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An Immediate Shortage
By: Jason Hagerman


In October 2005, Eastern Health, the largest health authority in Newfoundland and Labrador, suspended testing of tissue samples from breast cancer patients at its St. John’s histology laboratory after it discovered that a patient received the wrong diagnosis as a result of a botched tissue test.

By May 2007, Eastern Health found itself the target of a massive class action lawsuit. The provincial government’s response—a commission led by Justice Margaret Cameron—produced a report that identified failings at every level of the pathology lab, particularly with how the pathologists performed tests. Quality control measures were not enforced. Accountability in the lab was almost non-existent.
The debacle at Eastern Health left many Canadians uneasy and exposed the anemic state of many of Canada’s under-staffed and ill-managed pathology labs.
Too few staff
The Cameron Report highlighted the central failing of the Eastern Health lab—the lack of competent laboratory staff.
The shortage of lab workers isn’t particular to Newfoundland and Labrador.
“Some provinces experience less of a shortage than others and labs that are close to a university or affiliated with one tend to be better staffed, but there is still a relative shortage in all of Canada,” says Dr. Serge Jothy, chief of the Department of Medicine at St. Michael’s Hospital in Toronto.
The department of medicine at St. Mike’s is equal parts pathology, microbiology, hematology, biochemistry and blood bank. It is well equipped, affiliated with the largest university in Canada—and understaffed. The chemistry lab is one person short, as is the hematology lab. Pathology, where Eastern Health caused so much trauma to so many people, is sufficiently staffed, but this is not so common.
“Impending retirements threaten to leave many labs with shortages of qualified laboratory professionals,” says Christine Nielsen, Executive Director of the Canadian Society for Medical Laboratory Science. And pathology labs are in staff level turmoil in particular.
According to the Canadian Association of Pathologists, the shortage demand for pathologists is growing due to a steadily increasing workload. A general increase of the number of cancer specimens due to an aging population and increases in cancer screening means pathologists are stretched thin. Cancer report requirements are increasing in complexity and quality assurance is increasingly critical.
“We are experiencing a relative decrease in pathologists,” says Dr. Laurette Geldenhuys, President of the Canadian Association of Pathologists. “The increase in the number of non-pathologist physicians generating pathology specimens, such as oncologists, is greater than the increase in the number of pathologists.”
In Ontario, Geldenhuys notes, the number of pathologists increased by 6 per cent from 1998 to 2008, while the number of radiation oncologists increased by 45 per cent.
Currently, 1,195 tissue pathologists work in Canada, and according to the Canadian Association of Pathologists’ Professional Affairs Committee, the country needs at least 370 more.
Tissue diagnosis remains the gold standard for cancer diagnosis. Canada will need an additional 820 tissue pathologists by 2020 to maintain timely, accurate results and treatment for the public.


Compensation questions
To address this shortage, and avoid a repeat of the Eastern Health debacle, Canada needs to keep current pathologists happy and train more pathologists to meet demand.
As of March 2010, Eastern Health completed or substantially completed 40 of the 60 recommendations outlined in the Cameron Report and undertook an overhaul of the lab with the help of more than $21 million from the provincial government.
One of the key recommendations was to increase the pay of pathologists. During the Eastern Health debacle, pathologists earned about $270,000 a year. Ontario pathologists start out making about $340,000 annually. The pay increase in 2008 brought the total compensation for St. John’s pathologists to around $350,000 per year. Outside of St. John’s, an additional $16,000 was tacked on. The pay increase puts Newfoundland and Labrador pathologists at the top of the heap.
Still there is work to do to reform the pathology labs. The Cameron report found communication on all levels at Eastern Health—between the health authority and patients, between pathologists and lab management—deficient.
Dr. Diponkar Banerjee of the B.C. Cancer Agency and Dr. Patricia Wegrynowski both undertook independent audits of the lab years before the inquiry and warned of issues from staff ineptitude to an absence of pathology reference material in the lab.
During her audit, Wegrynowski hosted an impromptu training session for pathology staff to provide basic skills. In 2003, Dr. Gershom Ejeckam wrote two memos concerning inconsistent test results he routinely experienced during his period of employment at the St. John’s lab. He also identified inadequate staffing levels that led to high worker stress and sloppy testing. Ejeckham’s concerns remained unknown to George Tilley, former Eastern Health CEO, until the memos became public in 2007. Had the lab contained an Internet connection, as one audit noted the absence of, management may have been better informed of employee concerns. By the time Tilley learned of the memos, the St. Mike’s lab confirmed 383 of the 1,103 patients retested received improper treatment based on faulty test results. Of the 383 identified patients, 108 were dead at the onset of the inquiry.
“One barrier to addressing the issue of training new lab workers is the appropriate resourcing of clinical education,” says Nielsen. “Without the appropriate resources, clinical education is a further stress on already burdened laboratory staff.”
Balanced workloads
Crushing workloads impact the ability of labs to provide the high quality clinical education necessary to train the next generation of pathologists.
At St. Mike’s, administrators visit the labs regularly to monitor the quality of work. Operational Leaders and Managers are present in the lab, taking the pulse of the workload and helping prioritize if workers are overwhelmed. The hospital also schedules discussion meetings at regular intervals to discuss education and technical updates as well as any difficulties or grievances in the lab.
“We spend a lot of time talking with people in our labs and it does a great deal for helping workers deal with stress,” says Jothy.

 

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