Proposition

[bberlioz]

Dear colleagues,

with the tremendous changes/progress within our field in the past decade, and the large majority/entirety of our surgical pathology practice dedicated to oncology nowadays, would it be wise to change the "archaic" name of our specialty (pathology) to:

Diagnostic Oncology

Alongside:
-Diagnostic Radiology
-Radiation Oncology
-Medical Oncology
-Surgical Oncology

"Diagnostic Oncology" would be a much more descriptive term, allowing the general public to understand what we do in surgical pathology 99% per of time:

Diagnosis and Prognosis of Cancer, while excluding/diagnosing other benign/inflammatory/infectious lesions.

I think this would be greatly beneficial for our field as a whole (as it has evolved beyond the ancient times of Autopsies) and would shed more light on our ever-changing field, especially with the development of molecular pathology and the era of -omics and personalized medicine.

Food for thought.

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[yaah]

Except for the fact that a huge portion of pathology has nothing to do with oncology. Close to half of GI biopsies, a large portion of derm biopsies, the existence of benign neoplasms, not to mention that a huge amount of CP doesn't have much to do with oncology.

 

[mlw03]

I think this is a horrible idea. In addition to yaah's point that significant parts of surgical pathology are non-neoplastic in nature, this name change would leave those of us in other areas within pathology without a title. Transfusion medicine specialists? Medical microbiologists? Forensic pathologists? Clinical chemists?

Dear colleagues,

with the tremendous changes/progress within our field in the past decade, and the large majority/entirety of our surgical pathology practice dedicated to oncology nowadays, would it be wise to change the "archaic" name of our specialty (pathology) to:

Diagnostic Oncology

Alongside:
-Diagnostic Radiology
-Radiation Oncology
-Medical Oncology
-Surgical Oncology

"Diagnostic Oncology" would be a much more descriptive term, allowing the general public to understand what we do in surgical pathology 99% per of time:

Diagnosis and Prognosis of Cancer, while excluding/diagnosing other benign/inflammatory/infectious lesions.

I think this would be greatly beneficial for our field as a whole (as it has evolved beyond the ancient times of Autopsies) and would shed more light on our ever-changing field, especially with the development of molecular pathology and the era of -omics and personalized medicine.

Food for thought.

 

[icpshootyz]

Diagnostic Pathology is just fine. There's too many things we do each day that are not oncology related, as others have pointed out. Personally I think we need to emphasize that what we do is consult on patients, we are not a lab machine spitting out a calculated diagnosis. When a biopsy/sample/excision/resection comes to us we are consulting on that piece of the patient to provide our expert diagnosis. We are not a CBC or a Chem7 test. We are expert consultants whose diagnostic interpretations are essential for a huge amount of patient care.

 

[mlw03]

I'd go for this over the other, but to me "diagnostic pathology" is redundant. Pathology is diagnostic medicine. Virtually everything any pathologist does is diagnostic (or prognostic) in nature. Very little therapeutic stuff doled out by the pathologist (I suppose a bit in transfusion medicine... the only pathologist I ever knew who had a prescription pad was a blood banker).

What would be the impetus for a name change anyway? Even with one, I doubt the public would understand what most of us do day to day.

Heck, I'm in one of the most visible subspecialties (FP) and still, most people don't know how we spend our days. People think every case I do is a suspicious death.

Diagnostic Pathology is just fine. There's too many things we do each day that are not oncology related, as others have pointed out. Personally I think we need to emphasize that what we do is consult on patients, we are not a lab machine spitting out a calculated diagnosis. When a biopsy/sample/excision/resection comes to us we are consulting on that piece of the patient to provide our expert diagnosis. We are not a CBC or a Chem7 test. We are expert consultants whose diagnostic interpretations are essential for a huge amount of patient care.

 

[bberlioz]

Very interesting points. I think one of the big misnomers lies in the belief by most people that cancer diagnosis is rendered by medical oncologists, and not by pathologists. This stems from the simple fact that medical oncologist are the ones who will inform the patient about the diagnosis and prognosis of their cancer.

