Workload Distribution Challenges and Solutions: Part 3

In this series, Karim Sirgi, MD, FCAP, details the causes, impacts, and solutions to workload distribution challenges. Read part one, What Causes Workload Distribution Challenges here and part two, the Impact of Workload Distribution Challenges here. 

Part Three: Implementing an Ideal Workload Distribution System

Workload distribution challenges are a major source of heartburn for pathology groups across the U.S. The situation is further complicated by the absence of an established standard and overreliance on an outdated coding system Relative Value Unit (RVU) that fails to quantify critical aspects of a pathologist's daily duties. It is the responsibility of pathology leadership to adopt a transparent and fair system that is tailored to the group's needs.

Here are some useful tips to consider when developing an in-house system:

• Leverage the expertise of certified medical and physician assistants. They will help enormously decrease your workload. 
• Consider instituting staggered pathologist shifts. Slides are not delivered continuously; they are usually made available in large batches with periods of idle time in between. This is especially true in histology laboratories that have adopted a 24-hour cycle of production, and therefore, have cases that become available even later in the evening. Matching pathologist staffing to histology production may lead to better streamlining for the entire operation.
• Design policies to allow partners to maintain partial partnerships or to job-share with another partner colleague. These policies help to increase the pool of experienced and available talent.
• Appreciate that every practice setting is different. This applies even within the same group or hospital system. My former pathology group covered nine different hospitals, two different hospital systems, as well as owning a private histology laboratory. Each setting had its own work culture. Some of my former colleagues wanted to homogenize their way of working across different settings, which was unrealistic.
• Consider establishing a separate call schedule. Busy subspecialized service lines (eg, hematopathology) can benefit from having separate call schedules.
• Address workload distribution with an open mind. Allow plenty of time and input from all members of the group and find a way to define roles and responsibilities that make the team recognize equivalent workloads.
• Commit to a system and get started. Seeking a perfect system is impossible. Be transparent about why you’re choosing a system, inform the group about the process to suggest changes, and re-evaluate the system on an annual basis.
• Regularly recognize any contributions to the group's success. Recognition needs to go beyond just the pathologists with the highest RVUs. Obsessing over RVU creates a culture of quantity over quality and increases competition among pathologists. Avoid systems where pathologists are incentivized to select the easiest and fastest cases first to maximize their RVU.
• Be open to opportunities for improvement and elimination of tasks. There might be improved ways of accomplishing the same tasks with technology innovations or additional non-pathology staff. Relatedly, look out for opportunities to eliminate tasks no longer deemed necessary. For example, only cover urgent cases on weekends. Your patients don’t need to hear their results on a weekend, regardless of great customer care.

Workload distribution in a group of pathologists ranks among the highest sources of stress and dysfunction, may lead to burnout and, therefore, cannot be ignored by the group's leadership without serious consequences. In addition to directly affecting the mood and morale of pathologists, workload distribution challenges also affect the mood and morale of everybody else in their work environment, including laboratory and office staff directly involved with the daily operation.

Karim E. Sirgi, MD, MBA, FCAP, owns Sirgi Consulting LLC and offers expertise to medical groups in various aspects of practice management and leadership. Dr. Sirgi is board-certified in anatomic, clinical and cytopathology with additional surgical pathology fellowship training, he also holds an MBA and has 30 plus years of practice and leadership experience in private, academic, and hospital-based pathology and medical staff settings. Among his previously held positions, Dr. Sirgi served as president of the largest multi-specialty pathology group in the Rocky Mountain region and chair of the regional medical staff council for the largest hospital organization in the US. Dr. Sirgi is the immediate past-president of the American Pathology Foundation, the chair of the CAP Practice Management Committee, and the Chief Science Officer of Breath Tech.