A little help...

[musom]

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So I have joined a one man private practice in a somewhat rural setting recently. I'm experiencing some "quality" issues with the aging solo-practice AP/CP generalist pathologist that has been isolated here at this community hospital for 30+ years. Part of my arrangement was to bring on IHC, which I have done. My issue is now this:

Now that IHC is in-house, the aging pathologist (Jim) wants to now read his own IHC instead of sending it out like he always did. He has never received formal training for interpretation of IHC, but when that is brought up he states "yea, i've looked in textbooks over the years". Needless to say, his interpretations are of questionable quality. Administration is now involved and wants to limit Jim by retroactively instating a formal credentialing/training process that he will obviously not qualify for, or have any further interest in pursuing (hopefully). My question to the public is this:

Where can I go to find any "credentialing" guidelines that will qualify (grandfather) a senior pathologist the ability to interpret IHC? For example, "Pathologist must either go through a formal training program or do this certification/qualification examination offered by X company and must score a 90% or greater for qualification purposes".

Obviously IHC is integral in the training of residents and fellows and has been for decades, however, he finished his training in the 60's and has close to zero skill/experience in these interpretations.

Can anyone offer some guidance? Anyone ever dealt with a similar situation?

 

[cmz]

How asking the hospital for mandatory AP/CP pathology re-certification (I assume you're young enough to have to endure this anyway)? Why is this guy gung-ho about reading his own IHCs? Sounds like he/she needs to retire.

I don't have any help for you, but I will be experiencing this sort of situation at my new job in the near future. The pathologist in question will not be reading/interpreting cases that require IHC.

 

[Over9000]

It is absolutely AMAZING how many old-timer pathologists either don't know how to interpret basic IHC or refuse to use it in situations where it is warranted. We have one of these at my shop. It's frustrating.

Is Jim the director of your department? Will you be taking over directorship duties when Jim eventually dies at the scope? If you will be, then it is certainly in your interest to ensure that proper IHC procedure is followed and that Jim doesn't go anywhere near it unless he's doing it right. The problem cases will come back to bite you when you're still there and he's underground.

If Jim is going to be the perpetual director instead, then unfortunately what he says would go in this case. Direct confrontation is not going to amount to much. Going to hospital risk management may be a good move to help patients out, but like farting in an elevator, Jim'll know it was you. This'll sour your relationship with him for the duration of your time there, which in this bad job climate will cause a lot of stress on your end. You might be stuck with Jim for a long time.

Not only that, this is a big shame in that the pathologist in question does not realize his limitations, which gives administrators carte blanche to get involved as they have in your case. Once admin crosses the Rubicon, its hard to un-cross them in the future - they tend to overstay their welcomes, which means you'll have to deal with even more asinine admin commandments in the future.

Might be time to keep your eyes and ears open for a new job, if you can find it.

 

[musom]

Thanks for the response. I'm in a good and quite comfortable position here and hope to continue for a while.

Jim is the current medical director of the lab, of which I will take over next summer. He should officially retire then....should. I asked administration to get involved, as I did not feel comfortable having that direct confrontation (not typical of my personality though).

I believe Jims motivation is strictly financial. He is in his mid-seventies and has never shown interest in acquiring in-house IHC, that is until I showed up and brought it up, and now he conveniently decides it will make him extra $ during the last 9 months before he retires. All that aside, my concern is for the patient.