Notice of Faculty Disclosure - Amazon S3s3.amazonaws.com/ascpcdn/static/adasp/assets/2014... · AMA...

Pathologist Workforce Study

Stanley J Robboy, MDImmediate Past President – CAPVice Chair of Pathology - Duke

© 2013 College of American Pathologists. All rights reserved.

Notice of Faculty DisclosureI have no relevant financial relationship with any commercial interest to disclose:

Stanley Robboy

1

Pathologist Workforce Study

• Supply• Demand• Integrated model• Opportunities• Pathologist workforce summit

Modeling Supply

FTE SUPPLY OF PATHOLOGISTS

Current supply of

pathologists

Plus: Additions to Workforce

Less: Separations

from Workforce

Adjusted for: Working Hours by

Age, Gender

2

Results

• Imminent pathologist shortage: more pathologists will retire than residencies will graduate.

• Without significant changes in pathologist training, patients and their clinicians will experience potentially disruptive changes in current patterns of practice

Pathologists are older

0

1,500

3,000

4,500

6,000

7,500

35–4425–34 45–54 55–64 65–74 75 +

Male

Female

Age & Gender Distribution, 2009

Age Group

Num

ber o

f Pa

thol

ogist

s

5%

21%

33%30%

10%

2%

3

0

1,500

3,000

4,500

6,000

7,500

AMA Physician Age Distribution

35–4425–34 45–54 55–64 65–74 75 +

Male

Female

Pathologists vs All MDs

Age Group

Num

ber o

f Pa

thol

ogist

s

5%

21%

33%30%

10%

2%

AMA - Physician Characteristics and Distribution in the US, 2010 Edition

Path residency programs 1926-2010from1926 to

2372 in 2013

143 in 2013

4

Results

Yearly Net Changes to Pathology Workforce

2010 2014 2019 2024 2030

0

200

400

600

800

1000

1200

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Total Separations Separations from retirement Additions to workforce

"Retirement cliff" coming, but residency slots remain constant

5

0

5,000

10,000

15,000

20,000

25,000

2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030

FTE

Path

olog

ists

Supply

Demand

Supply Gap, 2014-2030

Modeling Demand

Demand for

Pathology Services

Population Demographics

Disease Incidence

Sub-specialization

New technologies

Role of Informatics

6


Calculations

© 2013 College of American Pathologists. All rights reserved. 13


Service types & Base locations


7

15

Baseline Demand Variables NAMCS09 – Analysis of Biopsies (1/2)

Age Groups

Number of Biopsies Performed (’00,000s) Total Patient Visits (MM)

Number of Biopsies per patient visit *

10,000

Relative Utilization Rates (compared to 0 – 17 female

group)0 -17 1.3 86.1 15 1.0

18 – 44 24.0 178.2 135 9.1

45 – 64 39.4 185.0 213 14.3

65 – 74 14.7 75.4 195 13.2

75 + 11.9 86.3 138 9.3

9.313.214.3

9.1

1.0

15

10

5

075+65-7445-6418-440-17

Rela

tive

ratio

s

Age Groups

Relative Utilization Ratios of Pathology Services – Female Population

Among females, the utilization rate increased with age till 64, but then showed a slight downward trend

Abnormal values

College of American Pathologists

Utilization Patterns for Pathology Svc

0.27

0.86

0.98

1.00

0.0 0.5 1.0

Uninsured

Exclusive Network HMO

All Other Managed Care

Fee-for-service

8

17

Follow-up on Demand ModelSegmentation of Demand across Service Areas (2/3)

3341236347041,0031,2321,3202,412

9,841

OthersAutopsyResearchProvider Consults

TeachingMedical Administration

CPLaboratory Medical Direction

AP Total0

10,000

5,000

FTE Count

35264

8271,0741,285

1,620

2,341

AP - PulmoAP - HemAP - GUAP - DermaAP - BreastAP - GyneAP - GI

3,000

0

1,500

Segmentation of Demand FTEs in AP across Specialties – 20101

Segmentation of Demand FTEs across Service Areas – 2010

Note: 1Graph does not depict FTEs contributed by othersSource: C4C


This image cannot currently be displayed.


