Department of Pathology & Laboratory Medicine Strategic Plan – 2009

Mission: To bridge basic and clinical sciences in the study, teaching and diagnosis of disease

Vision: To be a world leader in innovative pathology education, research and clinical service

Values: Our department strives to

  • Provide the highest quality diagnostic laboratory services, ensure patient and provider satisfaction and optimal patient care
  • Fulfill the educational and professional needs of our students, residents, faculty and staff
  • Work in harmony, support one another and promote trust, intellectual stimulation, creativity, innovation and productive research
  • Collaborate with and support the needs of other departments.

Goals for Strategic Plan

12 month goals

  • Establish faculty teaching awards for Anatomic Pathology, Laboratory Medicine, Medical Student Teaching, Dental Student Teaching and Graduate Student Teaching
  • Complete a pilot program providing distance education
  • Hold a Pathology Research Day to highlight the work of the Department
  • Benchmark laboratory utilization against national standards in collaboration with the Chief Quality Officer.

5 year goals

  • Become a national leader in distance education for practicing pathologists using innovative technologies such as Second Life
  • Secure funds for a clinical fellowship
  • Obtain extramural funding for the Biospecimen Archive Research Core
  • Increase total direct NIH and foundation support by 50% compared to 2008 levels
  • Have at least 4 Department multi-investigator grants/contracts, each with an annual direct budget > $500,000
  • Publish more than 35 papers per year in journals with an impact factor > 5
  • Balance the budget for the entire Department including the medical school, faculty practice plan, and research activities
  • Develop a required rotation in diagnostic medicine in conjunction with the Department of Radiology

History Brief history of the Department and the Mallory Institute

The Mallory Institute of Pathology was built by Boston City Hospital to house the Department of Pathology in 1933. It was named for Frank Burr Mallory, a senior, nationally respected pathologist who had worked in and led the department for the majority of his career. The Mallory Institute earned a reputation for research in the fields of histopathology, liver disease and colorectal cancer. Furthermore, it established international renown as a training and teaching institution for pathologists and research scientists. In 1974 Boston University School of Medicine (BUSM) became the sole academic affiliate of Boston City Hospital and the Mallory Institute grew to include research scientists from the BUSM Department of Pathology. Boston City Hospital and University Hospital merged in 1996 to form Boston Medical Center (BMC). At that time, the department became a single entity, committed to excellence and pursuing the academic mission of bridging basic and clinical sciences in the study, teaching and diagnosis of disease. In 2006 the department’s diagnostic and new research laboratories moved to a state-of-the art facility at 670 Albany Street on the BU Medical Campus and the department continued to consolidate its physical facility with relocation of faculty offices to this building and a planned relocation of the main clinical laboratory in Spring of 2011. Additional historical information is available here.

SWOC Analysis (Strengths, Weaknesses, Opportunities and Challenges)

