Pathology in Canada Richard G. Hegele, MD, FRCPC, PhD Professor and Chair, Dept. of Laboratory Medicine & Pathobiology University of Toronto Chief, Dept. of Paediatric Laboratory Medicine The Hospital for Sick Children richard.hegele@utoronto.ca www.lmp.utoronto.ca/
Conflict of Interest University and Hospital employee No commercial interests to disclose
Outline Introduction to Canadian healthcare Accreditation Education Research Service
Canadian Healthcare System Population: 35.3M ~90% live within 100 miles of US border Healthcare: Provincial jurisdiction Funding: ~70% government 4
Accreditation Laboratory Education Structures and regulations vary by Province Education UME: University (LCME; CaCMS) PGME: University (Royal College of Physicians and Surgeons of Canada) Fellowships: Hospital-based (+ University diploma) Hospital-University affiliation agreements
Royal College of Physicians and Surgeons of Canada “Primary” Lab Medicine Specialties Anatomical Pathology General Pathology Hematological Pathology Medical Microbiology Neuropathology Subspecialties Forensic Pathology (Medical Biochemistry) 6
Royal College: AFC Area of Focused Competence Transfusion Medicine Cytopathology Others in development 7
Trends in Education UME: Increasing integration PGME: Time-based to competency-based CanMEDS 2015 AFCs – American Board eligibility 8
LEADER www.royalcollege.ca 9
www.mainequalitycounts.org 11
Research Operating Personnel Research infrastructure/overhead Canadian Institutes of Health Research Charitable foundations Other Personnel Research infrastructure/overhead 12
Lab Testing in Canada Hospital laboratories Commercial laboratories Centralized laboratories (Public Health, etc.) Other (referred-out testing; point-of-care) 13
Hospital Laboratories ~ 55% of total lab work Inpatients ~4-5% of hospital global budget “Cost center” 14
Commercial Laboratories ~ 45% of total lab work Outpatients “Revenue center” 15
Service Utilization: “cost center” vs. “revenue center” Hospital labs – new revenue streams Commercial labs – capped Offloading Public-private partnerships Outsourcing 16
Ontario: Offloading Moving GI endoscopy out of hospitals into community clinics ? Impact on GI pathology, incl. residency training Hepatitis C outbreaks at three Toronto colonoscopy clinics kept secret Toronto Star September 27, 2014 Toronto Public Health, which revealed the outbreaks when pressed by the Star, said 11 patients were infected and tainted sedative injections were the “possible” cause in all cases. “It has gone beyond appalling that the same mistakes are being repeated and are not being reported” - France Gélinas (NDP Health Critic) 17
Ontario: Public-Private Partnerships Toronto Star, Oct. 9, 2014 Secret government reports released Thursday by the Progressive Conservatives reveal the province is finalizing a deal to spend $317 million to purchase the brand-new - but virtually empty building. 18
Alberta: Outsourcing Australian company wins $3-billion contract to run lab services in Edmonton Edmonton Journal October 17, 2014 EDMONTON - An Australian company has won a $3-billion, 15-year contract to provide laboratory services in Edmonton. Sonic Healthcare Limited was selected by Alberta Health Services after a request for a proposal process that began last year. Sonic expects the contract will initially generate annual revenue of more than $200 million. The anticipated contract term is 15 years, with an option to extend the agreement for another term. 19
Conclusions “Publically-funded” healthcare – myth vs. reality Education UME: Visibility PGME: Competency-based Fellowships: AFCs Research Non-traditional sources of support Service Utilization, funding, offloading, public-private partnerships, outsourcing 20