The long, strange, sad, sometimes bizarre tale of the AFIP's demise continues.  I have written on what has happened in the past following the BRAC announcement in 2005.  On September 30th the AFIP closed its doors to civilian consultations.  The newly formed Joint Pathology Center expected to open next Spring will offer DOD and VA consultations, education and continue telepathology consultations for military clients.

The real tragedy, in my opinion, of AFIP's closing the loss of a significant public health institution.  For decades the AFIP provided anatomic pathology services that could not be provided for by others or paid for by others in addition to their military-specific duties such as forensics and toxicology.  The breadth and depth of expertise given their unique role and the material sent for consultation contributed significantly to our understanding of human disease and pathology.  1000s of manuscripts, book chapters and courses have trained tens of thousands of pathologists and physicians.

Long story very short -- I think the AFIP suffered from several problems that could have been prevented with some leadership and vision:

1.  Lack of mentorship.  Decades past after Mostofi-Sesterhan; Enzinger-Weiss; Ishak-Goodman, etc... without anyone to follow in the legacy.  Talent was not recruited nor retained.  

2.  Lack of molecular.  Without rapid access to frozen tissue not being a hospital-based institution, while AFIP did its share of morphology with classification of tumors it could never make the leap to molecular on an equally large scale.  

3.  Lack of business plan.  I think the AFIP could have been a profitable organization with the right kind of infrastructure in place to appropriately bill and collect for technical and professional services from non-DOD/VA clients.  The American Registry of Pathology failed in this regard to its mission.

4.  What was the real value of the AFIP? The repository of over 3 million accessions as wet tissue, slides and blocks were kept forever.  The problem when you start to analyze the repositories "worth" was the actual condition of the tissue, slide and blocks and amount, or lack of, clinical history and follow up to correlate with the morphology.

Now in the wake of Bostwick Laboratories first forming "AFIP Laboratories", later changed to "AIP Laboratories" which was quickly disestablished, comes an announcement from former AFIP consultants that they have formed "Inova Pathology Institute". 

A couple points -- is it a positive to continue to include "Institute"?  How about "Inova Pathology Asssociates"?  The byline mentions "most difficult cases from physician offices..." Does this mean primary diagnostic services in addition to consultations?  I would have hoped that the failed Bostwick experiment showed this is a difficult model to sustain.

Sent via E-mail: 

October 4, 2010

Dear Physician:

As you may know, the Armed Forces Institute of Pathology (AFIP) closed its doors on September 30, 2010.

However, we are pleased to announce that AFIP's team of internationally renowned pathologists is still available to serve you. We have joined the Inova Pathology Institute (IPI), a comprehensive diagnostic anatomical pathology reference laboratory in Fairfax, Virginia.

IPI provides a full spectrum of expert pathology services. Led by AFIP's world-class second opinion subspecialty experts, IPI is routinely called upon to review the most difficult cases from physician offices, hospitals and laboratories around the world.

IPI offers you the same high quality clinical services you received from AFIP, including:

a.. Dedicated, organ-specific pathology experts

b.. Definitive diagnostic and consultative support

c.. State-of-the-art laboratory

d.. Fast turnaround time to provide answers more quickly

e.. A continuum of diagnostic expertise for your outpatient and inpatient cases

f.. Flexible billing policies and third-party billing

We look forward to continuing to provide you and your patients with leading-edge pathology services. Visit our Web site at http://www.inovapathologyinstitute.org for more information or to request a consultation. If you prefer, you can call us at 703-645-6190.

Sincerely,

Prakash Jha, M.D., M.P.H.
Medical Director
Inova Pathology Institute