks. Seems like a lot of quality groups work this way and don't really follow the usual formality of receiving applications.

 

[yaah]

The title of the thread should be "No good jobs".

Tons of terrible jobs are out there... boatloads of 'em! One of the previous posts outlined the lowlights nicely.

At a minimum, I believe that we should be paid what we're worth, work in a place we like, and have no less vacation time than we did as residents.

Then I wake up....

There are some good jobs. There are good jobs out there. I heard of or people told me about places starting at above $200k with partner in 3 years or less (and not sleazy places that are going to dump you either) - with partnership income at least double that. Places with 7-10 weeks vacation. 35-40 hr work week, etc. And good work environments also. Unfortunately, unless you happen to know people who are in the group or they know/respect someone who likes and knows you, you might not hear about these positions, and they may not be available anyway except for the right candidate. And while some of these jobs are rural, some are city-based (midwest). I am not going to post my details for various reasons, suffice it to say I am happy with how things turned out. I did not end up in true academics, although I will have some academic opportunities in my job. It was difficult to not do academics, but it became far less difficult when I saw this practice environment and the other benefits of such.

I agree those above listed jobs are not good jobs. I am not sure what I would do if confronted with those options, and I hadn't found an academic job that I really liked (I suspect I would have though, there were a couple quite appealing academic jobs, I just had to end up deciding before any of that started). Probably would have stayed in academics and kept up contacts with places I knew that were interested but had no openings when i was looking. Then by that point I might have decided I wanted to stay in academics, or I would be ready to leave anyway.

But I also know one resident who took a job down south somewhere, got a signing bonus of $50k and started around $250k, but then was overworked (14hrs a day or more) and bailed after 1 year, found a better, quieter job in the midwest close to his original home. And another one I know couldn't find a job in the state he wanted, so he went to West Virginia for a year and then found one in the right state, so he bailed. I don't know how common these scenarios are.

 

[yaah]

In the offers/pseudooffers I've received, I feel like if they snap their fingers I've got to come running [well, my story is biased b/c the groups I'm seeking out are super awesome with great pay/cases/workload/vacation/location]. And I should edit that people really don't "seek" them out; rather, they will hand-pick folks. Seems like a lot of quality groups work this way and don't really follow the usual formality of receiving applications.

That's very true - a lot of the good groups have a backlog of CVs that are randomly sent to them, or they have lists of people they want to contact if something opens up. So when they are ready, they start inquiring on their own, without advertising. One guy at a private place told me, "I hate advertising for positions, because they really crawl out of the woodwork and I get inundated with CVs from dozens of unqualified individuals."

But people do seek these groups out, it's just that they can choose whether or not they want to respond (usually they don't). Once in practice for a few years, you know who the better groups are in the area. So a lot of times people will just send in their CVs to this group. Not really a formal process, I agree.

I dunno, it kind of feels like Skull and Bones in some fashion (or at least how the rumors go about exclusive organizations). There are ways to express your interest but in the end they come to you, make you feel welcome but don't commit to anything, then after you visit and meet everyone they lock the doors and let you know in a week or two.

 

[listeriaismfb]

Agree, that there are some good jobs out there, but the vast majority of jobs out there are not good. Especially the advertised jobs...

So, if someone is "out of the network" (read out of residency for a couple years & desiring something different), how do they find a good job anyway?

 

[Pianoboe01]

Since I'm on the interview trail right now for residency, what's the best way to find out which places have the most well-connected people for finding their graduates/fellows good jobs?

 

[valgarizm]

even worse than that. Not only are the people about to leave jacked because of the economic vise of massive stock losses AND property devaluation(this maybe even bigger than stock/401K losses for many people), but at the very same time mid grade partners are getting killed by cuts from Medicaid, payors..and worst of all Medicare.

Prepare for this one: they are planning to "reclassify" many routine biopsies specifically prostate and skin as a new CPT code that pays only a fraction of an 88305....just when you thought it couldnt get worse, the government pops your left eye out and urinates in the socket.

If residency programs in path just dont outright close very soon, the current trainee glut will be absolutely obscene. Even beyond my biblical predictions.

Can you tell me where I may find more information about this new CPT code for prostate and skin biopsies? I scraped the internet and couldn't find anything about it.

 

[yaah]

So, if someone is "out of the network" (read out of residency for a couple years & desiring something different), how do they find a good job anyway?

I don't know, attend lots of local pathology meetings? National meetings? Call in old favors, ask your favorite ancient attending?

 

[yaah]

Since I'm on the interview trail right now for residency, what's the best way to find out which places have the most well-connected people for finding their graduates/fellows good jobs?

Hard to say. Generally the more nationally respected the attending, the more contacts and associates they are likely to have. Prestigious large programs generally have more of these individuals. Fellowship directors are often well connected also.

Like for example, Dr Fletcher at BWH knows everyone. Drs Myers and Appelman at U of Mich know everyone. Dr Schnitt at BIDMC knows everyone. There are lots. If you look on the USCAP website, just find a link to list of past USCAP presidents or current councilmembers. They are generally all well connected people, both in academia and the private world.

