March 2010

Stephen N. Bauer, MD

We have been talking about transformation of the specialty for more than two years now, studying the results of segmented member research panel surveys, and weighing feedback from the House of Delegates, councils, committees, the Board of Governors, and our staff. Our research supports the need for transformation: We have a good sense of who we are and who we want to be. One thing is clear: There will be many potential roles for transformed pathologists. Now we must identify those roles that are most promising and illuminate the path to reach them.

The necessary infrastructure is coming together. We now have a Transformation Program Office (the “TPO” for short) and a TPO steering committee that guides our efforts in a macro sense. The TPO is designed to provide a flexible interface that crosses the many divisions and activities of the College. The steering committee is intentionally inclusive, with seats for both CAP members and executive staff. The committee also includes one member from outside the College, and we hope to add more “outsiders” who can add divergent insights.

We held the first steering committee meeting in early February and prioritized a list of 40 trends and forces that represent challenges and opportunities for pathology. We ranked them on the basis of our best thinking about what other physicians want, what our patients need, and what health care reform might bring about. This prioritization, and the underpinning assumptions, must be validated with objective data where possible. The results of that research will enable us to construct a fact-based case for change.

In the meantime, we are moving rapidly to establish standards for evolving technologies and for critical areas of medical practice. The first of several ad hoc subcommittees of the TPO steering committee, chaired by M. Elizabeth Hammond, MD, administers the CAP Pathology and Laboratory Quality Center, which is charged with developing evidence-based guidelines to identify best practices in all disciplines of pathology. I encourage you to log on to the CAP Web site (www.cap.org/center) and volunteer to help with this effort. A form on the website identifies opportunities to contribute, including participation on a Center work group.

Another way to further the work of the Center is to propose an area for study. The most important consideration in evaluating a proposal is a strong and direct relationship to patient outcome, especially patient safety or treatment effectiveness. Projects should focus on those areas where there is clear evidence of the best testing strategy and in topic areas where controversy exists and practice by pathologists is variable. Center projects will focus on evidence, not opinion, and sufficient evidence in the literature is critical.

The steering committee has already endorsed three new projects for the Center, each of which will result in practice guidelines or a white paper. The first, to be undertaken in conjunction with the International Association for the Study of Lung Cancer, will address best practices for the use of molecular biomarker techniques in lung cancer. A second will seek to define universal parameters for validating digital pathology systems. And the third project team will harmonize nomenclature to describe HPV findings as they pertain to various anatomic sites.

While many pathologists are already at the cutting edge of transformation, pursuing new skills and roles on their own, the College must provide tools and resources for pathologists positioned all along the change curve. Our first efforts will be to identify those tools that are of most use to the greatest number in facilitating defined transformation goals.

Where there are perceived barriers to transformation, the steering committee will seek solutions. Sometimes that will mean advocacy; other times it may relate to education or innovation. Access to the electronic medical record is one such barrier that will require a little of both. The ability to access the medical record to incorporate clinically relevant comments in our reports is a critical objective even today. More important, it will further transformation by enabling us to integrate more fully as members of the patient care team and underscore that we are physicians who can contribute—a point that cannot be made too often.

Thomas Malone, the CAP vice president responsible for the TPO, encourages us to think in terms of a “transformation ecosystem” that takes in everyone who can affect or will be affected by our evolution. Many have a stake in our success, and if we’re smart, our strategies will factor in their evolution along with our own.

The “short list” of inhabitants of our ecosystem include not only CAP members and staff but also patients and patient groups, other pathology organizations, subspecialty pathology groups, the American Board of Pathology, the Association of Pathology Chairs, professional laboratory staff, PhDs who work with us, other physicians and medical societies, medical school faculty, residency program and fellowship directors, hospital administrators, policymakers, regulators, payers, and representatives of industry. Transformation requires us to step back to examine the environment and our potential places in it. Understanding the transformation ecosystem will help us find adaptive strategies that will lead us to survive and thrive in our rapidly evolving environment.

Successful transformation will be defined by the intensity with which we individually approach the task: The more each of us does, the farther we all go. And the outcome will be measured by the satisfaction that pathologists continue to take in their work, by the appeal of the specialty to tomorrow’s medical students, and by the extent to which we succeed in reframing, first, how we see ourselves and, second, how others see us.