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Clinical Laboratories and Pathology Groups

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Gen Z Set to Outnumber Baby Boomers and Will Be 75% of the Workforce within the Next Year, Report States

Zoomers’ unique approach to work and personal health could affect clinical laboratory workplaces, how staff is managed, and how they personally use lab tests

Would it surprise you to learn that Generation Z is poised to make up 75% of the workforce in the United States by 2025? This fact has many implications for clinical laboratories, genetic testing companies, and pathology practices. That’s because Zoomers, as they are called, will be dominant in two ways. First, they will make up the majority of the lab workforce. Second, they will be the majority of consumers and patients accessing medical laboratory testing services.

Zoomers (born 1997-2012) approach work and their own healthcare differently than previous generations. This is partly due to Zoomers being “digital natives who have little or no memory of the world as it existed before smartphones,” according to Pew Research.

Now, a recently released report by economic research firm Glassdoor on 2024 workplace trends states that Zoomers are about to overtake Baby Boomers (born 1946-1964) in the full-time workforce, and that the shift will “represent a pivotal moment of cultural change that US companies cannot ignore.” This includes clinical laboratories and pathology groups that employ them.

According to Glassdoor, Gen Z workers “care deeply about community connections, about having their voices heard in the workplace, about transparent and responsive leadership, and about diversity and inclusion.”

Zoomers bring unique requirements and attitudes to the workplace, but they may also be the fresh infusion of talent a shrinking healthcare workforce needs. It’s no secret that clinical laboratories and pathology groups are facing a labor shortage. An aging workforce combined with burnout from the COVID-19 pandemic have left the entire healthcare industry scrambling for workers.

“A recent survey by Elsevier Health predicts that up to 75% of healthcare workers will leave the profession by 2025. And a 2020 study conducted by the Association of American Medical Colleges (AAMC) projected a shortfall of up to 139,000 physicians by 2033,” Medscape reported.

In “Clinical Laboratories Suffer During the Great Resignation,” Dark Daily noted other causes that are behind the abundance of open positions, such as early retirements, graduating individuals experiencing more specialized training programs, and a shift in the way the current working generation views employment.

Thus, the current healthcare workplace should not only expect unique challenges as Zoomers take over, but also changes that come with adapting to a smaller, younger workforce.

Mark Beal

“[Gen Z] will pressure employers to establish a company’s purpose in a way that contributes to a better society and prioritize a company’s purpose along with profits,” Mark Beal (above), Assistant Professor of Professional Practice and Communication at Rutgers University, told Forbes. “Having succeeded at remote learning, they will influence an increased transition to hybrid and remote work as well as the four-day work week.” Clinical laboratories that understand Zoomers’ motivations will likely have more success integrating them into their workforce. (Photo copyright: Rutgers University.)

Generational Shift in Healthcare

Zoomers are the most technically-minded generation yet, especially considering they had to master remote learning during the COVID-19 pandemic. And, as we reported in “Despite Technical Challenges During COVID-19 Pandemic, Healthcare Networks Plan to Increase Investment in Telehealth Technologies,” healthcare systems that have increased their investment in telehealth technologies may benefit greatly from having these tech-savvy workers on board.

However, there could be unique challenges with a Zoomer workforce as well. According to Forbes, more than half of these new workers are willing to leave their jobs over “dissatisfaction with fulfillment (59%), professional development (57%), and providing value (53%).”

Although this may make some older workers scoff, each generation has entered the workforce with its own unique perspective based on personal values, and the workplace has shifted and changed to reflect the new workers. The same can be said of the clinical laboratory and pathology workforces.

The chart above shows the different generations as a proportion of the total population of the United States as of 2025. It dramatically illustrates why the largest number of working age individuals will be from Generation Z (aka, Zoomers). With their unique interests and traits, Zoomers will want their workplaces to be responsive in ways that are much different than the generations that preceded them. This will be equally true of how Gen Z accesses clinical laboratory testing services. (Graphic copyright: The Wall Street Journal.)

Gen Z Likes Automation

Another aspect to the increasing Zoomer workforce is Gen Z’s comfort with automated technology. Automation has always shifted how clinical laboratories work, and it can have great benefits for clinical pathology as well.

According to Today’s Clinical Lab, automation reduces error rates by more than 70% and reduces the time needed for each staff member per specimen by 10%.