 

[pbp4]

I am wondering how much leverage you have once you get an offer. Say you get an offer from a corporate-type company, and they offer you X dollars a year and Y days of vacation. Can you say, Um, I'd like X+P dollars per year and Y+M days of vacation instead . . . is there bargaining? I wonder if they would just say, "forget you" and move in in this climate, or if they would say, well, let's see what we can do to meet you halfway . . .

Other similar experiences?

If you feel strongly about something - you ask for it. If they say forget you because you were merely looking out for your interests then you just dodged a major bullet. You could have been working for these nut jobs. I think many groups expect you to ask for something and they certainly expect questions- but if you call them fifty times that would be a different story- and you most likely need some therapy anyway.

I will say groups do not seem to like it if you only ask about the money and really there is much more to it- I have not made that mistake but groups have said others have.

I still find all this fear a little strange- I am getting pressure from groups to make a decision because they are afraid they will lose good people to other places. SO if we think there are not many good jobs, the folks hiring are not sure there are so many good applicants......

 

[deleted57552]

If you feel strongly about something - you ask for it. If they say forget you because you were merely looking out for your interests then you just dodged a major bullet. You could have been working for these nut jobs. I think many groups expect you to ask for something and they certainly expect questions- but if you call them fifty times that would be a different story- and you most likely need some therapy anyway.

I will say groups do not seem to like it if you only ask about the money and really there is much more to it- I have not made that mistake but groups have said others have.

I still find all this fear a little strange- I am getting pressure from groups to make a decision because they are afraid they will lose good people to other places. SO if we think there are not many good jobs, the folks hiring are not sure there are so many good applicants......

I echo these sentiments. It never hurts to ask...if they say yes, they can add to the contract. They may simply say no to some of your demands but at least you know that you addressed the issue by asking. You never know what you can get unless you simply make your demands (just be careful that you don't ask for ridiculously unreasonable things like three Porsches )

The negotiation period is the time to ask for things because once you sign the dotted line, you're stuck with whatever is in the contract and your leverage goes way down.

 

[scurred]

You know what I find the most funny...

IS THAT NOT A SINGLE PERSON ON THIS BOARD HAS APPLIED FOR A JOB IN PATHOLOGY YET

Everything you claim is hearsay or based on second hand facts. I, for one,

HAVE NEVER HEARD OF AN OUT OF WORK PATHOLOGIST.
HAVE NEVER HEARD OF A PATHOLOGIST THAT HATES THEIR JOB.

Stop with this crap. The one thing RESIDENCY PROGRAMS are good at doing is limiting the number of spots. The number of spots are based on case load. There are a certain number required to gain an additional residency position, hence why a place like MGH has like 30...and why podunk falls has like 4.

Popularity and salaries in medicine swing like the pendulum. I DONT THINK ANYONE ON THIS BOARD IS QUALIFIED TO MAKE A FRICKEN JUDGEMENT AS TO THE NUMBER OF RESIDENCY SPOTS THE COUNTRY NEEDS.

SOMEBODY PLEASE END THIS DUMB BASELESS THREAD...every time i read a post its like someone scratching a chalk board.

 

[djmd]

You know what I find the most funny...

IS THAT NOT A SINGLE PERSON ON THIS BOARD HAS APPLIED FOR A JOB IN PATHOLOGY YET

Everything you claim is hearsay or based on second hand facts. I, for one,

HAVE NEVER HEARD OF AN OUT OF WORK PATHOLOGIST.
HAVE NEVER HEARD OF A PATHOLOGIST THAT HATES THEIR JOB.

Stop with this crap. The one thing RESIDENCY PROGRAMS are good at doing is limiting the number of spots. The number of spots are based on case load. There are a certain number required to gain an additional residency position, hence why a place like MGH has like 30...and why podunk falls has like 4.

Popularity and salaries in medicine swing like the pendulum. I DONT THINK ANYONE ON THIS BOARD IS QUALIFIED TO MAKE A FRICKEN JUDGEMENT AS TO THE NUMBER OF RESIDENCY SPOTS THE COUNTRY NEEDS.

SOMEBODY PLEASE END THIS DUMB BASELESS THREAD...every time i read a post its like someone scratching a chalk board.

It is true. The attendings and fellows (who have jobs) were just granted them via wishes (well, lamp, talking fish, etc..)

Don't worry the rest of what you said is JUST as accurate as the statement about no one has applied for a job in pathology.


And please feel free to stop reading this thread.. There is no way anyone here know anything you don't...

 

[DrBloodmoney]

Can you tell me where I may find more information about this new CPT code for prostate and skin biopsies? I scraped the internet and couldn't find anything about it.

Here is a recent discussion on the PATHO-L list:

[SIZE="2"]USA Specific: CMS HCPCS G-Codes
11 messages
Deepak Mohan <[email protected]> 	Thu, Nov 13, 2008 at 12:14 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
Does anyone have any details on HCPCS G-codes? Apparently we need to
use it for prostate billing starting Jan 2009 as opposed to the 88305
Cpt code.

