Pathologist Satisfaction with "Pod Lab" Positions

In a recent post (see: Dayhawk Radiology and the Decline of the General Radiologist), I made the following statement at the end of the note:

A variation on this [pod lab] theme is for the urology group to submit their tissue specimens to a commercial surgical pathology lab for processing and then use their own in-house pathologist to interpret the prepared glass slides that are returned by the commercial lab. In fact, I have been told that many of the surgical pathologists who are practicing in this type of environment are very satisfied with their positions.

In response to it, Daniel Schneider submitted the following comment:

Your last paragraph attempts to put some positive spin on a sketchy practice designed to increase urologists' revenue at the expense of pathologists' and drives overutilization (in the form of excessive numbers of biopsies) at the expense of the patient, and the American healthcare system. Who are these pathologists who are "very satisfied" with that arrangement?

On one hand, Daniel is correct that my statement about the condition of pathologists working in pod labs is too general and somewhat ambiguous. I don't present the names of the individual pathologists who  are "very satisfied with their positions." On the other hand, this practice can be controversial so that I am not sure that I could, or would, publish such names even if I had then. To do such might expose them to harassment from their pathologist colleagues. He is also correct that the employment of a pathologist by a urology group could provide an incentive for the urologists to take more biopsies. After all, many of us still live in a fee-for-service world. Such an issue needs careful study but raises a different question than whether a pathologist should break ranks and serve as a member of a urology group.

However, let's run this thought experiment. Let's say that you are a pathologist who has spent a number of years in training including a fellowship in urologic pathology. Let's further assume that this individual cannot obtain a position working in his or her specialty area in a large hospital or academic center or receives a better offer for employment in a urology group. Would such an individual perhaps not prefer to work exclusively in urologic pathology, perhaps with a less grueling schedule, and give up some of the advantages of employment by a pathology group? For such an individual, the personal advantages might outweigh the more "politically acceptable" choice of working only with pathologists.

My goal here is not to put a "positive spin" on an emerging business model but rather to engage in a dialogue. Having said this, I will offer this blog forum to any pathologist working, say, inside a urology group, to discuss his or her degree of satisfaction. I am not seeking heated polemics but rather a balanced discussion including consideration of whether our teaching programs are not to blame in some ways for this problem. We may be turning out too many surgical pathologists whose comfort zone lies primarily in a specialty area of practice.

Comments

[drneelesh]

I think that whatever makes the most economic sense will naturally come to pass. The acceptability of the practice for the pathologist will not be an issue.

[Anonymous M.D.]

I cannot speak from the horse's mouth, but can only relate the experience of a former partner of mine. He read or consulted on most all the GI biopsies in our hospital-based group of six. He was specially trained in GI pathology, he was the only one who liked reading them, and he regularly found stuff we didn't recognize. We both eventually left the group, and he joined a large group of gastroenterologists as a full partner, personally constructed a lab computer system which meets all their needs (including a stellar QA component), and supervises several other GI pathologists. He is happy as a clam, and so are his GI partners. This is not a "pod lab" as he is a full partner in their group. What is wrong with this?

P.S.: I wish to remain anonymous because I am posting this note without his knowledge or permission.