% o

f Tim

e Sp

ent a

nd

% o

f Res

pond

ents

Percentage of Time Spent across Services (n=1028)

We Intend to segment the supply of pathologists by services in the following manner:1. Calculate the total supply of FTE hours in the base year (Input from Phase I model)2. Distribute the total FTE hour supply into various services based on the % of time spent by pathologists in various services

from the Case for Change survey3. Convert FTE hours spent in various services into FTE count of pathologists across various services

Research

27%4% 277

Consults to Physicians

60%

4% 613

Teaching

50%

6% 517

Medical Administration

50%

7% 512

Clinical Pathology Interpretation

65%

7% 671

Laboratory Medical Direction

71%

14% 728

Anatomic Pathology Services

89%56%

911

90%

50%

0%

% of Pathologists Involved% of Time Spent

241974

Pulmonary

2%0%

Autopsy/Forensic

2%1%

Hematology

7%2%

GynecologicalPap SmearCytology

46%

3% 474

Immunohisto-chemistry

73%

4%747

GenitourinaryPathology

72%

5%738

OtherGynecological

Pathology

68%

6%704

Dermato-pathology

66%

6% 674

BreastPathology

74%

7%763

GastrointestinalPathology

78%

13% 797

% o

f Tim

e Sp

ent a

nd

% o

f Res

pond

ents

90%

50%

0%

Sum of % of time spent across various services is not 100%, as services

insignificant time spent are not listed here

Segment Supply of Pathologists by ServicesSegmentation of Current Supply

9


Expected Change in Time Spent Across Services Young1 vs. All Pathologists (n=1028)

Medical Administration

Laboratory Medical Direction

Consult to Physicians

Clinical Pathology Interpretation

ResearchAnatomic Pathology Services

TeachingServices

Increase

Remain at current level

Decrease

Expected Change in Time Spent

Larger percentage of young pathologists1 are expected to increase the time they spend in Lab Medical Direction, Medical Administration and Teaching

32%31%44%34%

18%20%35%

20%46%

26% 25% 25%28% 28%

Young PathologistsOverall Pathologists

61%61%51%58% 68%66%56% 61%51% 59% 62% 55%62% 57%

2%3%3%6% 10%9%5% 14%0% 12% 6% 16%6% 14%

Overall: n=512Young: n=59







Note: 1 We have included pathologists below the age of 40 years in the category ‘young pathologists’

This data will enable us to understand how percentage of time spent across services is expected to change over time, for overall population and for the young pathologists

Segment Supply of Pathologists by ServicesExpected Increase in Supply Across Services (1/3)


This image cannot currently be displayed.


Increase

Remain at current level

Decrease

Expected Change in Time Spent

AP Services Immunohisto-Chemistry

Breast Pathology Gastrointestinal Pathology

Genitourinary Pathology

Dermato-pathology

Other Gynecological

Pathology

Gynecological Pap Smear Cytology

24%29%36%35%18%21%

46%19%

38%21% 18% 24%21% 19%

Young PathologistsOverall Pathologists

56%53%52%54% 47%62%47% 62%51% 66% 62% 53%62% 49%

12%12%6%6%

30%11%3%

14%4% 8% 10% 15%9%

23%








In comparison to overall pathologist population, lower percentage of young pathologists1 feel that the time they spend in Gynecological Pap Smear Cytology would decrease

Expected Change in Time Spent Across AP Services: Young1 vs. All Pathologists (n=1028)We intend to analyze how the percentage of time spent across AP services is expected to change over time

Note: 1 We have included pathologists below the age of 40 years in the category ‘young pathologists’

Segment Supply of Pathologists by ServicesExpected Increase in Supply Across Services (2/3)