STRENGTHS

  • Energetic Chair with a clear understanding of the value, resources and challenges of fulfilling the mission of the department. Dr. Daniel Remick, who joined the department as Chair in 2006, has brought “bilingual” expertise in both clinical pathology and basic science and continually increasing NIH research support, and has recruited 24 new faculty. He has recently obtained an interdepartmental NIH T32 training grant to study traumatic injury, beginning in January 2010, which will fund 2 physician-in-training salaries for 2 years each, a total of 4 positions.
  • BUSM and BMC affiliation and support, providing a diverse patient population with professionally challenging cases, increased financial support and infrastructure. The institutional leadership at BMC and BUSM recognize and acknowledge the contributions and value of our department, a welcome change in attitude in the last few years.
  • Core group of dedicated faculty with basic, clinical and translational research interests aligned with institutional priorities. Research areas include asthma and sepsis, emerging infectious diseases, cancer, neuroscience, and angiogenesis. Our department has 20 clinical faculty, 17 research faculty, and 5 “hybrid” clinical faculty who divide their time between clinical service and basic research. We are, therefore, uniquely positioned to be a change agent in education innovations, basic and translational research and clinical expertise by bridging basic and clinical sciences.
  • Strong core of experienced and dedicated managers, technical supervisors and support staff. The Department is fortunate to have the dedication, experience and expertise of these individuals. Their talents support both our mission and vision
  • Consolidated, state of the art physical facilities, research cores and operations. Over the last 3 years, the department has consolidated many of its physical facilities on the 3rd, 4th and 6th floors of the newly constructed Biosquare III building at 670 Albany Street. In addition to providing a modern, pleasant work environment, the physical proximity greatly facilitates interaction between clinical and research faculty. Two research cores located in our department and directed by departmental faculty are poised to participate in and facilitate the research endeavors of departmental members: the Biospecimen Archive Research Core (BARC) and the Experimental Pathology Laboratory Service Core (Ex+). Furthermore, the clinical staff are proficient in service and operate efficiently using modern equipment.
  • Well-received courses and above-average performance of medical students on the USMLE Step I portions covering departmentally-taught material. The Pathology and Immunology courses have been consistently praised by medical students, with over 90% of respondents ranking the courses Good to Excellent in most categories (the specific evaluation of the Pathology component in 2008 was hindered by the integration of Pathology into the Disease and Therapy course). The performance of BUSM students on the 2008 Pathology, Microbiology and Immunology, and Hematopoietic and Lymphoreticular Systems was 0.3 – 0.4 standard deviations above the national mean.
  • Increasing overall quantity and quality of clinical service, as judged by the increase in number of cases and outside validation rate, and the decrease in processing time and the percent amended reports.
  • Increasing academic productivity, as judged by the number of peer-reviewed publications and by the higher impact factor of the publishing journals.
  • Excellent distribution of senior and junior faculty. Assistant Professors > Associate Professors > Professors. Senior faculty provide experience and mentorship, whereas junior faculty are poised to perpetuate and revitalize the departmental mission and vision; their expanding number will ensure future departmental growth.
  • Successful graduate school program. The department runs a successful graduate program offering general pathology as well as subspecialty education in pathology-immunology, pathology-neuroscience and pathology-cell molecular biology. The department enjoys a diverse student body averaging 4-6 PhD and MD-PhD students per academic year, which results in 20-30 graduate students working in the department in any given year. This adds richly to the department’s academic mission and allows for positive interaction between faculty and students. A significant advantage of the pathology graduate program is its flexibility and access to laboratories beyond the boundaries of pathology. Many of our faculty teach in the School of Graduate Medical Sciences, either managing or contributing to courses. The department also recently began to offer a Master of Arts degree in pathology which has graduated 6 students. The collegiality and accessibility of the faculty has often been cited as a positive for the department.

WEAKNESSES

  • Below average NIH funding and little or no funding from foundations, biotech or industry. Additionally, there is misalignment of faculty percent effort and research support. In 2008, faculty expended 36% effort on research, but only 15% of salaries were paid from grants. Multiple research faculty have limited or no salary support from grants, placing a burden on the finances of the Department.
  • Few clinical faculty with percent effort on extramural grants, compared to other academic departments.
  • No research productivity incentive, compared with 59% of Pathology departments which have such incentives.
  • Few high impact publications. The department has failed to recruit many high profile faculty or graduate students, who would likely have contributed higher impact publications.
  • Few service fellowships. Currently only cytology has a fellowship.
  • Lower percentage of complex surgical pathology cases. Compared to other academic medical centers we have fewer large cases; this affects reimbursement levels, availability of cases for clinicopathologic studies, for resident training and education and for tissue archival in the biospecimen archive research core.
  • Poor identity of pathology as a discipline in medical and graduate student teaching. This is due to integration of the pathology sessions in the new Disease and Therapy course and the lack of recognition of pathology as a basic science discipline among students applying to graduate school, especially MD/PhD students. Pathology teaching is divided among multiple courses within the medical school, with limited Pathology teaching during the clinical years.
  • Failure to identify appropriate administrative support for clinical faculty, such that faculty are uncertain who to contact.
  • Busy clinical faculty, with Relative Value Unit (RVU) rankings above 84% and 91% for General Surgical Pathology and Hematopathology respectively, compared to other pathology departments in the United States. This workload leaves limited time available for scholarly activities.

OPPORTUNITIES Divided into teaching, research and service.

