1

Perspectives on Our Future in PathologyPerspectives on Our Future in Pathology

College of American PathologistsCommittee Member Audio Conference

The struggle of today, is not altogether for today—it is for a

vast future also.

The struggle of today, is not altogether for today—it is for a

vast future also.

~ Abraham Lincoln

2

Perspectives on Our Future in Pathology

• What is happening in healthcare?• How will these changes affect our

specialty?• What are the implications for CAP and

your role as committee members and leaders in the College?

Where have we been?

St. Barnabus Health SystemUPMCUC DavisSUNYUniversity of VermontNew York UniversityUniversity of Utah

Industry EventsMolecular SummitPathology VisionsAPIIIWar CollegeGE & Siemens Meetings

Residency ProgramsWashington UniversityDuke UniversitySt. Louis UniversityEast Carolina UniversityLongwood Group(Deaconess, Beth Israel, Brigham Women’s)

Mt. Sinai Hospital NYUNC Chapel HillUniversity of Miami

CAP FunctionsResidents’ ForumHouse of DelegatesFuturescapePathology Practice MgmtNational Meeting

Futurescape

3

Changing demographics will impact our future practice

Source: U.S. Census Bureau

0 5 10 15 20 25 30 35 40 45 50

Heart disease

Cancer

Cerebrovascular diseases

Chronic lung disease

Pneumonia and influenza

Diabetes mellitus

Chronic liver disease andcirrhosis

Renal disease

Septicemia

Alzheimer’s disease

Atherosclerosis

1979 1996 2005

The nature of disease and disease treatment is changing

% of Total Deaths in the US% of Total Deaths in the US

Source: National Vital Statistics Reports, Vol 47, No 9, Nov 10, 1998; Vol 56, No 10, Apr 24, 2008

4

What does the consumer want?

• High quality• Convenience & access• Fast & accurate information• Trust & confidence• Time

Help!Help!• Fast and accurate

results• Understandable and

useful information• Direction on therapy

What does the patient’s treating physician want?

5

…and sometimes that primary care provider

isn’t a physician“Nurse practitioners with master’s degrees are already filling the primary care shortages and providing quality, cost-effective care, many times in places that physicians are unwilling to practice.”

Wendy VogelNurse Practitioner, Oncology

Blue Ridge Medical Specialists, TNWSJ, April 2, 2008

Traditional trial-and-error method of care is no longer acceptable

Patient presents with symptoms

Doctor makes a “most likely” diagnosis, may order

tests to confirm, and prescribes a treatment plan

(drugs and/or surgery)

Weight & age may affect drug selection & dosage or other

intervention

Plan works or doesn’t work, +/-

side effects?

Treatment plan success

Doctor revises treatment plan

6

…and the outcomes are disappointing and costly

25%Oncology30%Alzheimer’s Disease47%HCV48%Osteoporosis50%Rheumatoid Arthritis50%Migraine (prophylaxis)52%Migraine (acute)60%Schizophrenia60%Cardiac Arrythmias60%Asthma80%Analgesics for pain (Cox-2 inhibitors)

% who respond to therapyCategory of Disease

Source: Physicians’ Desk Reference; Patient response rates to a major drug in selected categories of therapy

Diagnostics saves lives and money

Langreth, R. (2008), ‘Imclone’s Gene Test Battle’, Forbes.com, 16May

K-ras TestingDo Not Treat

Treat with Erbitux

TreatmentSuccess

Treat with Erbitux

7

Personalized Medicine: revolution or evolution?

Investment in Dx

& Prevention

Improved Quality of Life & Financial

SavingsH

ealth

Car

e $$

Years

Current Practice

Potential of Personalized Medicine

Individual Health Care Spending Curve

Source: Deloitte Development LLC 2006

Investment in Dx

& Prevention

Improved Quality of Life & Financial

SavingsH

ealth

Car

e $$

Years

Current Practice

Potential of Personalized Medicine

Individual Health Care Spending Curve

Source: Deloitte Development LLC 2006

Industry recognizes the opportunity

Are diagnostics the Are diagnostics the newnew wonder drug on wonder drug on

Wall Street?Wall Street?

8

Diagnostics innovation and invention are racing forward

Circulating Tumor Cells

Use of Imaging Tools

Clinical and Anatomic Pathology Convergence

Are we keeping up with the trends?

Early Adopters—target for leadership and

resource committees

Innovators—target for foundation grants

Consensus Adopters—Primary target for education and accreditation products

Late Adopters—Members at the

sunset of their careers

1 2 3 4 5

Early Adopters—target for leadership and

resource committees

Innovators—target for foundation grants

Consensus Adopters—Primary target for education and accreditation products

Late Adopters—Members at the

sunset of their careers

1 2 3 4 5

Where is the specialty of pathology?

Cautious Adopters—Target for technology education

Cautious Adopters—Target for technology education

9

Are we delivering what the market wants and needs?

• Physicians not technicians– Skilled professionals– Flexible– Curious; lifelong learners– Good communicators

… it’s not about the tools

10

It’s time to knock down the

walls

11

Pathologists have a bright future in the house of medicine

• Researcher/Innovator• Test Provider• Interpreter• Clinical Data Integrator• Clinical Consultant• Lab Director• Business Developer• Practice Leader

CAP is a key driver in the transformation of the specialty into this

futureMission

The CAP, the leading organization of board-certified pathologists, serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine.

Vision

The CAP is the primary driver in the transformation of the specialty of pathology and pathologists. As the transformation agent, CAP will greatly strengthen and evolve its position into:– The leading organization guiding

pathologists– The leader in promoting quality patient

care– The primary resource for information

and education – The most influential advocate for

pathologists

12

Advocacy/Policy

Communication, Education & Tools

Standards/Best Practices

Financial Viability & Growth

…with strategies to ensure the continued relevance and strength of

our specialty

Our directives focus on addressing key questions about the future of the specialty

and the College• What happens if CLIA ’88 is

finally cracked open?• Are we prepared to harness

the emerging technologies?• What is our role in

personalized healthcare?• Will the electronic health

record adequately address our needs?

• How do we fulfill today’s education needs while preparing for the future?

• How do we strengthen pathology’s voice and ensure fair payment?

• Will future reimbursement models focus more on value than activity?

• With which organizations can we align to better achieve our mission?

• How do we strengthen our role as laboratory directors?

• Can we improve our accreditation and PT programs to further improve lab quality?

13

Success depends on you• Technical expertise• Practice knowledge• Innovation & creativity• Enthusiasm• Common sense• Good judgment• Hard work• Relationships & team work• Stick-to-itiveness• Leadership

…in every aspect of what we do

When it comes to the future, there are three kinds of people: those who let it happen, those

who make it happen, and those who wonder what happened.

When it comes to the future, there are three kinds of people: those who let it happen, those

who make it happen, and those who wonder what happened.

~ John M. Richardson, Jr. ~ John M. Richardson, Jr.