No JOBS in pathology

[octopusprime]

It looks like you figured out why I am out here trying to correct misconceptions about the field. Some people say, oh well, it sucks, and other people say, wait a second, if you are a normal person and put your best foot forward, you will be able to do what you love, not get burnt out, have a comfortable salary--266k on average, up to 333k on average for multispecialty private practice-- (pathologists are in the top 2 specialties for feeling "fairly compensated" (Pathology: A Satisfying Medical Profession, Xu and Remick, 2016), AND have a hobby or two. I'm trying to let the upcoming generation know that big changes are coming in pathology and now is the time to get in! If you like technology, biochemistry, genetics, if you are a visual person, if you like radiology but enjoy things more on a cellular level - check it out! Within the decade we will be converted to digital systems with image recognition software, immediate sharing of images. We will be getting away from scopes and into AI. Don't underestimate pathology - it's not going anywhere - it still forms the backbone of hospital diagnostics, cancer diagnostics, blood tests, etc.

I give my anecdotal numbers in support of what the research shows. The research conducted shows that most are finding jobs they are satisfied or very satisfied with (The Recent Pathology Residency Graduate Experience: A Synthesis, by Gratzinger, Powell, etc. 2017).

If you want to point at the 61%, go ahead. I already mentioned that only takes into account people who still have several months left before the end of residency, and on average, I would venture to guess that the average pathology resident doesn't really do much networking to find jobs beyond asking people in their own residency programs. So a little effort goes a long way. May I ask, did you opt to take a job in a large city? Demand is greatest in smaller cities.

To be in-demand as a pathologist, do a fellowship in surg path and a fellowship in cyto, (and be competent, ethical, etc.) and you are a candidate for the largest number of job openings.

I believe the largest problem is that we're now accustomed to accepting "266 - 333" as a "comfortable salary" for our field within the medical profession...strictly talking within the profession, not compared to avg. blue collar electician/janitor/teacher--talking within the profession. Those are family practice numbers, primary care, peds, IM...fields that are a dime a dozen, non-competitive, have residencies in every community hospital across the country.

So why is it that some/most pathologists are "content" making 266-333? Because that's what most academic centers/Ameripath/Quest/Labcorps/et al pay, and that's where most of the jobs are. Other specialties (ent, derm, gastro, etc) may have similar salaries in academics, but outside the walls of teaching institutions, they are capable of being stand-alone entities and making fantastic income, which is why it's impossible for hospitals to hire derms, GIs, etc, as employees...and without large corporate entities driving price down, they're able to maintain a premium for their services.

266k is a "good salary" in general terms, i get it, and many are content with a "good salary" compared to per capita income. But why do some pathologists pull down 500? 600? 700? 900? A combination of good payers, location, volume and 'management'...no employed pathologist--whether at a hospital, corporate lab, or academics-- is going to pull down 5-600 unless you've written textbooks or have some grandfathered contract. But if you're not making at least 400 as a PP partner with reasonable volume, something is wrong, the product of some combination of bad payer mix/bad reimbursement, over staffing/low volume, or just bad business. If you're making 266 as an employed pathologist at Quest/Fillintheblank University/Joe Smith Regional Hospital with reasonable volume, you're being taken advantage of...no ifs, ands or buts about it. Period.

So yes, if you're competent, amiable, work well with others, have at least 1 fellowship, and even a few yrs of sign out experience under your belt, you'll find a job. Whether it's a "266-333" job or a better one depends on timing & how content you are to make 266-333 and knowing you're being literally raped.

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[Thrombus]

It looks like you figured out why I am out here trying to correct misconceptions about the field. Some people say, oh well, it sucks, and other people say, wait a second, if you are a normal person and put your best foot forward, you will be able to do what you love, not get burnt out, have a comfortable salary--266k on average, up to 333k on average for multispecialty private practice-- (pathologists are in the top 2 specialties for feeling "fairly compensated" (Pathology: A Satisfying Medical Profession, Xu and Remick, 2016), AND have a hobby or two. I'm trying to let the upcoming generation know that big changes are coming in pathology and now is the time to get in! If you like technology, biochemistry, genetics, if you are a visual person, if you like radiology but enjoy things more on a cellular level - check it out! Within the decade we will be converted to digital systems with image recognition software, immediate sharing of images. We will be getting away from scopes and into AI. Don't underestimate pathology - it's not going anywhere - it still forms the backbone of hospital diagnostics, cancer diagnostics, blood tests, etc.

I give my anecdotal numbers in support of what the research shows. The research conducted shows that most are finding jobs they are satisfied or very satisfied with (The Recent Pathology Residency Graduate Experience: A Synthesis, by Gratzinger, Powell, etc. 2017).

If you want to point at the 61%, go ahead. I already mentioned that only takes into account people who still have several months left before the end of residency, and on average, I would venture to guess that the average pathology resident doesn't really do much networking to find jobs beyond asking people in their own residency programs. So a little effort goes a long way. May I ask, did you opt to take a job in a large city? Demand is greatest in smaller cities.

To be in-demand as a pathologist, do a fellowship in surg path and a fellowship in cyto, (and be competent, ethical, etc.) and you are a candidate for the largest number of job openings.

To be an "in-demand" pathologist you have to do 2 fellowships and you can earn 266-333K working for some path mill taking orders from a suit with a C average undergraduate business degree from State U, who plays golf while you work chained to the scope?

