NYT Article: On community practice breast pathology errors

[yaah]

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Another problem this article, and the organizational responses from what I have seen, fails to address is clinician-pathologist communication. To me it seems bizarre that a case like this which was sent out by the original pathologist, given a concurrence but acknowledged to be difficult by the consultant, was not treated with appropriate caution by the clinician. Pathologists need to be clear when their findings are not clear or the diagnostic features are borderline. To me, there is no harm in this - it allows the clinician to be flexible in treatment strategies and acknowledge the difficulties. I know some pathologists disagree - there are many who only want to put a diagnosis, no matter how difficult or borderline it is, without acknowledgement of this.

If I get a difficult prostate case or a truly borderline prostate case I don't sign it out like a typical standard obvious cancer.

 

[zao275]

Pathologists need to be clear when their findings are not clear or the diagnostic features are borderline. To me, there is no harm in this - it allows the clinician to be flexible in treatment strategies and acknowledge the difficulties.

This is just good patient care. Not everything fits into the boxes we create. I wish that wasn't true, but it is.

 

[zao275]

Did all of you see USCAP's response to the article?

On July 20, 2010 the New York Times published an article entitled "Prone to Error: Earliest Steps to Find Cancer". This article described the unfortunate plight of several women who were initially given the diagnosis of ductal carcinoma in situ (DCIS) of the breast, only to find out later that the diagnosis was incorrect and that, as a consequence, they had had unnecessary treatment. The article describes several problems in the diagnosis of DCIS that are well known to those of us who practice pathology and that require no further elaboration here. In addition, in that article several pathologists who were interviewed offered suggestions for addressing the problems in the diagnosis of DCIS. One of the solutions mentioned was a plan by the College of American Pathologists (CAP) to offer a program for certification of pathologists in breast pathology.

In follow-up to that New York Times article, Dr. Betsy Bennett, Executive Vice President of the American Board of Pathology (ABP), sent a letter to the editor of the Times on behalf of the trustees of the ABP. In that letter she, along with the Trustees of the Board, wanted to reiterate that "The ABP encourages such continuing educational programs offered by the CAP, the United States and Canadian Academy of Pathology, the American Society for Clinical Pathology, and other pathology societies to enhance the ability of all pathologists to sharpen their diagnostic skills. As a member of the American Board of Medical Specialties (ABMS), however, the ABP is the only nationally recognized certifying organization for pathologists in the United States." She further notes that "The Maintenance of Certification program sponsored by the ABP as a member of the ABMS will help practicing pathologists to maintain competency in all areas of their practice including new approaches to the diagnosis of DCIS of the breast. This program includes continuing medical education courses, self-assessment courses, participation in activities that assure the quality of ones' practice, and an examination geared toward advancements in the field since the pathologist was last certified. Participation is mandatory for pathologists who completed training in 2006 or later, and the program will also be open to all other pathologists as well....The ABP takes this activity very seriously and will be diligent about enforcing provisions of the program and encouraging all of its diplomates to take part."

In the past week, USCAP leadership as well as the leadership of multiple Cooperating Societies have been inundated with comments from pathologists around the country regarding this article and, in particular, the proposed CAP certification program. Our collective view is similar to Dr. Bennetts'. We feel that the best way to ensure competence in the practice of breast pathology, as in every other area of pathology, is a commitment by pathologists certified by the ABP to lifelong learning by attending the many fine CME courses offered by USCAP, ASCP, ASIP, APC, CAP, medical school pathology departments, and other organizations and to obtain CME and Self Assessment Module (SAM) credits to fulfill the requirements of the ABP's Maintenance of Certification Program.

