Rule changes over the past few years regarding Pathology Laboratory supervision by the federal governing body on matters relating to the accreditation of pathology laboratories, the National Pathology Accreditation Advisory Council (NPAAC), have meant that less on-site pathologist supervision is now allowed. This especially applies to the top General category pathology laboratories (Categories GX and GY).
The new rules allow for telephone and video link supervision to a much greater extent than even a decade ago. The stated reason for this is a nationwide shortage of appropriately qualified pathologists, especially in the pathologist subcategories of qualification including cytology, specialist haematology, forensic services and genetics.
My working pathology history was in the area of cytopathology and, although I was initially trained in the largest teaching hospital in Perth, Western Australia, I spent the majority of my professional career in a rural NSW pathology setting.
The diagnostic pathology science of Cytology is a specialised area of pathology that requires scientists to undertake years of extra training and study to become proficient. Hence the number of cytologists was never large. Australia-wide there are now between 1,000 to 1,500 cytology positions, the vast majority residing and working in state capitals.
When I came to rural NSW pathology in the 1990’s, there were approximately six rural cytology positions employed in the government pathology laboratories in the state and a single rural cytology position employed by the private sector. So the number of trained cytology positions was never large and very much fewer in rural areas. However, as of 2016-17 they are non-existent in any rural NSW pathology setting, private or public sector. Similarly, numbers are greatly reduced for most of the other specialist pathology positions, especially pathologists themselves.
There has also been a marked decline in local autonomous pathology laboratories, of which the Albury/Wodonga region is a prime example. This region had three separate pathology providers in 2010 and has now been reduced effectively to a single pathology provider. This shrinkage has caused the loss of local pathology positions at all levels and with that loss the loss of local expertise. This scenario is being repeated in many rural areas that previously had multiple pathology providers.
The decreasing choice of pathology providers and the increasing centralisation of specialised pathology services and positions matters because it causes delays between specimen collection and the pathology reports being issued when specimens are referred elsewhere.
If your pathology is not referred elsewhere you won’t notice much change in the timeframe for commonly requested pathology tests. It’s only when that pathology work falls outside of what your local pathology laboratory can perform that you may notice it takes longer, sometimes much longer, for a report to be issued.
Things don’t necessarily improve with time and that now especially applies to rural pathology services.
The take away from this is to ask, firstly, to what category type laboratory is your pathology testing is being referred?
Secondly, is the testing asked for by your doctor or specialist able to be performed by that local laboratory or will the result be delayed by it being sent elsewhere to a larger laboratory?
This information is important to know because the time delays can be substantial even with modern specimen transfer and electronic reporting regimes.
Robert McGuigan
Chief/Senior Cytologist (rtd)
MSc. Applied medicine (Cyt); Assoc Dip Cyt; Assoc Dip Lab Tech; CT:ASC; CMIAC