Pathologists feel compensated probably because the ones surveyed escaped their dreaded third world hellhole to come to America!! We are over half foreign national as Americans who are high achieving WINNERS do not want to enter this COMMODITIZED PATHOLOGY DISASTER!!!

AND NEWSFLASH: Technology will further reduce the need for more pathologists as we become more and more EFFICIENT. Either we can take this efficiency and make more money or the suits who employ pathologist for 266-333K can make more money. IT SHOULD BE OUR CHOICE! NOT THE DAMN ACADEMICS WHO ARE OVERTRAINING PATHOLOGISTS BY THE HUNDREDS EVERY YEAR!!!!!! THIS DESTROYS OUR BARGAINING POWER/LEVERAGE FOR YOU WHO ARE COMPLETELY INCOMPETENT IN ECONOMICS!!!!!

 

[Morichka]

To be an "in-demand" pathologist you have to do 2 fellowships and you can earn 266-333K working for some path mill taking orders from a suit with a C average undergraduate business degree from State U, who plays golf while you work chained to the scope?

Pathologists feel compensated probably because the ones surveyed escaped their dreaded third world hellhole to come to America!! We are over half foreign national as Americans who are high achieving WINNERS do not want to enter this COMMODITIZED PATHOLOGY DISASTER!!!

AND NEWSFLASH: Technology will further reduce the need for more pathologists as we become more and more EFFICIENT. Either we can take this efficiency and make more money or the suits who employ pathologist for 266-333K can make more money. IT SHOULD BE OUR CHOICE! NOT THE DAMN ACADEMICS WHO ARE OVERTRAINING PATHOLOGISTS BY THE HUNDREDS EVERY YEAR!!!!!! THIS DESTROYS OUR BARGAINING POWER/LEVERAGE FOR YOU WHO ARE COMPLETELY INCOMPETENT IN ECONOMICS!!!!!

Agree with both of you - there is an overtraining problem. Technology will reduce the need for pathologists who will be able to do more than in previous years. We need to limit the spots and attract dyanamic people with tech skills to take us there. I believe that when there are fewer spots and we can be more selective, there will be more med students attracted to the specialty. This will also partially address the issue of foreign nationals driving down the cost of diagnostic services and essentially taking "warm-body" jobs for the lowest pay the partners can muster. I hear you. Preaching to the choir.

But can we also address this by making pathology more attractive to AMGs. Surely there's not one thing that will solve all the problems? So why don't you all hop on board and let's do something about it instead of rioting and whining? We are doing ourselves and our specialty a disservice by dissuading people from entering pathology, when one of the answers to the issue would be to attract AMGs who are dedicated to the specialty, seek its advancement, know its potential, and understand the healthcare environment we operate in. What do you suggest? How do we attract the best and brightest? Is limiting residency slots the answer? I thought one answer would be to start speaking positively about pathology on this forum. This is one place med students come to get their info, so I want to put pathology in a good light. Sometimes I feel like I'm fighting an uphill battle.

 

[Thrombus]

Agree with both of you - there is an overtraining problem. Technology will reduce the need for pathologists who will be able to do more than in previous years. We need to limit the spots and attract dyanamic people with tech skills to take us there. I believe that when there are fewer spots and we can be more selective, there will be more med students attracted to the specialty. This will also partially address the issue of foreign nationals driving down the cost of diagnostic services and essentially taking "warm-body" jobs for the lowest pay the partners can muster. I hear you. Preaching to the choir.

But can we also address this by making pathology more attractive to AMGs. Surely there's not one thing that will solve all the problems? So why don't you all hop on board and let's do something about it instead of rioting and whining? We are doing ourselves and our specialty a disservice by dissuading people from entering pathology, when one of the answers to the issue would be to attract AMGs who are dedicated to the specialty, seek its advancement, know its potential, and understand the healthcare environment we operate in. What do you suggest? How do we attract the best and brightest? Is limiting residency slots the answer? I thought one answer would be to start speaking positively about pathology on this forum. This is one place med students come to get their info, so I want to put pathology in a good light. Sometimes I feel like I'm fighting an uphill battle.

The answer is to aggressively close residency programs until there is a line of hospitals and other docs begging for pathologists to take their work.

Until then, we all will suffer. This field has been killed by underperforming academics who suck money out of CMS by overtraining residents.

 

[jupiterianvibe]

Agree with both of you - there is an overtraining problem. Technology will reduce the need for pathologists who will be able to do more than in previous years. We need to limit the spots and attract dyanamic people with tech skills to take us there. I believe that when there are fewer spots and we can be more selective, there will be more med students attracted to the specialty. This will also partially address the issue of foreign nationals driving down the cost of diagnostic services and essentially taking "warm-body" jobs for the lowest pay the partners can muster. I hear you. Preaching to the choir.

But can we also address this by making pathology more attractive to AMGs. Surely there's not one thing that will solve all the problems? So why don't you all hop on board and let's do something about it instead of rioting and whining? We are doing ourselves and our specialty a disservice by dissuading people from entering pathology, when one of the answers to the issue would be to attract AMGs who are dedicated to the specialty, seek its advancement, know its potential, and understand the healthcare environment we operate in. What do you suggest? How do we attract the best and brightest? Is limiting residency slots the answer? I thought one answer would be to start speaking positively about pathology on this forum. This is one place med students come to get their info, so I want to put pathology in a good light. Sometimes I feel like I'm fighting an uphill battle.

