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Pathology manpower
CORRESPONDENCE
CORRESPONDENCE Pathology Manpower To the Editor:—In the article by Alexander1 and the associated editorial by Sobanya and Weinstein,2 references are made to the job market as one of the end points by which residency program directors judge their ability to attract new residents to their programs. In a negative sense, Sobanya and Weinstein refer to managed care as “the universal scapegoat” for the failure to attract more bodies to their programs. However, managed care may be part of the reason the job market for new graduates of residency programs has turned up. That new graduates are less expensive than experienced pathologists is consistent with the thinking of managed care. Afterall, a recent graduate of a residency program can easily handle the 40 surgical specimens per week and 1 autopsy per month that constitutes the workload in the average hospital for less money than the experienced pathologist.3 Alexander states that 18,000 pathologists now exist. This ever-increasing number is at an all-time high, and underemployment challenges the ability of every pathologist to maintain skills.4 Deliberately ignored is the number of hospitals in existence at the same time. By using the Chicago area as a test market for pathology services (a service commonly regarded as hospital based), the Chicago area may be defined as a region of northeast Illinois and adjacent northwest Indiana extending 50 miles radially from a center in downtown Chicago in all directions except directly east (Lake Michigan). Because of Lake Michigan, this region has the rough shape of a partial annulus with an inner margin about 65 miles long and an outer margin about 100 miles long. Eight and a half million people live in this region currently, and the population is estimated to be 10.5 million people by the year 2020, with most of the growth along the outer edge of the annulus. Since 1980, 26 hospitals have closed in this region and no new hospitals have opened. The sizes of these disappearing hospitals range from less than 50 beds to 550 beds. With the exception of a free-standing maternity hospital, all were general medical and surgical acute care hospitals. In spite of an increasing population, no new hospital construction has been approved through state licensing agencies. Many larger hospitals still in existence have downsized, making these eliminated beds equivalent to the closure of smaller hospitals. Along with all these closures and reductions is the loss of pathology positions, including the “early retirement” of experienced pathologists. Sobanya and Weinstein term JAMA data as misleading, term e-mail warnings as “an offshore agitator,” and describe a “handful of pathologists who believe the oversupply is real.”2
In the manner of a self-fulfilling prophecy, the handful of pathologists who operate residency programs claim to have shown the need for pathology residency programs, and to them the need is absolutely clear. Like a running water faucet that residency program directors have deliberately refused to shut off, the need for residency programs was not so clear to the U.S. Congress in 1999 when Medicare allotments for funding residency programs came under scrutiny. To my satisfaction and to the satisfaction of others, Congress passed a reduction in Medicare allotments for residency training programs that is part of a larger budget reconciliation act singed into law by former President Clinton. The Medicare funding for residency programs is now undergoing a gradual reduction, and hospitals are now placed on a competitive basis for this funding. Finally, this long overdue small victory is for those of us who believe that the oversupply of pathologists is an ever worsening problem. The comment by Sobanya and Weinstein on the possible effect of molecular pathology on the future of pathology is speculation at best and remains to be proven. Within historical context, electron microscopy and immunohistochemistry, new technologies at one time, did not appear to have created the need for more pathologists. Let us not spend too many millions of dollars and waste the careers of too many young physicians testing the value of molecular pathology on the future of pathology practice.