Dr. Stuart Schnitt, President, USCAP Dr. Mark Stoler, President, ASCP

Dr. Fred Silva, EVP, USCAP Dr. Blair Holladay, EVP, ASCP

Dr. Charles A. Parkos, President, ASIP Dr. Jeffrey Myers, President, ADASP

Dr. Mark E. Sobel, Executive Officer, ASIP & APC Dr. Peter Jensen, President, APC

 

[yaah]

To me it looks a bit like the USCAP and ASCP (and others including ABP, ADASP, APC) are all teaming up to go on record against the CAP's subspecialty "certifications." Interesting, I think. I am not too thrilled with the idea of those subspecialty certs either - many great subspecialty pathologists never did fellowships in those areas.

 

[pathstudent]

What will be wonderful is if ASCP and USCAP create their own breast pathology certificates.

But I got to get back to Mary E. Edgerton of MD anderson. She did such a huge national disservice to the field of pathology that CAP/ASCP and every other path group entity should kick her out. She claims that if someone did a fellowship with David Page and happened to go into private practice or a non-US & News elite hospital that their diagnosis should be doubted by the patient and sent to a U.S. News Medical Center. Is Vanderbilt one of the top 20 Cancer Centers in the US? I doubt it is, so according to her, David Page should have his cases reviewed by some jr faculty at MD Anderson or Cleveland Clinic with no publications. What a joke she is. Breast radiologists and surgeons should be the judge of the pathologists and counsel their patients whether a case should be reviewed or not.

Personally, I have no problem with someone wanting a second opinion on anything I sign out. But I have a huge problem with someone like Mary E. Edgerton saying every breast case I sign-out should be reviewed.

Back to the breast certificate. What I do like about them is that it sort of does away with a breast fellowship, because let's face it, that is a meaningless thing. It is not defined and not regulated by the ACGME or anyone. If you do a NP or DP or HP or CP fellowship, you know what are the minimum requirements. I have seen so called breast fellows who only did four extra months on breast service with the rest on gyn and elective. I mean big god damned deal, a private practice pathologists probably sees more breast in a couple years than most breast fellows do in their year of fellowship. Every single breast fellow person should have to do the CAP certificate and then every non-breast fellow who can do it also would be their equal, including Mary E. Edgerton.

 

[KCShaw]

I dunno, the non-CAP responses just seem to say they're supportive of MOC (another arguably screwed-up hot topic) and CME/SAM, not exactly that they're against the CAP certificate. Those reading waaay between the lines could choose to infer that, but I don't know that the average person or media member would. Seems to me to be weak and wishy-washy ways to not-really-support the certificate program -- though those who -expect- the other organizations to be supportive of it could choose to interpret it as such.

I also wouldn't overread into Dr. Edgerton's comments (if that's who was posting). She suggested a couple of ways someone could find what should be an experienced & reputable pathologist, not that those were the only suitable ones on the planet nor that every other pathologist was automatically a breast *****. On the other hand, the suggestion that essentially everything should go for a second opinion paid for by insurance, while impractical, also carries a self-serving feel -- although yes, finances may inhibit small practices from sending oodles of consults. But, IMO that is why practices should include board certified pathologists, who won't -need- to send oodles of consults.

Subspecialty pathologists -- I agree there are a lot of non-fellowship-trained pathologists who are very good at certain subspecialties. I dunno how much of that is related to the time since subspecialty fellowships &/or exams (where applicable) have been available, and how much is just twist of fate where someone with a lot of potential lands in a job where they do a lot of X or have a lot of interest, publish, and otherwise make themselves experts in Y.

 

[pathstudent]

I also wouldn't overread into Dr. Edgerton's comments (if that's who was posting). She suggested a couple of ways someone could find what should be an experienced & reputable pathologist, not that those were the only suitable ones on the planet nor that every other pathologist was automatically a breast *****. On the other hand, the suggestion that essentially everything should go for a second opinion paid for by insurance, while impractical, also carries a self-serving feel -- although yes, finances may inhibit small practices from sending oodles of consults. But, IMO that is why practices should include board certified pathologists, who won't -need- to send oodles of consults.