I sympathize. But no matter what we say, amgs will still notice that over half of our field is made up of fmgs. That looks bad and suggests that we have low standards and poor job security. The 222k number quoted above is also a poor starting number for specialists.

The true change has to begin at the academic program level. Which means many programs would have to downsize or close. But that will never happen.

All that can truly be done is to lower your own personal standards and accept mediocre conditions, or keep your standards high and change your career.

 

[Launcelot]

Would you say an individual AMG's job hunt experience would be easier than an FMG or IMG's?

 

[pathslides]

Would you say an individual AMG's job hunt experience would be easier than an FMG or IMG's?

For the most part, good AMGs (as well as some good FMGs) get residency spots at good institutions. It is coming from a good institution with name recognition that makes the job hunt easier in my opinion. An FMG who went to a great place and had good references and can speak english well is better in my book than an AMG who went to an average or subpar place.

 

[cmz]

In my region in TX, you have to sign out around 6900 tubular adenomas to make $266,666.00 (if you're only looking at medicare rates). That sounds easy and I sincerely WISH I could sign out nothing but TAs every day and make that much money. There are overhead costs to a pathology business. I don't need to outline every single cent, but I don't think people realize the overhead costs. So, in the end, it's gonna take a heck of a lot more than just signing out 6900 TAs every year to make that nice salary of 267K (not including benefits). In this scenario, you better be signing out over 12000 TAs before you start to ask me for a bump in salary.

I think people need to stop having 'salary tunnel vision' and consider the entire benefits package they receive. If you only receive a flat salary and feel that it isn't impressive, then I suggest you find work elsewhere.

 

[Alteran]

I believe the largest problem is that we're now accustomed to accepting "266 - 333" as a "comfortable salary" for our field within the medical profession...strictly talking within the profession, not compared to avg. blue collar electician/janitor/teacher--talking within the profession. Those are family practice numbers, primary care, peds, IM...fields that are a dime a dozen, non-competitive, have residencies in every community hospital across the country.

So why is it that some/most pathologists are "content" making 266-333? Because that's what most academic centers/Ameripath/Quest/Labcorps/et al pay, and that's where most of the jobs are. Other specialties (ent, derm, gastro, etc) may have similar salaries in academics, but outside the walls of teaching institutions, they are capable of being stand-alone entities and making fantastic income, which is why it's impossible for hospitals to hire derms, GIs, etc, as employees...and without large corporate entities driving price down, they're able to maintain a premium for their services.

266k is a "good salary" in general terms, i get it, and many are content with a "good salary" compared to per capita income. But why do some pathologists pull down 500? 600? 700? 900? A combination of good payers, location, volume and 'management'...no employed pathologist--whether at a hospital, corporate lab, or academics-- is going to pull down 5-600 unless you've written textbooks or have some grandfathered contract. But if you're not making at least 400 as a PP partner with reasonable volume, something is wrong, the product of some combination of bad payer mix/bad reimbursement, over staffing/low volume, or just bad business. If you're making 266 as an employed pathologist at Quest/Fillintheblank University/Joe Smith Regional Hospital with reasonable volume, you're being taken advantage of...no ifs, ands or buts about it. Period.

So yes, if you're competent, amiable, work well with others, have at least 1 fellowship, and even a few yrs of sign out experience under your belt, you'll find a job. Whether it's a "266-333" job or a better one depends on timing & how content you are to make 266-333 and knowing you're being literally raped.

I understand your point and yes, other surgical/procedural specialties certainly do rake it in assuming they have ownership of their own facilities and/or have a market monopoly in a geographic region (most likely an undesirable location). But you have to assume that these physicians are interested in 1) investing significant personal capital to open and manage their own office with overhead, 2) hiring and managing their own employees which can make or break a practice, 3) negotiating employee benefits, 4) negotiating insurance reimbursement rates every year, 5) and being perpetually tied in to the practice because of all the aforementioned. These are things that a significant number of recent grads, across all specialties, have no interest in doing. So I've seen where they'll gladly give up the 7 figure salary for a 500-600k salary + bonuses (if applicable) if it means they work 8-5 with minimal call as part of a large interdisciplinary practice that may or may not have some form of equity or partnership track.

So yes, you can make serious bank in any other specialty if you want to work that hard for it. From what I've seen in my region, that's a select few physicians who are very wealthy, but they work like dogs. Now, if we're talking the base salary from RVUs alone, that's another matter entirely.

 

[stickyshift]

In my region in TX, you have to sign out around 6900 tubular adenomas to make $266,666.00 (if you're only looking at medicare rates). That sounds easy and I sincerely WISH I could sign out nothing but TAs every day and make that much money. There are overhead costs to a pathology business. I don't need to outline every single cent, but I don't think people realize the overhead costs. So, in the end, it's gonna take a heck of a lot more than just signing out 6900 TAs every year to make that nice salary of 267K (not including benefits). In this scenario, you better be signing out over 12000 TAs before you start to ask me for a bump in salary.

I think people need to stop having 'salary tunnel vision' and consider the entire benefits package they receive. If you only receive a flat salary and feel that it isn't impressive, then I suggest you find work elsewhere.

