Transcript Pathology in Canada Richard G. Hegele, MD, FRCPC, PhD Professor and Chair, Dept.

Pathology in Canada
Richard G. Hegele, MD, FRCPC, PhD
Professor and Chair, Dept. of Laboratory Medicine & Pathobiology
University of Toronto
Chief, Dept. of Paediatric Laboratory Medicine
The Hospital for Sick Children
[email protected]
www.lmp.utoronto.ca/
Conflict of Interest
• University and Hospital employee
• No commercial interests to disclose
Outline
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Introduction to Canadian healthcare
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Accreditation
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Education
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Research
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Service
Canadian Healthcare System
• Population: 35.3M
• ~90% live within 100 miles of US
border
• Healthcare: Provincial jurisdiction
• Funding: ~70% government
Accreditation
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Laboratory
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Structures and regulations vary by Province
Education
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UME:
PGME:
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University (LCME; CaCMS)
University (Royal College of Physicians
and Surgeons of Canada)
Fellowships: Hospital-based (+ University diploma)
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Hospital-University affiliation agreements
Royal College of Physicians and
Surgeons of Canada
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“Primary” Lab Medicine Specialties
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Anatomical Pathology
General Pathology
Hematological Pathology
Medical Microbiology
Neuropathology
Subspecialties
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Forensic Pathology
(Medical Biochemistry)
Royal College: AFC
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Area of Focused Competence
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Transfusion Medicine
Cytopathology
Others in development
Trends in Education
• UME:
Increasing integration
• PGME:
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Time-based to competency-based
CanMEDS 2015
AFCs – American Board eligibility
www.royalcollege.ca
www.mainequalitycounts.org
Research
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Operating
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Canadian Institutes of Health Research
Charitable foundations
Other
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Personnel
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Research infrastructure/overhead
Lab Testing in Canada
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Hospital laboratories
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Commercial laboratories
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Centralized laboratories (Public Health, etc.)
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Other (referred-out testing; point-of-care)
Hospital Laboratories
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~ 55% of total lab work
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Inpatients
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~4-5% of hospital global budget
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“Cost center”
Commercial Laboratories
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~ 45% of total lab work
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Outpatients
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“Revenue center”
Service
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Utilization: “cost center” vs. “revenue center”
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Hospital labs – new revenue streams
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Commercial labs – capped
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Offloading
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Public-private partnerships
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Outsourcing
Ontario: Offloading
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Moving GI endoscopy out of hospitals
into community clinics
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? Impact on GI pathology,
incl. residency training
Hepatitis C outbreaks at three Toronto
colonoscopy clinics kept secret Toronto Star September 27, 2014
Toronto Public Health, which revealed the outbreaks when pressed by the Star, said 11
patients were infected and tainted sedative injections were the “possible” cause in all cases.
“It has gone beyond appalling that the same mistakes are being repeated and are not being
reported”
- France Gélinas (NDP Health Critic)
Ontario: Public-Private Partnerships
Toronto Star, Oct. 9, 2014
Secret government reports released
Thursday by the Progressive
Conservatives reveal the province is
finalizing a deal to spend $317 million to
purchase the brand-new - but virtually
empty building.
Alberta: Outsourcing
Australian company wins $3-billion contract to
run lab services in Edmonton
Edmonton Journal October 17, 2014
EDMONTON - An Australian company has won a $3-billion,
15-year contract to provide laboratory services in Edmonton.
Sonic Healthcare Limited was selected by Alberta Health Services
after a request for a proposal process that began last year.
Sonic expects the contract will initially generate annual revenue of
more than $200 million. The anticipated contract term is 15 years,
with an option to extend the agreement for another term.
Conclusions
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“Publically-funded” healthcare – myth vs. reality
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Education
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UME:
PGME:
Fellowships:
Visibility
Competency-based
AFCs
Research
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Non-traditional sources of support
Service
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Utilization, funding, offloading, public-private
partnerships, outsourcing