BECAUSE OF GENETIC TECHNOLOGY, the profession of anatomic pathology may be poised for a golden age. The range of new technologies and diagnostic assays heading for clinical use have the potential to give pathologists the ability to detect disease with greater precision. They will also allow pathologists to guide clinicians to the most effective therapies.
In this golden age of genetic medicine, the biggest market will be oncology. Every healthcare expert predicts explosive growth in rates of cancer, driven primarily as the baby boomer generation moves into their retirement years. For the anatomic pathology profession, this is a fortuitous conjunction of two events—new genetic knowledge and a huge demographic bulge that will produce growing numbers of cancer cases. Further, this is a fortuitous conjunction that may never happen again.
However, I fear that the bread and butter pathologist—the physician practicing medicine in a private group practice in one of the nation’s many community hospitals—will reap precious little economic benefit from this approaching opportunity. That’s because the collective anatomic pathology profession has already let the “oncology cat” out of the bag.
Since 1995, private practice pathologists allowed national lab companies to compete for cancer diagnostics almost unopposed and capture big shares of the market. THE DARK REPORT was the first, and for many years, the only, voice warning the pathology profession that the astounding growth rates of companies such as UroCor, Inc., and DIANON Systems, Inc., were based on competing successfully for specimens from office-based physicians practicing around community hospitals. These office-based physicians have been the primary sources of specimens for many private pathology groups.
Now an even greater financial menace has emerged. It is the trend of specialist physicians—such as urologists and gastroenterologists—taking steps to establish their own histology laboratories and perform their pathology work in-house. This threat challenges not just the private practice pathologist, but also the national pathology companies that compete for these specimens. A careful strategic assessment of this new development leads to the conclusion that, in the future, private practice pathologists are not likely to be the primary provider of oncology diagnostics to the American healthcare system, because that oncology cat is now “out of the bag!”