Implications of Changes for Readiness to Practice

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Implications of Changes for Readiness to Practice
Training Requirements for Certification of
Pathologists in the 21st Century:
American Board of Pathology Spring Meeting with
Cooperating Societies
May 5, 2015
Implications of Changes for Readiness to
Practice: Hybrid Academic/Private Practice
Perspective
Michael R. Pins, MD
Hybrid Academic/Private Practice Perspective Outline

Context



Introduce the Advocate System and Myself
Academic Affiliations
“Implications of Changes for Readiness to
Practice”


Proposed New Model
Sub-specialization



In General...
In Private Practice…
Comments
Hybrid Academic/Private Practice Perspective

Context - Introduce Advocate System
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Advocate System

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10 Hospitals, including 2 Children’s Hospitals (and
growing....?)
“Largest ACO in the U.S.”
Advocate Lutheran General Hospital
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600+ Beds
Referral Center for Thoracic, Hematologic (stem
cell transplant program) and Breast Malignancies,
Melaonoma
Hybrid Academic/Private Practice Perspective

Context - Introduce Advocate System
(cont’d)

Midwest Diagnostic Pathology (MDP)
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44 Pathologists (and growing....?), separate
business groups
ACL Laboratories
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“Largest hospital-owned laboratory in U.S. by
volume
Centralized lab. for all Advocate sites
Molecular Pathology: Advocate and Aurora
(southern Wisconsin) Systems
Hybrid Academic/Private Practice Perspective

Context - Introduce Advocate System (cont’d)

Academic Affiliations
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University of Illinois at Chicago College of Medicine
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4 Pathology Residents (General SP)
Electives in HematoP, SurgP, MolP, CytoP, DermP and RenalP
Chicago Medical School of Rosalind Franklin University
of Medicine and Science


Second year medical school course
Medical Student electives
Hybrid Academic/Private Practice Perspective

Context - Introduce myself
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Chicago Native – Returning to Chicago
Massachusetts General Hospital (7 years)
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Residency, Fellowships (Transfusion Medicine and
Surgical Pathology)
On staff: Assistant Director Blood Transfusion Service
and CVPath / Transplant Pathologist
Northwestern Memorial Hospital (11 years)
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On staff: Surgical Pathology (“….too many blood
bankers”)
Sub-specialization (depending on need): GU Pathology,
Perinatal Pathology, Gyn Pathology
Hybrid Academic/Private Practice Perspective

Context - Introduce myself


Chicago Native – Returning to Chicago (….geographic)
Massachusetts General Hospital (7 years)



Residency, Fellowships (Transfusion Medicine and Surgical
Pathology) (….marketability)
On staff: Assistant Director Blood Transfusion Service and CVPath /
Transplant Pathologist (….downside to sub-specialization)
Northwestern Memorial Hospital (11 years)


On staff: Surgical Pathology (“….too many blood bankers”) (….so
much for marketability)
Sub-specialization (depending on need): GU Pathology, Perinatal
Pathology, Gyn Pathology (….adaptability)
Hybrid Academic/Private Practice Perspective Outline

Context



“Implications of Changes for Readiness to
Practice”



Introduce the Advocate System and Myself
Academic Affiliations
Proposed New Model
Sub-specialization
Comments
Hybrid Academic/Private Practice Perspective

Implications of Changes for Readiness to Practice:
Proposed new Model
AP/CP, lab
management,
informatics, lab
accreditation
1 Yr
(6-18 mos?)
“Critical Thinking”

“Advanced”
AP
or CP
2 Yr
(12-36 mos?)
“Minutia”

Fellowship(s)
1 Yr
(per fellowship)
Hybrid Academic/Private Practice Perspective

Implications of Changes for Readiness to
Practice: Sub-specialization - In General

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Breadth of knowledge required to master the
disciplines of AP/CP (as defined by ABP in
1938) too great
Advantages: Better patient care (focus,
consistency, state of the art, clinicians know
whom to call, etc)
Refs: Sarewitz SJ. Arch Pathol Lab Med 2014:138;871-2 and
Domen RE and Baccon J. Hum Pathol 2014:45:1125-9
Hybrid Academic/Private Practice Perspective

