Designing an Anatomic Pathology Practitioner

For several years now there has been a push to revise and update training for cytotechnologists to ensure that they are prepared for the needs of the future. Both the American Society for Clinical Pathology and the College of American Pathologists have submitted letter to the Cytotechnology Program Review Committee (CPRC) detailing specific areas that they would like to see covered in all cytotechnology training programs, and the CPRC has taken these suggestions to heart and is actively engaged in the process of implementing these recommendations as part of the Standards and Guidelines for the Accreditation of Educational Programs in Cytotechnology

As a practicing pathologist and cytologist and as a member of the American Society of Cytopathology, I strongly support these efforts. I look forward to the day when the cytotechnologists in my hospital system can be aiding in the interpretation not only of tests that are traditionally in the area of clinical pathology (FISH, molecular diagnostics, laboratory management) but also in areas that are traditionally the purview of pathologists (special stains, immunohistochemistry, primary sign out of non-gynecologic cytology). I foresee a time when the name “cytotechnologist” may be too restrictive, and titles such as “Anatomic Pathology Practitioner” may be more appropriate.

Nevertheless, while I strongly support these efforts, I do see an area where my vision of the future is slightly different than the one that is described in these letters. In these letters, the rivalry between cytotechnologists and medical technologists/medical technicians (MTs) remains strong today. While MTs are willing to give up very specific and limited areas of their field, they most certainly are hanging on tight to their primary role in the clinical laboratory. This makes sense – like cytotechnologists, MTs are under pressure from management to justify their utility, and I would be hanging on tight if I were in their shoes as well. Since there are many more MTs than cytotechnologists, in any competition between these two specialties, cytotechnologists can not come out ahead. Does this matter for the future of the cytotechnology?

I would say yes. There is an opportunity out there that I have not seen clearly articulated in any of these letters to date. That opportunity is in the very small hospitals (where I spend most of my time), not the academic centers. There are many small hospitals in this country, and there is a real need for assistants to pathologists in this setting. In academic centers, there is enough work to keep an “anatomic pathology practitioner” busy just doing anatomic pathology. In small hospitals there is not. In my hospital there are 1-2 hours of anatomic pathology a day, and in no circumstance would I ever be able to hire an “anatomic pathology practitioner” for this setting. It’s simply not a financially viable arrangement. On the other hand, if I could hire some one who can cut the frozen, examine it at the microscope (with my help via telepathology), do the rest of the AP processing, and then work in the clinical laboratory for the remaining 6 hours of the shift, that would be highly attractive to many pathology groups and hospitals. What I am describing of course is a cytotechnologists/histotechnologist/medical technologist hybrid.

Other specialties have also used these small hospitals to gain acceptance as full -fledged members of their health care teams. While nurse anesthetists work in larger hospitals under the direct supervision of anesthesiologists it is their role in smaller hospitals, where they are often the only person on site, and where the extent of what they can actually do has been demonstrated. The same could happen for cytotechnologists.
But can we actually get to this point? I believe the key step to making this happen is for cytotechnologists to give up – they are never going to win a fight with MTs. Instead they should create a hybrid program that gives them just enough qualification to work in the clinical laboratory, but then focus on developing their anatomic pathology skills. While there are many models that can successfully enlarge the practice sphere of cytotechnologists, if they really want to gain acceptance as full-fledged anatomic pathology specialists, perhaps the easiest route is through smaller hospitals. A license that contains permission to practice in the clinical laboratory is the key to greater responsibility in the anatomic pathology world.

Andrew Renshaw, MD
ASC President, 2012-2013

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4 thoughts on “Designing an Anatomic Pathology Practitioner

  1. There is already a profession that addresses this, Pathologist Assistant. These are usually CTs, MTs or HTLs who enroll in programs that teach these skills and award a Masters degree. I have had a few students who have chosen this route immediately upon grduatioh from the CT program. There is, however, a large Academic Medical Center in the city where I live that has approached the issue in a very visionary way. They are providing the opportunity for their CTs to learn new skills in order to add value to their staff. I applaud them and am encouraged that there are new opportunities for CTs that can be learned on the job. This is a wonderful thing for these CTs, but the majority of CTs work in large reference laboratories and will not be given this opportunity. We need to develop a system where all CTs who want this opportunity can have access to it. Perhaps our professional organizations could spearhead this movement and put talk into action. I for one would be willing to lend assistance.

    • There needs to be a sense of urgency to save Cytotechnology. I’m getting tired of reading people’s thoughts are how to fix it but little to no action is taken. There have been a lot of layoffs in the last decade and many are looking to change careers. Just look at the CMS numbers for the GYN proficiency test as evidence. Who wants to sit chained to the imager pumping out 150 paps a day worrying about losing your job? I work at a facility that does many bronchs. We have pulmonologists and surgeons from other hospitals in the state come observe our procedures a lot. Virtually all of them tell me that they dont have on-site path for adequacy assessment. There is definitely a need there going unfilled. We have to find a way to provide this service along with enough work to condone some full time positions. Labs, schools and our organizations need to be working together to save this field by helping techs gain new skills. Specialization in cytology has to go. There just isnt enough work out there for cytotechs. We need to combine with histology and create Generalists in Anatomic Pathology. Almost all small hospitals have a histotech or two. There should be enough work just in the AP part of the lab without trying to work in the clinical lab.

    • First thing that needs to be fixed is billing. If those cuts CMS proposed go through next year, most of the small and moderate sized labs are going to go under. So the idea of working at small hospital lab in a hybrid job will never come to fruition. They are proposing 50-60 percent TC cuts for many pathology codes including 88173, 88160 series. Second, we need to get rid of client billing for pap tests IMMEDIATELY. They are a loss leader in many labs. When I go on CAP inspections, I see small labs without cytotech that have a decent volume of paps (5000). When I joke with them about hiring a tech and keeping paps in-house instead of sending them out, they let out audible moans. The majority of cytotech work is still the pap and its a notorious money loser. Get rid of client billing and it might be attractive. If we keep on the current track, the paps and jobs will continue going to large centralized labs. Third, the GYN proficiency test has got to go or at least do it every 5 years. The cost is a major burden and is preventing some labs from even considering doing pap testing in-house. I wish good old CAP and ASCP would use the money THEY are making off proficiency testing and use it to help get techs training, preferable histology. We hear all the time about the shortage of lab workers but then we watch highly trained cytotechs getting laid off in large numbers. Molecular is just too niche. Only 5 percent of FISH tests are being done in hospital settings so it likely will stay niche and not help get techs back to work in the short term.

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