Consult Service Advice

[Blaster1492]

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Hoping all you private practice and employed pathologists can give me some advice.

I'm an academic pathologist but have a business/entrepreneurial spirit. Most of my work is in a very niche area of AP where the vast majority of non-academic groups send the specimens out to large academic or private labs for processing and interpretation. My local-regional area has very little expertise in this field, which is part of what drew me to this job - the opportunity to build a consult service. Currently specimens are being sent out of state and often across the country. I'm just laying the foundation for this push right now.

I'm good at what I do, hardworking, and personable.

1. If you were a local group around me, how could I best earn your business?
2. Do you really care who you send esoteric specimens to? Do you care who your clinicians want their specimens sent to (if they have an opinion, or if I was referred to them by other clinicians that worked with me)?
3. Would you prefer working with a local pathologist(s) that you have a relationship with rather than sending to a large lab across the country?
4. Should I just cold-call? Call practice manager and ask to set up a time to chat? Stop by and discuss in person? Email?
5. Anything else I'm missing?

Thanks all, would really appreciate your thoughts on this.

 

[Allegri]

Is this renal pathology? If so I think it's more about the clinicians' preference than the pathology group. You will need to build a reputation among the clinicians in the area and offer a level of service that improves on what they are currently getting.

 

[deleted314957]

Is this renal pathology? If so I think it's more about the clinicians' preference than the pathology group. You will need to build a reputation among the clinicians in the area and offer a level of service that improves on what they are currently getting.

I’m my experience, renal is ALL about the nephros. Thank god. Who has the time to screw with sectioning those things, assuring glomeruli get in formalin, glut, Michel’s with big hand lenses or dissecting scopes. After a few of those,
i had a nephro path come in and he dealt strictly with the clinicians. He had a tech come in for the bx and do all the bs. All i did was eyeball his reports when they came in.
Kinda the same with nerves and muscles. I gave an inserv to all the o.r. people, gave them fixative, muscle clamps, told them how to submit fresh tissue and that i never want to see one on my desk; they go straight to the neuropath asap with a ready courier. got myself out of that loop.

 

[AZpath]

Funny renal path came to mind here too.
I never has clinicians care which lab on these.

 

[Napoleon1801]

Hoping all you private practice and employed pathologists can give me some advice.

I'm an academic pathologist but have a business/entrepreneurial spirit. Most of my work is in a very niche area of AP where the vast majority of non-academic groups send the specimens out to large academic or private labs for processing and interpretation. My local-regional area has very little expertise in this field, which is part of what drew me to this job - the opportunity to build a consult service. Currently specimens are being sent out of state and often across the country. I'm just laying the foundation for this push right now.

I'm good at what I do, hardworking, and personable.

1. If you were a local group around me, how could I best earn your business?
2. Do you really care who you send esoteric specimens to? Do you care who your clinicians want their specimens sent to (if they have an opinion, or if I was referred to them by other clinicians that worked with me)?
3. Would you prefer working with a local pathologist(s) that you have a relationship with rather than sending to a large lab across the country?
4. Should I just cold-call? Call practice manager and ask to set up a time to chat? Stop by and discuss in person? Email?
5. Anything else I'm missing?

Thanks all, would really appreciate your thoughts on this.

It probably depends on what sub-specialty you´re looking at. As mentioned above, there are some specialist pathology labs like Arkana (formerly Nephropath) that make consulting a full time gig. Arkana Laboratories | Renal and Molecular Pathology | Kidney Biopsy

If it were me, I´d have a couple people in marketing making cold calls to clinicians and pathologists to try for their business. Leverage your local connections and clinician buddy networks. Perhaps even present at a national meeting to get your name out there. On the back end, make sure you have excellent client service support and can deliver the goods in a timely fashion.

 

[Med Director New England]

Hoping all you private practice and employed pathologists can give me some advice.

I'm an academic pathologist but have a business/entrepreneurial spirit. Most of my work is in a very niche area of AP where the vast majority of non-academic groups send the specimens out to large academic or private labs for processing and interpretation. My local-regional area has very little expertise in this field, which is part of what drew me to this job - the opportunity to build a consult service. Currently specimens are being sent out of state and often across the country. I'm just laying the foundation for this push right now.

I'm good at what I do, hardworking, and personable.

