pathology in canada
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
Pathology in Canada
Richard G. Hegele, MD, FRCPC, PhD
Professor and Chair, Dept. of Laboratory Medicine & PathobiologyUniversity of Toronto
Chief, Dept. of Paediatric Laboratory MedicineThe Hospital for Sick Children
Canadian Healthcare System
• Population: 35.3M• ~90% live within 100 miles of
US border
• Healthcare: Provincial jurisdiction
• Funding: ~70% government
Accreditation
• Laboratory– Structures and regulations vary by Province
• Education– UME: University (LCME; CaCMS)– PGME: University (Royal College of
Physicians and Surgeons of Canada)– Fellowships: Hospital-based (+ University
diploma)
– Hospital-University affiliation agreements
Royal College of Physicians and Surgeons of Canada
• “Primary” Lab Medicine Specialties– Anatomical Pathology– General Pathology– Hematological Pathology– Medical Microbiology– Neuropathology
• Subspecialties– Forensic Pathology– (Medical Biochemistry)
Royal College: AFC
• Area of Focused Competence– Transfusion Medicine– Cytopathology– Others in development
Trends in Education
• UME:Increasing integration
• PGME:– Time-based to competency-based– CanMEDS 2015– AFCs – American Board eligibility
Research
• Operating – Canadian Institutes of Health Research– Charitable foundations– Other
• Personnel
• Research infrastructure/overhead
Lab Testing in Canada
• Hospital laboratories
• Commercial laboratories
• Centralized laboratories (Public Health, etc.)
• Other (referred-out testing; point-of-care)
Hospital Laboratories
• ~ 55% of total lab work
• Inpatients
• ~4-5% of hospital global budget
• “Cost center”
Service
• Utilization: “cost center” vs. “revenue center”
• Hospital labs – new revenue streams
• Commercial labs – capped
• Offloading
• Public-private partnerships
• Outsourcing
Ontario: Offloading• Moving GI endoscopy out of hospitals
into community clinics
• ? 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)
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.
Ontario: Public-Private Partnerships
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.