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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 Meeting with Cooperating Societies May 5, 2015 Training Requirements for Certification of Pathologists in the 21st Century:
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Hybrid Academic/Private Practice Perspective - Outline Context Context Introduce the Advocate System and Myself Academic Affiliations “Implications of Changes for Readiness to Practice” “Implications of Changes for Readiness to Practice” Proposed New Model Sub-specialization In General... In Private Practice… Comments Comments
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Hybrid Academic/Private Practice Perspective Context - Introduce Advocate System Context - Introduce Advocate System Advocate System 10 Hospitals, including 2 Children’s Hospitals (and growing....?) “Largest ACO in the U.S.” Advocate Lutheran General Hospital 600+ Beds Referral Center for Thoracic, Hematologic (stem cell transplant program) and Breast Malignancies, Melaonoma
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Hybrid Academic/Private Practice Perspective Context - Introduce Advocate System (cont’d) Context - Introduce Advocate System (cont’d) Midwest Diagnostic Pathology (MDP) 44 Pathologists (and growing....?), separate business groups ACL Laboratories “Largest hospital-owned laboratory in U.S. by volume Centralized lab. for all Advocate sites Molecular Pathology: Advocate and Aurora (southern Wisconsin) Systems
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Hybrid Academic/Private Practice Perspective Context - Introduce Advocate System (cont’d) Context - Introduce Advocate System (cont’d) Academic Affiliations University of Illinois at Chicago College of Medicine 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
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Hybrid Academic/Private Practice Perspective Context - Introduce myself Context - Introduce myself Chicago Native – Returning to Chicago Massachusetts General Hospital (7 years) Residency, Fellowships (Transfusion Medicine and Surgical Pathology) On staff: Assistant Director Blood Transfusion Service and CVPath / Transplant Pathologist Northwestern Memorial Hospital (11 years) On staff: Surgical Pathology (“….too many blood bankers”) Sub-specialization (depending on need): GU Pathology, Perinatal Pathology, Gyn Pathology
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Hybrid Academic/Private Practice Perspective Context - Introduce myself 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)
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Hybrid Academic/Private Practice Perspective - Outline Context Context Introduce the Advocate System and Myself Academic Affiliations “Implications of Changes for Readiness to Practice” “Implications of Changes for Readiness to Practice” Proposed New Model Sub-specialization Comments Comments
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AP/CP, lab management, informatics, lab accreditation Hybrid Academic/Private Practice Perspective Implications of Changes for Readiness to Practice: Proposed new Model Implications of Changes for Readiness to Practice: Proposed 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)
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Hybrid Academic/Private Practice Perspective Implications of Changes for Readiness to Practice: Sub-specialization - In General Implications of Changes for Readiness to Practice: Sub-specialization - In General 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
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Hybrid Academic/Private Practice Perspective Implications of Changes for Readiness to Practice: Sub-specialization - In General (cont’d) Implications of Changes for Readiness to Practice: Sub-specialization - In General (cont’d) Disadvantages: Marketability of younger Pathologists Certification: Sub-specialty MOC exams? Distinction between AP/CP/MP, other becoming blurred : NGS ECOG-ACRIN clinical trial not organ specific Ex: NGS ECOG-ACRIN clinical trial not organ specific : Hematology – Hematopathology – Transfusion Medicine Ex: Hematology – Hematopathology – Transfusion Medicine : AP-Research Tract vs. CP-Research Tract 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
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Hybrid Academic/Private Practice Perspective Implications of Changes for Readiness to Practice: Sub-specialization - In Private Practice Implications of Changes for Readiness to Practice: Sub-specialization - In Private Practice How will small groups sub-specialize? Develop networks De facto – System Mergers Telepathology Undergo training or recruit sub-specialists : NeuroP: One MD, PhD “go-to person” in our system Ex: NeuroP: One MD, PhD “go-to person” in our system : Microbiology: Central PhD - MALDI-TOF Ex: Microbiology: Central PhD - MALDI-TOF : MolP: ACL Lab, MD; MD, PhD; PhD 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
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Hybrid Academic/Private Practice Perspective - Outline Context Context Introduce the Advocate System and Myself Academic Affiliations “Implications of Changes for Readiness to Practice” “Implications of Changes for Readiness to Practice” Proposed New Model Sub-specialization In General... In Private Practice… Comments
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Hybrid Academic/Private Practice Perspective: Comments Critical Thinking (“7 th Competency”) Critical Thinking (“7 th Competency”) One (or two) Fellowships One (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?
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Hybrid Academic/Private Practice Perspective: Comments Critical Thinking (“7 th Competency”) Critical Thinking (“7 th Competency”) Core Competencies: 1. Patient Care 2. Medical Knowledge 3. Practice-Based Learning 4. Interpersonal 5. Professionalism 6. Systems-Based Practice “7th” Critical Thinking AP/CP, lab management, informatics, lab accreditation 1 Yr (6-18 mos?) “Critical Thinking”
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Hybrid Academic/Private Practice Perspective: Comments Critical Thinking (“7 th Competency”) Critical Thinking (“7 th Competency”) Chicago Medical School Experience: Fewer residency positions (all specialties) than U.S. graduates 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
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Hybrid Academic/Private Practice Perspective: Comments Critical Thinking (“7 th Competency”) Critical Thinking (“7 th Competency”) One (or two) Fellowships One (or two) Fellowships 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 DermP, CytoP, Trans Med, GIPath (Ref) Deficiencies “Lack of clinical context”
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Hybrid Academic/Private Practice Perspective: Comments Critical Thinking (“7 th Competency”) Critical Thinking (“7 th Competency”) One (or two) Fellowships One (or two) Fellowships Whom Would I Hire Today? Whom Would I Hire Today? “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])
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Hybrid Academic/Private Practice Perspective: Comments Critical Thinking (“7 th Competency”) Critical Thinking (“7 th Competency”) One (or two) Fellowships One (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.. ..maintain your general AP/CP skills Consider Academics (68% desire PP) for a few years, but.. ..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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Hybrid Academic/Private Practice Perspective - Outline Context Context Introduce the Advocate System and Myself Academic Affiliations “Implications of Changes for Readiness to Practice” “Implications of Changes for Readiness to Practice” Proposed New Model Sub-specialization In General... In Private Practice… Comments Comments
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