No she said that every DCIS or IDC diagnosis should be reviewed by someone at MD Anderson or one of the other top twenty US news hospitals even if it was diagnosed by David Page.

 

[KCShaw]

If you want to go that route, you could look and see that Vanderbilt is #18 on the US News list under the "cancer" heading. (I see no "breast" heading.)

 

[pathstudent]

If you want to go that route, you could look and see that Vanderbilt is #18 on the US News list under the "cancer" heading. (I see no "breast" heading.)

Ok is bidmc a top 20 cancer center because according to her every case of idc or dcis diagnosed there should be reviewed.

 

[Parts Unknown]

But I got to get back to Mary E. Edgerton of MD anderson.

Be sure to spell/grammar check!

 

[KCShaw]

But to be a real inreading literalist, one need also recognize she wants her -own- diagnoses reviewed by another institution, because, well, -everyone's- incompetent until someone else reviews it. At least, breast biopsy cases.

 

[pathstudent]

Be sure to spell/grammar check!

Spelling/grammar don't count in emails, tweets, or message board posts.

 

[yaah]

But to be a real inreading literalist, one need also recognize she wants her -own- diagnoses reviewed by another institution, because, well, -everyone's- incompetent until someone else reviews it. At least, breast biopsy cases.

But how do you know who is right? I remember a case where a community person thought a pancreatic FNA was atypical but probably benign. They sent it out to an expert (a real expert - textbook author) who called in unequivocal cancer. Whipple was done and it was a benign condition.

The article touches on that but not really. They say it was sent for a third opinion or something (by now this is what, the fourth or fifth opinion?) and that one agreed too. We don't really know ultimately who is "right" because it has been cut out. But we assume that the original pathologists were wrong because the last two opinions said they were?

 

[Parts Unknown]

Spelling/grammar don't count in emails, tweets, or message board posts.

No, no, of course not. All poor spelling and grammar does is make you look like an inarticulate slob who is unworthy of serious consideration.

 

[pathstudent]

No, no, of course not. All poor spelling and grammar does is make you look like an inarticulate slob who is unworthy of serious consideration.

What an ass you are. You are like a little gnat or little dwarf throwing darts from the side at me. You got nothing else to offer. Normally I don't respond to personal attacks which is all you seem to engage in, but in your case I will make an exception.

Harping on spelling/typing makes you sounds like a nit-picky, anal-retentive, wet-blanket, stick-in-the-mud, loser. Normal people understand that in this day and age, people are busy and typing as fast as possible and often times faster than they are thinking.

I have emails from renowned pathologists that are chock-full-of errors. People that oyu would start kow-towing to and sucking major ass. You certainly wouldn't call them an inarticulate slob. You are worth of serious consideration for being a nit-picky, whiny-weenie, anal-retentive, wet-blanket, stick-in-the-mud, loser.

 

[Parts Unknown]

Harping on spelling/typing makes you sounds like a nit-picky, anal-retentive, wet-blanket, stick-in-the-mud, loser. Normal people understand that in this day and age, people are busy and typing as fast as possible and often times faster than they are thinking.

Oh tsk tsk. If you want to come here and make serious discussion you should take the time to compose readable passages. I'm not asking for perfection, I'm just asking for something above garbage (which is your usual standard).

If you don't want to come here and make serious discussion, by all means keep writing like my 13 year old niece does on her cell phone. Just don't try to have it both ways.

Sometimes the clothing do make the man.

 

[LeeRain]

The article does a serious disservice to and major rapeage of community practice pathologists. I kind of can't even believe it and I am and uberacademic aupporter. Have you read the comments to the article. All the patients and all the pathologists are saying "have your case reviewed by an academic ". Mary erdington from mda flat states that every biopsy should be reviewed by an academic as if every comm practice pathologist should be assumed to be incompetent and every academic should be assumed to be infalliable. It is major pwnage of community practice pathology. Very harsh.

