State of the Society by Ritu Nayar, MD, ASC President

Ritu Nayar, MD

State of the Society
Ritu Nayar, MD, ASC President

I would like to take this opportunity to review where the ASC has been, where we are today, and where we are going. Let me begin, however, with some background on the current state of the nation’s health care as it pertains to members of our profession. The basic challenges in the rapidly evolving health care arena are not unique to pathology or cytopathology- namely, a relatively new and evolving health care system, workforce shortages, and economic pressures. With the implementation of the Affordable Healthcare Act, there will be changes in consumer demographics and new delivery systems. These changes, along with an increased emphasis on health information technology and advances in genomic medicine will demand that we, as health care providers, continue to be innovative, revamp our training and education programs, and deliver our services quite differently than we did and perhaps still do today.The issue of workforce shortages in pathology and laboratory medicine has been on the minds of the federal government, our professional societies, and our leaders for some time. Our sister organizations, The College of American Pathologists (CAP) and The American Society of Clinical Pathology (ASCP), have done substantial work in this area.1,2 Although significant shortages already exist in many areas of laboratory medicine, it has been projected that employment of clinical laboratory technologists and technicians will grow by 13% between 2010 and 2020.3 Pathology and laboratory medicine also have an aging workforce, associated with recruitment, and training funding challenges. Consider that pathologists are the second oldest practicing specialty (mean age of 57.5 years).4 The projected increase in the number of practicing pathologists of only 3% during the 2000 to 2020 time frame versus the projected required increase of 23% is very concerning.5-7 The Council on Graduate Medical Education sees graduate medical education as an essential public investment in tomorrow’s health care system that furthers the nation’s goal to attain the triple aims of better health, better health care, and lower costs. Approximately $13 billion per year is invested in graduate medical education, which though a sizable amount, is <1% of the $1.4 trillion of federal and state expenditures on health care.8,9 The Council on Graduate Medical Education believes that better targeting of graduate medical education money by providing more effective training programs will result in a workforce that is better aligned with the country’s future needs.8 Although the medical community is considered to have been slow in responding to changing health care needs, in the past years, a number of new requirements for and from medical schools and accreditation organizations have been put forward. Some of these are already in effect and others need to be implemented in 2014-2015. They include competency-based medical education, accreditation changes such as the Next Accreditation System (NAS), the Clinical Learning Environment Review Program, and milestones, along with new teaching and learning methods such as practice-based learning.

Specifically in cytopathology, our practice is changing and continues to do so, in both gynecologic and nongynecologic areas, bringing with it opportunities for us to be innovative and to take charge of our future. Winston Churchill reminded us that “a pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.”

So what has ASC done and what are we planning to do to address our evolving professional and member needs in the coming year(s)?
Our past leaders, so many of whom have been my personal mentors and role models, have paved the path for us over the past decade. The history of ASC’s strategic discussions regarding workforce and preparedness began in November 2001, when ASC members assembled with other cytology leaders at the Cytotechnology Education Consensus Retreat, to discuss the challenges facing cytotechnology educational programs, cytology professionals, and employers. Between 2001 and 2006, ASC conducted surveys, gathered information, and explored ways to define the scope of practice of cytotechnologists in the context of workforce needs. Then ASC developed strategies for cytology educators to gear curricula to address those needs. In 2006, The Forbes Group was hired as a consultant and presented the ASC with a report titled “Plotting the Future of Cytotechnology: An Environmental Analysis of the Driving Forces of Cytology.10” This document outlined changes in market forces and the relationships between pathologists, clinicians, and other specialists that might lead to the emergence of new professions (or professional roles) in the future, and it recommended that the ASC hold an Alternative Futures Summit to engage potential stakeholders in dialogue encompassing different outcomes identified in the report. A summit was held in November 2007 that produced a white paper titled “Facing the Future of Cytopathology,” focused on discerning the future needs of our profession.11 This document remains a valuable resource for future directions for the cytotechnology professional. The Cytotechnology Program Review Committee (CPRC), sponsored solely by the ASC for many years, has championed this cause, and just a few days before our annual meeting in November 2013, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) approved “The Standards and Guidelines for the Accreditation of Educational Programs in Cytotechnology,” which detailed new entry-level competencies (ELC) for cytotechnologists. The new ELC’s place the curriculum on a modern footing designed to integrate the emerging areas of molecular medicine and digital technology and to provide the basic tools necessary to expand the cytotechnologist’s role in diagnostic pathology. The profession needed these changes to allow for the potential of expanded roles in the future. Congratulations and thanks to everyone who worked so hard to get this done!