A good medical oncologist will explain that the diagnosis is in fact determined by the pathologist through their report, but from my personal experience (and often in private practise/community hospitals), most clinicians will skip this step and act as if the diagnosis came from them (for the simple sake of simplicity as they claim), perhaps to empower their role in the management of cancer?

What I was suggesting is that Pathology be subdivided into clinical pathology and surgical pathology. With the latter (surg path) changed to "diagnostic oncology". I know this is not ideal as it does not encompass all the roles that we take (including non-oncologic entities) but from a promotional point of view, it would better promote and describe our role in the medical system. Given the fact that oncology has taken the large part of surg.path practise, I thought this would be a practical alternative.

The name change might be necessary given the traditional role that pathology has played in clinical practise and how it has evolved recently. (It's quite ridiculous that some of our colleague clinicians (not in oncology) still think that most of our practise involves post-mortem examination and not actually clinically relevant decisions on live patients!)

These are dire times for pathology as we know, and unless we change how the public perceives us, it will be very hard to obtain strong support from either the population and/or policy makers.

 

[rollwithit]

General public? 80% of the population doesn't know the difference between a oncologist, pathologist, or radiologist. You've acknowledged the bigger issue and it is that so much of the pathologists work is behind the scenes. Whether for selfish reasons or not, the clinician gives the impression that he or she makes the diagnosis. Step 1 is to put your face on the value you add. Names are a waste of time if you can't establish the separation of duties yourself.

 

[BlondeDocteur]

Pathology is a transparent and simple name. I like it. It accurately reflects the discipline's position at the core of all of medicine.

You're right though-- clinicians definitely act as though a diagnosis ultimately comes from them. In some cases this is justifiable if not accurate (i.e. a supsicious skin lesion with all the hallmarks of a melanoma, which of course still requires biopsy & pathology to confirm) but unless it's accurately diagnosable by an excellent H&P, it's not fair to exclude the pathologist (and radiologist, often) from the glory.

But that's the case for all the behind-the-scenes doctors. No one ever writes tearful thank-yous to the diligent radiologist who picks up a subtle abnormality, or the anesthesiologist who tubes a crashing Class 4 airway, etc.

 

[Substance]

The OP makes an incredibly good suggestion. Pathology is a word associated with corpses, laboratories, awkwardness...not physicians, and not patient care. I think pathology might be the only medical discipline where a non-physician can obtain a PhD with the exact same name. I've not heard of any diagnostic imaging PhDs, medical oncology PhDs, internal medicine PhDs etc. My undergrad had a PhD department of pathology. Lab rats.

Pathology is not a transparent name. It's a prefix.

The general public isn't so much the target of a re-branding, it is legislators. No legislator wants to pay for autopsies, and all legislators want to reduce the prices of commodities. Hence, the situation your field is in.

Gotta brand it right, or nobody will give a rat's ass about it. And clearly your branding sucks because your field its getting killed with reimbursement cuts and you can't recruit worth crap.

 

[Pathman1000]

The OP makes an incredibly good suggestion. Pathology is a word associated with corpses, laboratories, awkwardness...not physicians, and not patient care. I think pathology might be the only medical discipline where a non-physician can obtain a PhD with the exact same name. I've not heard of any diagnostic imaging PhDs, medical oncology PhDs, internal medicine PhDs etc. My undergrad had a PhD department of pathology. Lab rats.

Pathology is not a transparent name. It's a prefix.

The general public isn't so much the target of a re-branding, it is legislators. No legislator wants to pay for autopsies, and all legislators want to reduce the prices of commodities. Hence, the situation your field is in.

Gotta brand it right, or nobody will give a rat's ass about it. And clearly your branding sucks because your field its getting killed with reimbursement cuts and you can't recruit worth crap.

