Implications of Changes for Readiness to Practice: Hybrid Academic/Private Practice Perspective Michael R. Pins, MD American Board of Pathology Spring

Implications of Changes for Readiness to Practice: Hybrid Academic/Private Practice

Perspective

Implications of Changes for Readiness to Practice: Hybrid Academic/Private Practice

Perspective

Michael R. Pins, MDMichael R. Pins, MD

American Board of Pathology Spring Meeting with Cooperating Societies

May 5, 2015

Training Requirements for Certification of Pathologists in the 21st Century:

Training Requirements for Certification of Pathologists in the 21st Century:

Hybrid Academic/Private Practice Perspective - Outline


ContextContext Introduce the Advocate System and MyselfIntroduce the Advocate System and Myself Academic AffiliationsAcademic Affiliations

““Implications of Changes for Readiness to Practice”Implications of Changes for Readiness to Practice” Proposed New ModelProposed New Model Sub-specializationSub-specialization

In General...In General... In Private Practice…In Private Practice…

CommentsComments

Hybrid Academic/Private Practice Perspective Hybrid Academic/Private Practice Perspective

Context - Introduce Advocate SystemContext - Introduce Advocate System Advocate SystemAdvocate System

10 Hospitals, including 2 Children’s Hospitals (and 10 Hospitals, including 2 Children’s Hospitals (and growing....?)growing....?)

““Largest ACO in the U.S.”Largest ACO in the U.S.”

Advocate Lutheran General HospitalAdvocate Lutheran General Hospital 600+ Beds600+ Beds Referral Center for Thoracic, Hematologic (stem Referral Center for Thoracic, Hematologic (stem

cell transplant program) and Breast Malignancies, cell transplant program) and Breast Malignancies, Melaonoma Melaonoma


Context - Introduce Advocate System (cont’d)Context - Introduce Advocate System (cont’d) Midwest Diagnostic Pathology (MDP)Midwest Diagnostic Pathology (MDP)

44 Pathologists (and growing....?), separate business 44 Pathologists (and growing....?), separate business groupsgroups

ACL LaboratoriesACL Laboratories ““Largest hospital-owned laboratory in U.S. by volumeLargest hospital-owned laboratory in U.S. by volume Centralized lab. for all Advocate sitesCentralized lab. for all Advocate sites Molecular Pathology: Advocate and Aurora (southern Molecular Pathology: Advocate and Aurora (southern

Wisconsin) SystemsWisconsin) Systems


Context - Introduce Advocate System (cont’d)Context - Introduce Advocate System (cont’d) Academic AffiliationsAcademic Affiliations

University of Illinois at Chicago College of MedicineUniversity of Illinois at Chicago College of Medicine 4 Pathology Residents (General SP)4 Pathology Residents (General SP) Electives in HematoP, SurgP, MolP, CytoP, DermP and RenalPElectives in HematoP, SurgP, MolP, CytoP, DermP and RenalP

Chicago Medical School of Rosalind Franklin University Chicago Medical School of Rosalind Franklin University of Medicine and Scienceof Medicine and Science

Second year medical school courseSecond year medical school course Medical Student electivesMedical Student electives

Hybrid Academic/Private Practice Perspective Hybrid Academic/Private Practice Perspective Context - Introduce myselfContext - Introduce myself

Chicago Native – Returning to ChicagoChicago Native – Returning to Chicago Massachusetts General Hospital (7 years)Massachusetts General Hospital (7 years)

Residency, Fellowships (Transfusion Medicine and Surgical Residency, Fellowships (Transfusion Medicine and Surgical Pathology)Pathology)

On staff: Assistant Director Blood Transfusion Service and On staff: Assistant Director Blood Transfusion Service and CVPath / Transplant PathologistCVPath / Transplant Pathologist

Northwestern Memorial Hospital (11 years)Northwestern Memorial Hospital (11 years) On staff: Surgical Pathology (“….too many blood bankers”)On staff: Surgical Pathology (“….too many blood bankers”) Sub-specialization (depending on need): GU Pathology, Perinatal Sub-specialization (depending on need): GU Pathology, Perinatal

