1. 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

2. Conflict of Interest University and Hospital employee
No commercial interests to disclose

3. Outline Introduction to Canadian healthcare Accreditation Education
Research
Service

4. Canadian Healthcare System
Population: 35.3M
~90% live within 100 miles of US
border
Healthcare: Provincial jurisdiction
Funding: ~70% government 4

5. 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

6. 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

7. Royal College: AFC Area of Focused Competence Transfusion Medicine
Cytopathology
Others in development 7

8. Trends in Education UME: Increasing integration PGME:
Time-based to competency-based
CanMEDS 2015
AFCs – American Board eligibility 8

9. LEADER 9

11. 11

12. Research Operating Personnel Research infrastructure/overhead
Canadian Institutes of Health Research
Charitable foundations
Other
Personnel
Research infrastructure/overhead 12

13. Lab Testing in Canada Hospital laboratories Commercial laboratories
Centralized laboratories (Public Health, etc.)
Other (referred-out testing; point-of-care) 13

14. Hospital Laboratories
~ 55% of total lab work
Inpatients
~4-5% of hospital global budget
“Cost center” 14

15. Commercial Laboratories
~ 45% of total lab work
Outpatients
“Revenue center” 15

16. Service Utilization: “cost center” vs. “revenue center”
Hospital labs – new revenue streams
Commercial labs – capped
Offloading
Public-private partnerships
Outsourcing 16

17. 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

18. 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

19. 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

20. 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