However, the benefit does not come from automation replacing workers, rather that automated processes reduce repetitive work that takes time and attention away from workers. And, as noted, Gen Z workers tend to be extremely tech-savvy given the prevalence of technology in their lives.

Automation could fill gaps when it comes to labor shortages, not by replacing workers, but by helping adjust the workflow and avoiding worker burnout by automating tedious tasks. And Gen Z workers may be uniquely suited to engage with automated testing technologies.

Evolving Healthcare Workplaces

“The coming year will … represent a pivotal moment of cultural change that US companies cannot ignore as Gen Z workers—who care deeply about community connections, about having their voices heard in the workplace, about transparent and responsive leadership, and about diversity and inclusion—make up a rapidly growing share of the workforce,” the Glassdoor report stated, adding that 2024 “will test the robustness of workplace institutions,” The Hill reported.

Clinical laboratory managers and pathologists will be managing a multi-generational workforce, each with its own attributes and requirements. Thus, lab managers will need to reflect these difference in the management decisions they make and how they organize the laboratory workplace.

—Ashley Croce

Related Information:

Gen Z Set to Pass Baby Boomers in Workforce: Report

Glassdoor’s 2024 Workplace Trends

Physicians May Retire En Masse Soon. What Does That Mean for Medicine?

Clinical Laboratories Suffer During the Great Resignation

How Gen Z’s Impact on the Workplace Continues to Grow

Despite Technical Challenges During COVID-19 Pandemic, Healthcare Networks Plan to Increase Investment in Telehealth Technologies

Should Lab Staff Be Concerned about Automation?

Florida Nurse Practitioner Convicted for Involvement in $200 Million Medicare Fraud Scheme Involving Clinical Laboratory Tests, Other Procedures

Federal prosecutors allege that this nurse practitioner ordered more genetic tests for Medicare beneficiaries than any other provider during 2020

Cases of Medicare fraud involving clinical laboratory testing continue to be prosecuted by the federal Department of Justice. A jury in Miami recently convicted a nurse practitioner (NP) for her role in a massive Medicare fraud scheme for millions of dollars in medically unnecessary genetic testing and durable medical equipment. She faces 75 years in prison when sentenced in December.  

In their indictment, federal prosecutors alleged that from August 2018 through June 2021 Elizabeth Mercedes Hernandez, NP, of Homestead, Florida, worked with more than eight telemedicine and marketing companies to sign “thousands of orders for medically unnecessary orthotic braces and genetic tests, resulting in fraudulent Medicare billings in excess of $200 million,” according to a US Department of Justice (DOJ) news release announcing the conviction.

“Hernandez personally pocketed approximately $1.6 million in the scheme, which she used to purchase expensive cars, jewelry, home renovations, and travel,” the press release noted.

Hernandez was indicted in April 2022 as part of a larger DOJ crackdown on healthcare fraud related to the COVID-19 outbreak.

Luis Quesada

“Throughout the pandemic, we have seen trusted medical professionals orchestrate and carry out egregious crimes against their patients all for financial gain,” said Assistant Director Luis Quesada (above) of the FBI’s Criminal Investigative Division, in a DOJ press release. Clinical laboratory managers would be wise to monitor these Medicare fraud cases. (Photo copyright: Federal Bureau of Investigation.)

Nurse Practitioner Received Kickbacks and Bribes

Federal prosecutors alleged that the scheme involved telemarketing companies that contacted Medicare beneficiaries and persuaded them to request genetic tests and orthotic braces. Hernandez, they said, then signed pre-filled orders, “attesting that she had examined or treated the patients,” according to the DOJ news release.

In many cases, Hernandez had not even spoken with the patients, prosecutors said. “She then billed Medicare as though she were conducting complex office visits with these patients, and routinely billed more than 24 hours of ‘office visits’ in a single day,” according to the news release.

In total, Hernandez submitted fraudulent claims of approximately $119 million for genetic tests, the indictment stated. “In 2020, Hernandez ordered more cancer genetic (CGx) tests for Medicare beneficiaries than any other provider in the nation, including oncologists and geneticists,” according to the news release.

The indictment noted that because CGx tests do not diagnose cancer, Medicare covers them only “in limited circumstances, such as when a beneficiary had cancer and the beneficiary’s treating physician deemed such testing necessary for the beneficiary’s treatment of that cancer. Medicare did not cover CGx testing for beneficiaries who did not have cancer or lacked symptoms of cancer.”

