January 2019—Excellence in the laboratory can have a powerful impact on the culture of our institutions because we come into contact with so many and so much. Mostly, we just need to do complex things extremely well and make it look easy. In other words, practice pathology.
R. Bruce Williams, MD
The more than 50 pathologists and numerous laboratory professionals in my group practice, Delta Pathology, serve nearly 100 institutions across Louisiana and Mississippi. My job, in addition to practicing pathology, is practice management, and I enjoy it. I like to see how well our team runs. I like knowing that we have our priorities straight—that we put patient safety first and work together to sustain a respectful culture. I am grateful for those things and the good people who enable them.
Of course, practice management and laboratory direction are about more than taking in the productive buzz. Pathology is complex, and managing a practice is balanced on top of that complexity. We need timely, relevant, and useful information about the market for our services, how to best position our groups, and what the market’s pivots may portend. The CAP provides a safe space to examine these things, to view them in ways both creative and pragmatic.
Practice management is more about working with other pathologists while laboratory direction is more about working with medical technologists and other laboratory professionals, but there’s a lot of spillover. It all falls under the greater umbrella of what is now often referred to as practice engagement—something everyone can embrace.
Within the CAP, interest in up-to-date tools and methods has grown with the pace of change in the greater environment. The CAP leadership team is committed to providing resources that will support pathologist productivity, competitiveness, and well-being. While not all CAP fellows are laboratory medical directors or practice managers, this affects everyone.
Practice evaluation and advice are costly when obtained by individual practices. More important, management consulting services designed for the distinct needs of pathologists and laboratory professionals are not commonly available. The CAP Practice Management Committee, chaired by Patrick Wilson, MD, and reporting to the Council on Membership and Professional Development, is coordinating a number of projects to enhance the resources accessible to members. For example, a practice assessment program piloted last year will be fully launched early this year with 10 hours of one-on-one targeted guidance by a CAP practice assessment expert available to the first 50 practices that sign up. Stay tuned for more on that.
CAP value-based toolkits, available as a membership benefit, are designed to be actionable, accessible, concrete, and specific. The billing assessment toolkit is a good place to begin, but the other seven toolkits—on practice self-awareness, market assessment, and annual reports, for example—are essential as well. See if some of your partners will volunteer to read and report back to the group about these practical resources.
Little (if any) of what we need to know to manage our practices effectively is covered in formal medical education. When it comes to the business side, most of us begin at square one. I think we should purposefully elevate the conversation around practice engagement in pathology. Set aside an evening to order in supper with your colleagues and talk about your respective priorities and how you can employ the CAP resources to reach them. The ultimate outcome should be a shared vision for your practice, something we all need to succeed.
Speaking of which, the second edition of Laboratory Administration for Pathologists, edited by Elizabeth A. Wagar, MD, Gene P. Siegal, MD, PhD, Michael B. Cohen, MD, and Donald S. Karcher, MD, is scheduled for release in the spring. I expect it will be one of the most popular selections in the CAP Press catalog, just like the first edition that is sitting, dog-eared, on my shelf.
Dr. Wagar developed the first edition with the late Richard E. Horowitz, MD, and Dr. Siegal; it was based on a popular course that she and Dr. Horowitz had put together when she was a residency program director at the University of California, Los Angeles. Today, Dr. Wagar is one of the most respected authorities in clinical laboratory management, but back then she was “very green,” she says, and when tasked with creating a laboratory management course for which there was no guidance in the literature, she was at a bit of a loss. Then she discovered a wonderful mentor in Dr. Horowitz, a much-admired expert on laboratory management on the private practice side. The two hit it off famously, writing and refining a widely acclaimed regional training program for pathology residents and fellows that eventually grew into this text. It’s a fine read, short on jargon and long on insightful observations directly useful to pathologists.
I saved this topic for the January column because it captures so much of what we have been working toward. When fully integrated into your practices, CAP member benefits can enable efficiencies, economies, and innovations, the potential value of which can far exceed the cost of CAP, AMA, and state pathology and state medical society memberships combined. (Incidentally, that would make this an excellent time to review the status of those memberships.)
While the Council on Membership and Professional Development manages most of our practice support tools and services, many more are dispersed across the CAP, often falling under the Council on Education and the Council on Government and Professional Affairs. There is much more about how all this integrates with our collective goals, especially in terms of learning and advocacy. I had planned to tell you about that, and to include something Dr. Wagar reminded me of: how attention to the human side of laboratory management is a bulwark against burnout. So much to tell, so much to do. Next month, we will explore further.
Dr. Williams welcomes communication from CAP members. Write to him at president@cap.org.