 

[pathstudent]

The article does a serious disservice to and major rapeage of community practice pathologists. I kind of can't even believe it and I am and uberacademic aupporter. Have you read the comments to the article. All the patients and all the pathologists are saying "have your case reviewed by an academic ". Mary erdington from mda flat states that every biopsy should be reviewed by an academic as if every comm practice pathologist should be assumed to be incompetent and every academic should be assumed to be infalliable. It is major pwnage of community practice pathology. Very harsh.

What excellent writing. Was that written by Abraham Lincoln or James Joyce or Sophocles or Virgil or Dave Eggers or perhaps Jonathan Lethem?

 

[Parts Unknown]

What excellent writing. Was that written by Abraham Lincoln or James Joyce or Sophocles or Virgil or Dave Eggers or perhaps Jonathan Lethem?

My money is on the Lindbergh baby, but let's wait until he has at least 500 crappy posts before we start ripping on him.

 

[Pathwrath]

To me it looks a bit like the USCAP and ASCP (and others including ABP, ADASP, APC) are all teaming up to go on record against the CAP's subspecialty "certifications." Interesting, I think. I am not too thrilled with the idea of those subspecialty certs either - many great subspecialty pathologists never did fellowships in those areas.

I would take more comfort in the ASCP's and USCAP's refreshing sanity if I didn't think it was due to the profession's kneejerk contrarianism rather than intelligent advocacy.

CAP says up, ASCP says down. One says black, the other says white. The two stooges couldn't even come together for a unified statement on PAP proficiency testing. I suspect the ASCP is jealous it didn't think of CAP's nifty new fundraising certification scam first.

 

[Pathwrath]

But how do you know who is right? I remember a case where a community person thought a pancreatic FNA was atypical but probably benign. They sent it out to an expert (a real expert - textbook author) who called in unequivocal cancer. Whipple was done and it was a benign condition.

The article touches on that but not really. They say it was sent for a third opinion or something (by now this is what, the fourth or fifth opinion?) and that one agreed too. We don't really know ultimately who is "right" because it has been cut out. But we assume that the original pathologists were wrong because the last two opinions said they were?

Any community pathologist with a decent case volume has been there, believe me. I've lost count of the cases where there was a significant discrepancy between my inital diagnosis and what came out of the Brigham, Cleveland Clinic, et al., only to be vindicated after turning on the spit for a few excruciating months.

The point is that everyone--everyone--makes mistakes. However, it's the community pathologist who needs his professional organization to have his back. That's what makes the CAP's response so reprehensible.

 

[2121115]

The point is that everyone--everyone--makes mistakes. However, it's the community pathologist who needs his professional organization to have his back. That's what makes the CAP's response so reprehensible.

Post of the month.

 

[ygdrasil]

Upon reading the article, having to review 250 breast biopsies/year seemed like a high bar (if all the breast biopsies at my busy, medium-to-large academic center went to one staff member [which they don't], we could probably produce 1-2 certified breast experts).

If you actually read the CAP's FAQ about the certification, however, you discover:
1) Cases toward the 250 count need not be biopsies. It's not totally clear, but it seems that any case concerning breast tissue would count (e.g. mammoplasties, lumpectomies, axillary lymph nodes)

2) Each "part" of a case would count (i.e. if you have a lumpectomy with two separate margins and three containers of axillary lymph nodes, that could potentially add up to 6 "breast cases")

3) You wouldn't actually have to be the pathologist signing out the case. Being consulted would count, as would being physically present at a tumor board conference wherein the case was discussed.

On the other hand, you would also have to undergo CAP's curriculum (and the expense entailed), take a test, and have some kind of "practical assessment", which sounds nasty.

I post this not in support of the certificate, but just to add a little nuance to the discussion. I think the first three points would probably make the certificate gettable by motivated practitioners in medium-to-large private practices.