You have some unresolved anger issues, bro.

 

[BlondeDocteur]

I think pathology might be the only medical discipline where a non-physician can obtain a PhD with the exact same name. I've not heard of any diagnostic imaging PhDs, medical oncology PhDs, internal medicine PhDs etc. My undergrad had a PhD department of pathology. Lab rats.

Now I know you're just trolling, instead of trying to contribute a substantive (albeit critical) opinion to the discussion. My alma mater:

http://www.ox.ac.uk/admissions/postgraduate_courses/course_guide/clinical_medicine.html
http://www.ox.ac.uk/admissions/postgraduate_courses/course_guide/obstetrics_.html
http://www.ox.ac.uk/admissions/postgraduate_courses/course_guide/paediatrics.html
http://www.ox.ac.uk/admissions/postgraduate_courses/course_guide/surgery.html

And so on, ad nauseam-- every single clinical discipline is one in which you can earn a PhD.

And of course, if you think a PhD in molecular pathogenesis granted by a Pathology department is the same thing as being trained to evaluate patients and generate a differential diagnosis based on the H&P & imaging, make histologic diagnoses, administer a blood bank, perform plasmapheresis, and do all the other patient care-related tasks for which an MD is absolutely necessary... I've got a bridge in Brooklyn to sell you.

Pathology is not a transparent name. It's a prefix.

A prefix? To what? Pathology-pediatrics? Pathology-surgery? "Pathology" is an excellent name, which again squarely places the discipline right at the heart of all of medicine.

If you honestly think that the general public's esteem and prestige for individual specialties matches up to the internal medical community's perceptions... again, that bridge is waiting. Great views. Act now!

The public thinks about 7 kind of doctors are prestigious:

1) Neurosurgeons
2) Cardiac surgeons
3) Trauma surgeons
4) ER physicians
5) Ob/gyns (just the obstetrics part)
6) Orthopedists
7) Oncologists

And people like pediatricians a lot, too.

ENT? Derm? Rad onc? Why on earth would you want to do that? Those must be the losers in med school who can't hack it with a fresh gunshot victim, right? Those poor sods who look at acne all day, or shoot deadly beams of radiation at patients hoping to kill a cancer before they kill everything surrounding the cancer... must have been bottom of the med school class.

But again, who cares. I got the flip side of this in surgery-- all of the "wow, that's amazing, I can't believe you can do that all day" while feeling like an imposter because it's not all it's cracked up to be. Now it's the opposite- "oh, uh, cool, good luck, what is that again?" while secretly being very pleased with my decision. I'll take internal satisfaction over public perception any day (just like the dermatologists and rad oncs, whom I am sure find their jobs stimulating, even though I'd rather swim through a shark-infested sea than trade places with them).

Hand-wringing about the job market aside, pathologists tend to be a very happy lot. It's among the most intellectually stimulating of specialties, it allows you to routinely play the 'expert' role, you get the final word in sleuthing and making diagnoses, and you get lots of time off for other pursuits. There are tons of positives and, like everything, a handful of negatives, and for the right person who is comfortable staying out of patient care entirely, it's a great field.

 

[bberlioz]

Well the main reason I am proposing this "rebranding" of pathology is because we are facing a crisis that neither ENT, Derm nor RadOnc are facing. (at least not to this extent)

Pathology literally means "study of disease" and to the general public and policy makers, it is incredibly hard to conceive what kind of role we could partake in the medical system apart from post-mortem examination, which could not be further from the truth.

People understand the role of radiologists quite well because well, they're "physicians who look at radiographs/ultrasound/CT/MRI to diagnose disease". What do pathologists do? "Well hum, they're physicians who study disease... like autopsies?" No, they actually diagnose disease, including ALL cancer. "Really???? I thought that was the Oncologist??"

If we do rebrand ourselves under "diagnostic oncology" or "diagnostic medicine" it would be much easier to stand our ground. We are making a statement by showing that we provide an essential service to the medical system, as diagnostician consultants. We diagnose disease (cancer especially) and that guides the ENTIRE management.

