Transformation of Pathology

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For a couple of years now the CAP has been banging on a drum they are calling the "Transformation" of pathology. Their claim is that pathology needs to transform or die. I see this initiative mentioned in many of their mailings, and at the couple of CAP meetings I have attended, it has been a major topic of plenary sessions and the like. They seem to be spending much of their (i.e., our) money on the transformation program office.

This (link) seems to be the main CAP webpage about this whole thing.

Major proposals of the transformation, if I understand correctly:
- Pathologists should find new ways to contribute to the health care team--for example by seeing patients directly. Never mind that this will never be billable.
- Pathologists should come up with more practice bulletins and other evidence to guide practice (in pathology AND other fields). Never mind that each specialty wants to make its own guidelines.
- There should be new certificate-type programs to certify pathologists in their new activities (e.g. performing US-FNA or reading breast predictive markers). Never mind that selling certificates could be viewed as a money-making enterprise--or that it jeopardizes anyone who might later do these activities competently, but without the certificate.

The stated evidence that we need to transform, besides (I can only assume) the CAP officers reading this forum, is a laughably unscientific survey called the "Case for Change", in which pathologists were asked point blank whether they felt a need to transform, and Beltway insiders were asked whether pathologists should transform. This part I am not making up, although I am abbreviating.

My own main objections are that no one can mandate innovation and that even in a specialty with an existential crisis, the proposed solutions do not address the problems. Within the context of a CAP meeting, the Transformation program seems cultish. Outside of that context it just seems irrelevant. I have no problems with the CAP's advocacy in general; I have been told that we are well represented by our lobbyists. But it bothers me that our main professional organization is going so far off the deep end with an initiative that most CAP members would basically laugh at.

Anyone else have any exposure to this, any reactions? Am I being uncharitable? Does anyone else out there feel a pressing urge to Transform?

 

[Pathguy11]

For a couple of years now the CAP has been banging on a drum they are calling the "Transformation" of pathology. Their claim is that pathology needs to transform or die. I see this initiative mentioned in many of their mailings, and at the couple of CAP meetings I have attended, it has been a major topic of plenary sessions and the like. They seem to be spending much of their (i.e., our) money on the transformation program office.

This (link) seems to be the main CAP webpage about this whole thing.

Major proposals of the transformation, if I understand correctly:
- Pathologists should find new ways to contribute to the health care team--for example by seeing patients directly. Never mind that this will never be billable.
- Pathologists should come up with more practice bulletins and other evidence to guide practice (in pathology AND other fields). Never mind that each specialty wants to make its own guidelines.
- There should be new certificate-type programs to certify pathologists in their new activities (e.g. performing US-FNA or reading breast predictive markers). Never mind that selling certificates could be viewed as a money-making enterprise--or that it jeopardizes anyone who might later do these activities competently, but without the certificate.

The stated evidence that we need to transform, besides (I can only assume) the CAP officers reading this forum, is a laughably unscientific survey called the "Case for Change", in which pathologists were asked point blank whether they felt a need to transform, and Beltway insiders were asked whether pathologists should transform. This part I am not making up, although I am abbreviating.

My own main objections are that no one can mandate innovation and that even in a specialty with an existential crisis, the proposed solutions do not address the problems. Within the context of a CAP meeting, the Transformation program seems cultish. Outside of that context it just seems irrelevant. I have no problems with the CAP's advocacy in general; I have been told that we are well represented by our lobbyists. But it bothers me that our main professional organization is going so far off the deep end with an initiative that most CAP members would basically laugh at.

Anyone else have any exposure to this, any reactions? Am I being uncharitable? Does anyone else out there feel a pressing urge to Transform?