I look at numbers like that and marvel that we can make any money at all. I wouldn't think that all that many pathologists sign out 7000+ 88305s/year. Of course, we get money from MD fees, and, if we're lucky, from more generous private insurance contracts (But in reality, those might be balanced out by your Medicaid cases . . . )

 

[yaah]

I've read all of the SDN horror stories here about having no jobs in pathology, say that you guys are right; Of the few jobs or little demand there is left for pathologists, which sub-specialties of path are MOST in demand?

If you experienced folks were forced to imagine the most qualified, in-demand pathologist, would this be a 2 fellowship-having (and which two), MBA/JD/MPH-carrying, ivy-league trained, combined AP/CP pathologist?

In my experience, the most valuable "fellowship" in pathology is the ability to be someone that people want to work with. That, and the ability to do multiple things. A lot of graduates don't want to do or think they can't do any CP, despite being CP trained. They don't want to sign out anything outside of their fellowship(s).

We get lots of applications for our jobs. Very few are people who would be good fits for our group. But most of them are not good fits because they disqualify themselves by one of the following ways:
1) Can't communicate
2) Make demands before they even get the job
3) Have bad references
4) Don't want to do something that everyone else in the group does (like be a medical director)
5) Are overconfident or outright obnoxious
6) Are so timid they would hesitate to diagnose almost anything.
7) Don't get along with others.

I am totally serious here. We have interviewed less than 20% of the people who on paper look like they would be good fits for our group. And why is that? Because they take themselves out of the game during a phone interview or email or whatever by one of the above. I have no idea who is hiring all these people or where they are working. This doesn't even include the people with very weak CVs (like 5 jobs in 6 years, multiple gaps in their employment record, very weak training record).

If you meet all these criteria, and you want to be in a private group, more general fellowships like heme or cyto or surg path are most helpful. But it also otherwise depends on timing. Like right now, we need breast path, but not GI path. 6 years ago we needed GI path.

 

[Alteran]

If you meet all these criteria, and you want to be in a private group, more general fellowships like heme or cyto or surg path are most helpful. But it also otherwise depends on timing. Like right now, we need breast path, but not GI path. 6 years ago we needed GI path.

If one needs a fellowship in breast or GI pathology (with the exception of medical liver and possibly pancreaticobiliary) to feel comfortable signing those cases out, I don’t think they went to a very good training program. My group feels that should have been learned in residency and someone who spent a year mostly looking at polyps or breast core biopsies doesn’t bring anything unique to the group. We expect everyone in the group to be able to do general surgical pathology- which for us is all GI, breast, neoplastic lung, endocrine, basic neuropath (we basically only get mets, high-grade gliomas, and meningiomas), and routine GYN.

 

[pathslides]

If one needs a fellowship in breast or GI pathology (with the exception of medical liver and possibly pancreaticobiliary) to feel comfortable signing those cases out, I don’t think they went to a very good training program. My group feels that should have been learned in residency and someone who spent a year mostly looking at polyps or breast core biopsies doesn’t bring anything unique to the group. We expect everyone in the group to be able to do general surgical pathology- which for us is all GI, breast, neoplastic lung, endocrine, basic neuropath (we basically only get mets, high-grade gliomas, and meningiomas), and routine GYN.

That's how I feel about a surg path fellowship. A good residency program should should be more than adequate for general surg path signout.

 

[yaah]

If one needs a fellowship in breast or GI pathology (with the exception of medical liver and possibly pancreaticobiliary) to feel comfortable signing those cases out, I don’t think they went to a very good training program. My group feels that should have been learned in residency and someone who spent a year mostly looking at polyps or breast core biopsies doesn’t bring anything unique to the group. We expect everyone in the group to be able to do general surgical pathology- which for us is all GI, breast, neoplastic lung, endocrine, basic neuropath (we basically only get mets, high-grade gliomas, and meningiomas), and routine GYN.

I agree with this but many trainees themselves do not. I don't get it, I don't understand it. There are some academic paths who have a feeling that one cannot competently do general surg path without doing a surg path fellowship - to me this is nonsense.

A general surg path fellowship is a good year to refine your skills and confidence, I have no problem with it. But it's typically not necessary if you're doing another fellowship.

If you are in a high-volume center with complexity, it does help to have a fellowship-trained person in your group. They don't have to sign out every case, but it helps for keeping practice patterns adequate, understanding changing fields, and such. You can get around this with a dedicated person in the group, however, but that can take longer.

Our group has fellowship trained individuals in our busiest specialties, but not everything. The hardest thing to fill, seemingly, is hemepath because most people who haven't done a hemepath fellowship will not feel comfortable enough in it. Kind of a shame, but it is what it is. I did multiple extra months in hemepath during my training so I am comfortable with it. But many are not.

 

[AZpath]

I try to read everything commonly submitted to the practice but I know when I need expert help.
Residents should have a good understanding of all organs before entering practice. We should know what a normal BM looks like verses abnormal, etc

Our practice just diagnosed a medical liver with AIH and PBC overlap. We don't see a ton of medical livers but enough cases to diagnose most of them.
We sent the case to Cleveland Clinic for a second opinion. That's how I thought our specialty should work when I got out of training.

How did our specialty come to require a "right toenail subspecialist" to be qualified to read a specific case?

When I earned my private pilots license, all the instructors told us it is a license to learn. I take that approach in pathology.
We need to address the mentality that thinks every skin, breast, GI, heme, cytology, neuro is the sole territory of fellowship trained pathologist.