In exchange for signing the orders, Hernandez received kickbacks and bribes from companies that claimed to be in the telemedicine business, the indictment stated.

“These healthcare fraud abuses erode the integrity and trust patients have with those in the healthcare industry … the FBI, working in coordination with our law enforcement partners, will continue to investigate and pursue those who exploit the integrity of the healthcare industry for profit,” said Assistant Director Luis Quesada of the Federal Bureau of Investigation’s Criminal Investigative Division, in the DOJ press release.

Conspirators Took Advantage of COVID-19 Pandemic

Prosecutors alleged that as part of the scheme, she and her co-conspirators took advantage of temporary amendments to rules involving telehealth services—changes that were enacted by Medicare in response to the COVID-19 pandemic.

The indictment noted that prior to the pandemic, Medicare covered expenses for telehealth services only if the beneficiary “was located in a rural or health professional shortage area,” and “was in a practitioner’s office or a specified medical facility—not at a beneficiary’s home.”

But in response to the pandemic, Medicare relaxed the restrictions to allow coverage “even if the beneficiary was not located in a rural area or a health professional shortage area, and even if the telehealth services were furnished to beneficiaries in their home.”

Hernandez was convicted of:

  • One count of conspiracy to commit healthcare fraud and wire fraud.
  • Four counts of healthcare fraud.
  • Three counts of making false statements.

Medscape noted that she was acquitted of two counts of healthcare fraud. The trial lasted six days, Medscape reported.

Hernandez’s sentencing hearing is scheduled for Dec. 14.

Co-Conspirators Plead Guilty

Two other co-conspirators in the case, Leonel Palatnik and Michael Stein, had previously pleaded guilty and received sentences, the Miami Herald reported.

Palatnik was co-owner of Panda Conservation Group LLC, which operated two genetic testing laboratories in Florida. Prosecutors said that Palatnik paid kickbacks to Stein, owner of 1523 Holdings LLC, “in exchange for his work arranging for telemedicine providers to authorize genetic testing orders for Panda’s laboratories,” according to a DOJ press release. The kickbacks were disguised as payments for information technology (IT) and consulting services.

“1523 Holdings then exploited temporary amendments to telehealth restrictions enacted during the pandemic by offering telehealth providers access to Medicare beneficiaries for whom they could bill consultations,” the press release states. “In exchange, these providers agreed to refer beneficiaries to Panda’s laboratories for expensive and medically unnecessary cancer and cardiovascular genetic testing.”

Palatnik pleaded guilty to his role in the kickback scheme in August 2021 and was sentenced to 82 months in prison, a DOJ press release states.

Stein pleaded guilty in April and was sentenced to five years in prison, the Miami Herald reported. He was also ordered to pay $63.3 million in restitution.

These federal cases involving clinical laboratory genetic testing and other tests and medical equipment indicate a commitment on the DOJ’s part to continue cracking down on healthcare fraud.

—Stephen Beale

Related Information:

Nurse Practitioner Convicted of $200M Health Care Fraud Scheme

Florida Nurse Practitioner Convicted in $200 Million Medicare Scheme

Florida Nurse Convicted for Fraudulent Orders Billing Medicare for $200M

South Florida Nurse Convicted of Medicare Scheme for Approving $200 Million in Bogus Products

Justice Department Announces Nationwide Coordinated Law Enforcement Action to Combat COVID-19 Health Care Fraud

Laboratory Owner Pleads Guilty to $73 Million Medicare Kickback Scheme

Laboratory Owner Sentenced to 82 Months in Prison for COVID-19 Kickback Scheme

Walmart’s Health and Wellness Chief Discusses Retail Giant’s Move to Healthcare/Telehealth Provider, a Step with Implications for Clinical Laboratory Testing

Retail giant now has primary care clinics at stores in five states, but the rollout has not gone smoothly

Healthcare is increasingly being driven by consumerism and one clear sign of this trend is Walmart’s ambitious plan to open health clinics at its retail locations. The retail giant set its plans in motion in 2019 with its first primary care site in a suburban Atlanta store, however, the rollout since then has presented certain challenges.