Based on my understanding of the concept of what the CAP hopes to achieve with the transformation campaign, I do NOT think it is a waste of time or resources. This all comes down to the direction that medicine seems to be going, in which specialties that can prove they have value and that are more central to the "medical home" will end up thriving and theoretically continue to get their share of reimbursement. Pathology suffers from the lack of visibility and understanding that not only our patients have for us but even our clinicians who half the time don't know what we do. Couple this with the stereotype that we are all anti-social, nerds with a microscope stuck in a morgue somewhere, we do run the risk of being moved to the periphery of the spectrum of value in the medical team. The underlying goal of transformation is to change this.

The initial Transformation campaign afew years back was confusing, in that there was nothing tangible about it. At meetings we heard that our field needed to transform and that we should be transformational Pathologists. Half the people even involved in the CAP had a hard to defining how that translated into practice. However, over the past couple of years the meaning of transformation and even more tangible examples have been made more clear for us (though the message needs to be continually refreshed).

I think too many people get caught up on the idea that transformation has to be some major change from what many of us are already doing (thought I realize this is implied by the title of the campaign). I don't think this is necessarily true though. Many Pathologists are already "transformational" in that they are doing their part to stop the stereotype and actively looking for ways to make themselves a more indispensible part of the medical team. There are others in the field who really need a lot of help in this department and do need a complete transformation. It's about each Pathologits asking themselves if there is anything "extra" they could do to improve their practice and the services we provide to our clinicians and patients. For some, volunteering to serve on a hospital multidisciplinary committee when in the past they have had no Pathology involvement may be a start in the right direction. I think it is important for those of us in the training who are the future of Pathology to understand this and not just jump on the bandwagon against it the concept of transformation until we understand the purpose. Anyone reading this who thinks we as a specialty do NOT still have tons of room for improvement with regards to our perceived value by patients, clinicians, and government, is simply delusional.

So, I for one am on board with transformation in the way I understand it. It does NOT mean that the CAP is pushing us all to start rounding on patients and hold clinic hours. It's really more of a case by case evaluation of what you can do in your own practice to become a more valuable player in the patient care team and thus more difficult to replace. Just my take...

Pathguy11

 

[pathstudent]

Transformation is sort of a dumb title but has a worthy goal of making sure pathologists don't let themselves get marginalized in the future.

But I do agree that selling 3000 dollar certificates with a 3-5 year expiration date is dismaying. I know there is a cme component to them but c'mon man!

 

[2121115]

CAP has been banging this drum for much longer than the past few years, try since it was founded. Back in the day, it was "take ballroom dancing lessons" and whatnot trying to get pathologists to not be the introverted nerds of The Big Bang Theory. The names have changed but the general message stays the same.

 

[Enkidu]

Would it make sense for pathologists to deliver their diagnosis directly to the patient? It would be within the standard realm of practice for pathology and pathologists would be in a better position to answer certain questions ("are you sure it isn't cancer, doc?"). Also, clinicians wouldn't be able to stop it, they could be at the same meeting with the patient, learning the diagnosis. That'll impress patients with the importance of pathology.

 

[Pathwrath]

There's really two issues here. One is whether we should be deliberately transforming pathology to meet future challenges . The other is whether CAP is qualified to direct the transformation.

Yes to first; no to the second.

 

[Pathguy11]

Transformation is sort of a dumb title but has a worthy goal of making sure pathologists don't let themselves get marginalized in the future.

But I do agree that selling 3000 dollar certificates with a 3-5 year expiration date is dismaying. I know there is a cme component to them but c'mon man!

These certificate programs are a direct result of requests by current practicing Pathologists from the House of Delegates who wanted to show expertise in some area of Pathology based on years of experience despite having not done a fellowship in the area. That is my understanding. I suppose the certificate program in a particular area of Pathology is a way to show your hospital and other clinicians documentation that you continue to have a level of expertise, despite not completing a formal fellowship in that area. Some examples were with GI or Breast Pathology where practicing Pathologists who were the most vocal at meetings expressed concern that the fresh out of training and fellowship trained Pathologist would be more desirable to clinicians. A few of them told examples that their breast surgeons and oncologists wanted to send their patient's specimens to a "breast Pathologist". There were fewer Pathologist opposing this "movement" at the time, only those who worried that these certficate program would then become the new status quo, where hospitals would require all their Pathologists to participate.

