What We Do
You may not be familiar with what a Pathologist does. Your first contact with a Pathologist will likely be a report or diagnosis that we perform for you or perhaps a bill for those services. But Pathologists perform a wide variety of unique and very important functions that help provide you with optimal care and help guide your "personal" physician in your care and treatment.
If you want to learn more about "The Doctor's Doctor," please read on...
What does it take to become a Pathologist?
Pathologists are first and foremost physicians. After obtaining an undergraduate college degree, an individual must attend medical school for four years and earn a Medical Doctor degree (or equivalent, in other countries). After medical school, to become a Pathologist, a Medical Doctor must complete a residency in Pathology. There are two branches of Pathology, Anatomic and Clinical. Most Pathologists are trained in both areas, which requires at least 4 years of training after medical school. Often Pathologists will continue in a subspecialty area of Pathology after their residency, called a "fellowship". Depending on which area is selected this can require between one and three additional years.
Just how long is this process? In most cases, Pathologists have between four and seven years of training after having completed medical school!
What is "Board Certification"?
Once a Physician has completed the above training, there are rigorous and comprehensive tests that are taken that cover a multitude of areas of a Pathologist's training. For Anatomic and Clinical Pathology, the test is three full days long. Only after passing this test can a Pathologist be "Board Certified". Some of Pathology's subspecialties also have additional Board Certification, however not all do.
All 4path pathologists are Board-Certified in Anatomic and Clinical Pathology. In addition, some hold subspecialty boards in Dermatopathology or Hematopathology.
What is "Anatomic Pathology"?
Anatomic Pathology can be best understood when you look at the first word in the specialty ... "Anatomic". This refers to "anatomy" or the study of the body and includes the fields of Surgical Pathology and Cytopathology. The practice of Surgical Pathology looks at the tissues and cells of the body for evaluation and detection of disease. It includes examination of specimens removed or sampled (biopsied) in surgery or other locations, such as the doctor’s office or in radiology. The pathologist is responsible for the examination of the tissue and giving a diagnosis to your doctor.
Cytopathology (also known as Cytology), like Surgical Pathology, is concerned with the evaluation and detection of disease in tissues. However, in Cytopathology, preparations of individual cells, rather than intact tissue, are examined. Cytologic examination is performed on just about any organ or fluid from the human body, but the most commonly recognized test is the Pap test. This is a screening test to help detect abnormalities of the cervix that would require further examination by biopsy or other techniques. It is not intended to be the "conclusive" means of examination of the cervix, but rather a "screening" technique. Cytologic examination is performed in concert with highly trained and qualified cytotechnologists, who look at the preparations and help locate abnormal cells for the pathologist to evaluate. This is an extremely important and difficult job. Sometimes there are just a few abnormal cells in the background of millions of normal cells!
One special area of Surgical Pathology is the examination of bone marrow biopsies. Many blood disorders, such as anemia, leukemia and pre-leukemic conditions, are complex and require the pathologist to review slides of the circulating blood, slides of the marrow, blood and a bone marrow biopsy at the same time. This “bone marrow examination” also includes reviewing the results of red blood cell, white blood cell and platelet counts and the results of special bone marrow studies such as flow cytometry and cytogenetics. All of this means that bone marrow biopsies usually take longer to interpret than other pathology specimens, often 2-5 days as opposed to the typical 1 day turn around time. This is so that the final diagnosis and report can give the best possible interpretation of any blood cell abnormalities present.
The pathologist will send a bill to you (or your insurance) company for the examination they provide. This is called the "professional component". In most cases, there will also be another charge from the hospital laboratory for the preparation of the slides (called the "technical component") for the pathologist to read. This is an involved process requiring the expert skill of histotechnologists. The processing of specimens involves many steps and typically takes between 12 and 18 hours to complete, in most cases.
What is "Clinical Pathology"?
Clinical Pathology is quite different from Anatomic Pathology, and is primarily concerned with the "clinical laboratory". That laboratory is where blood, urine, and other body fluids are examined with complex machinery to evaluate the chemical and cellular makeup of the specimen. It also includes identification of infectious agents in microbiology and the preparation of blood products in blood bank to provide as safe transfusions as possible. The Clinical Pathology Laboratory functions on a day-to-day basis because of highly trained and qualified Medical Technologists. The pathologists do participate in the direct performance of some of the tests, however they are responsible for the oversight of the entire clinical laboratory. This oversight includes assurance that the tests, examination and procedures are properly performed, recorded and reported by the medical technologists. The pathologists interact and educate the general medical staff (i.e. other non-pathologist doctors) regarding issues of the laboratory operation, quality and test availability. Pathologists design protocols for testing and establish parameters for performance of clinical laboratory testing. They may help doctors select the optimal test for patients, as well as appropriate follow up testing. Pathologists supervise the professional activities of the Medical Technologists and assist in the evaluation and final disposition of abnormal results.
Pathologists also help select new tests to be performed in the laboratory and help ensure that they are properly performed by overseeing the areas of Quality Control, Quality Assurance and Quality Improvement. Finally, the pathologist assures that the laboratory is in compliance with state license and certification standards, Medicare requirements, voluntary accreditation standards and Federal certification standards.
Why do I get a bill from the Pathologist?
If a pathologist performs an examination on a tissue specimen, (i.e. an "Anatomic" service...see above), you will receive a bill for their service. This bill is highly structured to represent the various services provided. The method of determining the billing has been standardized by the American Medical Association.
If you were in the hospital and received a blood test or some other type of test that was performed in the clinical laboratory, you may receive a bill from the pathologist for the indirect services provided to you. This is called the "professional component", and are different from the "technical component" billing from the hospital to cover the costs of performing the individual test. The "professional component" are essential services provided by the Pathologists, that help ensure that you received quality laboratory testing by the Medical Technologists in the hospital laboratory. Like anatomic services, the method of billing is highly structured according to standards put out by the American Medical Association.
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