 

[jadedenvy]

Genuine question - what fellowships do you believe are worth doing?

One of the things I really liked about pathology was the breadth and depth of the field, and that there would be a lot of variety to keep me engaged and occupied. I haven't started residency yet but I'm not quite sure if I could see myself settling on one system in particular, yet it seems the majority of pathologist have to subspecialize, and nearly every institution I interviewed at had subspecialty sign out. Of course these were big academic places, whereas I'd guess private practice you'd have a more generalized approach. But because of this I was thinking of investigating pediatric pathology as a potential fellowship because from what I've heard, you're doing more generalized/multi-system work as opposed to sticking to a single organ. Is pediatrics something that's worth doing a fellowship in? This would probably relegate me to sticking to academics for jobs, right? (Which I don't necessarily mind since I'd like to teach, but unsure of how I might feel later on once I start thinking about compensation, etc).

 

[LoaLoa]

Depending on your practice setting, pretty much every board-certified subspecialty can be worth doing. Many general pathologists get very uncomfortable signing out anything other than the most basic hematopathology, dermatopathology, and neuropathology cases. Most pathologists can sign out 75% of cytology cases without a fellowship, but don’t enjoy it.

I don’t really see the utility of a surgical pathology fellowship, unless you’re doing resume CPR or don’t feel adequately trained by your residency program. Non-board certified subspecialty fellowships, e.g. breast, GI, are perhaps useful but you are competing against generalists who feel perfectly comfortable doing those cases, for the most part.

 

[LoaLoa]

Depends where you end up going. I know a hemepath grad who went to a private group who needed breast help. First week actually getting cases got 5 mastectomies, 3 lumpectomies and 8 biopsies in one day. That pattern continued. Residency should prepare you for most general surg path but that kind of volume, especially if complex is for someone with more experience or fellowship trained. Oh and 90% of cases need to be signed out 48 hours from accessioning date. Pathology mills.
Needless to say, he didn't stay long.

Whoa. That's a lot of breast cases. Sounds like a waking nightmare .

 

[cmz]

I look at numbers like that and marvel that we can make any money at all. I wouldn't think that all that many pathologists sign out 7000+ 88305s/year. Of course, we get money from MD fees, and, if we're lucky, from more generous private insurance contracts (But in reality, those might be balanced out by your Medicaid cases . . . )

If you have a hospital contract, the PC-CP billing should definitely add something (depending on payer mix) and so should your part A. I keep hearing that more and more hospitals are offering nil for part A compensation. Hypothetically speaking, would hospital administration go out of their way to find a cheaper solution (i.e. less part A) by offering up the contract to another group/company? If the answer is yes, then there's obviously something else going on that they don't like about their current group.

 

[octopusprime]

I understand your point and yes, other surgical/procedural specialties certainly do rake it in assuming they have ownership of their own facilities and/or have a market monopoly in a geographic region (most likely an undesirable location). But you have to assume that these physicians are interested in 1) investing significant personal capital to open and manage their own office with overhead, 2) hiring and managing their own employees which can make or break a practice, 3) negotiating employee benefits, 4) negotiating insurance reimbursement rates every year, 5) and being perpetually tied in to the practice because of all the aforementioned. These are things that a significant number of recent grads, across all specialties, have no interest in doing. So I've seen where they'll gladly give up the 7 figure salary for a 500-600k salary + bonuses (if applicable) if it means they work 8-5 with minimal call as part of a large interdisciplinary practice that may or may not have some form of equity or partnership track.

So yes, you can make serious bank in any other specialty if you want to work that hard for it. From what I've seen in my region, that's a select few physicians who are very wealthy, but they work like dogs. Now, if we're talking the base salary from RVUs alone, that's another matter entirely.

That's certainly true, but even if it's not the norm it's still inherently more possible with other specialties.
I guess I was mainly deriding the fact that with pathology, it's not the case of grads wanting to work for Ameripath/Quest for half the money and better hours...it's half the money for worse hours, worse management, worse everything. People entering the market in anesthesia, gastro, derm, allergy, etc...they EXPECT they are going to make 500 +/- ...more if they want. People entering path EXPECT they're going to make 260-333, likely at the lower end.

 

[coroner]

I have mentioned before that the last time we advertised publicly for a job, we listed specific qualifications we wanted. We got I think 80-100 applications, probably 60-70% were not qualified (many due to just not having the specific skills we needed, but also for reasons ranging from inadequate training, poor communication skills, poor references, poor track record of employment). But yet most of these people got jobs somewhere.

We have interviewed less than 20% of the people who on paper look like they would be good fits for our group. And why is that? Because they take themselves out of the game during a phone interview or email or whatever by one of the above. I have no idea who is hiring all these people or where they are working.

Mmmkayyy...So at first, most of these bad candidates wound up getting jobs. But now their fate is a mystery...?

 

[BrainPathology]

My group just hired two, every job here is partnership track. What Yaah said about the actual dearth of barely recognizable human candidates was identical to our experience. If someone doesn't have a job in pathology, they don't deserve one, simple as that.

 

[AZpath]

My group just hired two, every job here is partnership track. What Yaah said about the actual dearth of barely recognizable human candidates was identical to our experience. If someone doesn't have a job in pathology, they don't deserve one, simple as that.

