All not well with surgical pathologists

By RUTH HILL

Before you can treat someone, you have to know what's wrong with him.

But the surgical pathologists whose job it is to find this out, such as Dr Jan Craik of North Shore Hospital, are becoming much harder to find in New Zealand.

"Pathology - the study of disease - is the basis of medicine," she says.

"Pathology asks: what's wrong with this person and how can we treat it? Everything else depends on that."

Dr Craik says there's a chronic shortage of about 50 pathologists nationwide, making the job of those left more and more pressured.

"There are only about 100 of us anyway, so that's a huge shortage.

"I don't believe patients are being affected at this stage - there's no huge backlog of tests because we're all just working harder and harder.

"But that's only sustainable up to a point."

The long-term implications of the medical workforce shortage is of huge concern to a number of groups, including the Breast Cancer Foundation and its medical committee, of which Dr Craik is a member.

The pressure on those remaining in the profession has been exacerbated by the increased complexity of the work, she says.

Every time a tissue sample is taken from a patient's body, whether that be a breast lump or a piece of lung or bowel, a surgical pathologist examines it.

"Ten to 20 years ago, the only sort of information a surgeon expected to get was, 'Is this cancer?'

"Now we can tell them what sort of cancer it is and how far it has spread so we can work out how best to treat it.

"Twenty years ago, surgeons used to remove the entire breast every time - now there are a range of treatment options."

Essential though their work is, pathology has "never been seen as a particularly glamorous speciality", says Dr Craik.

"It doesn't have the same public profile as being a surgeon."

Nor are there the same opportunities to work privately and so their earning potential bears no comparison to that of plastic surgeons, for instance.

The big attraction of surgical pathology used to be the regular hours - it was seen as a nine-to-five, Monday-to-Friday kind of job.

But that is no longer the case.

At North Shore Hospital, three surgical pathologists are having to do the work of four.

The fourth position has been advertised for the past two years without success.

One of Dr Craik's colleagues has just resigned, and from January 16 there will be just two of them.

"So we'll be working at least twice as hard as we should be.

"That means being on call every second week for 24 hours a day, which is incredibly stressful.

"While you're not physically at work all the time, you can never fully relax."

This is not a problem that can be fixed overnight, she says.

Nor can it be resolved by simply throwing money at it.

"It takes a long time to train a surgical pathologist.

"First you have to do a medical degree, which is six years, and then work as a junior doctor in a hospital for two years and then be accepted into specialist training and do a five-year postgraduate course, and pass some very difficult exams.

"Many bright young people are choosing not to go into medicine because of the time it takes and the debt you incur."

Young New Zealand-trained pathologists are going overseas, pushed by student debt and lured by the much higher pay offered by overseas institutions.

While young doctors have traditionally gone overseas for experience and to further their medical knowledge, the majority used to come home eventually.

But increasingly they are staying away permanently, Dr Craik says.

"Certainly people can earn a lot more money overseas, but it's not just about money. They also feel they're not getting a lot of support here."

Dr Craik is not sure that, if she had known when she was younger what she knows now, she would have chosen surgical pathology as a career.

"I enjoy my work and I get a lot of satisfaction and intellectual stimulation from it - but if I had my time over, I probably wouldn't have gone down this path."

The personal cost to specialists is enormous and sooner or later that will have some impact on patients, she says.

"Something has to give eventually, but at the moment we all just work harder and harder ...

"I mean, we're not talking about 'fancy stuff' like heart or lung transplants here.

"We're talking about diagnosing cancer. That's pretty basic."

- NZPA