Nevertheless, the trend of placing nearly full-service primary care clinics in retail locations continues. Clinical laboratories in these areas need strategies to serve customers accessing healthcare through these new channels, particularly as Walmart and the national retail pharmacy chains continue to expand the clinical services offered in their retail stores.

“Consumer engagement is a huge part of healthcare, [yet it is also a] gap for us in healthcare,” cardiologist and Walmart VP of Health and Wellness Cheryl Pegus, MD, told Modern Healthcare. “Healthcare is incredibly complicated,” she added. “And where we are in healthcare today is not in having great treatments. It’s not in having evidence-based medicine. It’s understanding how we engage consumers.”

The company also entered the telehealth business with last year’s acquisition of multispecialty telehealth provider MeMD.

“Telehealth offers a great opportunity to expand access and reach consumers where they are and complements our brick-and-mortar Walmart Health locations,” said Pegus in a Walmart new release announcing the acquisition. “Today people expect omnichannel access to care and adding telehealth to our Walmart healthcare strategies allows us to provide in-person and digital care across our multiple assets and solutions.”

Currently, Walmart Health centers only operate in Georgia, Florida, Illinois, and Arkansas. But telehealth enables Walmart “to provide virtual healthcare across the country to anyone,” Pegus said. With both offerings, “we’re really attempting to allow people to get healthcare the way they need it without disrupting the rest of their life.” Many users of these services are Walmart “associates,” she added, using the company’s term for its retail employees.

Cheryl Pegus, MD
 
“In this country, about 25% of people don’t have a primary care physician,” cardiologist Cheryl Pegus, MD (above), Walmart’s VP of Health and Wellness, told Medscape. “So, your options for being able to solve in real time something that will help you, they’re quite limited. What we’re trying to do is give those options. We’re not trying to take away emergency rooms, or healthcare systems, or existing primary care. We’re asking, how do we expand that infrastructure so that people get care when they need it?” And this includes clinical laboratory testing, radiology, and telehealth services as well. (Photo copyright: Walmart.)

Large Portfolio of Healthcare Offerings

Pegus joined Walmart (NYSE:WMT) in December 2020 to oversee a portfolio that now includes more than 4,700 pharmacies and 3,400 Vision Centers, in addition to the telehealth operation and the Walmart Health centers. She was previously chief medical officer at Walgreens and Cambia Health Solutions and worked in private practice as a cardiologist.

The retail giant opened its first Walmart Health center in Dallas, Ga., an Atlanta suburb, in September 2019, followed by additional centers in Georgia, Arkansas, and Illinois.

Earlier this year, it opened five new clinics in northern and central Florida with plans for at least four more in the Jacksonville, Orlando, and Tampa areas, according to a press release. Each health center is adjacent to a Walmart retail location.

These centers offer a range of primary care medical services, including:

  • physicals,
  • injury care,
  • immunizations,
  • radiology, and
  • care for chronic health conditions.
One of the first health clinics established by Walmart
Pictured above is one of the first health clinics established by Walmart. This location is in a western Atlanta suburb. Note that the services advertised include more than just primary care. Also offered are “labs and X-ray,” along with dental, hearing, optometry, and counseling. Clinical laboratory managers and pathologists may want to monitor whether consumers embrace primary care delivered from clinics located in retail stores. (Photo copyright: Georgia Health News.)

As Dark Daily reported in May 2020, the Walmart Health centers also offer clinical laboratory testing at cut-rate prices, such as:

  • $10 for a lipid test,
  • $10 for Hemoglobin A1c, and
  • $20 for a strep test.

On the Walmart Health website, patients can enter their Zip code to view a list of Walmart Health clinics in their area, including links to price lists.

Walmart’s Expansion into Healthcare Not Without Problems

In “Walmart to Open 4,000 Healthcare ‘Supercenters’ by 2029 That Include ‘Comprehensive’ Clinical Laboratory Services,” Dark Daily covered how Walmart was poised to become a much bigger healthcare player with an expanded menu of clinical laboratory testing services including EKGs, vision care, dental care, and more for children and adults.

However, the company’s expansion into healthcare has not gone smoothly. In 2018, the Walmart board signed off on a plan to open 4,000 health centers by 2029, Insider reported. By the end of 2021, Walmart expected to have 125 health centers in operation, but as of June 2022, the Walmart Health website listed only 25 locations, mostly in Georgia.

