Workload measurement in subspecialty dermatopathology.

AIM: To measure pathologist workload in subspecialty dermatopathology. METHODS: Three subspecialty dermatopathologists, working in a university-affiliated laboratory, participated in a time-motion study during which they reported 2891 consecutive skin cases received from community-based dermatologists. All pathology reports were retrospectively reviewed and workload measured using the Royal College of Pathologists (RCPath) guidelines and the level 4 equivalent (L4E) method. RESULTS: The majority of dermatopathology cases were scored as low (32%) or intermediate (52%) complexity using the RCPath matrix. Only 16% of cases were considered high or very high complexity. The mean RCPath score per case was 2.68 units. Using L4E complexity levels, 83% of specimens were level 3, 15% were level 4, and only 2% were higher complexity (levels 5 and 6). Mean values for specimens/case, blocks/case, and slides/case were 1.31, 1.52, and 2.92, respectively. Time-motion analysis demonstrated a mean workload per hour of 16.3 cases, 21.3 specimens, 45.1 slides, 43.0 RCPath units, and 12.2 L4E. All three dermatopathologists reported >35 RCPath units per hour. CONCLUSIONS: The RCPath histopathology workload guidelines underestimate the workload achievable by an experienced dermatopathologist, and thus are not directly applicable to subspecialty dermatopathology practice. Hourly work rates 3-4 times that recommended by the RCPath workload matrix are routinely achievable, but extrapolation to yearly workload estimates requires detailed knowledge of practice pattern and time required for non-clinical duties such as teaching, research and administration.

November 2000: 13 year old girl with back pain and leg weakness.

A 13 year-old girl presented with back pain and recurrent falls of one year, with more recent loss of ambulation and bladder control. Examination showed spasticity and a sensory level bilaterally at T8. CT and MRI scans showed an epidural soft tissue mass with spinal cord compression and destruction of the pedicle, transverse process and other portions of a mid-thoracic vertebral body. Histologic examination of the gross total resection showed a pigmented villonodular synovitis (PVNS). PVNS is most common in the knee and only 26 cases have been reported in the spine. Although vertebral bodies are rarely involved, it is important to include PVNS in the differential diagnosis of spinal lesions because of its tendency to recur locally if not totally resected.