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Subspecialty in Community Pathology Practice.

To the Editor.--I disagree with Dr Sarewitz (1) when he states that "in the future, most community pathologists will need to practice as subspecialists, and my kind of career path [as a general pathologist] will become obsolete." After almost 40 years of private pathology practice, I see a bright future for pathology that rests in the hands of well-trained, board-certified anatomic and clinical pathologists.

The practice of future pathologists will be based not on subspecialization, but on the same skill set that marks today's successful general pathologist. This skill set includes current competence, the ability to effectively communicate with colleagues, and (to paraphrase the film character Dirty Harry) a knowledge of their limitations.

In our southern California group practice, more than 95% of our cases (breast, gastrointestinal, hematopathology, genitourinary, gynecology, etc) are signed out without the need of a subspecialist. In our metropolitan area, as in more remote practice areas, subspecialty consultation is easily obtained by US mail, messenger, or overnight delivery. Sarewitz states that in the future "there will be no reason for anyone to look at a brain frozen section except for a network's neuropathologists."

In our practice, neurosurgeons operate late into the evening, and a pathologist is often requested for frozen section. I wonder who in Dr Sarewitz's neuropathology network will come into the hospital to prepare and interpret a frozen section when requested by the neurosurgeon at 1 o'clock in the morning. I suspect none other than the general pathologist he sees as becoming obsolete.

In my opinion, the network he envisions will simply not be necessary. I am optimistic about the future of pathology, competently practiced by board-certified anatomic and clinical pathologists rather than subspecialist pathologists.

Kenneth Frankel, MD

Citrus Pathology Medical Group

Pasadena, CA 91105

(1.) Sarewitz S. Subspecialization in community pathology practice. Arch Pathol Lab Med. 2014; 138(7):871-872.

doi: 10.5858/arpa.2014-0397-LE

In Reply.--Considering the disruptive changes currently affecting many aspects of health care--in technology, the marketplace, reimbursement, and regulation--it is hard to believe that the practice of community pathology will stay the same. Already, a large health care insurer is implementing a program that will require subspecialty pathologist review of certain kinds of cases. (1) Whether or not this particular program gains traction, it is a sign of the changes to come.

With respect to neuropathology, in the future, there need be no barrier whatever for all brain frozen sections to be examined in real time by a neuropathologist. The local hospital pathologist, or even a pathologist assistant, will be the individual onsite who performs the technical preparation of the frozen section slide. This slide will then be digitized in real time and reviewed microscopically by the neuropathologist on-call for that particular laboratory's network, wherever he or she may be located. The neuropathologist will be able to review the patient's imaging studies and medical record electronically and, through videoconferencing, will discuss the case directly with the surgeon. Because the electronic network can include multiple neuropathologists across the country, the on-call schedule would not be unduly burdensome for any single individual.

I also am optimistic about the future of community pathology practice. I just think we will need to practice differently.

Stephen J. Sarewitz, MD

Department of Pathology

Valley Medical Center

Renton, WA 98055

(1.) United Healthcare Laboratory Benefit Management Program. https://www.united do ? channel Id=9cc7b96891e22410VgnVCM2000002a4ab10a. Accessed August 29, 2014.

doi: 10.5858/arpa.2014-0472-LE
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Title Annotation:Letters to the Editor
Author:Frankel, Kenneth
Publication:Archives of Pathology & Laboratory Medicine
Article Type:Letter to the editor
Date:Jun 1, 2015
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