Today, the ASC has a committed, experienced executive director and staff and a new strategic plan with goals spanning organizational, financial, membership, educational, advocacy, quality, and research-related initiatives. Our greatest asset, however, is you, our members, who come together to support and volunteer to help sustain the ASC and move us forward.

My priorities for the coming year are based on the current “big picture” regarding evolving health care dynamics and the evaluation of our ASC member needs as assessed by surveys and personal communications. So what do our members value about being a part of the ASC family? Professional growth, education, networking, and friendships are high on the list. Thus, I have chosen to focus predominantly on 3 of our strategic goals: education, advocacy, and increasing ASC membership value, with emphasis on teamwork and partnerships.

The ASC’s mission is accomplished in large part due to the energy and dedication of our committee chairs and members toward advancing our strategic goals and keeping our vision alive and focused. This year we have 6 standing committees and 16 ad hoc committees with common responsibilities as well as specific goals. I have put forth expanded initiatives relevant to our challenges and member needs and also appointed additional members to motivate the committees to come up with great ideas and products that will foster our efforts and the ASC mission. In addition, we have 3 ad hoc task forces that have been established to fulfill specific short-term goals. This year, 145 of 294 volunteer positions were new appointees and 85% of new volunteers were assigned to a committee. If you would like to offer your time and expertise and get involved on ASC committees, do take a few minutes to fill out the volunteer form, which can be found on the member section of the ASC Website. No effort is too small! The ASC also appoints a large number of liaisons and representatives to various other organizations and committees to collaborate and effectively represent the interests of cytopathology. Please refer to the ASC Website for a complete listing of ASC committee initiatives and members, so that you can review our goals for the coming year.

With respect to ASC’s support of pathologists’ and cytotechnologists’ training and accreditation efforts:

1. The ASC Cytopathology Program Directors Committee will be compiling resources for our residency and fellowship program directors that will help provide guidance for the many new training and accreditation requirements. This committee also organizes the annual meeting’s strategies in cytopathology education session in parallel with the session for cytotechnology training. To ensure representation for cytopathology training and accreditation requirements, the ASC and Papanicolaou Society of Cytopathology (PSC) have joint representation on a newly formed ad hoc Fellowship Directors Committee developed by the Association of Pathology Chairs. The ASC Progressive Evaluation of Competency (PEC) program has proved to be an extremely popular product for residents and fellows and it will be further strengthened in 2014.

2. In 2011, the ASC welcomed ASCP, ASCT and CAP as CPRC co-sponsors. In 2013, the CPRC appointed a subcommittee to undertake the task of providing cytotechnology programs with resources to meet the new entry-level competencies that will take effect in July 2014. The ASC is establishing a specific area on its Websited CELL (Cytology Education and Learning Lab) to support this endeavor. Rest assured that this dynamic collaborative group will represent us well.

I strongly believe in teamwork and that as professional organizations there is more that unites us than divides us. Thus, we have recently taken the following steps to make sure that ASC participates as a partner in organized leadership, ensuring that we are proactively associating ourselves with the right efforts and advocating for our profession.

1. “We can do more with less.” Sounds familiar right? In November 2013, ASC and the Papanicolaou Society of Cytology (PSC) appointed a joint ASC-PSC Task Force to review the “Current and Future Role of Cytologic and Small Biopsy Specimens in Ancillary Testing.” We hope that the document generated by this group will provide good guidance on the value of cytopathology in today’s pathology and personalized medicine practice, while also specifying qualitative and quantitative requirements.

