College of American Pathologists
Printable Version



cap today

June 2005

An oversupply

The article “From hunt to hire—tips for landing that just-right job” (April 2005, page 14) reminded us of the skills needed to find a good job. Unfortunately, it will not change the difficult job market for today’s graduates. When I started my residency, we were told there was a shortage of pathologists and job prospects were good, but that is not the case and it never will be. It’s simple: There are more residency programs and pathologists in the market than are needed, and we can see the outcome of this in many of the problems we are facing. Why can other physicians direct bill? There are too many pathologists competing for a limited number of specimens. Why can hospitals relentlessly reduce our pay in our contract for Part A reimbursement? Because they can easily find an alternative to cover the service. Why will commercial laboratories soon dominate the outpatient anatomic pathology specimen market? They can hire someone at a less favorable income. Why do many graduates do second and third fellowships? There are too few jobs for them. Why is our locum tenens pay rate only half that of the radiologists? More pathologists than radiologists are available for this type of work.

If we don’t solve this oversupply problem, it will only worsen because more and more pathologists are entering the market, and two classes of residency graduates will finish training together next year.

Ming Cao, MD

Flint Clinical Pathologists PC

Flint, Mich.

In the April issue of CAP TODAY (page 6) are several letters about client billing. Robert Hubbard, MD, is on target, but all the contributors raise valid observations. To paraphrase Clinton, “It’s the oversupply, stupid!”

I retired in 1997 as chairman of a three-person group in a Philadelphia community hospital. Deals were made behind closed doors with HMOs whereby the hospital collected the technical fees for anatomic pathology but we were not permitted to bill for Part B services. My group experienced a drastic cut in our modest Part A remuneration for administration, supervision, and teaching. We operated a successful school of medical technology of which I served as medical director and, along with my associates, gave my share of lectures. After I retired and the students graduated, the program was terminated as not being “cost-efficient.” A year or two after my retirement, the Philadelphia Inquirer published an article listing the salaries of the Philadelphia and surrounding area hospital CEOs. Obviously our Part A reduction and that of other hospital-based departments helped fund the inflated salary at the hospital where I worked.

During the 1990s my friends in urology and neurosurgery knew that residency programs in their specialties had already been reduced—an action that pathology should have taken.

Reimbursement for Part B services has been steadily declining and all pathologists working in that arrangement will slide backward in income. Our friends in radiology have advantages: First, the reimbursements are better, and, second, every service qualifies as part B and those studies far outnumber what is available to us. Again, basic economics.

During my early years as a pathologist there was good-natured jesting between “town and gown” pathologists. It doesn’t require an advanced degree in common sense to acknowledge that academia has a different agenda (namely cranking out residents) from the grunts in community hospitals.

In my early days I enjoyed reading the Alvan G. Foraker, MD, stories published in Pathologist magazine about the harried Job Plodd, MD, pathologist at Podunk General Hospital. They were classics then and fit well in today’s environment.

William J. Warren, MD
Furlong, Pa.