“The pathologist is there to take care of the patient, it is not their responsibility to run the lab or concern themselves with how much they get paid for a test.”
In case you missed it or have been out of the office enjoying family, friends and football — OK – maybe friends and football – there is an interesting post and perhaps more interesting comment board running on a recent email pathologyblawg.com received about some discussions a reader had with folks affiliated with the College of American Pathologists, or as one commenter put it, the “Coalition Against Pathologists”.
For the record, again, I am a proud card carrying member of what I still consider my “College” outside of course of Michigan State and Northwestern Universities. I have been through and conducted many CAP inspections, participate in PT and PIP testing and have personally and professionally benefited tremendously from my affiliations with the College and many of its members. My role on CAP committees have provided what may be lifelong relationship with peers and colleagues.
While the sources, post and perhaps many of the comments are anonymous, I think the discussion taking place here is providing a forum for many to share their views on the lack of involvement it seems, and perhaps some self-induced errors by many of us as a specialty, community and College to not demonstrate to the public and CMS, our importance and value in the healthcare environment.
I went to medical school thinking I would be a surgeon. Many do. Cold steel will heal. Not letting skin get in the way of making a diagnosis. Being a healer. Instant treatment and/or cure and you made it happen. Saving lives.
Then the chairman of pathology told our class the first day of pathology (the first 5 minutes of 180 didactic lectures on tissue injury, repair, infections and neoplasms) that “The hospital was the temple and the pathologist was the priest.” The surgeons respected the pathologists and told them so (rarely). Internists, pediatricians, medicine sub-specialists visited pathology and pathologists were directly involved in dozens of conferences, meetings, teaching sessions and even clinical rounds with clinical colleagues. If it was true then, I do not think it is any longer true that we are valued as much as perhaps pathology and laboratory medicine once was.
Aside from clinical day-to-day issues of training and working with pathologists, our roles as part of a clinical care team seems diminished, our voice on a national level seems muted and our lobbying organizations somewhat tone deaf.
How did we get here? Many ways. Fractured healthcare delivery systems, competing interests, self-referral (including by pathologists with perhaps abuse of certain tests), in-office laboratories, sub-specialization, poor management and leadership with little or no training in residency or fellowship and ineffective lobbying with a reactionary prose rather than a proactive stance. The list goes on and on.
Of course we as a specialty are not unique. Read the internal medicine, cardiology or hospitalist physician blogs and you will here similar concerns about reimbursements, workload, diminishing salaries, career dissatisfaction, issues with payors, hospitals, healthcare systems and colleagues/partners. In addition to these issues, we in pathology also appear to have some internal issues and lack of coherence when it comes to business models that can insure the highest level of care for our clients – patients, providers, families, payors, hospitals, healthcare systems and laboratories.
On The Pathology Blawg site, there was a comment received from “DrSTP” who said the following in response to the post and comments:
“The CAP is the “Coalition Against Pathologists”. The phone over there should be ringing off the hook with complaints. It is time for the members to deactivate from the organization so they can feel it in their wallets. I already have and I have dumped their inane CAP accreditation too. The fat cats at the CAP are “on the take.” They are being paid off by somebody at the behemoth labs and are not lobbying for the interests of the average pathologists. Or It is as if the secretaries over there are running the CAP. Dr Gosnell, most pathologists do not abuse IHCs or specials. It is the in-house labs and fee splitters that are doing the vast majority of the abusing. Unless it is the lousy dopey residents that you trained that don’t know how to use their two eyeballs and their brain. You really have taken this crusade against “greed” too far. A lab is a business too. You cannot have the antibodies cost more than the payment for the service. Wise up. That is what we have here and that is going to compromise patient care. Wise up Dr Gosnell. There are honest pathologist practicing out here that are trying to make a living and now with these cuts are not going to get paid at all. So pathologists should be working for free or giving up our practices. The CAP should be defending our interests just like the Urology, GI, Derm and Neuro groups. They are a pathetic for-profit organization that is self righteous and corrupt. It is a culture of liberal cronyism over there. The ASCP with their keynote speaker Hillary Clinton is no better. ASCP =American Society of Cutting and Slashing Pathologists. That President at the CAP is Dr Eunuch. He needs to put that in his worthless column.”
Change is hard. Since I entered medical school, I was told “not to rock the boat” when it came to change — people were getting paid for what they did – perhaps it wasn’t as efficient, simple or at a higher margin than it could be but it was good or good enough. DRGs were coming into existence and few wanted to rock the boat. For the most part it worked good or good enough with some adjustments but no significant changes that were seismic shifts.
What I think has happened now is that the boat which contains pathologists, laboratories, payors, hospitals, healthcare systems, families, administrators, regulators, clinicians, vendors, manufacturers and technologists/technicians has a hole in it and we don’t have enough oars or buckets.
How do we right this ship?
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