By rebranding ourselves, people will be less inclined to queston our role in the medical system. Although I agree that staying behind the scenes can be gratifying at times, it cannot be viable if the future of our profession is at stake.

 

[mlw03]

What crisis is pathology facing that other specialties aren't? Every specialty has its problems, pathology included.

If we rebrand ourselves as suggested, to whom are we making that statement? The public? Politicians? I think many of us are making the classic mistake of believing we are more important than we are, and that people care. No one cares about any kind of doctor other than their primary doc until the need the services of a ___. Rebranding isn't going to change that.

Putting words in bold doesn't make them more true, nor does it make them more likely to be read by people with any decision making capacity. This is a discussion forum read by pathologists. I'm pretty sure John Boehner isn't perusing SDN at night as he considers healthcare policy. Maybe (Dr.) Rand Paul, but probably not.

 

[bberlioz]

10

 

[LADoc00]

Re-branding will do nothing at this point. It would be like crew of the Titanic rebranding themselves as "Ocean life tour guides" as the ship and all the passengers slipped into the water.

We are at the point where NO ONE CARES.

~Break out the long knives.

 

[Substance]

Re-branding will do nothing at this point. It would be like crew of the Titanic rebranding themselves as "Ocean life tour guides" as the ship and all the passengers slipped into the water.

We are at the point where NO ONE CARES.

~Break out the long knives.

It'd probably help in the long game, but wouldn't make a dent in your current problems.

Part of the reason, if not the whole reason, that your field is in such an abysmal position is because of the caliber of person that goes into it. Part of that is because pathology = autopsies and lab freaks, and what sane-minded medical student wants to be associated with either of those things? It's like trying not to sit at the freak table in the high school lunch room.

 

[Overhauser]

It'd probably help in the long game, but wouldn't make a dent in your current problems.

Part of the reason, if not the whole reason, that your field is in such an abysmal position is because of the caliber of person that goes into it. Part of that is because pathology = autopsies and lab freaks, and what sane-minded medical student wants to be associated with either of those things? It's like trying not to sit at the freak table in the high school lunch room.

I'd rather sit at that table than whichever one pricks like you occupy.

 

[coroner]

:troll:

 

[Substance]

I'd rather sit at that table than whichever one pricks like you occupy.

You're the one calling people names brah...

I'm not trying to be inflammatory (though it appears I do have a talent for it). It is pretty apparent that not a lot of students want to go into pathology, and a big part of that stems from the image of pathology. Don't get all huffy because I pointed out how the sky is grey and you just didn't like it.

 

[Overhauser]

You're the one calling people names brah...

I'm not trying to be inflammatory (though it appears I do have a talent for it). It is pretty apparent that not a lot of students want to go into pathology, and a big part of that stems from the image of pathology. Don't get all huffy because I pointed out how the sky is grey and you just didn't like it.

Freaks, *****s, knuckle-draggers - words you've used to describe people on this forum. Yes, I'm the only one name calling around here.

 

[Substance]

Freaks, *****s, knuckle-draggers - words you've used to describe people on this forum. Yes, I'm the only one name calling around here.

I admit I can be hyperbolic but it is never aimed at any one particular individual on this forum. My intention was never for anyone to take it personally.

Beyond the colorful language I employ, the major crux of my argument is that pathology is in a tenuous situation and requires a drastic overhaul of its fundamentals in order to improve patient care quality. Much of the issues that face pathology today are a direct result of recruitment difficulties, those being underrecruitment of strong people and overrrecruitment of weak ones.

This is a major issue because, as I had alluded to above, patient safety is compromised because of such things. A winning team needs a good coach and good players, and unfortunately I see neither of those things in pathology (vs rads, anesthesia etc, which have good players, and derm, rad onc and most surgical fields, which have both).

