Training programs in general haven’t given pathology residents the administrative know-how to run a laboratory. Now, three pathologists have written a book, from the perspective of pathology and sans the business school jargon, to narrow the knowledge gap.
Elizabeth A. Wagar, MD, Richard E. Horowitz, MD, and Gene P. Siegal, MD, PhD, are co-editors of a new CAP book released this month: Laboratory Administration for Pathologists. They foresee a leadership crisis in health care, and they aren’t alone: More than 40 percent of hospital and other health care executives think the industry’s supply of future leaders is inadequate, according to the American Management Association. Some health systems are developing succession programs to groom young physicians, including pathologists, for leadership roles. But that will not be enough. Dr. Wagar, professor and chair of the Department of Laboratory Medicine at MD Anderson Cancer Center in Houston, says every pathologist will need leadership and management skills to meet the challenges that lie ahead and to work within the large systems likely to dominate health care.
“We are not going to be working in small enclaves,” Dr. Wagar says. “We are going to be working in ACOs as partners with other clinicians, and the best way to do that is to develop leaders who really understand all aspects of health care.”
Laboratory Administration for Pathologists is a primer on management for residents and a how-to guide on the fundamentals for those already in practice. It’s designed to be of use at every career level, but especially for those just starting out.
The book’s genesis was a series of management lectures that Dr. Wagar and Dr. Horowitz, who is a clinical professor in the Department of Pathology at the University of Southern California’s Keck School of Medicine, began offering to pathology residents 10 years ago. Together, the two presented or coordinated nearly 40 lectures on management topics, from personnel to ethics, for residents from six training programs in and around Los Angeles. (Before MD Anderson, Dr. Wagar was director of the UCLA clinical laboratories.)
One of the book’s themes that evolved from the lectures was that it’s not enough for pathologists to take on the role of medical director—they need to be true directors of the laboratory. Yet most don’t learn in residency training what they need to know about leading a lab. “There has been a serious gap in leadership training for medical residents over the last 20 years,” Dr. Wagar says.
Part of the reason, says Dr. Siegal, is that “there’s not a textbook or monograph on the subject.” Another rea-son: the instructors themselves. “Most teachers were never well trained in this, and they learned it through trial and error,” says Dr. Siegal, who directs the Division of Anatomic Pathology at the University of Alabama Birmingham Health System and is executive vice chair of pathology. “We spend so much time trying to teach people the subtleties of making a diagnosis, be it in the blood bank or in surgical pathology, that this is seen as ‘business stuff.’ But rightly or wrongly, the practice of pathology is also a business.”
The co-editors, along with seven contributing authors, spent two years developing the content. “To get a flavor of the spectrum of pathology, we invited contributors who were academics, in private practice, and running reference laboratories,” Dr. Wagar says. (See the list of contributors at end of story)
Unlike existing laboratory management books, the 260-page Laboratory Administration for Pathologists is designed for physicians. “While other books out there are very good for laboratory managers, they are unreadable to pathologists,” Dr. Wagar says. She and her co-editors organized their book so it would be physician-friendly. “It has a lot of useful tools without requiring in-depth understanding of accounting practices or other business issues,” she says. “It’s not designed to make MBAs out of pathologists.”
The book’s 14 chapters cover laboratory operations, information systems, personnel and quality management, legal affairs, laws and regulations, financial management of the lab and the pathology practice, and more. To make sure they were covering the most important topics, the authors reviewed the leadership competencies and recommendations of the American Board of Pathology, professional associations, and pathology residency program directors. Some of the book’s content has never been covered in print, Dr. Wagar believes, such as how pathologists should organize a pathology practice.
In the book are dozens of illustrations and tables to help clarify key points. Each chapter ends with a list of questions (and answers) with which readers can test their knowledge. “It’s a great addition for young pathologists who may be taking their boards,” says Dr. Wagar, who plans to give the book as a graduation gift to her fellows.