 

[Pathwrath]

Upon reading the article, having to review 250 breast biopsies/year seemed like a high bar (if all the breast biopsies at my busy, medium-to-large academic center went to one staff member [which they don't], we could probably produce 1-2 certified breast experts).

If you actually read the CAP's FAQ about the certification, however, you discover:
1) Cases toward the 250 count need not be biopsies. It's not totally clear, but it seems that any case concerning breast tissue would count (e.g. mammoplasties, lumpectomies, axillary lymph nodes)

2) Each "part" of a case would count (i.e. if you have a lumpectomy with two separate margins and three containers of axillary lymph nodes, that could potentially add up to 6 "breast cases")

3) You wouldn't actually have to be the pathologist signing out the case. Being consulted would count, as would being physically present at a tumor board conference wherein the case was discussed.

On the other hand, you would also have to undergo CAP's curriculum (and the expense entailed), take a test, and have some kind of "practical assessment", which sounds nasty.

I post this not in support of the certificate, but just to add a little nuance to the discussion. I think the first three points would probably make the certificate gettable by motivated practitioners in medium-to-large private practices.

Each part of a case would not count as separate specimens, only that multiple cases from the same patient would. Whatever. The program and the motivation behind it are dubious.

 

[deleted314957]

This issue does not seem to have gained the "traction" on any of the media or instant "electricity" that the PAP smear fiasco from so many years ago did. Does anyone else get that sense. I believe it could be because toe pap interp was/is generally done at some remote large lab that no one ( doctor or patient) has any real connection to whereas the breast bx is gen erally done by your local hospital via a local and personal referral and every one kind of knows every one, at least at the rad/surgeon/path/pc doctor level.
There just is not this big anonymous lab that "just gave some one cancer or just missed someones cancer."

 

[pathstudent]

Any community pathologist with a decent case volume has been there, believe me. I've lost count of the cases where there was a significant discrepancy between my inital diagnosis and what came out of the Brigham, Cleveland Clinic, et al., only to be vindicated after turning on the spit for a few excruciating months.

The point is that everyone--everyone--makes mistakes. However, it's the community pathologist who needs his professional organization to have his back. That's what makes the CAP's response so reprehensible.

I saw a case a few months ago where a community pathologist called a renal tumor a sarcomatoid renal cell carcinoma arising from a papillary renal cell. It was reviewed at the Colorado university medical center which classified it something completely different. I believe they called it a collecting duct carcinoma. The community pathologist then sent it to epstien who completely agreed with Him, the community pathologist. Then the university pathologist sent it to Stanford who wrote a comment that said. "we are in complete agreement with community pathologist dr x". I guess that is one way to handle it. Appeal to a higher authority if you know you are right.

 

[2121115]

The truth of this whole matter is that most pathologists at most academic medical centers are no different than those at community practices. There are only a select few Epstein's (and the equivalent thereof) in the world and you can basically count them on one hand. Simply working as an Instructor or Asst Prof at Random State University NOS does not make someone an expert on anything.

 

[ygdrasil]

Each part of a case would not count as separate specimens, only that multiple cases from the same patient would. Whatever. The program and the motivation behind it are dubious.

Ah. The FAQ reads: "Different specimens obtained from the same patient represent separate cases." Guess I misinterepreted that.

Again, I'm not crazy gung-ho for this certification, but isn't it plausible that it would have some meaning? If you're the guy in your practice that everyone shows hard breast cases to, if you handle the breast cases at tumor board, if you sign out a bunch of breast cases, that would make you more of an expert than not, yes?

My understanding of CAP's reasoning is that the point of the certification would be to show that "In our group, we have this crazy guy. This crazy guy? He loves the breasts. So we show him, all of our breasts. And he looks and looks." And that would, you know, be comforting to referring clinicians, as opposed to groups that don't have "that guy".

 

[Gyric]

All rather entertaining. I am not convinced CAP has the community pathologist's best interests in mind here, more about $.