 

[bberlioz]

Substance brings out a good point. I agree that the quality of pathology residents probably has suffered a great deal over the past decades, because of the stigma attached (autopsies, poor social skills, etc.) Futhermore, there seems to be a great discordance between the quality of pathologists trained at ivy league schools and the lesser-name schools.

However, in the past decade, the role of pathology has greatly evolved and now the majority of clinical decisions actually depend on laboratory results. As a result, an accurate and competent pathologist's assessment is critical in determining the final outcome of patient care.

Isn't it scary that no matter how good the clinician is, if the pathologist's assessment is wrong from the start, the patient's entire management can be jeopardized? I think it's time to tighten our belts and start filtering the quality of new trainees who make it into our field.

 

[bberlioz]

What crisis is pathology facing that other specialties aren't? Every specialty has its problems, pathology included.

If we rebrand ourselves as suggested, to whom are we making that statement? The public? Politicians? I think many of us are making the classic mistake of believing we are more important than we are, and that people care. No one cares about any kind of doctor other than their primary doc until the need the services of a ___. Rebranding isn't going to change that.

Putting words in bold doesn't make them more true, nor does it make them more likely to be read by people with any decision making capacity. This is a discussion forum read by pathologists. I'm pretty sure John Boehner isn't perusing SDN at night as he considers healthcare policy. Maybe (Dr.) Rand Paul, but probably not.

I see that you are a pathologist who decided to move from the United States to Canada to practise pathology. Sadly, the crisis that I am mentioning affects primarily the United States, and not Canada.

 

[deleted314957]

Substance brings out a good point. I agree that the quality of pathology residents probably has suffered a great deal over the past decades, because of the stigma attached (autopsies, poor social skills, etc.) Futhermore, there seems to be a great discordance between the quality of pathologists trained at ivy league schools and the lesser-name schools.

However, in the past decade, the role of pathology has greatly evolved and now the majority of clinical decisions actually depend on laboratory results. As a result, an accurate and competent pathologist's assessment is critical in determining the final outcome of patient care.

Isn't it scary that no matter how good the clinician is, if the pathologist's assessment is wrong from the start, the patient's entire management can be jeopardized? I think it's time to tighten our belts and start filtering the quality of new trainees who make it into our field.

I am recently retired and have pretty extensive experience in the field (military, PP associate, PP owner and corporate employee) and I disagree with your knee-jerk assessment of the "great discordance" between ivy trained pathologists and those from "lesser schools". I've seen no real quantifiable difference. We do need to filter the new trainees. When I took the boards the pass rate was a hell of a lot lower than now. If you do not have boards you are effectively excluded from the vast majority of the pathology job community.

 

[LADoc00]

Mike,

Just curious. When I took the boards the pass rate was 50%. How much lower could it have possibly been in your era? Especially before Path was flooded with FMGs...

 

[deleted314957]

Mike,

Just curious. When I took the boards the pass rate was 50%. How much lower could it have possibly been in your era? Especially before Path was flooded with FMGs...

it was about 50% to pass combined both AP/CP. today it is much higher.

 

[coroner]

Here's some data from a couple of years ago. Surprised the CP pass rate was higher than AP. At one time, I thought it was the other way around...

 

[neulite30]

Not to detract from the post, but here's the 2012 numbers for Australian residents and their pathology board(s).

 

[Pollux]

Not to detract from the post, but here's the 2012 numbers for Australian residents and their pathology board(s).

For a country with a population of 23 million (1/13 of US population), they are pumping out ~100 pathologists a year? No wonder I recently heard that the pathology job market in the major cities in Australia isn't much better than that in the US...

 

[ratherbefishing]

Not sure how you can filter applicants when many places are struggling to fill. I think the most straightforward fix (but hard to execute) would be to drastically cut down on the number of residency spots and stop overwhelming the market with a huge supply. You'd be able to recruit better talent if the job market was excellent and salaries were high. People respond to incentives.