– One in a series on LG Health's Department Chairs
Dr. John Yelcick, pictured at the new Core Lab at LG Health.
Pathology Department Chair Dr. John Yelcick, sat down with Progress Notes' managing editor Roxanne Bolinger to discuss goals and challenges for the Department.
What is your practice location, work history? I was recruited to be Medical Director of the Laboratory in November 2004. I had been at working in Newark, New Jersey at Cathedral Healthcare System a not-for-profit small hospital system, owned by archdiocese of Essex County. I wasn't looking to leave that the time; I had my own private practice and was settled. But a couple of factors, both personal and professional made me consider the move.
I am a native Pennsylvanian and at the same time I was being recruited, my identical twin brother had just bought a house in Chester County.
Another incentive was the positive feedback about LG Health I got from Dr. Bonnie Zehr with Roseville Pediatrics. I went to medical school with Bonnie and when I called to tell her I was coming for an interview, she told me I was going to love living here. I stayed with her family when I came for the interview and her daughter wrote on chalk on the driveway, "Welcome Dr. Yelcick." That was a good sign!
But what really clinched the decision was how impressed I was by the LG Health leadership. It was clear that LG Health had a bright future ahead and was investing in its people. Those are inherent strengths that a lot of hospitals don't have so I decided to make the move here, and arrived in early 2005, taking the role of Medical Director of the Laboratory.
Why are you interested in assuming the Department Chair role? I actually became Chair two years ago. The role of Medical Director is a federal requirement of the Clinical Laboratory Improvement Amendments, and mandates that I license the lab and take responsibility for a large number of items to guarantee quality and safety of the results and the laboratory environment. Those functions overlap with the duties of the Chair so it made sense to combine the role of Medical Director and Department Chair.
Do you envision establishing any divisions in your department? Each physician in our department has an area of special expertise. For example, Dr. Susan Bator specializes in transfusion medicine and is in charge of our Blood Bank, a division in the lab. Dr. Elizabeth Grove-Mahoney oversees cytopathology for the lab. Dr. Charles Romberger's expertise is in point-of-care testing, encompassing testing both within the hospital as well as smaller labs all over the county, ensuring the quality of those labs and results. Dr. Bruce King oversees hematopathology. Dr. Ronald Grenko is in charge of anatomic pathology, surgical and autopsy pathology. Dr. Christopher Anthony is in charge of clinical chemistry. Dr. Joseph Kontra oversees microbiology.
What are your goals for the Department over the next one to three years? We want to continue modernization and upgrade of the lab; we are two-thirds of the way done now. The next phase is Microbiology and we start construction on that part of the lab this fall.
We have been roping off pieces of the lab and knocking out walls completely rebuilding those sections several for years. It's a major, multimillion dollar project, which started after I came here. It was one of my projects to work with hospital and laboratory leadership to redo our aging laboratory.
We started the laboratory overhaul first with a new computer system, then we started the construction which includes all new instrumentation. The Blood Bank was first section completed, then Anatomic Pathology. The third phase was the Core Lab, with Hematology and Clinical Chemistry, which just opened in May, 2012. The next phase is Microbiology, which will be completed in spring 2013, leaving mostly administrative and miscellaneous areas to be finished subsequently.
What opportunity do you see for medical staff with regards to restructuring and the increased responsibilities for the Department Chairs? There are a lot of opportunities to reduce wasteful practices, such as giving transfusions unnecessarily to patients who don't need it. There is no medical justification to give blood because someone is tired, or to get the hemoglobin up because the number is low without accompanying demonstrated need for increased oxygen carrying capacity.
But there is potential harm to get unnecessary transfusion, it's not the benign thing people think it is. In fact, white blood cells from a transfusion can be detected two years afterwards in the circulation of recipients. There is an effect on the immune system, increasing risk of acquired infection every time a patient receives a transfusion, which may or may not be due to the transfer of the white cells.
I saw an opportunity to communicate those concerns to Dr. Scott Lauter, our new Medicine Chair. He has now made it one of his Department goals to reduce transfusions for internal medicine. A similar effort to reduce unneeded transfusion is underway under the leadership of Dr. Thomas Westphal and Melody Dillman, RN, in orthopedics.
Another opportunity is to work with oncologists on an integrated hematopathology consultation report in conjunction of bone marrow biopsies. When these biopsies are performed, the patients get a raft of molecular tests. But now a new report will combine all these tests into a single, comprehensive diagnostic narrative that ties the testing all together with the pathologic evaluation of the specimen. The oncologist will work with the pathologist who will order the test, using the diagnosis the oncologist is considering the pathologist can help determine what testing is appropriate for the diagnosis based on our evaluation of what is appropriate and realistic.
What challenges do you foresee in your department area? Inpatient lab testing (except pathology and blood orders) is not reimbursed by Medicare or any insurer. A single test a doctor can order can cost $8,000 or more. It is therefore critical that we utilize laboratory testing appropriately and effectively.
We use the Diagnostics Committee to provide guidance on our resources. For instance, we don't do screening for most inherited genetic disease on the inpatients, with rare exceptions. The challenge is always to direct the resources of the lab to where they will be effective; we want to have a meaningful impact on patient care.
Anything else you would like to add? I love the professional opportunities everyone on Medical Staff has here at LG Health. I was a member the first class of the Physician Leadership Academy; my old hospital would never have done something like that. There are many opportunities for CME and career advancement. I would urge physicians to take advantage of the opportunities offered here.
What is the best way for dept members to reach you? My email (JMYelcic@lghealth.org) or my direct dial 544-1898. Or you can find me at my office on the third floor of the hospital in the laboratory.