College of American Pathologists
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  President’s Desk Column


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Organized medicine and pathology: Mosaic or oxymoron?

August 2001
Paul Bachner, MD

I am writing this column en route to the July 25-28 annual meeting of the Association of Pathology Chairs, which I attend in my role as CAP president. Later this week I will be in Chicago moderating the CAP’s Pathology Practice Management Seminar 2001, cosponsored by the American Pathology Foundation, Clinical Laboratory Management Association, and Medical Group Management Association. During the past six months, I attended the annual meeting of the U.S. and Canadian Academy of Pathology, a meeting of the board of directors of the American Society of Clinical Pathologists, the annual American Medical Association meeting, and the annual AMA leadership conference. This travel odyssey reflects the College’s commitment to collaborative relationships that will improve the quality of laboratory medicine and support common goals of organized medicine and pathology.

When I speak to residents and other groups about the organization of pathology and medicine-which I will in an Aug. 14 Virtual Management College teleconference-I try to identify the reasons pathologists choose to belong to the College and other pathology and medical organizations. Membership surveys tell us CAP members look to the College first and foremost for advocacy, because they recognize that the College is the largest and most effective organization that represents exclusively the interests of pathologists and patients. Of course, the CAP also provides members with educational opportunities, particularly in practice management, and is recognized as the primary source of laboratory improvement programs worldwide.

This multiplicity of pathology and laboratory medicine organizations-an alphabetic challenge to all-reflects the vitality and enormous variety of pathologists’ clinical and scientific interests, practice environments, and areas of specialization. Most pathologists are "splitters" and not "lumpers," and though the complexity and apparent redundancy of our organizations may seem excessive, the mosaic ensures that the professional and advocacy needs of specialty areas are met and that they can be identified, articulated, and brought to the attention of larger organizations with greater resources, such as the College.

Of course, the downside of the large number of organizations representing pathologists is the potential for redundancy and conflict. During the recent negotiations over the complex patients’ bill of rights issue, the College and another society advocated alternative legislative positions in Washington. Fortunately, discussions at the Board and leadership levels resolved this in a manner that allowed for pathology to ultimately advance a united position to congressional leaders and staff. Differences in goals, societal cultures, and categories of members will continue to produce differences in opinions and approaches, particularly since pathologists’ advocacy issues may diverge at times from those of other members of the laboratory medicine community. Nonetheless, the CAP will continue to seek opportunities to cooperate and collaborate with other pathology and laboratory medicine organizations when common goals can be identified and worked toward.

How do pathologists relate to organized medicine? The AMA is a large, powerful, often effective, sometimes fractious, and frequently troubled organization. Its current tribulations are considerable. In the midst of the AMA annual meeting in June, the then executive vice president filed suit against the AMA and the chairman of the board, alleging interference by the board in the discharge of his duties and defamation of his character. This high-profile litigation is the foreground to a complex mixture of underlying problems, the most important of which is the declining membership of the AMA. The decrease in the number of direct AMA members reflects several trends that include the increasing difficulty for a single organization to represent all physicians, the growing importance of specialty societies meeting the needs of their members, and the larger number of employed physicians. The AMA argues, often effectively, that it speaks for the vast majority of physicians, not just those who are AMA members, because of the significant number of state and specialty societies represented in the AMA House of Delegates. The 19 delegates and alternates who compose the Pathology Section Council include representatives of the College, ASCP, USCAP, American Society of Cytopathology, and National Association of Medical Examiners. Extensive discussions in the section council (staffed by the CAP Division of Government and Professional Affairs) between delegates and the leadership of the pathology organizations represented in the House make it possible for the voice of pathology to be articulated and the goals of our organizations and needs of our members to be pursued effectively.

Pathologists and their organizations must be involved with state medical societies and the AMA-the importance of this cannot be overstated. We are less than two percent of American physicians, and we must leverage our influence through physician organizations. To achieve this goal, we must support the issues of all physicians. A case-in-point is the response to proposed state legislation that would allow nonphysicians to engage in activities that historically have been physician-performed and defined by state practice of medicine statutes as requiring physician performance. Examples are efforts by nurse practitioners to acquire independent practice status, by CRNAs to perform anesthesia without direct supervision by anesthesiologists, by optometrists to obtain statutory permission to perform surgery, by psychologists to pursue prescribing authority, and, in our own bailiwick, by pharmacists to order and perform laboratory tests. If we avoid these conflicts, believing perhaps that these are not pathology issues, we risk supporting the "dumbing down" of patient care and the erosion of physician autonomy, and being viewed by our clinical colleagues as unresponsive and uninterested in their concerns.

For all of these reasons, the CAP cultivates liaison and cooperative relationships with many organizations, and we encourage you to support and be involved with other medical organizations in addition to the CAP.