--
Deepak Mohan, MD | Laboratory Medical Director | San Joaquin General Hospital
500 West Hospital Road | French Camp, CA 95231 | (209) 468-6069 |
(209) 468-6386 | [email protected] | http://www.sjgeneralhospital.com/
_______________________________________________
PATHO-L mailing list
[email protected]
http://www.mailman.srv.ualberta.ca/mailman/listinfo/patho-l
Adel Assaad <[email protected]> 	Thu, Nov 13, 2008 at 2:39 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

First I hear of it but a quick look at CMS website

http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=descending&itemID=CMS1216704&intNumPerPage=10

yields the following codes:









G0416
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate 1-20 spc

13


G0416
00200
4

SATURATION BIOPSY SAMPLING, 1-20 SPECIMENS




G0417
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate 21-40

13


G0417
00200
4
SATURATION BIOPSY SAMPLING, 21-40 SPECIMENS





G0418
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate 41-60

13


G0418
00200
4

SATURATION BIOPSY SAMPLING, 41-60 SPECIMENS




G0419
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate: >60

13


G0419
00200
4

SATURATION BIOPSY SAMPLING, GREATER THAN 60 SPECIMENS



Adel Assaad Seattle, WA
_________________________________________________________________
Stay up to date on your PC, the Web, and your mobile phone with Windows Live
http://clk.atdmt.com/MRT/go/119462413/direct/01/
[Quoted text hidden]
Deepak Mohan <[email protected]> 	Thu, Nov 13, 2008 at 2:58 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
What is saturation biopsy sampling? Is it the same as Prostate needle
core biopsy?
They probably mean total number of cores when they say "Number of
specimens". We usually refer to specimens as a specific anatomic site
(in separate cointainer) and bill one 88305 for each container. So we
just bill one code based on number of cores (1-20, 21-40, 41-60, >60)?

Is everyone planning on using these codes? What if we continue to use
the cpt code of 88305?

Dr. Mohan
[Quoted text hidden]
--
Deepak Mohan, MD | Laboratory Medical Director | San Joaquin General Hospital
500 West Hospital Road | French Camp, CA 95231 | (209) 468-6069 |
(209) 468-6386 | [email protected] | http://www.sjgeneralhospital.com/
_______________________________________________
[Quoted text hidden]
Lester Raff MD <[email protected]> 	Thu, Nov 13, 2008 at 3:02 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
Saturation sampling generally refers to the procedure in which far more
biopsies are taken than in the general urology office practice, usually
as a follow up to a previous abnormality, or when several office
biopsies have been negative but PSA continues to rise. The number of
biopsies can be over 100, although we usually get them in 8 vials from
the Prostate Cancer Center in our area, and thus bill 88305x8

I am HOPING that these new codes won't be applied to the sextant or 12
part biopsies most urologists do in their offices.

Lester J. Raff, MD
Medical Director
UroPartners Laboratory
2225 Enterprise Dr. Suite 2511
Westchester, Il 60154
Tel 708.486.0076
Fax 708.486.0080
[Quoted text hidden]
[email protected] <[email protected]> 	Thu, Nov 13, 2008 at 3:10 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

 -------------- Original message ----------------------
From: "Lester Raff MD" <[email protected]>

> I am HOPING that these new codes won't be applied to the sextant or 12
> part biopsies most urologists do in their offices.

Looks to me like someone has managed to kill the goose that laid the golden eggs.

Bill
--
William D. Kasimer
[email protected]
[email protected]
[Quoted text hidden]
Warren White <[email protected]> 	Thu, Nov 13, 2008 at 3:32 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
Whatever is the absolute worst case scenario for the pathologist; that
is what this means and what will happen. Have a nice day........

WWhite
[Quoted text hidden]
Adel Assaad <[email protected]> 	Thu, Nov 13, 2008 at 8:23 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

The G codes are to be used for saturation biopsies only when a specific clinical CPT code is applied. see statline issue below, article about final fee schedule.
The cash cow lives another year...
Adel Assaad Seattle, WA

From: [email protected]: [email protected]: STATLINE--November 13, 2008 (Volume 24, Number 23)Date: Thu, 13 Nov 2008 12:48:25 -0600