1. If you were a local group around me, how could I best earn your business?
2. Do you really care who you send esoteric specimens to? Do you care who your clinicians want their specimens sent to (if they have an opinion, or if I was referred to them by other clinicians that worked with me)?
3. Would you prefer working with a local pathologist(s) that you have a relationship with rather than sending to a large lab across the country?
4. Should I just cold-call? Call practice manager and ask to set up a time to chat? Stop by and discuss in person? Email?
5. Anything else I'm missing?

Thanks all, would really appreciate your thoughts on this.

Get buy in from your dept chair first. You’ll need your dept on board if you need infrastructure (like a courier system) and or $ to support outside paths who are triaging your renal paths into the various media’s. You’ll also need a little time to market yourself

I assume you are either renal or neuropath
This sort of service can be very useful to a small group.

 

[Doormat]

Neuropath is an interesting niche right now. Even if you are a fellowship-trained neuropathologist, you need access to an advanced infrastructure of advanced diagnostics to provide value. A small group with a neuropathologist is like a race car team, complete with a professional race car driver, without a race car.

Last week, I had a thalamus tumor in a young woman that I sent to a major academic center. They identified an H3 K27M mutation using a mutation-specific antibody and the tumor was diagnosed as a diffuse midline glioma, H3 K27M-mutant, WHO grade 4.

A month ago, I had a medulloblastoma of the midline cerebellum in a kid. I sent it to a major children's hospital. They did the SHH and WNT immunostains, NGS, FISH for NMYC, and lastly they performed a genome-wide methylation microarray study and categorized the tumor within a "methylation category".

Last year I had a case that looked like a low-grade (WHO grade 2) infiltrating glioma. I sent it to a major academic center. A bunch of GBM-associated molecular alterations (TERT promoter mutation, loss of chromosome 10) were identified and it was classified as an infiltrating glioma with molecular features of a grade 4 glioma -- even though morphology was low-grade.

I would say that the field of neuropathology has advanced to the point that a private practice group absolutely cannot sign out a glial neoplasm without expert consultation or send-out studies. Our community hospital intracranial neurosurgeon asked me if I could recruit a neuropathologist last year.

First I say -- we can't recruit one (like Forensics, neuropathologists are few and far between and demand is greater than supply)

Second I say -- even if I did, we'd need 5 million dollars in new equipment to keep neuropathology in-house.

 

[deleted314957]

Neuropath is an interesting niche right now. Even if you are a fellowship-trained neuropathologist, you need access to an advanced infrastructure of advanced diagnostics to provide value. A small group with a neuropathologist is like a race car team, complete with a professional race car driver, without a race car.

Last week, I had a thalamus tumor in a young woman that I sent to a major academic center. They identified an H3 K27M mutation using a mutation-specific antibody and the tumor was diagnosed as a diffuse midline glioma, H3 K27M-mutant, WHO grade 4.

A month ago, I had a medulloblastoma of the midline cerebellum in a kid. I sent it to a major children's hospital. They did the SHH and WNT immunostains, NGS, FISH for NMYC, and lastly they performed a genome-wide methylation microarray study and categorized the tumor within a "methylation category".

Last year I had a case that looked like a low-grade (WHO grade 2) infiltrating glioma. I sent it to a major academic center. A bunch of GBM-associated molecular alterations (TERT promoter mutation, loss of chromosome 10) were identified and it was classified as an infiltrating glioma with molecular features of a grade 4 glioma -- even though morphology was low-grade.

I would say that the field of neuropathology has advanced to the point that a private practice group absolutely cannot sign out a glial neoplasm without expert consultation or send-out studies. Our community hospital intracranial neurosurgeon asked me if I could recruit a neuropathologist last year.

First I say -- we can't recruit one (like Forensics, neuropathologists are few and far between and demand is greater than supply)

Second I say -- even if I did, we'd need 5 million dollars in new equipment to keep neuropathology in-house.

Surgical pathology neuropath has changed 1000% since i left the big Navy hospital in 1988. Back then it was almost ALL morphological with a few immuno stains. I never had to do any when i got in PP.

The “other” side of neuropath is fp/np. not many around. Hirsch did a lot although i don’t think he had np boards. Dragovitch in detroit, Rosen-somebody in Baltimore.
Brain cutting is a big deal in a number of settings and it is almost all gross pathology of the brain. Emphasis on trauma of course.

 

[Blaster1492]

Thanks all, appreciate your help!