Pathology, Gyn PathologyPathology, Gyn Pathology

Hybrid Academic/Private Practice Perspective Hybrid Academic/Private Practice Perspective Context - Introduce myselfContext - Introduce myself

Chicago Native – Returning to Chicago Chicago Native – Returning to Chicago (….geographic)(….geographic) Massachusetts General Hospital (7 years)Massachusetts General Hospital (7 years)

Residency, Fellowships (Transfusion Medicine and Surgical Pathology) Residency, Fellowships (Transfusion Medicine and Surgical Pathology) (….marketability)(….marketability) On staff: Assistant Director Blood Transfusion Service and CVPath / Transplant On staff: Assistant Director Blood Transfusion Service and CVPath / Transplant

Pathologist Pathologist (….downside to sub-specialization)(….downside to sub-specialization)

Northwestern Memorial Hospital (11 years)Northwestern Memorial Hospital (11 years) On staff: Surgical Pathology (“….too many blood bankers”) On staff: Surgical Pathology (“….too many blood bankers”) (….so much for (….so much for

marketability)marketability) Sub-specialization (depending on need): GU Pathology, Perinatal Pathology, Gyn Sub-specialization (depending on need): GU Pathology, Perinatal Pathology, Gyn

Pathology Pathology (….adaptability)(….adaptability)




““Implications of Changes for Readiness to Implications of Changes for Readiness to Practice”Practice” Proposed New ModelProposed New Model Sub-specializationSub-specialization

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AP/CP, lab management,

informatics, lab accreditation


Implications of Changes for Readiness to Practice: Implications of Changes for Readiness to Practice: Proposed new ModelProposed new Model

“Advanced”AP

or CP

Fellowship(s)

1 Yr(6-18 mos?)

“Critical Thinking”

2 Yr(12-36 mos?)

“Minutia”

1 Yr (per fellowship)


Implications of Changes for Readiness to Implications of Changes for Readiness to Practice: Sub-specialization - Practice: Sub-specialization - In GeneralIn General Breadth of knowledge required to master the Breadth of knowledge required to master the

disciplines of AP/CP (as defined by ABP in disciplines of AP/CP (as defined by ABP in 1938) too great1938) too great

Advantages: Better patient care (focus, Advantages: Better patient care (focus, consistency, state of the art, clinicians know consistency, state of the art, clinicians know whom to call, etc)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


Implications of Changes for Readiness to Practice: Implications of Changes for Readiness to Practice: Sub-specialization - Sub-specialization - In GeneralIn General (cont’d) (cont’d) Disadvantages: Disadvantages: Marketability of younger PathologistsMarketability of younger Pathologists Certification: Sub-specialty MOC exams?Certification: Sub-specialty MOC exams? Distinction between AP/CP/MP, other becoming blurredDistinction between AP/CP/MP, other becoming blurred

Ex: NGS ECOG-ACRIN clinical trial not organ specific: NGS ECOG-ACRIN clinical trial not organ specific Ex: Hematology – Hematopathology – Transfusion Medicine: Hematology – Hematopathology – Transfusion Medicine Ex: AP-Research Tract : AP-Research Tract vsvs. CP-Research Tract. CP-Research Tract


Hybrid Academic/Private Practice Perspective Hybrid Academic/Private Practice Perspective Implications of Changes for Readiness to Implications of Changes for Readiness to

Practice: Sub-specialization - Practice: Sub-specialization - In Private PracticeIn Private Practice How will small groups sub-specialize?How will small groups sub-specialize?