Implications of Changes for Readiness to Practice:
Sub-specialization - In General (cont’d)
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Disadvantages:
Marketability of younger Pathologists
Certification: Sub-specialty MOC exams?
Distinction between AP/CP/MP, other becoming blurred
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Ex: NGS ECOG-ACRIN clinical trial not organ specific
Ex: Hematology – Hematopathology – Transfusion Medicine
Ex: AP-Research Tract vs. CP-Research Tract
Refs: Sarewitz SJ. Arch Pathol Lab Med 2014:138;871-2 and
Domen RE and Baccon J. Hum Pathol 2014:45:1125-9
Hybrid Academic/Private Practice Perspective

Implications of Changes for Readiness to
Practice: Sub-specialization - In Private Practice

How will small groups sub-specialize?
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Develop networks
De facto – System Mergers
Telepathology
Undergo training or recruit sub-specialists
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Ex: NeuroP: One MD, PhD “go-to person” in our system
Ex: Microbiology: Central PhD - MALDI-TOF
Ex: MolP: ACL Lab, MD; MD, PhD; PhD
Refs: Sarewitz SJ. Arch Pathol Lab Med 2014:138;871-2 and
Domen RE and Baccon J. Hum Pathol 2014:45:1125-9
Hybrid Academic/Private Practice Perspective Outline

Context



Introduce the Advocate System and Myself
Academic Affiliations
“Implications of Changes for Readiness to
Practice”


Proposed New Model
Sub-specialization



In General...
In Private Practice…
Comments
Hybrid Academic/Private Practice Perspective:
Comments
Critical Thinking (“7th Competency”)
 One (or two) Fellowships
 Whom Would I Hire Today?
 What Advice do I Give My Residents?

Hybrid Academic/Private Practice
Perspective: Comments

Critical Thinking (“7th
Competency”)
AP/CP, lab
management,
informatics, lab
accreditation
1 Yr
(6-18 mos?)
“Critical Thinking”

Core Competencies:
1. Patient Care
2. Medical Knowledge
3. Practice-Based Learning
4. Interpersonal
5. Professionalism
6. Systems-Based Practice
“7th” Critical Thinking
Hybrid Academic/Private Practice Perspective:
Comments

Critical Thinking (“7th Competency”)

Chicago Medical School Experience: Fewer
residency positions (all specialties) than U.S.
graduates
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Case studies
Medical School Elective Credit (Advanced Placement
Model)
Harvard Medical School Anecdote
Reliance on Board exams (NBME, ABP, MOC,
etc) undermines fostering critical thinking skills
Hybrid Academic/Private Practice Perspective:
Comments
Critical Thinking (“7th Competency”)
 One (or two) Fellowships


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My opinion: “Readiness to Practice” in new model
requires Fellowship - “Over qualification”
Survey: Horowitz, RE Expectations and Essentials for the Community
Practice of Pathology Hum Pathol 2006:37:969-73.

Choosing the best fellowship
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DermP, CytoP, Trans Med, GIPath (Ref)
Deficiencies
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“Lack of clinical context”
Hybrid Academic/Private Practice Perspective:
Comments
Critical Thinking (“7th Competency”)
 One (or two) Fellowships
 Whom Would I Hire Today?

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“Critical Thinkers”: My only hire out of
Fellowship was a past Resident of ours
Capable (and willing) to help with the RenalP
service with mentoring (adaptability)
Adaptability: My most recent hire job
description (70% CMS; 30% service [system
PulmP])
Hybrid Academic/Private Practice Perspective:
Comments
Critical Thinking (“7th Competency”)
 One (or two) Fellowships
 Whom Would I Hire Today?
 What Advice do I Give My Residents?

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Do your Fellowship (67% do 1 [72%] or 2 [27%]), but..
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..maintain your general AP/CP skills
Consider Academics (68% desire PP) for a few years, but..
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..maintain your general AP/CP skills
Refs: Lagwinski N and Hunt JL. Fellowship Trends of Pathology Residents. Arch Pathol Lab
Med 2009:133;1431-6
Hybrid Academic/Private Practice Perspective Outline

Context



Introduce the Advocate System and Myself
Academic Affiliations
“Implications of Changes for Readiness to
Practice”


Proposed New Model
Sub-specialization



In General...
In Private Practice…
Comments

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