2. ASC has joined the Pathology Collaborative Round Table, which was implemented in January 2013 by the Association of Pathology Chairs with the aim of facilitating networking and communication and promoting synergistic planning about issues and joint initiatives of high priority to our profession.

3. Primary human papillomavirus (HPV) testing is being piloted and/or is near implementation in the United Kingdom and parts of Europe. In the United States, we have a pending premarket approval supplement to the US Food and Drug Administration seeking the addition of a cervical cancer primary screening indication for the cobas HPV test (Roche Molecular Systems).12 The American Society for Colposcopy and Cervical Pathology and the Society for Gynecologic Oncology have organized a committee to provide clinical guidance on primary HPV testing, as a mechanism for cervical cancer screening in the United States. The ASC/CAP/ASCP jointly appointed 2 pathology representatives and 1 alternate to this group, which began its work in November 2013. Guidance from this effort is expected to be forthcoming in 2014.

4. A Multi Society Pathology Workforce Summit has been organized by CAP, Association of Pathology Chairs, ASCP, and USCAP. The goal of this meeting, which is scheduled for December 2013, is to articulate the broad strokes of a statement of workforce needs in pathology and laboratory medicine suitable for sharing with health policy decision makers and key stakeholders. The focus will be on changes in training (and recruitment) of pathologists and laboratory professionals, how these shortages are likely to affect the workforce’s ability to fulfill its responsibilities to patients, and to identify shared opportunities to advance workforce issues. ASC and our interests will be represented in person at this summit.

5. The ASC collaborates with ASCP, American Society for Cytotechnology, CAP, International Academy of Cytology, and PSC on the Cytopathology Education and Technology Consortium (CETC); ASC also provides the CETC’s administrative leadership support. The history of the CETC is rich and interesting; I refer you to the September 2013 issue of the ASC Bulletin to read about its accomplishments on behalf of cytopathology.13 In 2013, we updated the CETC policies and goals to align them with the current practice of cytopathology. Look out for an updated HPV test utilization statement to be published in early 2014 by this group, as well as other collaborative efforts that can be best achieved by multisociety participation.

6. The ASC’s Companion Meeting Committee organizes educational sessions at a number of other pathology meetings, in coordination with both national and international professional organizations. In the coming year, we hope to expand these further to include non-pathology organizations and begin to give some awards in recognition of participants’ work in cytopathology.

7. ASC has a memorandum of understanding with the ASCP, and we recently signed a nondisclosure agreement with the CAP to explore additional areas of overlapping interest. We look forward to further increasing collaborations with both of these societies. We are also actively exploring nonpathology organization collaborations.

The above mentioned partnerships pertain to advocacy for our profession; however, my additional goals in the coming year are to increase advocacy efforts with allied health care organizations and patient advocacy groups and to help connect ASC members who wish to volunteer to help with education, training, and hands-on services required in low-resource areas. This charge is among the initiatives assigned to the newly named ASC Public Information and Advocacy Committee.

Our members (and nonmembers) have asked about ASC’s support of the local and state cytopathology organizations. The identified needs include time, and costeffective networking, and continuing medical education credits. Over the past year, the ASC Executive Board cytotechnologists and representatives from the ASCP have been developing a course that will be held in 2014 in California. In addition to the ASCP, the California Society of Pathologists will also participate in this joint endeavor. This upcoming year, the Executive Board will look into how ASC may be able to provide support to sustain local/state cytology societies, and if warranted, the details of such support and a pilot will follow in 2014.
ASC’s educational efforts are strong and appreciated by our members. The Scientific Program and Cyto-eConference committees and The ASC Bulletin Editorial Board must be congratulated for continuing to provide us a wonderful balance of basic research and new clinical applications that keep us current. We now have JASC to add support to the ASC education and research missions. ASC provides a significant number of Accreditation Council for Continuing Medical Education (ACCME) continuing medical education/self-assessment module credits. Make sure you know how to take advantage of free CME and SAMs offered by ASC. In the coming year, ASC will also take the lead on 2 exciting new educational endeavors: (1) establish a standardized terminology for urinary cytology, in collaboration with the International Academy of Cytology, and disseminate it via a print atlas and educational web atlas; and (2) publish the third edition of the cervical cytology Bethesda atlas and update the corresponding Web atlas. Both these educational task forces will ask for your input on draft recommendations on the ASC Website. Please do participate and share your opinion, and stay tuned for the results to be shared in various upcoming national and international forums. A newly named and expanded ASC Website Committee has been charged with coordinating the look, functionality, and ease of finding relevant information for ASC Website users.

