N.B. urged to consider interprovincial licensing of pathologists to deal with 'critical' shortage

New Brunswick and other regions facing a shortage of pathologists should consider interprovincial or national licensing, says the incoming president of the Canadian Association of Pathologists.

Dr. Jason Karamchandani, an associate professor in the Department of Pathology at McGill University in Montreal, says it could be a good short-term solution for the Vitalite Health Network, which has a "critical shortage."

"Particularly in the age of digital pathology, with just a few slide scanners placed strategically across the country, pathologists like myself might be able to help offset some of the acute staffing shortages," he said.

"But we are not licensed to practise medicine in all of the provinces across Canada, so I cannot sign out a case in New Brunswick."

Vitalite has at least seven vacant pathologist positions — two in Edmundston, two in Campbellton and three in Bathurst, data released to CBC shows.

Affect on wait times unclear

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

Pathologists conducts autopsies and analyze samples of body tissues and bodily fluids to diagnose and monitor various diseases and conditions, such as cancer.

They also collaborate with other health-care professionals to develop treatment plans, and develop strategies to prevent the spread of infectious diseases.

Vitalité has declined to reveal what impact its vacancies are having on wait times and backlogs. CBC also asked the Department of Health but did not receive a response.

Horizon has four vacancies, but expects the positions in Miramichi and Saint John to be filled in July and September, a spokesperson has said. Horizon continues to actively recruit to fill the remaining two positions in Moncton and Fredericton.

I'm sure there are pathologists across the country who may have the bandwidth or capacity to help a hospital that's in an acute shortage.- Jason Karamchandani, incoming president of the Canadian Association of Pathologists

The Canadian Medical Association has been advocating for pan-Canadian licensure as one way to address doctor shortages.

In May, an Atlantic Physician Registry was launched. It allows doctors in Atlantic Canada to work in any of the four provinces for one yearly fee, without additional licensing requirements.

It's the first multi-jurisdiction licensing model in the country, according to the Department of Health.

Karamchandani calls the initiative "brilliant" and would like to see a similar agreement extended to pathologists in other provinces.

"The larger you make the denominator, meaning the number of pathologists who contribute, the more likely you are to help when you have a staffing shortage that may exist also in other Atlantic provinces," he said.

"So if the pathologists in P.E.I. are overworked, it's very hard for them to lend support to someone in New Brunswick. But the reality of our practice is, some months are busier than others, and I'm sure there are pathologists across the country who may have the bandwidth or capacity to help a hospital that's in an acute shortage."

Department of Health mum on idea

The Department of Health declined to say if New Brunswick would look at expanding licensing agreements to other provinces for pathologists.

Dr. Laurie Potter, registrar of the College of Physicians and Surgeons of New Brunswick, did not respond to a request for comment Monday.

The New Brunswick Medical Society is encouraged by the Atlantic Physician Registry and continues to support the Canadian Medical Association's pursuit of a pan-Canadian licensure model, according to president Dr. Michèle Michaud.

"Increasing physician mobility is an important factor in addressing health human resource issues throughout the country," she said in a recent emailed statement. "Ultimately, however, in New Brunswick decisions relating to physician licensure and credentialing are the responsibility of the College of Physicians and Surgeons of N.B."

P.E.I. Premier Dennis King has said he would like to see the program expand to nurses and other health-care professionals, and is also open to the idea of opening it up to other provinces. Ontario, in particular, is interested, King has said.

Need to attract more medical students to 'fascinating' field

Longer term, Karamchandani hopes the field can attract more medical students by doing a better job of communicating how interesting and important the specialty is.

AIDS, the West Nile virus, and mad cow disease, for example, were all identified by forensic pathologists who noted an unusual increase in deaths from rare diseases, he said. Forensic pathologists were also among the first to "recognize the fallout from over-prescription and abuse of synthetic opioids," such as such as fentanyl.

The whole practice of pathology has "evolved dramatically" over the past 30 years, stressed Karamchandani, a neuropathologist, which covers the study of diseases in the central nervous system (brain and spinal cord), peripheral nervous systems, and skeletal muscle.

In the early 1990s, a pathology report for a women who underwent a mastectomy for suspected cancer, for example, would have consisted of a total of three lines, he said.

"You would see 'a final diagnosis of breast, right, mastectomy. The diagnosis is invasive ductal carcinoma.' And if you had a very keen pathologist who wanted to go the extra mile, she or he might add 'margins clear.'"

That same report today, would be several pages long, according to Karamchandani.

Most unfilled residency positions after family medicine

As it stands, the discipline with the largest number of vacancies for residency positions after family medicine is laboratory medicine, which includes pathology, said Karamchandani.

"So this means that we are not producing enough lab medicine physicians to replace, or that we believe that are needed to replace, people that are retiring from this specialty."

It takes at least nine years to become a pathologist — four years of medical school, followed by a five-year residency. Most residents who wish to enter an academic practice, will also pursue an additional one- or two-year fellowship, Karamchandani said.

"This loss of capacity and bandwidth has a 'knock-on' effect that makes all Canadians slightly less safe from the next (inevitable) public health crisis — particularly as the geographic boundaries of diseases are changing along with the climate," he said in an email.