Citing anonymous sources, Insider reported problems that include “leadership changes, competing business priorities brought on by the coronavirus pandemic, and the complexity of scaling a massive healthcare operation.”

In Sept. 2021, Insider further reported that the clinics were experiencing operational difficulties including hidden fees and billing problems. One culprit, the story suggested, was the company’s electronic health record (EHR) software. That same month, Walmart announced it would adopt the Epic health records system, beginning with the opening of new clinics in Florida locations.

Pegus’ arrival at Walmart appears to be part of a management shakeup. In January 2022, Insider reported that she had assembled a new executive team, with David Carmouche, MD, Senior VP, Omnichannel Care Offerings, overseeing the health centers and telehealth operations. By then, the original executives leading the rollout of the health centers had all left, Insider reported. Carmouche was previously an executive VP with Ochsner Health in New Orleans.

Partnership with Quest Diagnostics

Meanwhile, in January, Walmart announced a deal with Quest Diagnostics that allows consumers to order more than 50 lab tests through The Wellness Hub on Walmart.com, which is separate from the Walmart Health website. The tests cover “general health, digestive health, allergy, heart health, women’s health, and infectious disease,” according to a press release announcing the partnership.

Consumers can order at-home test kits for certain conditions or set up appointments for tests at Quest Patient Service Centers. The tests on the Walmart/QuestDirect website include:

  • COVID-19 Active Infection ($119+)
  • COVID-19 Antibody Test ($69)
  • Cholesterol Panel ($59)
  • Complete Blood Count ($59)
  • Comprehensive Metabolic Panel ($49)
  • CRP Inflammation Marker ($59)
  • Diabetes Management ($69+)
  • Diabetes Risk ($99+)
  • Food Allergy Test Panel ($209)
  • Chickenpox ($59)

The website also offers a combined Basic Health Profile with CBC, CMP, cholesterol panel, and urinalysis for $149. “Each purchase is reviewed and, if appropriate, ordered by a licensed physician,” the press release states.

What does all this mean for clinical laboratories? “They need to recognize that the Millennials and Gen Zs are driving a consumer revolution in healthcare,” said Robert Michel, Publisher and Editor-in-Chief of Dark Daily and its sister publication The Dark Report.

“Walmart was early to recognize and respond to this, in part because it employs 1.3 million Americans, many of whom are Gen Y and Gen Z and quick to use telehealth and similar virtual health services,” he added.

Clinical laboratory leaders need to understand this trend and develop strategies to attract and serve new patients who are willing to access healthcare virtually, while still needing to provide blood and other specimens for the lab tests ordered by their providers.

Stephen Beale

Related Information:

Q/A with Dr. Cheryl Pegus of Walmart: ‘Consumer Engagement Is a Huge Part of Healthcare’

Nine Numbers That Show How Big Walmart’s Role in Healthcare Is

Walmart Health Opens Two More Locations in Chicago

Change Makers: Dr Cheryl Pegus on How Walmart Is Rethinking Health

Walmart to Open Two Health Clinics in Rogers, Fort Smith

Walmart Deepens Healthcare Offering with Lab Test Partnership

Walmart Tests Leap into Healthcare Business by Opening Second Clinic

Walmart to Open 4,000 Healthcare ‘Supercenters’ by 2029 That Include ‘Comprehensive’ Clinical Laboratory Services

CDC Issues Warning on Candida Auris, a Highly Drug Resistant and Dangerous Yeast Infection

CDC advises clinical laboratories and microbiologists encountering C. auris to follow their own protocols before adopting federal agency guidelines

In July, the Centers for Disease Control and Prevention (CDC) warned healthcare facilities and clinical laboratories to be on the alert for Candida auris (C. auris) infections in their patients. An outbreak of the drug resistant and potentially deadly fungus had appeared in two Dallas hospitals and a Washington D.C. nursing home.

Since those outbreaks, researchers have studied with urgency the “superbug’s” emergence in various types of healthcare facilities around the nation, not just hospitals. Their goal was to discover how it was successfully identified and contained.

One such recently released study involved researchers from the Orange County Health Department (OCHD) working with the California Department of Public Health and the CDC to track C. auris in long-term acute care hospitals (LTACHs) and ventilator-capable skilled-nursing facilities (vSNFs), Medscape reported.