That states the case well for too many and poorly trained candidates. The weaker candidates get the poorer paying jobs and at bad labs with little over-site.
Right now you can do two fellowships and still be recognized quickly as a poor hire from a good group.

Btw, someone stated that most general pathologist will be able to sign 75% of cytology cases.
I have been a member of several small groups we signed 99%+ of all cytos. Most of us were not fellowship trained.
Actually, at one group we hired a new cytology fellow, highly recommend from a good program.
Well that hire was so scared of signing out cases including cytology it was no benefit.
They turned into an excellent pathologist but it took some on the job training including cytology.

As I have said before the real risk for new grads is market place shakeout driven by technology or changes in reimbursement, only the strong will survive.

 

[yaah]

Mmmkayyy...So at first, most of these bad candidates wound up getting jobs. But now their fate is a mystery...?

Um, yes? Is there supposed to be an incongruence here?

There fates aren't entirely mysteries - because some of them continue to apply the next time there is a position, only now their CV includes three different jobs in three years. This is a major red flag. But someone keeps hiring them because they had three different jobs.

If there really were stellar candidates lined up for the few jobs that open up, as so many on this forum claim, then why do we keep getting applications like this?

 

[LADoc00]

The main thing concerning me about Path is job consolidation, specifically in towns where there maybe were 5-6 pathologists there are now only 2. Towns where there were 4 FT pathologists in the 1980-90s, there might be one with locums coverage. What is driving this is multi-factorial and I wont go into it here, but I am noticing this is very common in areas outside big urban centers with big medical centers (which are massively overly medicalized to begin with).

The "country pathologist" if that is even an archetype seems to be in decline.

 

[jupiterianvibe]

Um, yes? Is there supposed to be an incongruence here?

There fates aren't entirely mysteries - because some of them continue to apply the next time there is a position, only now their CV includes three different jobs in three years. This is a major red flag. But someone keeps hiring them because they had three different jobs.

If there really were stellar candidates lined up for the few jobs that open up, as so many on this forum claim, then why do we keep getting applications like this?

If a pathologist comes from a sub-par program (and we all know there are many of those), the only jobs that will be available to them are most likely bad jobs (low pay, slide mills etc). But a job's a job. While in that job they realize that their concerns were warranted - the job sucks - and since the terms are poor, or even exploitive, they feel no loyalty and look for a better one elsewhere. Of course, they can't get better ones, only lateral ones. So they keep rolling the dice on jobs until they get one that's not crap.

The same situation could be applied to someone who comes from a good program but is geographically restricted for family reasons. Big cities are rife with churn-and-burn slide mills.

To blame the pathologists entirely on this is not fair. It's not a personal red flag for them as much as it is a potential indicator, with emphasis on the word "potential", of coming from a bad program. Of course, you could actually read their CV and find out what program they trained at, which would give you a better answer than trying to surmise based on their job histories.

 

[LoaLoa]

If a pathologist comes from a sub-par program (and we all know there are many of those), the only jobs that will be available to them are most likely bad jobs (low pay, slide mills etc). But a job's a job. While in that job they realize that their concerns were warranted - the job sucks - and since the terms are poor, or even exploitive, they feel no loyalty and look for a better one elsewhere. Of course, they can't get better ones, only lateral ones. So they keep rolling the dice on jobs until they get one that's not crap.

The same situation could be applied to someone who comes from a good program but is geographically restricted for family reasons. Big cities are rife with churn-and-burn slide mills.

To blame the pathologists entirely on this is not fair. It's not a personal red flag for them as much as it is a potential indicator, with emphasis on the word "potential", of coming from a bad program. Of course, you could actually read their CV and find out what program they trained at, which would give you a better answer than trying to surmise based on their job histories.

This is true. There are good pathologists out there who have hopped around or who have non-traditional job histories that are due to factors outside their control. It’s really difficult to separate the wheat from the chaff if you’re in a position to hire.

 

[AZpath]

Your spot on with rural pathology.
Small groups are getting smaller and big groups are getting bigger .
This spells bad news for rural surgery and pathology.

 

[AZpath]

If a pathologist comes from a sub-par program (and we all know there are many of those), the only jobs that will be available to them are most likely bad jobs (low pay, slide mills etc). But a job's a job. While in that job they realize that their concerns were warranted - the job sucks - and since the terms are poor, or even exploitive, they feel no loyalty and look for a better one elsewhere. Of course, they can't get better ones, only lateral ones. So they keep rolling the dice on jobs until they get one that's not crap.

The same situation could be applied to someone who comes from a good program but is geographically restricted for family reasons. Big cities are rife with churn-and-burn slide mills.

To blame the pathologists entirely on this is not fair. It's not a personal red flag for them as much as it is a potential indicator, with emphasis on the word "potential", of coming from a bad program. Of course, you could actually read their CV and find out what program they trained at, which would give you a better answer than trying to surmise based on their job histories.

If your are smart guy from a weak programs you can do fine too. Better than a dim witt from a top name.
(You will be might be more likely to change jobs in first few years.)
I know some real dummies and jerks that trained at top programs.
If your are smart you can still find a good fellowship elsewhere too.

Btw, the end fellowship training is only the start of your career.
Don't find a position at the local polyp mill for your first gig if you can help it. ( You may be happy as a clam there too.)
Your experience will be very limited. There is a larger need for folks with a flexible skill set.