>From the College of American PathologistsNovember 13, 2008 • volume 24, number 23
View and print the complete STATLINE(http://www.cap.org/apps/docs/hints/index1.html)
Rep. Ehlers Takes Lab TourRep. Vern Ehlers (R-MI) views a digital cytology slide with Robert Knapp, MD, FCAP.Go to full story
CAP-led Cytology Proficiency Improvement Coalition Discusses CPT Regulation with OMBA delegation of pathologists and College staff representing the Cytology Proficiency Testing Improvement Coalition met with the Office of Management and Budget (OMB) and US Department of Health and Human Services Nov. 6 to recommend alternatives to proposed Cytology PT regulations submitted last month by the Centers for Medicare and Medicaid Services to OMB for review and approval prior to publication.Go to full story
CMS Releases 2009 Physician Fee Schedule Final RuleThe 2009 Physician Fee Schedule Final Rule was released by the Centers for Medicare and Medicaid Services, including an extension for the technical component “grandfather” and the Physician Quality Reporting Initiative, updates to the clinical lab fee schedule and the conversion factor, and a requirement for the use of new G codes for specific prostate biopsy saturation sampling.Go to full story
New CPT II Code for Breast and Colorectal Cancer ApprovedA new CPT II code will be available in 2009 for reporting on the PQRI breast and colorectal cancer reporting measures in addition to three codes currently available (3260F, 3260F-1P, 3260F-8P).Go to full story
Election Day 2008 Charts New Path in Direction ofHealthcare Policy ReformElection Day 2008 heralded in sweeping changes to both the Executive and Legislative branches of government, and with them the direction of healthcare policy reform.Go to full story
Senator Baucus Unveils Universal Healthcare PlanSenate Finance Committee Chairman Max Baucus (D-MT) unveiled a universal-coverage healthcare “call to action” this week, in a move that pushes medical policy reform amongst the top of the 111th Congress' agenda with an emphasis on improving value by reforming health care delivery.Go to full story
AMA House of Delegates Discusses Physician Payment andthe Medical HomeAlternative physician payments strategies, the principles of the “patient-centered medical home,” comparative effectiveness research and other issues of healthcare reform were key topics at the American Medical Association House of Delegates meeting in Orlando, Fla. Nov. 8-11.Go to full story
Illinois Court Upholds Pathologists’ Right to Bill forProfessional ComponentThe right of pathologists to bill for the professional component of clinical pathology services was upheld by an Illinois circuit court ruling Nov. 3, citing an Amicus Curiae brief by the College, in a case where a clinic refuses to pay a laboratory for the services.Go to full story
Advocacy BriefsMichael Merwin, MD, FCAP, hosted Rep. Mike Thompson (R-TX) during a lab tour at Queen of the Valley Medical Center in Napa, CA, Nov. 7.Go to full story


(For Statline reprint permission, please contact Justin Herman.)


Visit the STATLINE archive
STATLINE is published biweekly.Justin Herman, editor, 800-392-9994 ext. 7127.


Information About This Service
The CAP member mailing list is closed and confidential. Its purpose is to distribute important news and information to CAP members. Individual members are not able to post messages to the list.
Visit the CAP Web site for additional news and information. If you have comments or questions regarding this mailing list, contact Justin Herman at 800-392-9994 ext. 7127, or [email protected].
To remove yourself from this list, go to http://leda.cap.org/UM/U.asp?B1.98.14089.161192 and you will be removed immediately. Thank you.
© 2008 College of American Pathologists325 Waukegan RoadNorthfield, IL 60093
_________________________________________________________________
Get 5 GB of storage with Windows Live Hotmail.
http://windowslive.com/Explore/Hotmail?ocid=TXT_TAGLM_WL_hotmail_acq_5gb_112008
[Quoted text hidden]
[email protected] <[email protected]> 	Fri, Nov 14, 2008 at 7:43 AM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
This has always been a game of being "one-step-ahead."

When Urologists realized that Medicare would pay for each separate 88305,
they decided start their own labs, and stop the "naive" practice of dumping
multiple biopsies into one container. Soon, the total amount that medicare
was paying out for this became big enough for people to take notice and
realize that one did not need 18 to 24 diagnoses on each patient with a
elevated PSA. (Do the math for the millions of patients with elevated PSAs
who undergo prostate biopsies).

There were 28 million males (approx. 2000 census), between 50 and 75.
Between 2001 and 2004, approximately 58% of American males above 50 had had
a PSA done in the previous year (CDCP data 2002-2005), for approximately 16
million. If even only 10% of these, or 1.8 million had elevated PSA leading
to biopsies, annually (This number is not unreasonable, as it is about 7
times the estimated number of new cases of prostate cancer for 2007),
raising the average number of 88305s from 2/ per case (3 left cores, and 3
right cores) to an average of just six, would raise the number of units
from 3.2 million to 10 million. Even at just 100 dollars dollars a unit ,
that comes to a Billion dollars a year.(i'm not even including 88342s that
I often see on multiple biopsies with wall to wall cancer from some of the
Pod labs) The cost is probably closer to 3-4 billion dollars per year, just
for screening!.

This is not the first time that physicians have tried to game the system,
and we can rest assured that whatever medicare comes up with - someone,
somewhere is going to find a creative "solution" for it, that will be
technically legal and its going to be back to the drawing board again for
Medicare.


Mahesh.
PS: Why is it that excellent academic oncological urologists seem to be
satisfied with multiple cores in three to four - occasionally six -
containers, but private practice urologists with their own Pod labs - who
will never enter an operating room because of the unfavorable CPT codes -
find the need for 18-24 separate diagnoses on every patient with an
elevated PSA?
[Quoted text hidden]
Mahesh M. Mansukhani, MD
Associate Professor of Clinical Pathology
Director, CUMC Molecular Pathology Laboratory
Columbia University Medical Center, New York NY 10032
VC14-237; 212-305-2646
[Quoted text hidden]
[email protected] <[email protected]> 	Fri, Nov 14, 2008 at 7:49 AM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

>
> The G codes are to be used for saturation biopsies only when a specific
> clinical CPT code is applied. see statline issue below, article about
> final fee schedule. The cash cow lives another year...
> Adel Assaad Seattle, WA

I guess this means we will have to know which CPT code the urologist used
to obtain the biopsy?