What exactly gives CAP the authority to certify pathologist expertise? They are blurring the boundaries too much and should just call it a CME program and avoid the controversy.

Better yet, send me $5k and your CV and I will give you my own super special certificate. I will even frame it for you and put a gold star on it, imagine how impressed the breast surgeons will be!

 

[2121115]

LOL. While we are busy further credentialing our already board certified pathologists to impress clinicians, other specialties are busy taking care of business. Just classic pathology. You think radiologists are worried about convincing clinicians that they can read a chest CT and trying to get an ACR certificate in how to read a chest CT, which they already learned in residency? No they are too busy innovating imaging technology and making $$$ to worry about that.

 

[Pathwrath]

LOL. While we are busy further credentialing our already board certified pathologists to impress clinicians, other specialties are busy taking care of business. Just classic pathology. You think radiologists are worried about convincing clinicians that they can read a chest CT and trying to get an ACR certificate in how to read a chest CT, which they already learned in residency? No they are too busy innovating imaging technology and making $$$ to worry about that.

Exactly.

This is not about subspecializing rare sarcomas and shipping them off to "certified" experts. This is recategorizing basic surgical pathology and intentionally shutting out losers. And once you accomodate clinicians on this organ, what is to stop them from demanding it on any other system?

And don't give me this crap about the difficulty of breast lesions, because the same applies across the board to any organ which is subjected to INSANE INSANE medical and legal attention. Its inherent difficulty is not greater than any other polymorphic neoplastic process. Believe me, anyone making a career staring at a single organ malignancy with a propensity to hair-splitting and free rein to do so will uncover marvelous complexity, shades of gray with dubious distinctions.

 

[Art]

LOL. While we are busy further credentialing our already board certified pathologists to impress clinicians, other specialties are busy taking care of business. Just classic pathology. You think radiologists are worried about convincing clinicians that they can read a chest CT and trying to get an ACR certificate in how to read a chest CT, which they already learned in residency? No they are too busy innovating imaging technology and making $$$ to worry about that.

This gets said a lot on this board, that pathology should be more like radiology because they know how to make money while we sit and argue about minor things. So I went to the American College of Radiologists (ACR) website to see if the ACR provides a certificate for specialists. Turns out that they do. In fact, if you are going to bill Medicare you MUST be certified. Here is the information from the website. http://www.acr.org/accreditation.aspx

Effective Jan. 1 2012, all providers that bill for MRI, CT, PET and nuclear medicine under part B of the Medicare Physician Fee Schedule must be accredited in order to receive technical component reimbursement from Medicare.

The ACR has the expertise and infrastructure to assist large numbers of advanced medical imaging providers get accredited and protect their reimbursements by the Jan. 1 2012 deadline mandated by CMS.

The ACR has accredited more than 20,000 facilities and has a dedicated staff of certified radiologic technologists to guide providers through the accreditation process. ACR accreditation is a comprehensive, yet flexible process where special attention is paid to image quality in addition to equipment, quality control procedures, quality assurance programs, and personnel qualifications.

Does this mean that pathology is behind the times, since there is not a requirement to be specialty certified to bill. Or did organized pathology protect the community pathologists?

 

[2121115]

This gets said a lot on this board, that pathology should be more like radiology because they know how to make money while we sit and argue about minor things. So I went to the American College of Radiologists (ACR) website to see if the ACR provides a certificate for specialists. Turns out that they do. In fact, if you are going to bill Medicare you MUST be certified. Here is the information from the website. http://www.acr.org/accreditation.aspx

Effective Jan. 1 2012, all providers that bill for MRI, CT, PET and nuclear medicine under part B of the Medicare Physician Fee Schedule must be accredited in order to receive technical component reimbursement from Medicare.

The ACR has the expertise and infrastructure to assist large numbers of advanced medical imaging providers get accredited and protect their reimbursements by the Jan. 1 2012 deadline mandated by CMS.

