An Environmental Analysis of the Driving Forces of Cytology
In 2005 the American Society of Cytopathology (ASC) formed the Study Group on the Future of Cytotechnology to explore the possibility of developing a new cytotechnology profession perhaps modeled after the physician assistant or nurse practitioner. This study group was formed based on what ASC considered “strong” evidence suggesting demand for cytotechnologists’ traditional services was declining while new technologies and treatments were creating new treatment services and patient needs that cytotechnologists could meet but not within their current training and scope of practice.
Based on an analysis of changing market models, payment mechanisms, patient demographics, and technologies The Forbes Group found that the relationships between the clinician and the pathologist and the pathologist and the technologists were undergoing profound reform and redefinition. As a result, perhaps several new professions were emerging to support the practice of cytopathology and clinical medicine in the future. What was clear that is not emerging is a hybrid technologist/pathologist profession, such as that recently was created through negotiations between the Royal College of Pathology and the Institute for Biomedical Sciences in the U.K.
Driven by the growing shortage of physicians, the diffusion of healthcare delivery out of centralized institutional environments, such as hospitals, and into independent practices has transformed the delivery of healthcare from closed, exclusive supply-chains to open, flexible provider networks that are geographically and professionally distancing the pathologist from the technologist.
New transformational technologies such as digital pathology, telemedicine, and nanotechnology are redefining the relationships among various medical specialties and subspecialties, even to the point of questioning whether anatomic and clinical pathology would remain distinct fields in the future. These new technologies also hold the possibility of transforming pathology from being strictly a consultative diagnostic function to a prognostic treatment role.
In each potential future, The Forbes Group asked how such changes in the practice of pathology would influence the support services the profession would demand. It concluded that anticipated changes in cytopathology would place numerous new demands on support functions that cannot be met by today’s cytotechnologists. In fact, ASC instead may have been looking at the features of several different emerging professions and trying to envision them within a single professional.
To support the growing demand placed on cytopathology, there will be new professional requirements in sample harvesting, quality analysis, and management that go well beyond the abilities of today’s cytotechnologists. The introduction of digital pathology brings with it technical skills in digital imaging and data management that today do not exist outside the radiology department. And ASC needs to identify what kinds of technical and professional support will be demanded by pathologists whose practice goes from lab table to bedside.