 

[path24]

"We have filled our open Pathologist position. We did select an individual that responded to the ad posted on your service site. In addition, your prompt turnaround in posting the position was paramount in expediting the candidate search process. The quality of the candidates who responded were topnotch." L. Tatum, Bowling Green Associated Pathologists, Kentucky, 13 March 2018

"Advertising only on your site provided almost more candidates than I could deal with and we were able to select from many highly qualified individuals. I will certainly recommend using you guys to anyone looking in the future!" R. Forsythe, M.D., Boulder Valley Pathology, Colorado, 1 February 2018

Something doesn't add up. Lots of high quality candidates out there! Hmm...Guess its tough to find the gi/dermpath/breast fellowship trained pathologist, so everyone is a crappy candidate and see we have a massive shortage. Sounds about right.

 

[octopusprime]

The main thing concerning me about Path is job consolidation, specifically in towns where there maybe were 5-6 pathologists there are now only 2. Towns where there were 4 FT pathologists in the 1980-90s, there might be one with locums coverage. What is driving this is multi-factorial and I wont go into it here, but I am noticing this is very common in areas outside big urban centers with big medical centers (which are massively overly medicalized to begin with).

The "country pathologist" if that is even an archetype seems to be in decline.

Same might be true in urban centers, they're just better positioned to adjust/adapt. Talking to old VA docs it's common to hear their staff used to be 2 - 3 x what it is now.
Maybe mikesheree can chime in here being from the old guard.

combination of decreased reimbursement, the loss of CP billing ( i understand that used to be huge in the golden days), increased regulation, more "efficiency" by admin (meaning we're doing more work with less people / working harder)...

 

[yaah]

"We have filled our open Pathologist position. We did select an individual that responded to the ad posted on your service site. In addition, your prompt turnaround in posting the position was paramount in expediting the candidate search process. The quality of the candidates who responded were topnotch." L. Tatum, Bowling Green Associated Pathologists, Kentucky, 13 March 2018

"Advertising only on your site provided almost more candidates than I could deal with and we were able to select from many highly qualified individuals. I will certainly recommend using you guys to anyone looking in the future!" R. Forsythe, M.D., Boulder Valley Pathology, Colorado, 1 February 2018

Something doesn't add up. Lots of high quality candidates out there! Hmm...Guess its tough to find the gi/dermpath/breast fellowship trained pathologist, so everyone is a crappy candidate and see we have a massive shortage. Sounds about right.

I very much agree something doesn't add up - kind of what I have been saying. the job search we conducted starting about 3 years ago we did get multiple strong applicants. The more recent job ads we have put out have most decidedly NOT gotten strong applicants. The stronger applicants have been people who we found on our own or encouraged to look at the ads.

As far as loss of rural pathologists - the bigger trend (I think) is for large hospital systems to consolidate their labs - so smaller hospitals which previously had 3 of their own pathologists become part of the larger network. Typically when this happens the small group is either merged into the larger group or hired by the system (depending on how the system does things). Then the bigger group runs the smaller lab but can do it with a smaller onsite presence because specimens can also be consolidated centrally. Not all of this is bad, but it does reduce small hospital jobs.

 

[coroner]

If a pathologist comes from a sub-par program (and we all know there are many of those), the only jobs that will be available to them are most likely bad jobs (low pay, slide mills etc). But a job's a job.

For the most part this is true, and it is another indicator that the job market is suboptimal. As I stated before, an internist graduating from Johns Hopkins or Grand Rapids Community Medical Center will have a lot more parity in terms of quality (and quantity) of job opportunities vs the same for a pathology grad.

The "country pathologist" if that is even an archetype seems to be in decline.

Small groups are getting smaller and big groups are getting bigger. This spells bad news for rural surgery and pathology.

Not all of this is bad, but it does reduce small hospital jobs.

All true and unfortunately a shame for pathologists. It offers less choices for practice settings for one's career. I've worked at some of those smaller type places and they can be a diamond in the rough. Usually solo or two person type practice with typically friendlier staff, generous Part A, nearly non-existent call, done signing out by 2-3pm...

 

[LADoc00]

I wanted to add something I think that may get lost in the "weeds" on this issue: larger consolidated multi-facility Pathology and Lab operations make more catastrophic mistakes than most solid small 'close to point of care' pathology groups.

I say definitively from a combination of personal anecdotes and actual meta analysis of the data on malpractice.

From a common sense perspective, massive lab consolidation is BAD for patient care. There is almost no upside as well aside from the obvious medical economics standpoint. Im sure someone will pipe in that their 40-man mega group has a derm and a neuro person offering broader expertise but the reality of that is total B.S. I can send a case to neuro at Mayo, GI to Michigan or skin to Harvard and I can bet the farm they are 10x better than whatever rando is doing a combination of derm and general path or neuro and general path.

In terms of error detection, being close to point of care with active knowledge of a smaller pool of patients getting biopsies has allowed me to intercept no less than 6 absolutely catastrophic errors over a several year span and actually SAVE LIVES. These would have been errors that may have led to death, massive lawsuits, end of career of pathologists in my group and general misery in my community. These errors were caught only by 'total situation awareness' of a smaller number of clinicians and patients well known to me. This simply isnt possible in mass consolidated lab operations where every case is seen in a black box.