The ACR has accredited more than 20,000 facilities and has a dedicated staff of certified radiologic technologists to guide providers through the accreditation process. ACR accreditation is a comprehensive, yet flexible process where special attention is paid to image quality in addition to equipment, quality control procedures, quality assurance programs, and personnel qualifications.

Does this mean that pathology is behind the times, since there is not a requirement to be specialty certified to bill. Or did organized pathology protect the community pathologists?

Maybe I am wrong, but that is referring to getting your imaging center accredited in order to bill technical component services to Medicare (analagous to a lab being CAP accredited with CLIA deemed status). It is not referring to an individual radiologist getting an ACR certificate so they can bill for professional interpretation or impress their referral base or anything else of that sort.

 

[zao275]

What exactly gives CAP the authority to certify pathologist expertise?

They do not have the authority to officially "certify", nor have I heard or seen CAP use that word. The ABP holds that authority. However, I agree that the use of the word "certificate" has led to much confusion. Perhaps a name change would help clarify the issues here?

I believe that CAP came up with this idea based on requests from CAP members (many of whom are community pathologists) who wanted to show that they, too, were experienced in many of these subspecialty areas, despite not having done a fellowship (more discussion of this topic in the thread: "Complete List of Breast Pathology Fellowship Programs"). It seems that the idea behind this was good. However, detractors bring up the possible consequence of creating a new standard by these certificates, and thus excluding everyone else.

I am not saying this in support or opposition. Just want to clarify the facts so we can all discuss the issue more effectively.

 

[zao275]

This is not about subspecializing rare sarcomas and shipping them off to "certified" experts.

As you know, soft tissue pathology is not subspecialty boarded anyway! So even those experts are experts based on reputation and experience.

Believe me, anyone making a career staring at a single organ malignancy with a propensity to hair-splitting and free rein to do so will uncover marvelous complexity, shades of gray with dubious distinctions.

Eloquently stated!

 

[Art]

Maybe I am wrong, but that is referring to getting your imaging center accredited in order to bill technical component services to Medicare (analagous to a lab being CAP accredited with CLIA deemed status). It is not referring to an individual radiologist getting an ACR certificate so they can bill for professional interpretation or impress their referral base or anything else of that sort.

I think that it does refer to accrediting the physicians, based on their FAQ about the accreditation process.

1. What are the physician qualifications?
The physician qualifications are consistent with the ACR Standard for Performing and Interpreting Computed Tomography, in effect January 1, 2002.

 

[Gyric]

They do not have the authority to officially "certify", nor have I heard or seen CAP use that word. The ABP holds that authority. However, I agree that the use of the word "certificate" has led to much confusion. Perhaps a name change would help clarify the issues here?

I believe that CAP came up with this idea based on requests from CAP members (many of whom are community pathologists) who wanted to show that they, too, were experienced in many of these subspecialty areas, despite not having done a fellowship (more discussion of this topic in the thread: "Complete List of Breast Pathology Fellowship Programs"). It seems that the idea behind this was good. However, detractors bring up the possible consequence of creating a new standard by these certificates, and thus excluding everyone else.

I am not saying this in support or opposition. Just want to clarify the facts so we can all discuss the issue more effectively.

I think calling it a certificate makes CAP's intentions clear. I am sure there was discussion and that CAP leadership actively chose to use this term. I have heard that "Susan G. Koman for the cure," is providing money to CAP to develop this certificate granting program, so there is likely some outside pressure specifically pushing the breast certificate through. I have also heard that some of the original "expert" pathologists on these certificate program committees have resigned.... It will be interesting to see what direction CAP takes on this issue when Stanley Robboy is at the helm.

 

[2121115]

It will be interesting to see what direction CAP takes on this issue when Stanley Robboy is at the helm.

It will be interesting. He is a lifelong academic apparently. I wonder what stance he'll take on this issue.