ASCP Resident Council Chair Message by Anna M. Moran, MD
Will microscopy as we know it eventually become obsolete? Will glass slides be replaced by high definition digital images that can be carried around on small portable storage devices or transported long distances via the Internet? Will pathologists find themselves competing not with pathologists across town or in the next state but on the other side of the world? Will tiny robots be implanted in patients and used to detect and monitor disease?
According to ASCP’s Task Force on the Future of Pathology and Laboratory Medicine and ASCP’s Task Force on Facing the Future (see Critical Values, January 2008, pp. 26-33), those in the know are not asking “if” these things will happen but “when.” These and many other changes are already occurring – almost at an exponential rate. They are driven by the pursuit for improved quality, better patient care and lower costs as well as by growing worldwide competition for scarce healthcare resources.
Three major trends impacting our profession should be of particular interest to pathology residents: technology, globalization and the changing perception of pathology and laboratory medicine with regard to its role in patient care.
Technology
One of the most important technological developments is in the area of molecular technology. Although this technology is still relatively new, the use of genetic analysis and proteomics for both prognostic and diagnostic purposes is growing rapidly; and its role will certainly expand. We have also seen the rapid development of digital imaging technologies that allow us to produce digital micrographs with tremendous image clarity. A digital image has several advantages over glass slides. It provides a digital database that is quantitative rather than qualitative. The digital database is also easier to manipulate, easier to store and more durable than slides. Some pathologists expect digital imaging to eventually replace glass slides and conventional microscopy.
On the horizon is another new technology that enables scientists to create structure and materials at the atomic level, one molecule at a time. Nanotechnology is expected to have tremendous medical applications, including more powerful and precise methods for detecting and diagnosing disease. Imagine, for example, nano-sized robots carrying chemotherapy drugs to a specific cancer cell, nanoscale biosensors that help detect disease, or new skin made from corn protein. How small is a nanometer? A strand of DNA is approximately 2.5 nanometers in diameter [www.nano.gov/html/facts/nanoscale.html].
Globalization
Not too surprisingly, economics – the quest for higher quality at lower cost – is behind much of the change. And, competition has always been seen as a good way to reduce costs. For the local laboratory, this means competitive bidding for laboratory services as well as regionalization and other economies of scale. For the anatomic pathologist, competition will be more global in nature. With computers and digital imaging technology, information once fixed on glass slides can now be sent anywhere quickly and easily and interpreted by pathologists anywhere in the world. Despite some current legal barriers, routine remote analysis of anatomic specimens will become increasingly feasible and will probably become reality.
Our Changing Role in Health Care
Laboratory professionals are currently endangered, says the Task Force report, because they are not indispensable – partly because our once labor-intensive work has become much more technology-intensive. Thus, laboratory results – even anatomic pathology diagnoses – are increasingly seen as a commodity rather than a service. And, commodities can be supplied by the lowest bidder. Another factor is our lack of interaction not only with patients but with clinicians. This has eroded our image as members of the healthcare team and, once again, caused our work to be viewed as a product or commodity. Also affecting our image is the trend toward specialization among pathologists at a time when the lines between medical specialties are becoming increasingly blurred, greater generalization is needed for the sake of economy and growing collaboration is required to provide certain kinds of medical services.
Shaping Our Own Destiny
Although I have barely touched on the wide-ranging collection of changes shaping the future of the profession, it is clear that we must be aware of and understand the importance of current trends. Unfortunately, a majority of pathologists and other laboratory professionals are only passive participants in the evolving healthcare system. For example, most have been slow to incorporate molecular diagnostics into their clinical practice and make it their own. Now, the window of opportunity is beginning to close, with clinicians and other medical specialists preparing to move into the gap.
As already noted, to a large degree pathologists have stopped participating in the “clinical” component of medicine in the sense that they rarely talk with patients. This reality has made the laboratory invisible to patients and estranged pathologists from other physicians. We want to be viewed as valuable members of the healthcare team who provide consultative services to clinicians. Most clinicians, however, are finding less need for these consultative services thanks to technological advances that are reducing the value of the pathologist’s current expertise.
How can we stay relevant in tomorrow’s healthcare environment? First, we must be both visible and accessible to clinicians. Get actively involved in the workplace, especially when it comes to evaluating and adopting new technologies. Keep your medical knowledge and techniques on the cutting-edge. I recommend getting involved with a professional organization that will keep you informed and that offers workshops and other educational programs on new technologies and diagnostic techniques. ASCP offers quite a few. Just check them out.
Please email comments and questions to me at ResidentChair@ascp.org.