So these programs did not just pop out of thin air. And of course the are not going to be cheap 🙂 . I am personally neither for or against them, but those are some of the facts on why they exist.

Pathguy11

 

[Pathguy11]

There's really two issues here. One is whether we should be deliberately transforming pathology to meet future challenges . The other is whether CAP is qualified to direct the transformation.

Yes to first; no to the second.

I don't think any one person or organization is "qualified to direct transformation" or perhaps better stated, is not going to single handedly force transformation. This will be accomplished on more of a grass roots effort with each Pathologist looking at his or her own practice and participation in order to continue to look for opportunities to improve. But I also DON'T think you can fault the CAP, as our primary specialty organization, for trying to support the advancement of our profession. I think the intentions of the transformation campaign by the CAP are genuinely meant to help continue to evolve our Pathology to suceed in the current and future world of medicine. Just the point that we are discussing it in this forum is a good thing, whether or not you agree with the CAP or the way they are trying to support transformation. Just my 2 cents...

Pathguy11

 

[Pathwrath]

But I also DON'T think you can fault the CAP, as our primary specialty organization, for trying to support the advancement of our profession. I think the intentions of the transformation campaign by the CAP are genuinely meant to help continue to evolve our Pathology to suceed in the current and future world of medicine. Just the point that we are discussing it in this forum is a good thing, whether or not you agree with the CAP or the way they are trying to support transformation. Just my 2 cents...

Pathguy11

I respect your opinion; I just don't agree with it. I don't think CAP handles actual current problems facing the profession well enough to also entrust it with any kind of "visioning" or whatever. The certificate programs you mention are a good example. I remember CAP's response to the NYT's breast biopsy article back in 2010, a good example of how NOT to deal with a crisis. Here's the SDN thread:

http://forums.studentdoctor.net/showthread.php?t=749172

I would also revisit CAP's handling of PAP proficiency testing, but I just don't feel like bringing that hot mess up again. The point is, I don't trust CAP's priorities.

 

[Pathguy11]

I respect your opinion; I just don't agree with it. I don't think CAP handles actual current problems facing the profession well enough to also entrust it with any kind of "visioning" or whatever. The certificate programs you mention are a good example. I remember CAP's response to the NYT's breast biopsy article back in 2010, a good example of how NOT to deal with a crisis. Here's the SDN thread:

http://forums.studentdoctor.net/showthread.php?t=749172

I would also revisit CAP's handling of PAP proficiency testing, but I just don't feel like bringing that hot mess up again. The point is, I don't trust CAP's priorities.

Unfortunately the concept of having a minimum number of cases required as part of a certificate program was NEVER a realistic option, that was a misquote by the media. In responses issued immediately by the CAP after the article they made it clear that IF such "certificate" programs were to be created, there would be no such requirements. Much of the article was written out of context from that was actually said. I know this for a fact as I know who the quote was taken from. And you mention the "handling of the PAP PT"...I actually was one of many Pathologist who went to Washington D.C. a few years back through the CAP to try and have this process completely reformed. That IS what the CAP was initially trying to do both before PT testing started and the year or so after. But the issue of PAP PT is not exactly a top priority in Congress and the proposed reform bill never really went anywhere. As a compromise since it PAP PT was going to continue whether or not we like it, I think the CAP's efforts to make the test less punative, easier to pass and with more opportunities to pass the second time were successful. The initial goal of the proposed reform bill was to have it more like a CME style PT but that didn't happen. Blame that on your congressman and other Pathologists for not making enough of a fuss to congress to make it more of a priority.