Such a resource would have been helpful to Dr. Horowitz when he was first starting out. “My residency taught me nothing whatsoever about management,” he says. Like most pathologists, Dr. Horowitz learned management in the trenches. Two years after he finished his training and became a full-time faculty member at L.A. County Hospital, he landed his first leadership position. “I was plunged into the role of acting director of the laboratory, knowing nothing about management,” he says. “But I was fortunate to have several administrators take me under their wing.”
Not wanting today’s residents to face the same dearth of management training, Dr. Horowitz began including mini-management lectures as part of his weekly organ recitals with residents after he left academics. “I would start the organ recital with a problem I had in community practice, such as personnel management,” he says. “I wanted to let them know that anatomic pathology consists of more than just organs.”
Dr. Horowitz, who is also an attending pathologist at the West Los Angeles Veterans Affairs Medical Center, believes effective communication is one of the missing elements in residency training. “Pathology is basically an information specialty. As the saying goes, the best diagnosis is of no value if it is not properly communicated. How the pathologist interacts with his or her various publics—customers, employees, colleagues—is the most critical aspect of management that has to be learned.”
The Centers for Disease Control and Prevention in 2007 released a report on laboratory medicine that identified the lack of leadership and communication skills as one of the quality gaps that afflicts the specialty. While Dr. Horowitz believes that some pathologists were once attracted to the specialty because they thought they could avoid communicating and managing, doing so is becoming more difficult as the nature of pathology changes. That is particularly true in community hospitals where 80 percent of pathologists now practice, he says.
Laboratory Administration for Pathologists can help by giving physicians the confidence to speak with their colleagues in other areas, such as purchasing, he says. “It provides pathologists with the nomenclature used by people who buy the equipment and write contracts, so they can interact with those doing the actual work.”
When writing and editing the book, Dr. Horowitz says he and his co-authors took great care to ensure the proper tone. Unlike many laboratory administration books that tend to be technical because medical technologists wrote them, this book is written by and for pathologists. His favorite areas of the book are the appendices at the end of most chapters. For example, trailing the chapter on personnel management are sample interview questions, guidelines for employee handbook contents, and a performance evaluation template. In other appendices: how to present a lecture, how to lead a committee meeting, and how to make a decision.
Dr. Siegal, too, has a favorite section: The chapter by James H. Harrison Jr., MD, on managing pathology information systems. “It’s the most lucid 30 pages on this topic I’ve ever read,” he says. The chapter succinctly covers data standards, system and data security, record retention, application and interface management, image compression, computer basics, and more than a dozen other topics.
Dr. Siegal says Laboratory Administration for Pathologists can help ease the anxiety of the next generation of pathologists who need to master a broad range of topics for their board examinations. Pathologists who are starting their practices will benefit from the medicolegal issues covered in the text, such as handling their first subpoena and becoming an expert witness.
“There are a million books on management, but they are not laboratory based or written by physicians for physicians,” Dr. Siegal says. “This fills a tremendous niche in pathology.”
Laura Hegwer is a writer in Lake Bluff, Ill. Laboratory Administration for Pathologists is $85 for CAP members and $100 for nonmembers. To order, call the CAP at 800-323-4040 and choose option 1 to request Pub No. 312, or download an order form on the CAP website.
The contributing authors are C. Bruce Alexander, MD, professor of pathology and vice chair of the Department of Pathology, University of Alabama at Birmingham School of Medicine; Isam-eldin A. Eltoum, MD, MBA, professor of pathology and head of cytopathology, University of Alabama at Birmingham; James H. Harrison Jr., MD, PhD, associate professor and director of biomedical informatics, University of Virginia, Charlottesville; Michael O. Idowu, MD, MPH, associate professor and director of breast pathology and anatomic pathology quality management, Virginia Commonwealth University Medical Center, Richmond; Raouf E. Nakhleh, MD, professor of pathology, Mayo Clinic Florida, Jacksonville; David S. Wilkinson, MD, PhD, professor and chair, Department of Pathology, Virginia Commonwealth University; and Ronald L. Weiss, MD, professor of pathology/ARUP Laboratories, University of Utah, Salt Lake City.