Workload measurement in subspecialty dermatopathology

Abstract

The RCPath histopathology workload guidelines underestimate the workload achievable by an experienced dermatopathologist, and thus are not directly applicable to subspecialty dermatopathology practice. Hourly work rates 3-4 times that recommended by the RCPath workload matrix are routinely achievable, but extrapolation to yearly workload estimates requires detailed knowledge of practice pattern and time required for non-clinical duties such as teaching, research and administration.

Do the RCPath-published workload guidelines underestimate the work rate achievable in subspecialty practice in cellular pathology?

“…In this issue, Horne et al 3 ( see page 435 ) provide evidence that “experienced” dermatopathologists are capable of workloads far in excess of that recommended by the RCPath workload matrix for dermatopathology 1. The authors comment, “It is intuitive that specialist dermatopathologists can handle higher skin pathology workloads than general surgical pathologists without such subspecialty expertise.” Three dermatopathologists, in their time–motion study, averaged 43 RCPath points/h compared with a proposed reasonable workload of 10 points/h cited in the RCPath document 1 3.…”

“…The authors comment, “It is intuitive that specialist dermatopathologists can handle higher skin pathology workloads than general surgical pathologists without such subspecialty expertise.” Three dermatopathologists, in their time–motion study, averaged 43 RCPath points/h compared with a proposed reasonable workload of 10 points/h cited in the RCPath document 1 3. This approximates to 16 case requests (21 specimens) per hour and equates to an individual annualised workload of 12 800 cases based on five reporting programmed activities (PA) of 4 h each and a 40-week year (for annualised individual workload calculation to account for leave and routine sickness).…”

“…Importantly, though, working in a smaller number of specialties facilitates greater familiarisation with a specialty, and hence the potential to comfortably report a given workload faster, while maintaining standards. The publication by Horne et al 3 lends more support to the subspecialisation route of service development by highlighting a three to four times greater work rate achievable by a group of expert dermatopathologists than guidelines published by the RCPath. We note that all the skin cases were cut-up by Biomedical Science (BMS) staff, and therefore all the “college points” accrued were for the microscopy part of the reporting process.…”

“…Horne et al 3 highlight the difficulty in factoring achievable workload into a robust job plan given the other non-clinical roles of a consultant pathologist, including teaching, administration, research and management. We have used a Microsoft Excel spreadsheet to generate a departmental job plan, within which, time required for these non-clinical and leadership roles is highlighted by individual consultants, and hence remaining available direct clinical time, including reporting time, is identified.…”

How overworked are pathologists? An assessment of cases for histopathology and cytopathology services

“…6 Guidelines on workload provide a mechanism to ensure safe medical practice. Workload, in this light, refers to the number of pathology cases that a pathologist examines per year.…”