Don't get me wrong, I do respect your opinion and understand why you have some of the opionions that you do. But as someone who has seen some of the things that go on behind the scenes at the CAP, I don't have the same level of distrust as you do. Take the PAP PT testing for example, you are only looking at the end result which is that now the CAP is part of the PAP PT testing. However, this was NOT where the fight was for at leasst two years before...instead this was a compromise and I think the lesser of two evils.

Since you seem to be critical of the CAP's handling of these issues, how would you have proposed they handled the NYT's story and the PAP PT issue?

If you have some good ideas about current issues that the CAP is not addressing, I am sure there are committees that would be interested in hearing your thoughts. It is one things to have a discussion on a forum like this about what we are unhappy with, and it is another to actually do something constructive with those ideas.

-Pathguy11

 

[pathstudent]

These certificate programs are a direct result of requests by current practicing Pathologists from the House of Delegates who wanted to show expertise in some area of Pathology based on years of experience despite having not done a fellowship in the area. That is my understanding. I suppose the certificate program in a particular area of Pathology is a way to show your hospital and other clinicians documentation that you continue to have a level of expertise, despite not completing a formal fellowship in that area. Some examples were with GI or Breast Pathology where practicing Pathologists who were the most vocal at meetings expressed concern that the fresh out of training and fellowship trained Pathologist would be more desirable to clinicians. A few of them told examples that their breast surgeons and oncologists wanted to send their patient's specimens to a "breast Pathologist". There were fewer Pathologist opposing this "movement" at the time, only those who worried that these certficate program would then become the new status quo, where hospitals would require all their Pathologists to participate.

So these programs did not just pop out of thin air. And of course the are not going to be cheap 🙂 . I am personally neither for or against them, but those are some of the facts on why they exist.

Pathguy11

Either the certificate should be indefinite or it should be cheaper, like 300 bucks just to take the test.

I think they pick the price not by what it costs them to cover their costs, but based on what they know is the typical income for a pathologist and the fact that the cost is usually tax deductible.

 

[Pathwrath]

Unfortunately the concept of having a minimum number of cases required as part of a certificate program was NEVER a realistic option, that was a misquote by the media. In responses issued immediately by the CAP after the article they made it clear that IF such "certificate" programs were to be created, there would be no such requirements. Much of the article was written out of context from that was actually said. I know this for a fact as I know who the quote was taken from. And you mention the "handling of the PAP PT"...I actually was one of many Pathologist who went to Washington D.C. a few years back through the CAP to try and have this process completely reformed. That IS what the CAP was initially trying to do both before PT testing started and the year or so after. But the issue of PAP PT is not exactly a top priority in Congress and the proposed reform bill never really went anywhere. As a compromise since it PAP PT was going to continue whether or not we like it, I think the CAP's efforts to make the test less punative, easier to pass and with more opportunities to pass the second time were successful. The initial goal of the proposed reform bill was to have it more like a CME style PT but that didn't happen. Blame that on your congressman and other Pathologists for not making enough of a fuss to congress to make it more of a priority.

Don't get me wrong, I do respect your opinion and understand why you have some of the opionions that you do. But as someone who has seen some of the things that go on behind the scenes at the CAP, I don't have the same level of distrust as you do. Take the PAP PT testing for example, you are only looking at the end result which is that now the CAP is part of the PAP PT testing. However, this was NOT where the fight was for at leasst two years before...instead this was a compromise and I think the lesser of two evils.

Since you seem to be critical of the CAP's handling of these issues, how would you have proposed they handled the NYT's story and the PAP PT issue?

If you have some good ideas about current issues that the CAP is not addressing, I am sure there are committees that would be interested in hearing your thoughts. It is one things to have a discussion on a forum like this about what we are unhappy with, and it is another to actually do something constructive with those ideas.

-Pathguy11

I'm not sure of the difference between internet discussions and "doing something constructive" if the latter means ending up with PAP PT and certificates anyway.