I am fervent and even fanatical believer that pathologists being consolidated away from smaller hospitals is bad.

Food for thought.

 

[AZpath]

LADoc00 you hit the nail on the head.
The big box subspecialist model does not lead to better care. It only leads to greater throughput.


The most important information often gets lost once we loose local access.
Patient are not necessarily handled well by large single subspeciality or multi-subspecialty pathology groups or labs.
It just sells better.

 

[AZpath]

When was the last time anyone here got mail, email or call from a recruiter for a permanent position.?
I think a got something in the mail around 2006...

My pals in other specialties routinely see offers from all over.

 

[stickyshift]

I get a lot of stuff in the mail for permanent positions, usually to be a director of a hospital lab in the greater metropolitan area of some "desirable" city. No details about compensation or partnership, of course.

 

[Pathbusiness]

I look at numbers like that and marvel that we can make any money at all. I wouldn't think that all that many pathologists sign out 7000+ 88305s/year. Of course, we get money from MD fees, and, if we're lucky, from more generous private insurance contracts (But in reality, those might be balanced out by your Medicaid cases . . . )

7000 88305's means less than 700 12 core biopsies. That used to be six weeks(M-F) numbers for me once upon a time... In addition to countless other 88305's, 88342's, and equal if not more of 88112's). End result absolutely no leverage on the whole operation.

 

[Alteran]

When was the last time anyone here got mail, email or call from a recruiter for a permanent position.?
I think a got something in the mail around 2006...

My pals in other specialties routinely see offers from all over.

I made the mistake of showing up to a physician job fair during my pathology residency training. By the bewildered stares I was getting from the recruiters, you'd have thought I was a leper with an eyeball hanging out of its socket. Not even the military recruiters were sure if they needed pathologists.....

 

[senior pathologist]

My advice for all, as a path fellow having done fellowships in ivy leagues and still finding no jobs is DO NOT GO into pathologist. My co-fellows are suffering as well.
Market is absolutely terrible.

In last 20 years academia doubled the number of PGY1 residents in pathology from 300 to about 600. In the meantime, corporations merged many smaller labs and at least doubled if not tripled amount of work (number of surgical cases signed out per pathologist).

Do not just complain but rather sign a petition, google:
THE OVERSUPPLY OF PATHOLOGISTS IN THE US

 

[AZpath]

In last 20 years academia doubled the number of PGY1 residents in pathology from 300 to about 600. In the meantime, corporations merged many smaller labs and at least doubled if not tripled amount of work (number of surgical cases signed out per pathologist).

Do not just complain but rather sign a petition, google:
THE OVERSUPPLY OF PATHOLOGISTS IN THE US

About

Very good right up. Right on!

 

[AZpath]

About

Very good right up. Right on!

This is the link About
About= The over supply about page

 

[tensoranalysis]

all fields of medicine have seen consolidation and cuts to reimbursement - this story is echoed in every specialty.

 

[AZpath]

True,

The question is pathology different or not ?
I would say different. Pathologist = commodity in great supply.
This not true is most specialties

 

[Nilf]

all fields of medicine have seen consolidation and cuts to reimbursement - this story is echoed in every specialty.

#bluepilledpathologist

 

[dukeresident]

True,

The question is pathology different or not ?
I would say different. Pathologist = commodity in great supply.
This not true is most specialties

Experiencing this first hand...

 

[Napoleon1801]

I made the mistake of showing up to a physician job fair during my pathology residency training. By the bewildered stares I was getting from the recruiters, you'd have thought I was a leper with an eyeball hanging out of its socket. Not even the military recruiters were sure if they needed pathologists.....

Yes, this. Found zero hits through job fairs or recruiters when I was searching. It's either pathologyoutlines or good connections in this market. Jobs are there, but many are in undesirable locations. This is a limitation that many trainees don't consider before jumping into path.

 

[dukeresident]

And then there is this:

American health-care workers are committing suicide in unprecedented numbers

The author is a path.

 

[Unty]

My friend interviewed at a city in California which he described as a "desert barren wasteland" lol.

He didn't want to raise his family and child there and I don't blame him.

Luckily he got a job through connections.

 

[Morichka]

pathologistoversupply.weebly.com/about.html

Good site explaining the reasons for our pathologist oversupply as well as the d-bags who keep talking about a shortage (i.e. McKenna). Also, I agree with others, CAP is super corrupt. I wish all labs would just use jcaho. I will never personally pay money to CAP. Luckily my group pays for PIP for everyone.

About

If you trust the math, the monetary benefits that CAP provides each member simply in the increased reimbursements and representing the profession in DC are much greater than the cost of the membership. I have spent time on committees at CAP and every single meeting starts with the affirmation that the organization exists to benefit the members. If something seems skewed or fishy, like a program seemingly designed purely for the purposes of furthering the business aspect of CAP, the members who sit on the directing committees quickly take note and make sure the program is re-evaluated and that the revenue is directed as it should be. I think it is run fairly, with extensive input from the general membership, and smartly (the staff are second to none). Because it brings in a large amount of money from PT and accreditation, etc. some view it as "corrupt" but this is because 1) they don't understand how businesses run, and 2) they don't understand where the money goes (back into education, professional development, advocacy, the annual meeting, etc.).

If you don't appreciate the benefits CAP provides the profession, you can keep your money. Unfortunately, this makes you a free-rider because you still get the benefits!