HIGHER ACHIEVABLE WORK RATES? MORE EVIDENCE FOR THE BENEFITS OF SPECIALISATION

The current Royal College of Pathologists (RCPath) workload guidelines1 represent a big step forward in assessing pathologist workload in cellular pathology by reflecting individual specimen complexity rather than crude specimen numbers.2 The “new” approach is to allocate specimen points and to translate points into time, enabling workloads to be defined in line with a time-based consultant contract. The subspecialty matrices published include an assessment of cut-up and microscopy time, and give an assessment of both pathologist and laboratory input.

In this issue, Horne et al3 (see page 435) provide evidence that “experienced” dermatopathologists are capable of workloads far in excess of that recommended by the RCPath workload matrix for dermatopathology.1 The authors comment, “It is intuitive that specialist dermatopathologists can handle higher skin pathology workloads than general surgical pathologists without such subspecialty expertise.” Three dermatopathologists, in their time–motion study, averaged 43 RCPath points/h compared with a proposed reasonable workload of 10 points/h cited in the RCPath document.1 3 This approximates to 16 case requests (21 specimens) per hour and equates to an individual annualised workload of 12 800 cases based on five reporting programmed activities (PA) of 4 h each and a 40-week year (for annualised individual workload calculation to account for leave and routine sickness). Horne et al state that their own practice (population of 1.2 million) totals 18 000–20 000 requests, indicating that their entire clinical reporting workload could theoretically be reported in a total of 7.5 PA (30 h) per week. Such workloads are markedly higher than would be considered the norm in most current NHS practices in the UK. Horne et al do comment that their audit may be more applicable to “contracted” work rates rather than annualised calculations in isolation from other commitments in the job plan. The implication is that, in routine …