Comments on the Future of Pathology

This is an article that I wrote for the ASCP, featured in Pathology Today. I am republishing it on this blog space in hope of getting your input with the permission of the American Society of Clinical Pathology. It can also be found at http://www.ascp.org/AboutUs/Newsroom/pathologytodaynews.aspx



In 2005,ASCP formed the Task Force on the Future of Pathology and Laboratory Medicine to assess the future of our profession, undoubtedly the subject in which we residents should have the greatest interest. After all, it is in the future where we will spend our professional careers as practicing pathologists.We’re all banking that the future and pathology will provide us with stable, rewarding careers. I am certain that there is a cornucopia of reasons why we chose to pursue careers in pathology. I do not pretend to know all – or even most – of them, but I’ll bet they share one common thread: our perception of the field is based on our relationships with practicing pathologists. By working, interacting, and talking with those in the profession, we have developed our own ideas and concepts about the scope of the profession. For this reason, I found that reading the Task Force report was a sobering experience. Why? The contention of the Task Force is that the current scope of pathology may have to change to maintain, not to mention enhance, its role in the healthcare system. Initially, this was difficult for me to accept because I have spent the last three years working hard to develop my skills in pathology based on my current expectations of the field. If the scope of our field and our practice were to change, does that mean the expectations, and ultimately our skill sets, also have to change? The answer is "Yes," we will face changes, but, fortunately not everything about this profession will change. Reading further, I realized the changes recommended by the Task Force were not radical to the fundamentals of our field and could be applied without making impractical leaps. Importantly, though, many of the recommended changes would ultimately require not only our willingness to adapt, but to play active roles in making the changes. In other words, as the future changes, it will be we – today’s resident pathologists – who will play a major role in creating that future. As with many specialties in healthcare, the Report states, the role of the pathologist is changing – and doing so faster than most because of globalization, the rapid development of molecular technology, and our relative isolation from direct patient contact.

Globalization
The Task Force suggests that globalization has increased economic competition in our profession
just as it has in every other segment of our world. Consolidation, regionalization and national laboratories are more of a reality than ever before. Furthermore, continuing advances in digital technology will likely make routine remote analysis of anatomic specimens a reality in the very near future.

Molecular Technology
The Report points out that there is an everexpanding role for the use of genetic analysis and
proteomics for prognostic and diagnostic purposes today than ever before – and this technology is still in its infancy.New molecular techniques have improved accuracy and cost of performance. Additionally, many clinical specialties have embraced this technology and are demanding access to it.While histologic morphology still comprises the backbone of our diagnostics, molecular
biology will likely play a bigger role in the future.

Isolation From Direct Patient Care
While there are always brilliant exceptions to the general perception that we are laboratorians rather than clinicians, the Task Force points out that that perception may be based on the unfortunate reality that many of the services we perform are perceived as commodities at a time when collegial interaction is at an all-time low.

Creating Our Own Future
It is our duty, as the next generation of pathologists, to understand these trends in healthcare and our world at large. Most importantly, however, it is imperative that we use this understanding to shape our profession by embracing these trends and actively being part of making the right changes to the profession for the right reasons. The risk of doing otherwise is unthinkable: if we wait and are forced to react rather than respond to the demands of our clinical colleagues, then we only increase the probability of losing their respect and being further marginalized. Along with defining the trends, some of which I have not mentioned here (i.e., patient safety and quality, medical informatics, and demographics), the ASCP Task Force has suggested changes that can be made to address these trends. A new Task Force with the same name has been convened to formulate a more definitive outline for possible changes to our profession’s scope. And that, too, is great news for residents because ASCP wants resident input to this process. Your Society recognizes very well that we are the future of this profession. I will be a participating member of this Task Force and I want – and need –to hear your comments, questions, and concerns regarding this topic.