August 2011

Stephen N. Bauer, MD

A focus on small group practices

The window in my study offers a clear view of the nesting box that I built for a pair of Western Screech Owls that took up residence in our yard a couple of years ago. I’ve mentioned them before. After dark, the pair flies off to hunt, always together. One evening last spring, I looked up from something I was reading and watched them take off again. It was the last time I saw them. When we were not looking, the owls moved on. There was no evidence of fowl play, so to speak, so most likely they had just found a new niche.

Our work supporting transformation is also moving on and into new spaces as well. The College is addressing transformational change on three levels: the individual pathologist, the group practice setting, and the greater environment. Our work at the first and third levels is well established and positioned to grow. In the near future, we plan to focus more attention on that segment of the middle ground where most of our members reside: the small group practice.

We need a clearer understanding of the needs and transformational status of small pathology groups in order to support them. For example, do small groups believe they will have meaningful input when local physicians develop an accountable care organization? What would need to change to give them a place at the table when these ACO conversations are taking place? Do their staff physicians see them as part of their team or are they inclined to think of pathology as an ancillary service? If it’s the latter, have the pathologists tried to do something about that?

To encourage more conversation around questions like this, the College is launching a series of 100 practice roundtable meetings to take place between now and the end of 2012. Local pathologists in partnership with CAP leaders will convene these groups. To ensure an easy give-and-take, no more than 10 pathologists will be asked to take part. No PowerPoints will be allowed—in fact no presentations of any kind. This will be your turn to educate us.

The practice roundtables grew out of a feeling that nothing about transformation is one-size-fits-all. What is it that keeps you up at night? We intend to focus considerable energy on transformation at the group practice level and, although no two groups are alike, we hope to find common needs and concerns to guide us.

I expect conversations at practice roundtables will demonstrate that transformation is an ongoing process that is fundamentally local. When we talk about transformation, we envision not a leap into the future but a stepwise approach to meaningful change, rapid but incremental, that takes in how we relate to one another, what local needs and barriers exist, and how we can facilitate a collective effort to show what we can do and how much we have to offer.

The roundtables should also foster a stronger grassroots network across the College. After the initial meetings with CAP leaders, roundtable members will be asked to continue to meet in person, communicate through electronic conferences, and stay in touch in less formal ways. We hope local groups of pathologists will find ways to support one another and to continue to share ideas with the College that we can propagate.

From Surveys to laboratory accreditation to outstanding CME, the College has a solid track record developing novel approaches to secure and promote excellence. Our core competency in synthesizing medical data confers insights into how new tools are best employed, but not everyone realizes that. Transformation is as much about what we intend to do as it is about enabling others to see that we are the ones who can do it best. In the new spaces we are beginning to occupy, pathologists should be leaders in improving evidence-based medicine. If all of this is to happen, we need to better understand how group practices are experiencing transformation, what they need and when. As in politics, the real action is always local.

Which brings me back to the owl box in our front yard. It was empty for a short time, but before long honeybees looking for a home discovered it. We thought about hiring a beekeeper to relocate them but decided they would be good for the local flora. Once you get past the buzzing, they are a case study in productive collaboration. In no time at all, they had built an extraordinary honeycomb and our owl box was transformed into a honey factory.

It is interesting that the College’s locally focused team-building project coincided with a shift in our local wildlife from owls (loners) to bees (team players). The timing is purely coincidental, of course. But then again they say there are no accidents in nature.

Oh, the owls are still around; I hear them at night calling to one another. I do miss seeing them, but our environment is always changing. They have moved into new spaces, and so will we.