You seem heavily invested in CAP and I doubt that any criticism I have of the organization is going to seem valid to you. If there's someone to fault in the handling of these issues, it's not going to be CAP (media, "Congressmen or other Pathologists"). That's fine. But if you and I can both agree that the end result of PAP PT and specialty certificates is not the ideal, or even close to it, then why should CAP take on additional projects?

 

[Pathguy11]

I'm not sure of the difference between internet discussions and "doing something constructive" if the latter means ending up with PAP PT and certificates anyway.

You seem heavily invested in CAP and I doubt that any criticism I have of the organization is going to seem valid to you. If there's someone to fault in the handling of these issues, it's not going to be CAP (media, "Congressmen or other Pathologists"). That's fine. But if you and I can both agree that the end result of PAP PT and specialty certificates is not the ideal, or even close to it, then why should CAP take on additional projects?

Again we can agree to disagree...no problems in that. And I can understand from different points of view that things apear differently...no problems there either. But I also think that in general it is easy to be a critic of something than taking the time to really understand the different aspects involved or in this case the efforts that were made. For the record, I don't particularly see a lot of value in the specialty certificates either but that doesn't make me think that the CAP in general is inept. And the arguement to look at the end result of PAP PT as proof that the CAP the is ineffective is also based on an assumption that a "set amount of effort" could have made a difference. Who knows what it would have taken, but I know that a significant amount of time and money was spent in what I consider a valid attempt to have the CLIA requirement for PAP PT changed. Guess what...it didn't work. Again blame your government or lack of Pathologists rallying together versus blaming the primary organization that is making efforts to change these things. By the way it was also the CAP involvement the AMA and CMS that the 88305 was NOT cut upon its recent review. Perhaps the CAP does not advertise it's daily efforts well enough. The reality is that the CAP is "run" by Pathologists like you and me who try to make decisions that they feel are the best for our specialty. Sure there are some exceptions to this, but for the most part people don't bolunteer to get involved in order to make a negative impact. That's why I say again that forums like this a nice to discuss issues. But if you have some real suggestions on current issue then you should convey those to the CAP. Or better yet rally together a larger group of Pathologists on a topic to bring it to the CAP's attention. Help them help you. If you want changes to PAP PT then think of some better solutions, write them down and perhaps start a signed petition to have these issue addressed. Many of the policies including the "certificate program" which is not actually what they are called was introduced because enough Pathologists asked for it openly at assemblies like the House of Delegates. More reason to be invovled. I consider myself a prety objective person and by no means think the CAP is perfect. But I am aware of enough of the behind the scenes operations that I don't doubt intention or integrity of the organization. That is one point I will NOT budge on. By the way here a portion of the response statement from the CAP regarding the NYT article:

"The New York Times article also included statements about the CAP educational program in breast pathology that reflected a number of misunderstandings. One was that those wishing to participate in the breast program would be required to meet a prerequisite number of annual breast cases. While the breast program is still in development, there are no plans for a numerical minimum. The baseline for entry into the CAP advanced practical pathology programs is American Board of Pathology certification; any additional prerequisites will be identified by experts who are developing that course, and will be evidence-based.
The article also suggested that the CAP had started the advanced practice programs out of concern about the quality of diagnoses, which is nothing if not upside down. We started the advanced practice programs because our members asked for focused learning structured in a way that would enable practicing pathologists who had examined thousands of specimens in the course of a career to demonstrate that their expertise was at least equal to that of someone just out of fellowship. The advanced practice programs were initiated at the request of our members for that purpose—to facilitate focused continuing education and demonstration of empirical knowledge.
There has also been concern about the name of the advanced practice learning opportunities. We had been referring to these learning opportunities as “certificate programs” because a certificate would be awarded at the end. This seemed straightforward to us, but it caused such widespread and persistent confusion in the marketplace, where callers believed these certificates could be confused with board certification, that we decided to change the name. While the expert teams that develop these programs discuss a new name, we will refer to the breast program to be released in the spring, and those advanced practice programs already in place, as “advanced practical pathology programs.” "

