At 8:01 AM -0500 8/23/06, Julia Dahl wrote:
>So much for sending a brief overview.... but I hope this gives some insight,

Julia,

This is an excellent overview of a complex, changing situation which 
may be the straw that puts me out of business if it becomes 
legislated.

I am a solo pathologist with 30+ years of experience who serves 
several small rural hospitals (too small to have an on site 
pathologist). I do about 3000 cases a year primarily GI, breast, GYN 
and skin. My background is in Neuropathology and gen Surg Path. I 
send out between 50-100 cases a year, both consults I want and slides 
reviewed by large institutions where primary therapy is being done 
and cases requiring immunohistochemistry since we are not large 
enough to do it ourselves. All of this I use as peer review (quality 
assurance if you will). We also use a number of devices to minimize 
mailing costs.

Being rural, it is not usually the clinicians or patients that 
initiate consults (2nd opinions), but me, as I know my limitations 
and in many circumstances working solo causes a gut feelings that 
someone else needs to look at a case.

The statistics you mention sound troublesome, but one MUST remember 
that such numbers only apply to large groups of pathologists and not 
to individuals. Unfortunately they will be used to control the 
behavior of individuals which will make the numbers look better while 
doing little to ensure accuracy in individual cases. Nor do they take 
into account case mixes. Sending out 2-3% of hernia sacs or SK/BINs 
would not be of much use.

Bill

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