JAMES BRYANT, MD Tissue Diagnostic Services Chicago, IL 1. Alexander CB: Trends in pathology graduate medical education. HUM PATHOL 32:671-676, 2001 2. Sobanya RE, Weinstein RS: Pathology manpower: A few rays of sunshine. HUM PATHOL 32:669-670, 2001 3. Smith RD, Benson ES, Anderson RE: Some characteristics of the community practice of pathology in the United States. Arch Pathol 113:1335-1342, 1989 4. Bryant J: Underemployment: Another aspect of the oversupply in pathology. HUM PATHOL 30:1118-1119, 1999
doi:10.1053/hupa.2002.31288
Reply To the Editor:—Dr. Bryant’s comments regarding the article, “Pathology Manpower: A Few Rays of Sunshine,”1 do not ring true in some areas. I doubt that his quoted workload for the average hospital pathologist is really 40 surgical speci-
259
CORRESPONDENCE Pathology Manpower To the Editor:—In the article by Alexander1 and the associated editorial by Sobanya and Weinstein,2 references are made to the job market as one of the end points by which residency program directors judge their ability to attract new residents to their programs. In a negative sense, Sobanya and Weinstein refer to managed care as “the universal scapegoat” for the failure to attract more bodies to their programs. However, managed care may be part of the reason the job market for new graduates of residency programs has turned up. That new graduates are less expensive than experienced pathologists is consistent with the thinking of managed care. Afterall, a recent graduate of a residency program can easily handle the 40 surgical specimens per week and 1 autopsy per month that constitutes the workload in the average hospital for less money than the experienced pathologist.3 Alexander states that 18,000 pathologists now exist. This ever-increasing number is at an all-time high, and underemployment challenges the ability of every pathologist to maintain skills.4 Deliberately ignored is the number of hospitals in existence at the same time. By using the Chicago area as a test market for pathology services (a service commonly regarded as hospital based), the Chicago area may be defined as a region of northeast Illinois and adjacent northwest Indiana extending 50 miles radially from a center in downtown Chicago in all directions except directly east (Lake Michigan). Because of Lake Michigan, this region has the rough shape of a partial annulus with an inner margin about 65 miles long and an outer margin about 100 miles long. Eight and a half million people live in this region currently, and the population is estimated to be 10.5 million people by the year 2020, with most of the growth along the outer edge of the annulus. Since 1980, 26 hospitals have closed in this region and no new hospitals have opened. The sizes of these disappearing hospitals range from less than 50 beds to 550 beds. With the exception of a free-standing maternity hospital, all were general medical and surgical acute care hospitals. In spite of an increasing population, no new hospital construction has been approved through state licensing agencies. Many larger hospitals still in existence have downsized, making these eliminated beds equivalent to the closure of smaller hospitals. Along with all these closures and reductions is the loss of pathology positions, including the “early retirement” of experienced pathologists. Sobanya and Weinstein term JAMA data as misleading, term e-mail warnings as “an offshore agitator,” and describe a “handful of pathologists who believe the oversupply is real.”2
In the manner of a self-fulfilling prophecy, the handful of pathologists who operate residency programs claim to have shown the need for pathology residency programs, and to them the need is absolutely clear. Like a running water faucet that residency program directors have deliberately refused to shut off, the need for residency programs was not so clear to the U.S. Congress in 1999 when Medicare allotments for funding residency programs came under scrutiny. To my satisfaction and to the satisfaction of others, Congress passed a reduction in Medicare allotments for residency training programs that is part of a larger budget reconciliation act singed into law by former President Clinton. The Medicare funding for residency programs is now undergoing a gradual reduction, and hospitals are now placed on a competitive basis for this funding. Finally, this long overdue small victory is for those of us who believe that the oversupply of pathologists is an ever worsening problem. The comment by Sobanya and Weinstein on the possible effect of molecular pathology on the future of pathology is speculation at best and remains to be proven. Within historical context, electron microscopy and immunohistochemistry, new technologies at one time, did not appear to have created the need for more pathologists. Let us not spend too many millions of dollars and waste the careers of too many young physicians testing the value of molecular pathology on the future of pathology practice.
JAMES BRYANT, MD Tissue Diagnostic Services Chicago, IL 1. Alexander CB: Trends in pathology graduate medical education. HUM PATHOL 32:671-676, 2001 2. Sobanya RE, Weinstein RS: Pathology manpower: A few rays of sunshine. HUM PATHOL 32:669-670, 2001 3. Smith RD, Benson ES, Anderson RE: Some characteristics of the community practice of pathology in the United States. Arch Pathol 113:1335-1342, 1989 4. Bryant J: Underemployment: Another aspect of the oversupply in pathology. HUM PATHOL 30:1118-1119, 1999
doi:10.1053/hupa.2002.31288
Reply To the Editor:—Dr. Bryant’s comments regarding the article, “Pathology Manpower: A Few Rays of Sunshine,”1 do not ring true in some areas. I doubt that his quoted workload for the average hospital pathologist is really 40 surgical speci-
259