Mahesh.





Mahesh M. Mansukhani, MD
Associate Professor of Clinical Pathology
Director, CUMC Molecular Pathology Laboratory
Columbia University Medical Center, New York NY 10032
VC14-237; 212-305-2646
_______________________________________________
[Quoted text hidden]
Ed Uthman <[email protected]> 	Fri, Nov 14, 2008 at 11:27 AM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
At 02:32 PM 11/13/2008, Warren White wrote:

>Whatever is the absolute worst case scenario for the pathologist; that
>is what this means and what will happen. Have a nice day........

Hasta la vista, pod labs! Maybe you can move on to homeopathy clinics
or something.

Ed


-----
Ed Uthman, MD ([email protected])
Pathologist, Houston/Richmond, Texas, USA
http://web2.airmail.net/uthman
http://www.flickr.com/photos/euthman
[Quoted text hidden]
Warren White <[email protected]> 	Fri, Nov 14, 2008 at 12:20 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
To avoid any misconceptions: Our lab (myself included) has not and does
not participate in any pod-lab/condo-lab scenario, any account bill/MD
office bill scam, or any clinician owned lab at any level.

Seems to me that the recent CMS anti-mark up ruling (and not the
mysterious "G" code), as I read it, will effectively kill the pod-lab
scenario (probably anyway). It does absolutely nothing to kill the
in-office clinician owned AP lab scenario as there are too many
loopholes for it to be effective in that regard. Again, this latter
scenario is not a pod-lab. It is a different beast altogether.

In my state (NC) it would be completely legal for an endoscopy center or
urology group (without the help of a pathologist) to have their own AP
lab in their office, bill all payors - including Medicare - for the full
technical component and get paid using the same pathology codes that we
use. They can then take the slides that they made (with no supervising
pathologist), mail them to a commercial lab, purchase the professional
reading for $10, mark that purchased professional component up to
whatever and, again using the same path codes we do, bill it and get
paid. The only thing they cannot do is mark-up the purchased
professional component for Medicare cases.

"G" codes? My office just called CMS and the person on the phone said:
"Never heard of them". The lowest level of "G" code for prostate
biopsies BTW pays $550, the next level over $1000. So - I would think
those numbers would still be attractive to clinician-owned in office AP
labs as those numbers are fairly close to the current reimbursement.

Hence my prior negative comment. Pathology as an independent practice of
medicine is not gaining any ground as far as I can tell. Have a nice
day........

WWhite
[/SIZE]

 

[listeriaismfb]

You know what I find the most funny...

IS THAT NOT A SINGLE PERSON ON THIS BOARD HAS APPLIED FOR A JOB IN PATHOLOGY YET

Everything you claim is hearsay or based on second hand facts. I, for one,

HAVE NEVER HEARD OF AN OUT OF WORK PATHOLOGIST.
HAVE NEVER HEARD OF A PATHOLOGIST THAT HATES THEIR JOB.

Stop with this crap. The one thing RESIDENCY PROGRAMS are good at doing is limiting the number of spots. The number of spots are based on case load. There are a certain number required to gain an additional residency position, hence why a place like MGH has like 30...and why podunk falls has like 4.

Popularity and salaries in medicine swing like the pendulum. I DONT THINK ANYONE ON THIS BOARD IS QUALIFIED TO MAKE A FRICKEN JUDGEMENT AS TO THE NUMBER OF RESIDENCY SPOTS THE COUNTRY NEEDS.

SOMEBODY PLEASE END THIS DUMB BASELESS THREAD...every time i read a post its like someone scratching a chalk board.

Wow! Strong words from someone who has not even gone through a residency yet. Let's see how you feel about all this business in about 4 years...

You should probably not make assumptions about the employment status of the people on this thread. Yes, I am a fellow - but I'm a fellow with a real job lined up, just like many of the other fellows who post here. There are aspects of the new job that are not ideal, hence my interest here.

I know of some pathologists who hate their jobs, I also know internists and FP docs who hate their work too. You cannot possibly be naive enough to think that there is not a single bit of discontent or unemployment in pathology.

 

[yaah]

That's true. I have a job also - one which was better than I thought I would get, actually. Maybe because I see the doom and gloom on here

I don't know if I technically "applied for a job" though. I contacted a couple of people I knew, and others contacted me. I guess if sending your CV out counts as applying for a job, I applied for 6 jobs. Only went on two interviews because things got decided pretty early, one of which I knew I probably wasn't going to take anyway (not because it wasn't a good job, but because it was too small).

Internet forums, it is important to remember, always cater to doom and gloom. The negative posts always get more attention and are better remembered by junior members than positive ones (unless the positive ones have to do with making lots of money ). And in fact, the disaffected are often more likely to post than the content.


