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R P Vance

Publications and source records attributed to R P Vance.

At least 19 recordsLinked to original sources
PubMed1999

Some thoughts about the past and future of pathology workforce.

Comprehensive information on pathology workforce is currently not available. Prudent planning for pathology Graduate Medical Education (GME) requires more timely data than presently exist. In addition, we lack understanding of workforce kinetics in academic pathology which often serves as a buffer in times of surplus. Although the heads of community hospital and private laboratory groups control the majority of decisions regarding pathology workforce, a database of these decision-makers does not exist. However, information from the most recent published sources strongly suggests that a significant surplus already exists. Furthermore, this position is supported by earlier unpublished work from the 1994-1995 Conjoint Committee on Pathology Enhancement (CCOPE) surveys.

Education, Medical, Graduate↗
PubMed1997

Outcomes management. New opportunities in a shrinking pathology market.

With the increasing prevalence of managed care, the short-term and long-term outlook for the pathology workforce has changed dramatically for the worse. Among the many new opportunities that are available for pathologists, one of the most significant is outcomes management. Outcomes management is a natural evolution for pathologists and requires skills that are typically found in well-respected practicing pathologists. One example of a pathologist-led department of outcomes management is presented.

Laboratories, Hospital↗
PubMed1994

Interprofessional ethics and public accountability.

Many ethical assessments of contemporary moral dilemmas have failed to appreciate the uncertainty and ambiguity that practitioners confront, especially when new and emerging technologies are involved. In an attempt to provide a more realistic and compelling approach to these problems, the seventh CAP Foundation Conference adopted an interprofessional perspective. Interprofessional ethics borrows from the American pragmatist tradition of John Dewey and Jeffrey Stout and the neothomistic perspective of Edmund Pellegrino and David Thomasma. Professions are public institutions that have made promises to preserve and enhance social goods, eg, health, justice, and tolerance. Yet, in a pluralistic democracy, each institution inevitably finds its moral presuppositions legitimately challenged by the presuppositions of others. The uncertainty and ambiguity that good physicians, lawyers, journalists, and regulators regularly confront arise from the partiality of each of their ethical perspectives. Hence, the more seriously we take our obligations to maintain public trust, the more clearly we should recognize our dependence on other professions.

American Medical Association↗
PubMed1993

National pathology manpower survey of 1991. Projected needs in community hospitals and private laboratory practice.

The third survey of a representative group of pathologists in community practice confirms the prediction based on the 1987 and 1988 surveys that there would be a growing deficit in the number of pathologists in this practice setting. There is an increasing number of reported vacancies in pathology groups and a significant increment in the percentage of older pathologists, with 32% being older than 54 years of age in 1991, compared with 25% in 1987. Projections based on the plan of individual respondents to retire and the anticipated changes in practice groups suggest that there will continue to be more pathologists leaving practice than new pathologists entering the specialty.

Adult↗
PubMed1992

Pathology trainee manpower. Historical perspectives.

Discussions of pathology manpower typically involve short-term projections. For example, the best current data indicate a significant shortage of community-hospital/private-laboratory pathologists over the 5-year period from 1988 through 1993. Even though such short-term predictions are important in the debate over strategic planning in pathology, they need to be placed in a broader historical context. Therefore, we present the long-term trends in pathology trainee manpower. These trends indicate why predictions of a shortage should not come as a surprise.

Education↗
PubMed1992

Problems and opportunities in pathology manpower.

Speculations regarding the future of pathology manpower most often depend on whether the perspective taken is pessimistic or optimistic. In this article, I propose that the pessimist-optimist options are inadequate. To speculate responsibly about the future, our first task must be to understand clearly the present problems and opportunities. Problems facing pathology are numerous: (1) practitioners are retiring at an increasing rate, (2) inadequate numbers of newly trained pathologists are available to fill vacancies, (3) training program numbers continue to decline, (4) attrition of trainees is substantial, and (5) recruitment of new trainees encounters significant barriers. Despite these problems, significant opportunities to improve training program environments, decrease attrition, and increase recruitment are available. The future of pathology will depend on how we respond to the problems and opportunities that we currently face.

Data Collection↗
PubMed1991

Pathology trainee manpower: APC program directors' questionnaire, 1989 results.

The shortage of pathologists is being created by a combination of three factors: inadequate trainee recruitment, high trainee attrition, and accelerating practitioner attrition. The current report provides comprehensive data on the first two factors. The third factor is, by every estimate, likely to become worse over the decade beginning in 1988. Demographics show that greater numbers of pathologists will be reaching retirement age every year. The trainee attrition problem appears to be very serious, and we currently do not have data on why residents leave pathology training, when they leave, or where they go (ie, to what other specialties, etc). Future APC program directors' questionnaires must address these issues. Yet, we must also solve a serious problem in recruitment. Currently, about 35% to 38% of all first-year pathology residents decide to enter pathology only after entering residency programs in other specialties with the intent to remain in that specialty. Therefore, we need to recognize both the problem of inadequate recruitment and the problem of high attrition in order to address the serious manpower shortage facing pathology. When shortages occur in specialties, practitioners tend to cease performing the most time-intensive tasks (eg, autopsy). However, shortages of the magnitude predicted for pathology suggest that many more tasks traditionally performed by pathologists may very well be in jeopardy. In such a setting, other specialties (especially subspecialties) are likely to fill the void. This is likely to be catalyzed by the emergence of the new resource-based relative-value scale. Subspecialties in medicine and surgery will be looking for additional ways to retain income when they cannot expect as much for their services as before. This scenario is especially worrisome given the necessity for the practice of pathology to expand into the domain of molecular biology. Unless problems causing the shortage in pathology manpower are addressed, not only are our traditional practices threatened, we are also likely to have inadequate manpower to take advantage of those areas crucial for the future of pathology.

Career Choice↗