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October 2005
What is AmeriPath?
The article “Rich Niche: AP Out reach Blossoming” (August
2005, page 1) completely mischaracterizes the role of AmeriPath in the
pathology community. To casually lump AmeriPath in with the two large
commercial laboratories con veys a complete lack of understanding of who
AmeriPath is as an organization and is misleading to the readers of CAP
TODAY.
For your and your readers’ benefit, AmeriPath is above all else
an organization of anatomic pathologists. AmeriPath was created in the
late 1990s as a vehicle to allow pathology practices to respond to the
powerful market forces that were beginning to affect our specialty at
the national, regional, and local levels. Through our history, AmeriPath
has been effective in making resources available to our local pathologists
in the areas of managed care, sales and marketing, medical malpractice
insurance, and pathologist advocacy. The fact was and still is that it
is difficult for many smaller community groups and even larger regional
groups to deal with issues in these areas alone. We have built numerous
successful anatomic pathology outreach programs for our member practices
that they would not have been able to create on their own. Most important,
we did this by maintaining the local delivery of pathology services by
local pathologists. In the area of pathologist advocacy, we have been
a valuable advocate against the proliferation of clinician joint ventures
and commercial payers refusing to reimburse the professional clinical
component within the hospital setting. All pathology groups benefit from
our efforts and achievements in the area of pathologist advocacy. Overall,
AmeriPath has been successful over the last 10 years because our pathologists
and their teams have powerful and lasting personal and professional relationships
with their local referring physicians and their staffs.
AmeriPath has the reputation for being a well-run, client-service-oriented,
integrated pathology ser vices organization among those whom we serve
or who have taken the time in an objective manner to at least find out
who we are. If it is still not clear who AmeriPath is, think of your fellow
members with in the CAP. We have 356 pathologists in our organization
who are CAP members. They give gener ous ly of their time to participate
in CAP inspections, serve on CAP committees, and take leadership positions
within their state pathology societies. AmeriPath pathologists recognize
full well the value that organization and cooperation within our specialty
have in protec ting the future of anatomic pathology.
Jeffrey A. Mossler, MD
Vice Chairman
AmeriPath
Palm Beach Gardens, Fla.
Pathologists then and now
The letter, “The oversupply,” by Mark Seifert, MD (August
2005), along with those of Ming Cao, MD, and William Warren, MD (June
2005), should be a wakeup call to pathologists. We have, over the years,
become our own worst enemies. As an honors major in philosophy at Penn,
a graduate of its medical school, a practicing internist for 10 years,
an assistant medical examiner (forensic) for Philadelphia, then an academic
and community hospital pathologist for over 30 years (and a lecturer in
a Department of Religion on death and dying, emphasizing the role of the
pathologist in society), my observations may be of constructive use in
discussions on the future of our beloved specialty.
In my view, we have become somewhat lazy, increasingly self-occupied
and oftimes selfish, and more and more vulnerable to every extrinsic pressure
that administrators, business executives, and ancillary medical professionals
put on us. We are increasingly behaving like narrow scientists rather
than well-rounded physicians who also happen to be pathologists, a specialty
we love.
For starters, consider the autopsy. There was a time when a pathologist,
assisted by a wonderful and colorful character called a diener, performed
the procedure from beginning (speaking with the clinician) to end, doing
the microscopy in timely fashion, and completing the case and winding
up with a great CPC the next month (while the staff still remembered the
patient). Now what do we have? Pathology assistants. Untrained residents
struggling, often without supervision. “Organ check-outs”
never attended by senior staffers. And horror stories of autopsies not
signed out for many, many months, up to a year, and completed by others.
(I kid you not—having done at least 150 left by others. And were
those staffers fired? No!)
Consider the grossing station—the “surgical bench.”
There was a time when the pathologist took pleasure in processing tissues
and organs that required a pathologist’s expertise and demonstrating,
step by step, to the novice resident the correct way to cut specimens
the first time to effect zero error. Now the resident or pathology assistant
has only a soiled and torn manual to flip through and the senior attending’s
admonition, “Call me if you need me.”
Consider, too, the education of medical students. There was a time when
every teaching module had an attending or visiting pathologist who had
abundant museum and autopsy “bucket-case” and bagged gross
specimens to use with a hands-on method as instructional objects. Now
there is increasing use of impersonal audiovisual cassettes or videos
or Powerpoint projections and no pathologist with whom to interact. Medical
students (and clinicians) love well-prepared and well-presented macropathology,
and they are being denied this mode of instruction. All they get is the
esoterica of someone’s research along with 100 projected slides.
And what happened to time? What gives nonmedical people the right to
ask how many minutes it takes to gross a gallbladder? Endometrial curettings?
A fibroid uterus? Various endoscopic specimens? What have we become—production
workers on an auto assembly line?
Yes, there is an oversupply, and there will continue to be an oversupply
of hungrier and hungrier young pathologists, and our specialty will suffer
for this. We might just as well open the gates and let the nonpathologists
come in.
Theodore B. Krouse, MD
Ocean City, NJ |
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