Develop networksDevelop networks De facto – System MergersDe facto – System Mergers TelepathologyTelepathology

Undergo training or recruit sub-specialists Undergo training or recruit sub-specialists Ex: NeuroP: One MD, PhD “go-to person” in our system: NeuroP: One MD, PhD “go-to person” in our system Ex: Microbiology: Central PhD - MALDI-TOF: Microbiology: Central PhD - MALDI-TOF Ex: MolP: ACL Lab, MD; MD, PhD; PhD: MolP: ACL Lab, MD; MD, PhD; PhD







Comments

Hybrid Academic/Private Practice Perspective: Comments


Critical Thinking (“7Critical Thinking (“7thth Competency”) Competency”) One (or two) FellowshipsOne (or two) Fellowships Whom Would I Hire Today?Whom Would I Hire Today? What Advice do I Give My Residents?What Advice do I Give My Residents?



Critical Thinking (“7Critical Thinking (“7thth Competency”)Competency”) Core CompetenciesCore Competencies::

1. Patient Care1. Patient Care

2. Medical Knowledge2. Medical Knowledge

3. Practice-Based Learning3. Practice-Based Learning

4. Interpersonal4. Interpersonal

5. Professionalism5. Professionalism

6. Systems-Based Practice6. Systems-Based Practice

““7th” Critical Thinking7th” Critical Thinking

AP/CP, lab management,

informatics, lab accreditation

1 Yr(6-18 mos?)

“Critical Thinking”



Critical Thinking (“7Critical Thinking (“7thth Competency”) Competency”) Chicago Medical School Experience: Fewer Chicago Medical School Experience: Fewer

residency positions (all specialties) than U.S. residency positions (all specialties) than U.S. graduatesgraduates

Case studiesCase studies Medical School Elective Credit (Advanced Placement Medical School Elective Credit (Advanced Placement

Model)Model)

Harvard Medical School AnecdoteHarvard Medical School Anecdote Reliance on Board exams (NBME, ABP, MOC, Reliance on Board exams (NBME, ABP, MOC,

etc) undermines fostering critical thinking skillsetc) undermines fostering critical thinking skills



Critical Thinking (“7Critical Thinking (“7thth Competency”) Competency”) One (or two) FellowshipsOne (or two) Fellowships

My opinion: “Readiness to Practice” in new model My opinion: “Readiness to Practice” in new model requires Fellowship - “Over qualification”requires Fellowship - “Over qualification”

Survey: Survey: Horowitz, RE Expectations and Essentials for the Community Horowitz, RE Expectations and Essentials for the Community Practice of Pathology Practice of Pathology Hum PatholHum Pathol 2006:37:969-73. 2006:37:969-73.

Choosing the best fellowshipChoosing the best fellowship DermP, CytoP, Trans Med, GIPath (Ref)DermP, CytoP, Trans Med, GIPath (Ref)

DeficienciesDeficiencies ““Lack of clinical context”Lack of clinical context”



Critical Thinking (“7Critical Thinking (“7thth Competency”) Competency”) One (or two) FellowshipsOne (or two) Fellowships Whom Would I Hire Today?Whom Would I Hire Today?

““Critical Thinkers”: My only hire out of Critical Thinkers”: My only hire out of Fellowship was a past Resident of oursFellowship was a past Resident of ours

Capable (and willing) to help with the RenalP Capable (and willing) to help with the RenalP service with mentoring (adaptability)service with mentoring (adaptability)

Adaptability: My most recent hire job Adaptability: My most recent hire job description (70% CMS; 30% service [system description (70% CMS; 30% service [system PulmP])PulmP])



Critical Thinking (“7Critical Thinking (“7thth Competency”) Competency”) One (or two) FellowshipsOne (or two) Fellowships Whom Would I Hire Today?Whom Would I Hire Today? What Advice do I Give My Residents?What Advice do I Give My Residents?

Do your Fellowship (67% do 1 [72%] or 2 [27%]), but..Do your Fellowship (67% do 1 [72%] or 2 [27%]), but.. ..maintain your general AP/CP skills..maintain your general AP/CP skills

Consider Academics (68% desire PP) for a few years, but..Consider Academics (68% desire PP) for a few years, but.. ..maintain your general AP/CP skills..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






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Implications of Changes for Readiness to Practice: Hybrid Academic/Private Practice Perspective Michael R. Pins, MD American Board of Pathology Spring