Pathologist shortage a national problem: officials
Inconsistent rules for monitoring medical tests and chronic underfunding in pathology
Last Updated: Friday, February 15, 2008 | 1:36 PM AT
CBC News
Chronic underfunding has led to a nationwide shortfall of pathologists, with many of them now compelled to work well past retirement age, as well as a failure to consistently double-check their diagnoses, several medical associations say.
"For the last more than 10 years there's been a very significant shortage of pathologists," said Jagdish Butany, president of the Canadian Association of Pathologists. "It's not just pathologists we're short of; pathology laboratories in general have been very underfunded."
The Miramichi Regional Health Authority announced on Monday that biopsies taken over a 12-year period will be audited. An independent review of 227 cases from 2004-05 found that for 18 per cent of biopsies, the pathologist provided incomplete results, and in three per cent of cases, they misdiagnosed the malady.
About 15,000 test results will be audited, but there aren't enough pathologists in the Atlantic region to complete all the work in a timely fashion, said Rosemary Henderson, a pathologist at Queen Elizabeth Hospital in Charlottetown.
A pathologist is a physician who specializes in diagnosing diseases by examining tissue, blood and body fluids in a laboratory.
Governments need to bring more qualified people into the pathology field by making more residency positions and training programs available, Butany said.
The number of medical-school spots available to students interested in pathology is beginning to increase in Atlantic Canada, said Dr. James O'Brien, vice-president of medical affairs at the Atlantic Health Sciences Corp.
"But by the time the students going in go through four years of medical school, five years of residency and one or two years of post-grad fellowship, you're out way beyond 2016, 2017 before the first ones start to appear for you," O'Brien said.
The shortage of pathologists has lead to several hospitals trying to retain their doctors even as they reach retirement age.
The Miramichi health authority has not named the former pathologist who is alleged to be connected to the flawed tests, but they are likely referring to Dr. Rajgopal Menon, who filled the position during the period in question. Menon was 72 when he was suspended in February 2007 after complaints of incomplete diagnoses and delayed lab results.
The situation at the Miramichi hospital is uncommon, said Andrew Padmos, CEO of the Royal College of Physicians and Surgeons of Canada, but it does highlight the shortage of trained personnel needed to help make correct diagnoses.
"If you talk to the pathologists here or at any other regional centre, they know that even the best pathologist is going to have errors a certain percentage of the time," said Ed Schollenberg, registrar of the College of Physicians and Surgeons of New Brunswick.
Hospitals should have at least two pathologists to ensure the results of each diagnosis are double-checked, said retired New Brunswick pathologist John MacKay.
"Why do they put two pilots on an airplane? Why do they put two engines on an airplane? In case one breaks down, they have a back up," Mackay said.
Hospital officials CBC News spoke to said that a rough guideline suggests 10 per cent of diagnoses should be randomly checked, but that policy is voluntary and most hospitals decide on their own how to check their pathologists' work.
Fredericton's health authority indicated it randomly retests about five per cent of its cases. Moncton's Georges Dumont Hospital officials said it has no policies in place for random reviews.
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