Pathguy11

 

[BrainPathology]

Again we can agree to disagree...no problems in that. And I can understand from different points of view that things apear differently...no problems there either. But I also think that in general it is easy to be a critic of something than taking the time to really understand the different aspects involved or in this case the efforts that were made. For the record, I don't particularly see a lot of value in the specialty certificates either but that doesn't make me think that the CAP in general is inept. And the arguement to look at the end result of PAP PT as proof that the CAP the is ineffective is also based on an assumption that a "set amount of effort" could have made a difference. Who knows what it would have taken, but I know that a significant amount of time and money was spent in what I consider a valid attempt to have the CLIA requirement for PAP PT changed. Guess what...it didn't work. Again blame your government or lack of Pathologists rallying together versus blaming the primary organization that is making efforts to change these things. By the way it was also the CAP involvement the AMA and CMS that the 88305 was NOT cut upon its recent review. Perhaps the CAP does not advertise it's daily efforts well enough. The reality is that the CAP is "run" by Pathologists like you and me who try to make decisions that they feel are the best for our specialty. Sure there are some exceptions to this, but for the most part people don't bolunteer to get involved in order to make a negative impact. That's why I say again that forums like this a nice to discuss issues. But if you have some real suggestions on current issue then you should convey those to the CAP. Or better yet rally together a larger group of Pathologists on a topic to bring it to the CAP's attention. Help them help you. If you want changes to PAP PT then think of some better solutions, write them down and perhaps start a signed petition to have these issue addressed. Many of the policies including the "certificate program" which is not actually what they are called was introduced because enough Pathologists asked for it openly at assemblies like the House of Delegates. More reason to be invovled. I consider myself a prety objective person and by no means think the CAP is perfect. But I am aware of enough of the behind the scenes operations that I don't doubt intention or integrity of the organization. That is one point I will NOT budge on. By the way here a portion of the response statement from the CAP regarding the NYT article:

"The New York Times article also included statements about the CAP educational program in breast pathology that reflected a number of misunderstandings. One was that those wishing to participate in the breast program would be required to meet a prerequisite number of annual breast cases. While the breast program is still in development, there are no plans for a numerical minimum. The baseline for entry into the CAP advanced practical pathology programs is American Board of Pathology certification; any additional prerequisites will be identified by experts who are developing that course, and will be evidence-based.
The article also suggested that the CAP had started the advanced practice programs out of concern about the quality of diagnoses, which is nothing if not upside down. We started the advanced practice programs because our members asked for focused learning structured in a way that would enable practicing pathologists who had examined thousands of specimens in the course of a career to demonstrate that their expertise was at least equal to that of someone just out of fellowship. The advanced practice programs were initiated at the request of our members for that purpose—to facilitate focused continuing education and demonstration of empirical knowledge.
There has also been concern about the name of the advanced practice learning opportunities. We had been referring to these learning opportunities as “certificate programs” because a certificate would be awarded at the end. This seemed straightforward to us, but it caused such widespread and persistent confusion in the marketplace, where callers believed these certificates could be confused with board certification, that we decided to change the name. While the expert teams that develop these programs discuss a new name, we will refer to the breast program to be released in the spring, and those advanced practice programs already in place, as “advanced practical pathology programs.” "

Pathguy11

I'm involved in CAP too, agree with everything you've said about the hard work they put in and the intentions and motivations of the CAP leadership and members. So take this next statement not as an attack on CAP.

That response is so dense for a layperson reading the NYTimes it sounds like a wall of text meant to muddy the issue. With the average level of understanding the American public displays lately about anything CAP would have been better served by a press release saying "NO SIR!"

 

[sirenomelia]

I recommend we delegate the ABP to reconfigure and expand on required specialty certifications so they can ordain everyone must spend $2700 and fly to Fairbanks Alaska every three years for competency testing for hernia sac and foreskin signout privileges.