The researchers published their findings in Annals of Internal Medicine, titled, “Rapid Assessment and Containment of Candida auris Transmission in Post-acute Care Settings—Orange County, California, 2019.”

“Seeing what was happening in New York, New Jersey, and Illinois [was] pretty alarming for a lot of the health officials in California [who] know that LTACHs are high-risk facilities because they take care of [very] sick people. Some of those people are there for a very long time,” the study’s lead author Ellora Karmarkar, MD, MSc, told Medscape. Karmarkar is an infectious disease fellow with the University of Washington and formerly an epidemic intelligence service officer with the CDC.

“One of the challenges was that people were so focused on COVID that they forgot about the MDROs (multi-drug resistant organisms] … Some of the things that we recommend to help control Candida auris are also excellent practices for every other organism including COVID care,” she added.

According to Medscape, “The OCHD researchers screened LTACH and vSNF patients with composite cultures from the axilla-groin or nasal swabs. Screening was undertaken because 5%–10% of colonized patients later develop invasive infections, and 30%–60% die.

Medscape also reported that the first bloodstream infection was detected in May 2019, and that, according to the Annals of Internal Medicine study, as of January 1, 2020, of 182 patients:

  • 22 (12%) died within 30 days of C. auris identification,
  • 47 (26%) died within 90 days,
  • One of 47 deaths was attributed to C. auris,
  • Whole-genome sequencing showed that the isolates were all closely related in clade III.

“This is really the first time we’ve seen clustering of resistance in which patients seemed to be getting the infections from each other,” Meghan Lyman, MD, Medical Officer in the Mycotic Diseases Branch of the CDC, told Fox News.

Candida auris graphic

The graphic above illustrates how Candida auris is “spanning the globe,” The New York Times reported. Clinical laboratories that encounter this potentially deadly fungus are advised to contact the CDC immediately for guidance and to take proactive steps to prepare for the “superbug’s” arrival. (Graphic copyright: The Scottish Sun.)

Be More Proactive than Reactive in Identifying C. Auris, CDC Says

C. auris is a type of yeast infection that can enter the bloodstream, spread throughout the body, and cause serious complications. People who appear to have the highest risk of contracting the infection are those:

  • Who have had a lengthy stay in a healthcare facility,
  • Individuals connected to a central venous catheter or other medical tubes, such as breathing or feeding tubes, or
  • Have previously received antibiotics or antifungal medications.

The CDC is concerned about C. auris for three primary reasons:

  • It tends to be resistant to the antifungal drugs that are commonly used to treat Candida infections.
  • It can be difficult to identify via standard laboratory testing and is easily misidentified in labs without specific technology.
  • It can quickly lead to outbreaks in healthcare settings.

“With all this spread that we’ve been seeing across the country we’re really encouraging health departments and facilities to be more proactive instead of reactive to identifying Candida auris in general,” Lyman told STAT. “Because we’ve found that controlling the situation and containing spread is really easiest when it’s identified early before there’s widespread transmission.”

Dan Diekema, MD

There continues to be concerns over this highly drug-resistant infection among hospital physicians and medical laboratories. “Acute care hospitals really ought to be moving toward doing species identification of Candida from nonsterile sites if they really want to have a better chance of detecting this early,” Dan Diekema, MD (above), an epidemiologist and clinical microbiologist at the University of Iowa, told Medscape. (Photo copyright: University of Iowa.)

Candia Auris versus Other Candida Infections

C. auris can cause dangerous infections in the bloodstream and spread to the central nervous system, kidneys, liver, spleen, bones, muscles, and joints. It spreads mostly in long-term healthcare facilities among patients with other medical conditions.

The symptoms of having a Candida auris infection include:

  • Fever
  • Chills
  • Pain
  • Redness and swelling
  • Fluid drainage (if an incision or wound is present)
  • General feeling of tiredness and malaise

C. auris infections are typically diagnosed via cultures of blood or other bodily fluids, but they are difficult to distinguish from more common types of Candida infections, and special clinical laboratory tests are needed to definitively diagnose C. auris.

Whole-genome Sequencing of C. Auris and Drug Resistance

The CDC conducted whole-genome sequencing of C. auris specimens gathered in Asia, Africa, and South America and discovered four different strains of the potentially life-threatening Candida species. All four detected strains have been found in the United States.

