Vitalité hit with 'critical shortage' of pathologists

Vitalité Health Network has a "critical shortage" of pathologists in several of its health zones, according to its latest quarterly report.

At least seven positions are vacant, all in the northern part of the province, data released to CBC reveals.

Some of the positions have remained unfilled for more than two years, the data shows.

Horizon Health Network also has four vacancies, but two are expected to be filled in the coming months, according to a spokesperson.

Dr. Jason Karamchandani, incoming president of the Canadian Association of Pathologists and an associate professor in the Department of Pathology at McGill University in Montreal, described the New Brunswick vacancies as "significant."

"My heart goes out to the pathologists who are trying to cover the work for the province given this staffing shortage because the type of cases that come through the lab are typically really important cases," said Karamchandani.

People may not realize how important, he said, because many patients — and even some physicians — don't entirely understand what pathologists do.

Not just 'CSI' work

"When most people hear the word 'pathologist,' they think about a doctor who participates in an autopsy, where they conjure up images of someone from CSI looking at a bullet under the microscope," he said, referring to the popular televised crime scene investigation shows.

The reality is, autopsies make up a very small percentage of the type of work these specialists and subspecialists do," said Karamchandani, who is a neuropathologist, which covers the study of diseases in the central nervous system (brain and spinal cord), peripheral nervous systems, and skeletal muscle.

Pathologists also analyze samples of body tissues and bodily fluids to diagnose and monitor various diseases and conditions, such as cancer; collaborate with other health-care professionals to develop treatment plans; and develop strategies to prevent the spread of infectious diseases.

"So we're talking about patients who have had [biopsies] for cancer whose oncologists are waiting on important information to choose chemotherapy or whether or not to add radiotherapy. And all that information comes from the pathologist and the report they generate," he said.

"So it's important work and it means the people who are still there trying to care for the people of New Brunswick are almost certainly overworked and struggling to keep up."

Karamchandani also worries about what the shortages could mean for patients.

It is every pathologist's nightmare that a case that has been sitting on a shelf somewhere … turns out to be something that needed to be acted on in a time-sensitive manner.- Dr. Jason Karamchandani, incoming president of the Canadian Association of Pathologists

When pathologists are stretched, they attempt to prioritize critical cases, such as known cancers, he said. "But the reality of our practice is every once in a while there is an unsuspected diagnosis." A biopsy a doctor sends as a suspected harmless skin tag, for example, could actually be melanoma.

"It is every pathologist's nightmare that a case that has been sitting on a shelf somewhere, either in the lab or just underneath the stack of other cases, turns out to be something that needed to be acted on in a time-sensitive manner."

Not only does it delay diagnosis, it delays treatment and can hurt the patient's prognosis, said Karamchandani. He cited an example from his own practice where a patient suspected of having lymphoma, a white blood cell disease, actually had a parasite.

"If a case like that sits on a shelf, the impact to the patient can be immeasurable," he said, because a parasite is "incredibly treatable, but "until treatment begins, the parasite will consume brain tissue.

New Vitalité recruits will serve all 4 zones

Vitalité is actively recruiting pathologists and new recruits will serve all four of its zones, regardless of where they're based, said Dr. Natalie Banville, senior vice-president of client programs and medical affairs.

"This strategic approach" ensures even service across all zones, Banville said in an emailed statement. It provides "improved service quality and stability."

"Our assessment suggests that operating with 14 positions filled will sufficiently serve the needs of the Network," she said.

Vitalité currently has only nine pathologists — 36 per cent below what's needed to "sufficient serve the needs."

Seven of them are in the Moncton region, while the Campbellton and Bathurst regions each have one.

Of the seven vacancies, the Edmundston and Campbellton regions each have two, while the Bathurst region has three.

Asked when Vitalité switched to having pathologists cover all four zones, how many vacancies there were at that time, what impact these vacancies are having on wait times and backlogs, and what new recruitment ideas are planned to deal with these long-standing vacancies, an unidentified media spokesperson declined to comment.

"We have provided you with current geographical pathologists distribution statistics and a statement from Dr. Natalie Banville for added context. We believe this should suffice to clearly inform New Brunswickers on the current situation. We have no desire to further comment at this time."

Digital telepathology allows remote viewing of samples

According to its quarterly report, Vitalité has accelerated the implementation of digital telepathology to help address the critical shortage.

Introduced in the Edmundston and Bathurst regions, and recently expanded to the Campbellton region, this "state-of-the-art technology enables images of lab samples to be shared and viewed remotely," the report says.

"It also makes it possible for samples taken during cancer surgery to be viewed remotely and in real time, from any site, to guide the surgeon during the procedure."

"The use of this technology ensures that results are obtained within the recommended timeframe," according to the report. It does not indicate what those turnaround times are.

Horizon staffing 'currently stable'

At Horizon, four of the 36.4 full-time equivalent pathology positions are vacant — one in each region, said Gary Foley, vice-president of professional services.

But Horizon has "successfully identified candidates for the unfilled positions in Miramichi and Saint John, and these pathologists expected to join their teams in July and September, respectively," he said in an emailed statement.

Horizon continues to actively recruit to fill the remaining two positions in Moncton and Fredericton, said Foley, but he noted the demand for pathologists — "like many other medical specialties, is high all over the world."

Foley described staffing as "currently stable."