I do tend to agree somewhat with scurred on one point, that we as posters on this board are not really in position to judge the appropriate number of residency spots. We see how it affects us but not how it affects health care as a whole. We do, however, see the reality of what is out there perhaps better than those in positions of power. Don't forget, however, that there are a lot of people out there who can't find jobs for good reasons like poor skills, bad communication, dangerous attitudes, etc.

 

[listeriaismfb]

I got my job because I was at a meeting and I met the right people. It's an offer and I took it, but I have been sporadically sending CVs out in the hopes of something better. Obviously I have not even gotten a nibble, but I plan to be more aggressive in coming months.

No one from my residency program did any networking on my account, I was the red-headed stepchild there and they really did not know what to do with someone like me. Go figure.

 

[LADoc00]

Can you tell me where I may find more information about this new CPT code for prostate and skin biopsies? I scraped the internet and couldn't find anything about it.

not on the net, its in committee but looks likely to pass.

The government is smart, they dont advertise when they are going to screw you. They do all sneaky like, in the darkly lit private offices within HHS.

Think "The Illuminati", that is what we are up against.

 

[valgarizm]

Here is a recent discussion on the PATHO-L list:

[SIZE="2"]USA Specific: CMS HCPCS G-Codes
11 messages
Deepak Mohan <[email protected]> 	Thu, Nov 13, 2008 at 12:14 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
Does anyone have any details on HCPCS G-codes? Apparently we need to
use it for prostate billing starting Jan 2009 as opposed to the 88305
Cpt code.

--
Deepak Mohan, MD | Laboratory Medical Director | San Joaquin General Hospital
500 West Hospital Road | French Camp, CA 95231 | (209) 468-6069 |
(209) 468-6386 | [email protected] | http://www.sjgeneralhospital.com/
_______________________________________________
PATHO-L mailing list
[email protected]
http://www.mailman.srv.ualberta.ca/mailman/listinfo/patho-l
Adel Assaad <[email protected]> 	Thu, Nov 13, 2008 at 2:39 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

First I hear of it but a quick look at CMS website

http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=descending&itemID=CMS1216704&intNumPerPage=10

yields the following codes:









G0416
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate 1-20 spc

13


G0416
00200
4

SATURATION BIOPSY SAMPLING, 1-20 SPECIMENS




G0417
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate 21-40

13


G0417
00200
4
SATURATION BIOPSY SAMPLING, 21-40 SPECIMENS





G0418
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate 41-60

13


G0418
00200
4

SATURATION BIOPSY SAMPLING, 41-60 SPECIMENS




G0419
00100
3
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION FOR PROSTATE NEEDLE
Sat biopsy prostate: >60

13


G0419
00200
4

SATURATION BIOPSY SAMPLING, GREATER THAN 60 SPECIMENS



Adel Assaad Seattle, WA
_________________________________________________________________
Stay up to date on your PC, the Web, and your mobile phone with Windows Live
http://clk.atdmt.com/MRT/go/119462413/direct/01/
[Quoted text hidden]
Deepak Mohan <[email protected]> 	Thu, Nov 13, 2008 at 2:58 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
What is saturation biopsy sampling? Is it the same as Prostate needle
core biopsy?
They probably mean total number of cores when they say "Number of
specimens". We usually refer to specimens as a specific anatomic site
(in separate cointainer) and bill one 88305 for each container. So we
just bill one code based on number of cores (1-20, 21-40, 41-60, >60)?

Is everyone planning on using these codes? What if we continue to use
the cpt code of 88305?

Dr. Mohan
[Quoted text hidden]
--
Deepak Mohan, MD | Laboratory Medical Director | San Joaquin General Hospital
500 West Hospital Road | French Camp, CA 95231 | (209) 468-6069 |
(209) 468-6386 | [email protected] | http://www.sjgeneralhospital.com/
_______________________________________________
[Quoted text hidden]
Lester Raff MD <[email protected]> 	Thu, Nov 13, 2008 at 3:02 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
Saturation sampling generally refers to the procedure in which far more
biopsies are taken than in the general urology office practice, usually
as a follow up to a previous abnormality, or when several office
biopsies have been negative but PSA continues to rise. The number of
biopsies can be over 100, although we usually get them in 8 vials from
the Prostate Cancer Center in our area, and thus bill 88305x8

I am HOPING that these new codes won't be applied to the sextant or 12
part biopsies most urologists do in their offices.

Lester J. Raff, MD
Medical Director
UroPartners Laboratory
2225 Enterprise Dr. Suite 2511
Westchester, Il 60154
Tel 708.486.0076
Fax 708.486.0080
[Quoted text hidden]
[email protected] <[email protected]> 	Thu, Nov 13, 2008 at 3:10 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

 -------------- Original message ----------------------
From: "Lester Raff MD" <[email protected]>

> I am HOPING that these new codes won't be applied to the sextant or 12
> part biopsies most urologists do in their offices.

Looks to me like someone has managed to kill the goose that laid the golden eggs.

Bill
--
William D. Kasimer
[email protected]
[email protected]
[Quoted text hidden]
Warren White <[email protected]> 	Thu, Nov 13, 2008 at 3:32 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
Whatever is the absolute worst case scenario for the pathologist; that
is what this means and what will happen. Have a nice day........

