Plotting the future of cytotechnology:
An environmental analysis of the driving forces of cytology Summary
To download the complete report, click here
In 2006 the American Society of Cytopathology appointed the “New Profession for Cytotechnologists Task Force ” to address possible career threatening trends for our cytotechnologist members. The recommendation of the Task Force was to engage the Forbes Group, a strategic counseling firm, to assess if market forces would support a new cytology profession.
The following is a brief synopsis of the 43 page report “Plotting the future of cytotechnology. An environmental analysis of the driving forces of cytology “. The report forces us to take a different perspective of cytology; cytology is a portion of the broad practice of medicine, not an independent unit. To understand the changes facing cytotechnology one must examine the changes facing cytopathology and pathology. Changes in cytopathology are not linear but multi-directional. The future is moving in several directions at once. There is no single response to the defining healthcare market forces. Demands factors, supply factors, technologies, and federal policies will all influence the future of cytopathology. Sustaining and transformational technologies are changing the practice of pathology services as medical science moves in several directions. Cytology is at the crest of the changes.
There is no single answer to our question “Does a skills gap exists or is emerging to warrant the creation of a new profession.” The Forbes group defines our Profession as a “unique body of knowledge” that fills an existing or emerging market gap rather than a skill that serves a technological advance. There are multiple skill gaps created by emerging technologies and economics that are changing how pathology is performed. Public policies, market pressures, medical breakthroughs all play a role. The report also concluded that one cannot evaluate the requirements of a new profession that serve cytopathologists without making some assumptions as to how pathology will change.
Forbes also concluded that there is economic justification and support for a more highly skilled cytology profession. However, an expansion of current cytotechnology through a modest scope of practice expansion is not the answer. The growing shortage of clinicians and pathologists is going to require new systems of diagnosing and treating patients. The metamorphosis of the medical community from rigid institutionalized-care supply chains into more informal, diffused, and flexible community-based networks is already changing clinician-pathologist relationships and creating service gaps that neither cytopathologists nor cytotechnologists are qualified to fill.
There are several forks in the road that cytopathology can take. The ASC needs to decide which of these roads is best to promote the profession and remain a major discipline in a changing environment. As individuals, our members hold various points of views; all members need to be engaged to develop new visions for our discipline. The ASC is ideally positioned to lead this transformation of the new professionals that are best suited to provide the unique body of knowledge to carry us forward.
The key findings of The Forbes Group research are:
1. Do Market Dynamics Exist to Justify a New Profession?
Yes. In fact perhaps more than one. The traditional linear care delivery model is breaking down as innovative forms of medical delivery emerge in response to shortages of professional service providers, rising medical costs, aging and more demanding patients, and new technologies. These new medical systems are changing when, where, and by whom medical and healthcare are delivered. They demand new relationships among the professions and changing skill sets.
The Forbes Group concluded that while the Study Group’s hypothesis was correct, its anticipated solution, a single new profession functioning between the technologists and the pathologist was not. New practices for delivering healthcare are causing new professional relationships between doctors and support professions such as cytotechnology. The result is new professions, such as cytotechnology practitioner, and expanding scopes of practice for existing professions, such as nurse practitioners and pathology assistants.
2. Shortage of physicians NOT technologists is driving the needs for new professional relationships in Cytopathology
Rising demand and fewer medical providers are already redefining the practice of pathology. New technologies and new management practices are being rapidly adopted to improve productivity. The U.S. is not alone in facing the challenge of physician shortages. Among others is the U.K., where the expansion of cytotechnology and medical science was driven by physician shortages not technology breakthroughs. New non-institutional community-based business models increase patient “population thresholds” that increase economies of scale. Insurers are more willing to challenge state licensing requirements that limit telepathology. Medicare and Medicaid programs in 34 states now treat telepathology and teleradiology the same as local services. States are expected to liberalize state licensing laws as fiscal pressures force them to reassess the balance between quality control and access to care.
3. Health consumerism is also changing the laboratory industry, but is our ally.
Patients are being encouraged to become more proactive. Industry has adopted employee wellness programs, intended to promote more health consumerism and give patients vested interests in cost-savings. Their demands for more cost-effective testing should offset the declines imposed by more penurious insurers and government agencies. The rise in self-testing products, which already account for 25 percent of all lab work, certainly point to that direction. While the influence of self-testing products on laboratory revenues has yet to be determined, they should help to accelerate the drive toward large, centralized industrial labs at the expense of the local hospital-based lab, which in turn could lead to more competition between cytotechnologists and clinical technologists for the remaining business.
4. Most new technologies are transformational not sustaining
Digital imaging, telemedicine, and nanotechnology will change what pathologists do, not how they do it. Many pathologists interviewed for this study see the world around them changing while their practices remain the same. New digital imaging technologies could blur the borders between pathology and radiology departments as radiologists with greater experience in digital image management could become new gatekeepers. Thanks to rapidly accelerating adoption of telepathology and teleradiology, national and even global competition for radiology and pathology services is market fact . In today’s globalized telemedicine market, regulatory barriers are no longer sufficient to assure job protection.
5. Not a zero-sum game
Expanding scope of practice for technologists will not come at the expense of pathologists. On the contrary, refining and expanding the scope of practice for cytotechnologists could prove essential to increasing the productivity and efficiency of cytopathology will enhance the economic security of both professions. Growing demands on cytopathologists could encourage more efficient use of cytotechnologists in harvesting and evaluating samples, managing local physical and digital specimen files and databases, networking with similar facilities worldwide, and serving as consultants to the cytopathologists when evaluating which tests can be performed on which samples.
6. Blurring borders of specializations demand new training approaches
As telepathology becomes more commonplace, management of the digital image takes on great importance. Radiologists, declaring themselves the masters of digital imaging, are claiming to be best able to manage pathology imaging as well by saying that it is really radiopathology. Cytologists must decide whether their profession should include their own specialists in digital imaging management that is unique or promote the development of a medical digital imaging specialist who would be cross-trained in both pathology and radiology.
From lab table to bedside. As genetic science and nanotechnologies mature, the pathologist may be transformed from a clinician’s consultant to a clinical provider. Developing a direct relationship with the patient and stepping out from behind the “invisible provider” image may be pathologists’ best response to foreign outsourcing. What new kinds of support functions should cytotechnologists provide as pathologists take a more active role in patient care? And what new skills and capacities will they need to provide them?
This is a short summary of the Forbes findings. Please take time to read the entire report, and begin formulating your ideas. The leadership of the ASC is now engaged in developing a web based process for soliciting input from our members. Hopefully over the course of the next year we can explore the local needs of our professionals, and help identify resources to facilitate the changes.
To download the complete report, click here