ing and other Internet sites to talk to medical experts and
other patients; 66 percent of patients surveyed say they want
more direct consultation with pathologists.
“There is a rapidly growing population of patients getting
more actively involved in their health care decisions every
day,” Cangelosi says. “Information is empowering, and with
the wealth of knowledge available on the Internet these days,
it’s hard for the non-specialist to keep up with all the latest
information on disease. That’s where we, as pathologists, can
step in and offer assistance.”
A recent conversation Cangelosi had with a head and neck
surgeon at his hospital convinced him that a real opportunity
exists to directly interact with patients and make a difference.
The surgeon was having a difficult time explaining to his
patients the difference between two types of throat cancer.
“He openly desired a way for his patients to consult with
a pathologist in order to better understand the differences
between the two types of cancers and how differentiating
between the two might dramatically affect treatment options
and outcomes,” Cangelosi says. “We need to continue to have
these conversations with our physician colleagues. Undoubtedly, there are many others with similar problems that could
really use our help, such as advising other physicians on
treatment options and joining clinical colleagues on rounds.
It’s key that our patients know that their pathologist made the
diagnosis — not their surgeon, not their internist, not their
primary care physician — but their pathologists.”
Demand Up, Rates Down
Surveys and research conducted so far indicate a rapidly
increasing demand for pathologists, significant industry consolidation and declining reimbursement for services.
About CAP
Headquartered in Northfield, Ill., the College of American Pathologists is a medical society serving nearly
18,000 physician members and the laboratory community
throughout the world. It is the world’s largest association
composed exclusively of pathologists — board-certified
and in-training — and is widely considered the leader in
laboratory quality assurance. More than 6,000 laboratories
are accredited by the CAP, and approximately 23,000
laboratories are enrolled in the college’s proficiency testing
programs. The CAP has 600 staff and a $150 million operating budget. Visit www.cap.org for more information.
“It’s key that our patients know
that their pathologist made the
diagnosis — not their surgeon,
not their internist, not their primary care physician — but their
pathologists.”
Demand for pathology is forecast to dramatically increase
during the next five to seven years because of the increase
in new insured patients due to health care reform, as well as
an aging population, an increase in testing volume per case
driven by new testing technologies, and demand for those
tests by clinicians and patients. Meeting this demand will
require work changes such as standard work processes and
more automation and specialization.
There also is significant industry consolidation: The number of pathologists practicing in small groups ( 10 or fewer)
has dropped by about 30 percent in the past five years, while
the number practicing in larger groups ( 20 to 30) has quadrupled. Pathologists therefore need to pursue new practice
models, such as smaller practices banding together into more
competitive “virtual large practices” using a network practice
model.
The way pathologists are paid today is changing. Under
the current “fee-for-service” system, reimbursement rates
on average have declined more than 6 percent annually during the past six years, although incomes have stayed fairly
flat because pathologists are taking on more volume to cover
practice costs. Volume has been growing more than 3 percent
annually during the past few years — but trading volume for
price can occur for only so long.
Parallel Journey
Some ideas for pathology’s transformation are being modeled
after the American Society of Anesthesiologists’ experience
with fundamental change 15 years ago. ASA, on behalf of the
anesthesiology specialty, was successful in its transformation,
as it took the lead in redefining the roles and scope of the
anesthesiologist, according to John Olsen, M.D., anesthesi-