WWhite
[Quoted text hidden]
Adel Assaad <[email protected]> 	Thu, Nov 13, 2008 at 8:23 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

The G codes are to be used for saturation biopsies only when a specific clinical CPT code is applied. see statline issue below, article about final fee schedule.
The cash cow lives another year...
Adel Assaad Seattle, WA

From: [email protected]: [email protected]: STATLINE--November 13, 2008 (Volume 24, Number 23)Date: Thu, 13 Nov 2008 12:48:25 -0600


>From the College of American PathologistsNovember 13, 2008 • volume 24, number 23
View and print the complete STATLINE(http://www.cap.org/apps/docs/hints/index1.html)
Rep. Ehlers Takes Lab TourRep. Vern Ehlers (R-MI) views a digital cytology slide with Robert Knapp, MD, FCAP.Go to full story
CAP-led Cytology Proficiency Improvement Coalition Discusses CPT Regulation with OMBA delegation of pathologists and College staff representing the Cytology Proficiency Testing Improvement Coalition met with the Office of Management and Budget (OMB) and US Department of Health and Human Services Nov. 6 to recommend alternatives to proposed Cytology PT regulations submitted last month by the Centers for Medicare and Medicaid Services to OMB for review and approval prior to publication.Go to full story
CMS Releases 2009 Physician Fee Schedule Final RuleThe 2009 Physician Fee Schedule Final Rule was released by the Centers for Medicare and Medicaid Services, including an extension for the technical component “grandfather” and the Physician Quality Reporting Initiative, updates to the clinical lab fee schedule and the conversion factor, and a requirement for the use of new G codes for specific prostate biopsy saturation sampling.Go to full story
New CPT II Code for Breast and Colorectal Cancer ApprovedA new CPT II code will be available in 2009 for reporting on the PQRI breast and colorectal cancer reporting measures in addition to three codes currently available (3260F, 3260F-1P, 3260F-8P).Go to full story
Election Day 2008 Charts New Path in Direction ofHealthcare Policy ReformElection Day 2008 heralded in sweeping changes to both the Executive and Legislative branches of government, and with them the direction of healthcare policy reform.Go to full story
Senator Baucus Unveils Universal Healthcare PlanSenate Finance Committee Chairman Max Baucus (D-MT) unveiled a universal-coverage healthcare “call to action” this week, in a move that pushes medical policy reform amongst the top of the 111th Congress' agenda with an emphasis on improving value by reforming health care delivery.Go to full story
AMA House of Delegates Discusses Physician Payment andthe Medical HomeAlternative physician payments strategies, the principles of the “patient-centered medical home,” comparative effectiveness research and other issues of healthcare reform were key topics at the American Medical Association House of Delegates meeting in Orlando, Fla. Nov. 8-11.Go to full story
Illinois Court Upholds Pathologists’ Right to Bill forProfessional ComponentThe right of pathologists to bill for the professional component of clinical pathology services was upheld by an Illinois circuit court ruling Nov. 3, citing an Amicus Curiae brief by the College, in a case where a clinic refuses to pay a laboratory for the services.Go to full story
Advocacy BriefsMichael Merwin, MD, FCAP, hosted Rep. Mike Thompson (R-TX) during a lab tour at Queen of the Valley Medical Center in Napa, CA, Nov. 7.Go to full story


(For Statline reprint permission, please contact Justin Herman.)


Visit the STATLINE archive
STATLINE is published biweekly.Justin Herman, editor, 800-392-9994 ext. 7127.


Information About This Service
The CAP member mailing list is closed and confidential. Its purpose is to distribute important news and information to CAP members. Individual members are not able to post messages to the list.
Visit the CAP Web site for additional news and information. If you have comments or questions regarding this mailing list, contact Justin Herman at 800-392-9994 ext. 7127, or [email protected].
To remove yourself from this list, go to http://leda.cap.org/UM/U.asp?B1.98.14089.161192 and you will be removed immediately. Thank you.
© 2008 College of American Pathologists325 Waukegan RoadNorthfield, IL 60093
_________________________________________________________________
Get 5 GB of storage with Windows Live Hotmail.
http://windowslive.com/Explore/Hotmail?ocid=TXT_TAGLM_WL_hotmail_acq_5gb_112008
[Quoted text hidden]
[email protected] <[email protected]> 	Fri, Nov 14, 2008 at 7:43 AM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
This has always been a game of being "one-step-ahead."

When Urologists realized that Medicare would pay for each separate 88305,
they decided start their own labs, and stop the "naive" practice of dumping
multiple biopsies into one container. Soon, the total amount that medicare
was paying out for this became big enough for people to take notice and
realize that one did not need 18 to 24 diagnoses on each patient with a
elevated PSA. (Do the math for the millions of patients with elevated PSAs
who undergo prostate biopsies).

