Letters
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October 2005 What is AmeriPath? The article “Rich Niche: AP Out reach Blossoming” (August 2005, page 1) completely mischaracterizes the role of AmeriPath in the pathology community. To casually lump AmeriPath in with the two large commercial laboratories con veys a complete lack of understanding of who AmeriPath is as an organization and is misleading to the readers of CAP TODAY. For your and your readers’ benefit, AmeriPath is above all else an organization of anatomic pathologists. AmeriPath was created in the late 1990s as a vehicle to allow pathology practices to respond to the powerful market forces that were beginning to affect our specialty at the national, regional, and local levels. Through our history, AmeriPath has been effective in making resources available to our local pathologists in the areas of managed care, sales and marketing, medical malpractice insurance, and pathologist advocacy. The fact was and still is that it is difficult for many smaller community groups and even larger regional groups to deal with issues in these areas alone. We have built numerous successful anatomic pathology outreach programs for our member practices that they would not have been able to create on their own. Most important, we did this by maintaining the local delivery of pathology services by local pathologists. In the area of pathologist advocacy, we have been a valuable advocate against the proliferation of clinician joint ventures and commercial payers refusing to reimburse the professional clinical component within the hospital setting. All pathology groups benefit from our efforts and achievements in the area of pathologist advocacy. Overall, AmeriPath has been successful over the last 10 years because our pathologists and their teams have powerful and lasting personal and professional relationships with their local referring physicians and their staffs. AmeriPath has the reputation for being a well-run, client-service-oriented, integrated pathology ser vices organization among those whom we serve or who have taken the time in an objective manner to at least find out who we are. If it is still not clear who AmeriPath is, think of your fellow members with in the CAP. We have 356 pathologists in our organization who are CAP members. They give gener ous ly of their time to participate in CAP inspections, serve on CAP committees, and take leadership positions within their state pathology societies. AmeriPath pathologists recognize full well the value that organization and cooperation within our specialty have in protec ting the future of anatomic pathology. Jeffrey A. Mossler, MD Pathologists then and now The letter, “The oversupply,” by Mark Seifert, MD (August 2005), along with those of Ming Cao, MD, and William Warren, MD (June 2005), should be a wakeup call to pathologists. We have, over the years, become our own worst enemies. As an honors major in philosophy at Penn, a graduate of its medical school, a practicing internist for 10 years, an assistant medical examiner (forensic) for Philadelphia, then an academic and community hospital pathologist for over 30 years (and a lecturer in a Department of Religion on death and dying, emphasizing the role of the pathologist in society), my observations may be of constructive use in discussions on the future of our beloved specialty. In my view, we have become somewhat lazy, increasingly self-occupied and oftimes selfish, and more and more vulnerable to every extrinsic pressure that administrators, business executives, and ancillary medical professionals put on us. We are increasingly behaving like narrow scientists rather than well-rounded physicians who also happen to be pathologists, a specialty we love. For starters, consider the autopsy. There was a time when a pathologist, assisted by a wonderful and colorful character called a diener, performed the procedure from beginning (speaking with the clinician) to end, doing the microscopy in timely fashion, and completing the case and winding up with a great CPC the next month (while the staff still remembered the patient). Now what do we have? Pathology assistants. Untrained residents struggling, often without supervision. “Organ check-outs” never attended by senior staffers. And horror stories of autopsies not signed out for many, many months, up to a year, and completed by others. (I kid you not—having done at least 150 left by others. And were those staffers fired? No!) Consider the grossing station—the “surgical bench.” There was a time when the pathologist took pleasure in processing tissues and organs that required a pathologist’s expertise and demonstrating, step by step, to the novice resident the correct way to cut specimens the first time to effect zero error. Now the resident or pathology assistant has only a soiled and torn manual to flip through and the senior attending’s admonition, “Call me if you need me.” Consider, too, the education of medical students. There was a time when every teaching module had an attending or visiting pathologist who had abundant museum and autopsy “bucket-case” and bagged gross specimens to use with a hands-on method as instructional objects. Now there is increasing use of impersonal audiovisual cassettes or videos or Powerpoint projections and no pathologist with whom to interact. Medical students (and clinicians) love well-prepared and well-presented macropathology, and they are being denied this mode of instruction. All they get is the esoterica of someone’s research along with 100 projected slides. And what happened to time? What gives nonmedical people the right to ask how many minutes it takes to gross a gallbladder? Endometrial curettings? A fibroid uterus? Various endoscopic specimens? What have we become—production workers on an auto assembly line? Yes, there is an oversupply, and there will continue to be an oversupply of hungrier and hungrier young pathologists, and our specialty will suffer for this. We might just as well open the gates and let the nonpathologists come in. Theodore B. Krouse, MD |
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