10


AP Demand Growth

21


High Complexity Lab Growth

22

11


Lab Medical Direction


24

Service # Prioritized Services 11 Genomic consult (service to Providers)

29 International Insourcing

5, 28 Post diagnostic consult / Post dx clinic

37 In Vivo Microscopy

34 Acute care consultation

23 Patient and/or clinician education

12 Chronic disease monitoring

32 Bio-repository banking

6, 8 Mid-diagnostic consult / Predictive,therapeutic patient consult

33 Genomic data banking

10 Genomic consult (service to Patients)

22 Coordinating diagnostician

38 Institutional Informaticist

2 Ongoing wellness mng and consulting

1 Screening “risk assessment” consult


M2B Prioritized15 Services for Further Analysis

Mus

t Do

Shou

ld D

oO

ptio

nal

Later Soon Now

FE

A B C

D

G H I

• 29• 11 • 5 • 28

• 37 • 34

• 23 • 12 •32

• 6 • 8

• 10 •33

• 22

• 38

• 2

• 1

12

Coordinated Care Environment Non-Coordinated Care Environment

Rank Service name FTEs in 2016

1 In Vivo Microscopy30 (Status Quo)

50 (Interpret)400 (Intervene)

2 Genomic Consult 300

Rank Service name FTEs in 20161 Acute Care Consultation 600-1000

2 Institutional Informaticist 700-900

3 Mid/Post Diagnostic Consult 375-500

Rank Service name FTEs in 2016

1 Ongoing Wellness Mng 75

2 International Insourcing 120

All Environments

© 201 CAP. All rights reserved.

New Services for pathologists

B C

A

CB A

25

26© 2012 College of American Pathologists. All rights reserved.

1. Important for pathology.Pathologists, if not participating, may lose service to other physicians

2.Significant patient interaction; brings pathologists closer to patientsWill lead to increased personalization even if pathologists are not involved in endoscopic procedures

M2B Prioritized ServicesCoordinated Care/Non-Coordinated Care Environment: Top Two Services

In Vivo MicroscopyIn Vivo Microscopy

FTEs Required: -30–400FTEs Required: -30–400

1.Science making advances rapidly 2.Demand for targeted drug therapy will

increase in the future driving demand for this service. Several groups now tailoring specific chemoRx regimens to specific genomes

3.If not embraced, pharmacists (?) and other physicians may pick up service

4.In coordinated care, highly proximate action where pathologists can demonstrate value

5.Significant patient interaction6.Helps establish role for pathologists in field of

therapeutics

Genomic Consult (service to patients/providers)

Genomic Consult (service to patients/providers)

FTEs Required: 300FTEs Required: 300

1 2

Note: M2B Inputs; Grail Analysis

13


Genomic medicine, Cancer



Pathologist Efforts


ONE PATIENT AT A TIME 2010 2014 2018 2030Anatomic Pathology 9,083 11,053 11,709 12,855Autopsy 527 527 527 527Lab Medicine (CP) 2,425 2,956 3,136 3,445Provider Consults 316 316 316 316

POPULATION SERVICESLab Medical Direction 1,950 1,939 1,929 1,902Outcome Assessment 176 176 176 176

PROFESSIONAL DUTIESMedical Education 984 978 973 959Research 474 495 517 591Teaching 878 917 958 1,094

14


Workforce Summit 2013• Measure whether training in residency

programs aligns with skill sets needed in practice. Use survey data to modify certification testing and continuously reevaluate training.

• Develop communications (“branding”) to accomplish multiple goals for the specialty.



Workforce Summit 2013

Develop products that address:• Need for lifelong learning• Need for centralized training

resources in areas not readily accessible to all programs


15

Notice of Faculty Disclosure - Amazon S3s3.amazonaws.com/ascpcdn/static/adasp/assets/2014... · AMA...

Documents

Transcript of Notice of Faculty Disclosure - Amazon S3s3.amazonaws.com/ascpcdn/static/adasp/assets/2014... · AMA...