There are only three classes of antifungal drugs used to treat Candida auris infections:

However, 85% of the infections in the US have proven to be resistant to azoles and 38% are resistant to polyenes. Patients respond well to echinocandins, but more effective therapies are needed especially as some isolates may become resistant while a patient is on drug therapy, STAT reported.

“Even while it might be susceptible upfront, after a week or two of therapy, we may find that the patient has an infection now caused by an isolate of the same Candida auris that has become resistant to the echinocandins and we are really left with nothing else,” Jeffrey Rybak, PhD, PharmD, Instructor, Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, told Infection Control Today.

Although relatively rare, C. auris infections are on the rise. The good news is that there may be further pharmaceutical help available soon. New antifungal agents, such as Ibrexafungerp (Brexafemme) show promise in fighting C. auris infections, but more research is needed to prove their efficacy.

What Should Clinical Laboratories Do?

The CDC stresses that clinical laboratories and microbiologists working with known or suspected cases of Candida auris should first adhere to their own safety procedures. The CDC issued guidelines, but they are not meant to supersede the policies of individual labs.

The CDC also recommends that healthcare facilities and clinical laboratories that suspect they have a patient with a Candida auris infection immediately contact the CDC and state or local public health authorities for guidance.  

JP Schlingman

Related Information

U.S. Sees First Cases of Dangerous Fungus Resistant to all Drugs in Untreated People

‘Superbug’ Fungus Spread in Two Cities, Health Officials Say           

CDC: Candida auris

CDC: Drug-resistant Candida auris   

CDC Reports Two Outbreaks of Pan-resistant Candida auris

Notes from the Field: Transmission of Pan-Resistant and Echinocandin-Resistant Candida auris in Health Care Facilities―Texas and the District of Columbia, January–April 2021

Drugs in Development Might Help Fight Deadly Candida Auris

During Pandemic, Clinical Laboratories Should Be Alert for Drug Resistant Infections That Pose High Risk to COVID-19 Patients

Potentially Fatal Fungus Invades Hospitals and Public Is Not Informed

Medscape Report on Physician Salaries in 2020 Shows Pathologists at Middle in Pay, but Near Top in Job Satisfaction

Though pathology salaries rank 16th among 29 medical specialties, it is in the top 10 among specialties that attract women and respondents say that comes with a lot of paperwork

Despite “hardships” brought on by the COVID-19 pandemic, 18,000 physicians in more than 29 medical specialties who participated in Medscape’s 2021 Physician Compensation Report said that, overall, their 2020 income was similar to prior years. Pathologists reported earnings in 2020 of $316,000, $28,000 below the average specialist’s salary of $344,000.

The average pathologist’s salary ranked 16th among medical specialty salaries.

Compared to 2019, medical specialists on average made $2,000 less in 2020. The average salary for primary care doctors was $242,000 in 2020, down $1,000 from 2019, according to a Medscape news release.

“Physicians experienced a challenging year on numerous fronts, including weathering the volatile financial impact of lockdowns,” said Leslie Kane, Senior Director, Medscape Business of Medicine, in the news release. “Our report shows that many were able to pivot to use telemedicine and focus on tactics that would protect their practices.”

Medscape, a health information provider that is part of the WebMD network, said that in addition to telehealth, doctors turned to MACRA (Medicare Access and CHIP Reauthorization Act of 2015) value-based payment reward programs and other strategies to minimize the effects of office closures last year.

“COVID took a terrible emotional toll on physicians and healthcare workers, and many are still struggling financially, but our findings showed that physicians will innovate and change quickly to meet the needs of patients through extremely difficult times,” said Leslie Kane (above), Senior Director, Medscape’s Business of Medicine, in the news release. Pathologists who were at the center of the nation’s COVID-19 pandemic response would likely echo her sentiments. (Photo copyright: Medscape.)

Pathology Salary Unchanged

To complete its study, Medscape asked physicians to take a 10-minute online survey. The reported findings included responses from 17,903 physicians (61% male, 36% female) practicing in more than 29 specialties between October 2020 and February 2021.

Pathologists who participated in the survey reported no change in their annual salary since 2019. Other specialties that reported no salary change include:

  • Family medicine,
  • Infectious diseases,
  • Ophthalmology, and
  • Orthopedics/orthopedic surgery.