There were 28 million males (approx. 2000 census), between 50 and 75.
Between 2001 and 2004, approximately 58% of American males above 50 had had
a PSA done in the previous year (CDCP data 2002-2005), for approximately 16
million. If even only 10% of these, or 1.8 million had elevated PSA leading
to biopsies, annually (This number is not unreasonable, as it is about 7
times the estimated number of new cases of prostate cancer for 2007),
raising the average number of 88305s from 2/ per case (3 left cores, and 3
right cores) to an average of just six, would raise the number of units
from 3.2 million to 10 million. Even at just 100 dollars dollars a unit ,
that comes to a Billion dollars a year.(i'm not even including 88342s that
I often see on multiple biopsies with wall to wall cancer from some of the
Pod labs) The cost is probably closer to 3-4 billion dollars per year, just
for screening!.

This is not the first time that physicians have tried to game the system,
and we can rest assured that whatever medicare comes up with - someone,
somewhere is going to find a creative "solution" for it, that will be
technically legal and its going to be back to the drawing board again for
Medicare.


Mahesh.
PS: Why is it that excellent academic oncological urologists seem to be
satisfied with multiple cores in three to four - occasionally six -
containers, but private practice urologists with their own Pod labs - who
will never enter an operating room because of the unfavorable CPT codes -
find the need for 18-24 separate diagnoses on every patient with an
elevated PSA?
[Quoted text hidden]
Mahesh M. Mansukhani, MD
Associate Professor of Clinical Pathology
Director, CUMC Molecular Pathology Laboratory
Columbia University Medical Center, New York NY 10032
VC14-237; 212-305-2646
[Quoted text hidden]
[email protected] <[email protected]> 	Fri, Nov 14, 2008 at 7:49 AM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>

>
> The G codes are to be used for saturation biopsies only when a specific
> clinical CPT code is applied. see statline issue below, article about
> final fee schedule. The cash cow lives another year...
> Adel Assaad Seattle, WA

I guess this means we will have to know which CPT code the urologist used
to obtain the biopsy?

Mahesh.





Mahesh M. Mansukhani, MD
Associate Professor of Clinical Pathology
Director, CUMC Molecular Pathology Laboratory
Columbia University Medical Center, New York NY 10032
VC14-237; 212-305-2646
_______________________________________________
[Quoted text hidden]
Ed Uthman <[email protected]> 	Fri, Nov 14, 2008 at 11:27 AM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
At 02:32 PM 11/13/2008, Warren White wrote:

>Whatever is the absolute worst case scenario for the pathologist; that
>is what this means and what will happen. Have a nice day........

Hasta la vista, pod labs! Maybe you can move on to homeopathy clinics
or something.

Ed


-----
Ed Uthman, MD ([email protected])
Pathologist, Houston/Richmond, Texas, USA
http://web2.airmail.net/uthman
http://www.flickr.com/photos/euthman
[Quoted text hidden]
Warren White <[email protected]> 	Fri, Nov 14, 2008 at 12:20 PM
Reply-To: Pathology Discussion Group <[email protected]>
To: Pathology Discussion Group <[email protected]>
To avoid any misconceptions: Our lab (myself included) has not and does
not participate in any pod-lab/condo-lab scenario, any account bill/MD
office bill scam, or any clinician owned lab at any level.

Seems to me that the recent CMS anti-mark up ruling (and not the
mysterious "G" code), as I read it, will effectively kill the pod-lab
scenario (probably anyway). It does absolutely nothing to kill the
in-office clinician owned AP lab scenario as there are too many
loopholes for it to be effective in that regard. Again, this latter
scenario is not a pod-lab. It is a different beast altogether.

In my state (NC) it would be completely legal for an endoscopy center or
urology group (without the help of a pathologist) to have their own AP
lab in their office, bill all payors - including Medicare - for the full
technical component and get paid using the same pathology codes that we
use. They can then take the slides that they made (with no supervising
pathologist), mail them to a commercial lab, purchase the professional
reading for $10, mark that purchased professional component up to
whatever and, again using the same path codes we do, bill it and get
paid. The only thing they cannot do is mark-up the purchased
professional component for Medicare cases.

"G" codes? My office just called CMS and the person on the phone said:
"Never heard of them". The lowest level of "G" code for prostate
biopsies BTW pays $550, the next level over $1000. So - I would think
those numbers would still be attractive to clinician-owned in office AP
labs as those numbers are fairly close to the current reimbursement.

Hence my prior negative comment. Pathology as an independent practice of
medicine is not gaining any ground as far as I can tell. Have a nice
day........

WWhite
[/SIZE]

Very Interesting!!! However, this doesn't sound as bad as LADoc made it seem. Maybe I'm wrong. Also, there is no mention anywhere about skins being given a G code. I scraped the internet again and couldn't find anything about CPT codes being changed for skins. I found new CPTs for colon. Oh well. Anyone else hear about this?

 

[Nilf]

Here is a recent discussion on the PATHO-L list:



Hence my prior negative comment. Pathology as an independent practice of
medicine is not gaining any ground as far as I can tell. Have a nice
day........

WWhite
[/SIZE]
[/code]

Fascinating... The excerpt you posted should be a reading requirement for every pathology residency program out there.