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
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,
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
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