Surgical Pathology Outreach

1
Surgical Pathology Outreach

• Gregory A Threatte, MD
• Professor and Chair
• Upstate Medical University

2
Upstate History

• Entered Outreach looking for Clinical Pathology
  Referrals
• Usually out-bid by National Laboratories
• Shortage of Pathologists in Region led to
  unfulfilled needs at smaller hospitals
• Wound up trying several configurations

3
Prospects for the Future

• Shortage of Pathologists will get worse
• Will really impact hospitals with less than 5000
  surgicals annually
• Informatics capabilities can allow Academic
  Medical Centers to be virtual pathology
  departments

4
Our Experience 1

• Took on one hospital as solo Pathologist
  approached retirement.
• He had tried to recruit for years without success
• We recruiter for him, both Pathologists joined
  our staff and we eventually replaced the retiring
  Pathologist

5
Result 2

• Academics complained that Outreach Pathologists
  made more money than they did
• Outreach Pathologists complained that they were
  getting Academic Pay for Private Practice Work
• At contract renewal, we cut them loose

6
Our Experience 2

• Solo Pathologist dropped dead at 200 PM on a
  Friday afternoon
• We assigned a rotating group of surgical
  pathologists to staff hospital until a
  replacement could be recruited
• When replacement recruited, rotating group
  continued to provide Vacation/Sick coverage

7
Result 2

• Culture Clash again
• Amazing litany of excuses why rotating group
  could not participate
• Everything from illness to disability
• Hospital got picky about on-site Pathologist
• At contract renewal, we didnt bid

8
Experience 3

• Three small hospitals approached us about
  Pathology services
• Having learned, we would only agree to courier
  pickup with all processing done at University
  Hospital
• In separate contract, agreed to provide
  laboratory directorship

9
Result 3

• It worked
• To Surg Path faculty, specimens are just like
  those received from OR
• Great for residency training because greater
  variety of routine specimens
• Dropped network lines into hospital and as cases
  electronically signed, they print in lab at
  hospital

10
Lessons learned

• Surgeons can live without frozen specimens
• You cant rely on residents loading tissue
  processor
• The later the courier picks up, the better
• Shorter turn-around times are better
• Sending an occasional specimen by taxi with
  expedited processing keeps frozens low

11
Value - Added

• If there is any question about history or
  diagnosis, call them, they love it!
• Having the logic of special studies explained to
  them beats a two word diagnosis
• Expedited processing on the Friday before
  holidays also indicates respect

12
Finally

• These considerations may also apply if you have a
  hospital CEO who wants to gobble up small
  hospitals
• You might want to approach him/her about strategy
  before the takeover rather than after