December 2010

I read with great interest Joe Plandowski’s response (October 2010, page 11) to Jane Pine Wood’s presentation on technical component/professional component arrangements (August 2010, page 74). The section in his letter that begins: “What is fair value?” was of particular interest. Here Plandowski says some pathologists are willing to sign out cases for $10 because for them that is fair value. I would suggest that this phenomenon is due to undesirable external market forces that demand that the pathologist essentially “take it or leave it,” and with so many pathologists in the marketplace, there certainly are plenty who are glad to take it. As a part of its transformation agenda, the CAP has commissioned a workforce study. When pathologists engage in a race to the bottom and are relegated to competing for scraps from outpatient procedural physicians, I respectfully submit that this is prima facie evidence that there are already quite a few too many pathologists in the workforce.

Vincent Graffeo, MD, JD
University Pathology Services
Huntington, WVa.

Jennifer Hunt, MD, describes an important role that many pathologists will find rewarding and most patients will truly appreciate (November 2010, page 44). Starting in 1979 I performed thin needle biopsies of lesions, palpable and deep. I discovered that most patients welcome an immediate consultation about my preliminary diagnosis, any additional testing, and the obvious implications of the diagnosis. Beyond providing this service to patients, I came to understand the emotional, social, and economic impact of my diagnoses on real people, the need to be aware of this in making my diagnoses (especially in borderline circumstances), and my role in helping patients through often difficult circumstances (but more often sharing their joy and relief). We pay a small price (our time), but the return to us and to our patients outweighs other considerations.

Jerry Waisman, MD (retired)
New York, NY