Top 10 Medical Specialty Salaries

Medscape’s report listed these top-10 medical specialties as earning the highest salaries (see the graphic below for the full list of medical specialties surveyed):

Specialist Salary Increases and Decreases

Contrary to what many specialists reported, plastic surgeons did not experience slowdowns in appointments during the COVID-19 pandemic. In fact, not only did plastic surgeons earn the most, at 10% they are the medical specialists who got the biggest increase in pay of previous years as well.

According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), which conducted its own salary survey of its member surgeons, “70% of AAFPRS surgeons report an increase in bookings and treatments over the course of the COVID-19 pandemic, with nine in 10 facial plastic surgeons indicating an increase of more than 10%. Surgical procedures are the most common procedures as part of this upsurge, perhaps cancelling out any decreases that might have resulted from the economic crisis and lockdowns.”

Other specialist salaries which Medscape found increased in 2020 include:

  • Oncology: up 7%
  • Rheumatology and cardiology: up 5%
  • Diabetes/endocrinology: up 4%
  • Neurology, critical care, psychiatry: up 3%
  • General surgery, urology, public health/preventive medicine: up 2%

Medical specialties that reported reductions in salary included:

  • Otolaryngology and allergy/immunology: down 9%
  • Pediatrics and anesthesiology: down 5%
  • Dermatology: down 4%
  • Pulmonary medicine, physical medicine, gastroenterology, and radiology: down 3%
  • Emergency medicine and internal medicine: down 1%

About 92% of physicians surveyed indicated that the COVID-19 pandemic caused their income to decline. Also, 22% of doctors noted they experienced loss of work hours.

Pathologists Received Low Average Bonuses

Reporting on receipt of incentive bonuses, Medscape ranked pathology in the bottom half of its list with $42,000 as an average bonus. The top incentive bonuses went to those practicing:

  • Orthopedics/orthopedics surgery: $116,000
  • Ophthalmology: $87,000
  • Otolaryngology: $72,000

About 59% of primary care physicians and 55% of specialists surveyed reported receiving an incentive bonus.

Pathologists Rank High in Job Satisfaction

In responding to a question about compensation, pathologists ranked near the top (seventh position) with 64% saying they are content with their pay. Others expressing salary satisfaction included:

  • Oncology: 79%
  • Psychiatry: 69%
  • Plastic surgery: 68%
  • Dermatology: 67%
  • Public health/preventive medicine: 66%
  • Radiology: 65%
  • Pathology: 64%

Pathology Popular Among Women MDs

Medscape found that women MDs chose certain medical specialties more often than others, including pathology, which ranked eighth. The top eight specialties employing female physicians are:

  • Pediatrics: 61%
  • Obstetrics/gynecology: 59%
  • Diabetes/endocrinology: 50%
  • Family medicine: 47%
  • Dermatology: 46%
  • Infectious diseases: 46%
  • Internal medicine: 44%
  • Pathology: 43%

Specialties with the fewest female physicians are:

  • Plastic and general surgery: 20%
  • Cardiology: 14%
  • Urology: 11%
  • Orthopedics/orthopedics surgery: 9%

Pathology a Leader in Paperwork

Medscape also surveyed physicians as to the estimated hours they spend per week on paperwork and administration. Here, pathology ranked the fifth highest with 19%, while radiologists and hospital-based physicians were third from the bottom with 11.6%.

Specialists that reported the highest hours spent on paperwork include:

  • Infectious diseases: 24%
  • Public health/preventive medicine: 20.7%
  • Nephrology: 19.8%
  • Internal medicine: 19.7%
  • Pathology: 19%

If They Could Do It Again, Most Would

Amid a trying year, the Medscape survey respondents made an encouraging point: 78% of them said they would choose medicine as a career again. And 85% of pathologists said they would choose the same specialty.

Medscape’s report may be helpful to hospital-based clinical laboratory leaders preparing salary budgets and to pathologists in salary negotiations and determining professional responsibilities.

—Donna Marie Pocius

Related Information:

Medscape Physician Compensation Report: The Recovery Begins 2021

Medscape Physician Compensation Report Shows Salaries Held Steady Despite Pandemic

A Pandemic of Dysmorphia: “Zooming” into the Perception of Our Appearance

AAFPRS Announces annual Survey Results, A Look at How COVID-19 Disrupted Facial Plastic Surgery

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