  • Teaching:
    • Institutional mandate for educational innovation. The “bold curriculum reform” advocated in the BUSM 2009 statement of mission and goals points to a need for fresh innovation and leadership in the education of pathology. Many of our faculty are well positioned to meet this need. The scope and volume of existing department-sponsored teaching programs, including those for the dental school and graduate Masters and PhD programs, provide additional opportunities, especially for junior faculty, to develop robust teaching portfolios and ensure the continued excellence of our programs.
    • Growing demand for distance or on-line education, particularly in professional CME. The institutional expertise at Boston University in this area, our early adaptation of digital media in pathology education in the classroom, and the opportunity to apply innovative e-learning strategies such as Second Life, provide a basis for us to compete successfully in this education market.
    • Increased numbers of applicants to the PhD and Masters programs. In the past three years there have been more applicants to our graduate program and with a brief influx of funding from Boston University the student body was expanded. The greater number of students provides opportunities to significantly accelerate the department’s research portfolio.
  • Research:
    • Recasting of NIH research priorities for funding in translational research, cancer, neuroscience and emerging infectious disease, areas where our current research faculty interests are already aligned. The 10.8 billion dollars of new NIH funding provided by the American Recovery and Reconstruction Act targets many of the same research priorities and may offer additional opportunity for new grant applications over the next 2 years. Furthermore, the expanding NIH technological and research contract funding will provide additional opportunities that a number of our research faculty will continue to exploit.
    • New laboratory facilities in Biosquare III (670 Albany Street) should assist the recruitment of outstanding new research faculty who will be necessary to sustain the strong growth of the departmental research enterprise that has been evident over the past 3 years.
    • Improved institutional research infrastructure and increased institutional support for translational and inter-disciplinary research and for technology development and transfer. The establishment or reallocation of several core facilities within the Department contributes to and is also likely to benefit from institutional support for translational and inter-disciplinary research. The newly established Clinical and Translational Science Awards (CTSA) and the Clinical Innovation Awards Program (CIAP) provide funding opportunities for our faculty.
    • Capacity for additional research funding. As several of the research faculty currently have limited grant support, opportunities exist for new research initiatives.
  • Service:
    • Relocation of Laboratory Medicine to the Biosquare III building scheduled for Spring of 2011 will consolidate both anatomic pathology and clinical laboratory services in one building and provide opportunities for collaboration and interaction that will enhance our residency training program and add to the quality of our services to patients and their physicians. Planning the construction and re-equipping the new clinical laboratories, currently underway, provides an opportunity to apply state of the art systems that will create new efficiencies and facilitate the implementation of modern laboratory management techniques.
    • Rapid growth in cancer therapeutics and demand for diagnostic histopathology. Cancer therapeutics will continue to drive the expansion of our molecular diagnostic services and allow us to take advantage of the infrastructure already in place for outreach to oncology centers and community hospitals. In addition to opportunities for growth in molecular diagnostics, our success in providing diagnostic histopathology services to extramural endoscopy centers positions us for further growth that will benefit the department by providing valuable new revenues to support our mission.

CHALLENGES

  • Limited resources for faculty and staff development, course improvements and IT needs. Space, Information Technology (IT) services, and manpower shortages restrict faculty flexibility within the Department. The hospital supports only three major IT activities annually, although many more are needed. Similarly, small-group instruction requires additional faculty and administrative time and funds to train and reimburse facilitators.
  • High stress environment for the clinical faculty, with high pressures for productivity and competition from other health care providers. The clinical faculty are over-extended with service responsibilities and provide nearly double the workload or service. This leaves limited protected time for their other duties. Although some time management skills may be at play, comparison with other pathology departments in the United States, in the Association of Pathology Chairs (APC) survey, indicates a need for creative strategies to relieve the pressures on the faculty.
    • Increasing administrative and regulatory burdens. These include required Research Compliance applications (IRB, IACUC, Biosafety/Recombinant DNA) and membership on an increasing number of institutional and departmental committees, limiting faculty time for the core departmental mission.
  • Percieved lower visibility and fewer rewards for educational efforts compared to NIH grant and clinical service income, discouraging faculty from investing energy in this essential component of our mission.
  • Financial Uncertainties at Boston Medical Center. Universal health care in MA came with change in the way Boston Medical Center is reimbursed for medical services to the uninsured and underserved, from a block grant to an insurance (Medicaid) model. Because of low levels of remuneration, an adverse financial scenario for the medical center has been created which, unless modified, is currently on track to produce an deficit of 170 million dollars in FY 2010. Despite large cash reserves this is an untenable scenario for the hospital but it is likely to be corrected and the crisis resolved ultimately by negotiation with the state, perhaps when the new Federal Health Care Legislation is put in place later this year. It is unlikely, however, even with successful negotiations, that BMC revenues will be restored to 2008 levels. Some reduction in clinical programs and loss of patient volume are possible as a result, and this could impact our department adversely. If across the board layoffs of ancillary staff were to be implemented, this could affect the quality and timeliness of our laboratory services. A sense of uncertainty combined with the possibility of reductions in levels of physician salaries, might lead to loss of personnel in key clinical specialties; and this could, in turn, reduce anatomic pathology volume and revenues. It is also possible that, in the near term, there will be a reduction in institutional funds available for capital investment, and, given the absence of capital reserves within the department, this may require deferring necessary equipment replacement and upgrades. Finally, if financial constraints become very severe, existing institutional budgetary support for the department may also be reduced.