 

[Euchromatin]

Pathguy 11 - Could you give some more realistic, reasonable, concrete examples of what pathologists might do to be transformational and increase their value to the healthcare team? Because this idea still seems very fuzzy and intangible to me and I still question whether something like this is the best use of the CAP's time.

You already mentioned that no one really expects us to see patients or starting rounding with clinicians on a regular basis (thankfully, because that seems like a pointless waste of time that could better be spent doing what we are actually trained to do - and can bill for), but the only specific example you gave is participating in a multidisciplinary committee at your hospital.

I know many larger hospital-based groups already go to tumor boards - so the surgeons, oncologists, rad oncs and radiologists, at least, are likely to get to know the pathologists at least to some degree (depending on how the tumor boards are run). Our medical renal specialists also hold regular meetings for the nephrologists where the results of kidney biopsies are discussed; a team from gastroenterology (attending, fellows, IM residents rotating on their service) comes down regularly for educational slide sessions with one of our attendings. Blood bank attendings are on the transfusion committee, microbiology attendings are on the hospital infectious disease committee, etc. I would assume that things are fairly similar for most larger, hospital-based groups (academic or not - feel free to correct me if I am in error in making these assumptions).

So, basically, I'm not really sure what else CAP expects pathologists to be doing (that would be reasonable and useful) to further increase our interactions with clinicians and/or make ourselves more valuable beyond what I suspect many groups are already doing.

Enkidu - The idea of directly delivering results to the patients is interesting, but it doesn't seem very feasible/realistic to me and it would likely be very time-consuming. On the one hand, it could be beneficial to meet patients in person (they're less likely to sue docs they've met, they see our value, it would prevent the clinician from misinterpreting the results and/or blaming pathology for any confusion), but I really don't know how it could be implemented effectively. The clinicians have the infrastructure in place already to schedule appointments and see patients, so we would likely be "at their mercy" in terms of gaining access to patients. I doubt patients (or insurance companies if we were ever able to bill for it) would want to schedule a separate appointment JUST to get the diagnosis delivered by us, then have to go to a separate appointment to discuss treatment with the oncologist. Even if the clinicians had some tumor/cancer-specific clinic on a particular day of the week, which all of their patients with new diagnoses-to-be-delivered showed up at (again, assuming all the patients actually showed up and/or were on time) for us to speak with, what would we do during the rest of each patient's appointment while they were getting a physical exam, discussing treatment, treatment complications, how the prognosis was affected by their own personal functional status, age, comorbidities, etc. with the clinician? It sounds like we'd be sitting around some outpatient office all day picking our noses in between the few minutes of each visit we could be useful (or carrying around a pager that would be going off constantly and running back and forth from the path department to some clinician's office like a little beeyotch).

 

[Pathguy11]

Hi Euchromatin,

You know all the things you mentioned that many Pathologists are already doing in their practices would be consider efforts towards "transformation". I get that question a lot actually where a Pathologist will list the type of activities you mentioned and say "what else do they expect me to do". And many times the response would be nothing at the moment. Continue to do what you are doing and be mindful of opportunities that may arise in the future. Part of the focus is bringing everyone up to the same level and away from the stereotype. This could mean different things to different practices and it doesn't have to be some huge effort. Something as small as making a point to eat lunch in the general doctor's lounge to get to know you clinicians and ask for feedback on your reports. Are you telling them the information they want to know in a way they understand it. Is there additional info they would fine clinically useful? I know of another Pathologist who saw a need to a coagulation service and committee at her hospital. She started on in which Pathologists and hematologist worked together to cover the floor consults and see the patients. I know this is not for everyone but for this Pathologist it did incorporate taking on more clinical responsibility. Perhaps if it is allowed in your state you could make a point especially before the weekend to call a single patient with a benign diagnosis to tell them. I know there are some potential rules against this release of this sort of information but if it is allowed, it would be a way to educate one patient at a time that there are doctors called a Pathologist who are making a diagnosis on their tissue. Look at it from the patient's perspective or think about a loved one who has a breast nodule found on mammorgram. They have a biopsy and perhaps wait two weeks until a followup appointment until they get their results and likely worrying the majority of the time. Think that with just one phone call you could have a direct impact on that patient and educate them about your role in medicine. Again, I am just sort of free thinking ideas here but it is really more up to each person to figure out what they can start doing or continue to do in his or her own practice.