In summary, the society is proactively keeping abreast of anticipated changes in the health care arena by: (1) providing continuing education, discussion forums, and timely information to our members; (2) being engaged and present in the right place, at the right time; and (3) partnering with other professional organizations, other health care workers, and patients to help shape the future of our profession. These initiatives are true to the ASC visiondSaving Lives One Cell at a Time through innovation, teamwork, education, and advocacy. I am excited and honored to have been given the opportunity to lead our wonderful society and look forward to “roaring” with all of you in the coming year! Thank you in advance for your dedication, commitment, and hard work on behalf of the ASC, cytopathology, and the patients we serve.

References
1. ASCP 2013 Task Force on the Laboratory Professionals Workforce. Building a laboratory workforce to meet the future. Available at: http://www.ascp.org/PDF/Advocacy/ASCP-Task-Force-on-Lab-Pros.pdf. Accessed November 4, 2013.
2. Robboy SJ, Weintraub S, Horvath AE, et al., for the Workforce Project Work Group. Pathologist workforce in the United States [e-pub ahead of print]. Arch Pathol Lab Med. http://dx.doi.org/10.5858/arpa.2013-0200-OA, Accessed November 4, 2013.
3. Department of Labor, Bureau of Labor Statistics. Employment projections. May 2012. Available at: http://www.bls.gov/emp/ep_table_201. htm. Accessed November 4, 2013.
4. AAMC 2012 Physician Specialty Data Book. Available at: https://www.aamc.org/data/. Accessed November 30, 2013.
5. Health Resources and Services Administration. Physician supply and demand: projections to 2020. Available at: http://bhpr.hrsa.gov/healthworkforce/supplydemand/medicine/physician2020projections.pdf. Accessed November 4, 2013.
6. American Association of Medical Colleges. The complexities of physician supply and demand: projections through 2025. Available at: http://www.innovationlabs.com/pa_future/1/background_docs/AAMC%20Complexities%20of%20physician%20demand,%202008.pdf. Accessed November 5, 2013.
7. The physician workforce: projections and research into current issues affecting supply and demand. U.S. Department of Health and Human Services, Health Resources and Services Administration. December 2008. Accessed November 30, 2013.
8. Council on Graduate Medical Education. Twenty-First report: improving value in graduatemedical education.Available at: http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/twentyfirstreport. Accessed November 4, 2013.
9. Centers for Medicare and Medicaid Services. National health expenditure projections 2009-2019: forecast summary. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trendsand- Reports/NationalHealthExpendData/downloads/proj2009.pdf. Accessed November 4, 2013.
10. The Forbes Group. Plotting the future of cytotechnology: an environmental analysis of the driving forces of cytology. Available at: www. cytopathology.org. Accessed November 4, 2013.
11. ASC. Facing the future of cytopathology. Available at: http://www.cytopathology.org/wp-content/dynamic_uploads/3439.pdf. Accessed November 4, 2013.
12. Roche Molecular Diagnostics. Roche submits filing to FDA for cervical cancer primary screening indication for cobas HPV test. Available at: http://molecular.roche.com/News/LocalNews/Pages/RochesubmitsfilingtoFDAforcervicalcancerprimaryscreeningindication forcobasHPVTest.aspx. Accessed November 4, 2013.
13. ASC Bulletin September 2013. Available at: http://www.cytopathology.org/wp-content/uploads/2006/02/The-ASC-Bulletin-September-2013. pdf. Accessed November 30, 2013.