Pathguy11

 

[KCShaw]

Frankly, most of this sounds like puerile ballyhooing to perceived politics by throwing around some keywords and telling pathologists not to be like pathologists. What's wrong with the "stereotype," really? Everybody needs a knowledgeable dork every now and then. Don't get me wrong, I agree that the best way for pathologists to get involved is to..y'know..GET INVOLVED. And getting involved generally equals obtaining influence. I just don't happen to think that has anything to do with the specialty as a matter of 'best practice of pathology' -- more like 'how to get rich and influence people.' Both useful and important, but they're different things, and need to be addressed separately.

If the specialty as a whole wants to alter its influence (rather than simply locals exerting influence in their local hospital system), then I think the much discussed and little agreed upon market concern is one of the pink polka-dotted elephants masturbating in the corner. In the good ol' days people who thought they were being underappreciated/underpaid exerted some influence, and if they had nothing else they went on strike and found out whether they really were replaceable or not. This has been done, successfully and fairly recently, in the health care sector with nurses. But one needs a lot more solidarity than pathologists have in order to even remotely consider such a thing -- there's too many of us willing to screw the next guy or simply ignore the national organizations. One really can't expect the specialty to have or exert much influence when clinicians have their choice of half a dozen or so labs cutting one another's throats for specimens -- and that happens because of the market. It has little to nothing to do with pathologists not rounding on patients. Trying to compete with clinical or radiologic specialties for clinical duties isn't going to get them behind our cause, either. Keep in mind that PA's/NP's, if not techs, may soon be doing essentially all of the relatively low-skill/low-risk minor procedures anyway.. they tend to fill in where the market allows, and once they're in they're too inexpensive to get rid of (much like PhD's in the labs - alas, that ship has pretty much sailed).

Basically, what I keep hearing is "go and make everything better, it'll be great!" But the only real plan or guide(s) towards that end have been equally vague, or at best tangential to what the goal seems to be -- get rich and influence people -- which is somewhat vague in itself.

Personally? Sure, I think more AP/CP pathologists should get more involved -- in med school teaching, local hospitals, even community, as it helps them keep current in medicine and have some influence on the current and next generations. Absolutely. But I don't see that as altering the specialty. And I certainly don't have some desire to turn, or trade, a good dork of a pathologist for an eh pathologist but a good politician.

 

[Euchromatin]

Great post KCShaw, hysterical!!!

NERDY AND PROUD!

 

[deleted314957]

I have really tried to avoid this negative attitude but the changes that are coming at us are coming so fast and furious that I think the fundamental practice of pathology will be profoundly changed in the coming years. Things are pretty stark. I am glad i am 60 and not 30. i do want to keep working in my current situation but if and/or when things get too burdensome on i will hang it up. i am only working now because it is my "hobby".

 

[pathstudent]

I have really tried to avoid this negative attitude but the changes that are coming at us are coming so fast and furious that I think the fundamental practice of pathology will be profoundly changed in the coming years. Things are pretty stark. I am glad i am 60 and not 30. i do want to keep working in my current situation but if and/or when things get too burdensome on i will hang it up. i am only working now because it is my "hobby".

What are some specific things you predict and how will it change the practice?

I hear a lot of people say molecular is going to take over and put an end to the beloved H&E, but I think if you look at hemepath, where ancillary studies including molecular are the most advanced and most intergrated into practice, pathologists are still heavily involved.