Perception vs Reality and the “shortage” of pathologists

[coroner]

Recently I was reading an article in the first North American edition of ‘The Pathologist’ (a European based journal) regarding the supply of pathologists on both sides of the Atlantic.

They had a section in this article espousing the shortage of pathologists worldwide, including in the US and various experts chimed in supporting this:

“There’s a pending shortage of pathologists” – William Schreiber, President ASCP. Citing ASCP Vacancy survey statistics that reveal increased vacancy rates in all specialties except cytology and cytogenetics, along with the US Bureau of Labor & Statistics’ estimation that the need for lab services will grow as much as 16% over the next decade.

“We’re in a retirement cliff for pathologists in the United States. We’re an aging population, and we haven’t increased the number of trainees, so we’re heading for a deficit in the number of pathologists.” – Michael Prystowsky, Chair of Pathology, Albert Einstein College of Medicine.

“When I talk to people around Canada, there’s always the sense they’re understaffed and workloads are becoming more complex. It's an uphill battle trying to convince the people with the money that additional positions are needed.” – Victor Tron, President of the Canadian Association of Pathologists.

“We know that many pathologists plan to retire over the next few years and in some disciplines there are too few trainees coming through to replace them.” – Suzy Lishman, President of the United Kingdom’s Royal College of Pathologists.

Seems like we’ve been hearing the so-called retirement cliff for a better part of a decade or so. I just don’t get the disconnect between perception and reality between ‘Team Excess’: SDN posters, private practice, trainees vs ‘Team Shortage’: academia, heads of organizations, and apparently US Bureau of Labor & Statistics. It’s like the Sixth Sense where we see dead people because they’re really there or nobody else sees them because they’re not really there (or maybe they are). It also reminds me of the quote by Thoreau, “It’s not what you look at that matters. It’s what you see.”

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[HeyDalaron]

“When I talk to people around Canada, there’s always the sense they’re understaffed and workloads are becoming more complex. It's an uphill battle trying to convince the people with the money that additional positions are needed.” – Victor Tron, President of the Canadian Association of Pathologists.
.

Im canadian so i can elaborate. The bottleneck is not due to a lack of pathologists. There may be too many, actually.

Pathologists in canada are paid flat rates based on funding distributed by provincial governments. There is not enough funding being allocated to make new positions for pathologists, or to pay fair value for increases in volume or complexity.

To summarize, the funding is where the shortage is, not the manpower.

 

[KCShaw]

There is no unbiased, well researched source addressing this that I am aware of. The different views have been going at it for probably more like decade*s*, and may be incapable of backing down from their positions by now. I suspect those who assume there is a manpower bubble about to burst are not considering the big picture, including that in the face of declining reimbursements, among other things, roughly the same number of pathologists are handling higher volumes and some are likely staying in the workforce longer. There have already been trade-offs to accomplish this. And frankly, even if suddenly every path group was down 15% of their needed & funded pathologist positions, those groups would again adapt to make it work -- at least for a time, and possibly with implementation of poor practice methods which, given time, will become the new norm. Much like pathologists generally not doing their own grossing, provision of PA's, cytotechs, and so on with increasing autonomy, etc. The same is already well under way in the clinical setting, partly because of funding, partly because of antipathy by physicians, partly because of aggressiveness by mid-levels, etc. On the other hand, those on the other side saying the population is aging, the pathologists are aging, case loads are or are expected to go up, the annual crop of new pathologists isn't increasing...are probably saying accurate things, it's just not clear that that means what they claim/fear it does. What's worse, having too many pathologists such that none are able to get a good job at a decent salary and the jobs that exist are poor because groups know there are 10 more people waiting to fill your position, or having too few pathologists where some areas become underserved but the job market has groups fighting to attract pathologists?

 

[postbacpremed87]

This doesn't matter to some MS4s who cannot themselves doing clinical medicine. Just no way Jose.

 

[octopusprime]

I think the crux of the issue is that like Coroner said, Team Shortage--comprised of those in academics, "leadership" organizations, govt, et al NOT in the trenches where the world of pathology exists--cannot see the ground below their ivory tower. Remick can come on here and post to his heart's content, but he's viewing the world from his isolated position...academocentrism. There's no shortage of pathologists in academics...there's always positions that go unfilled because the pay is crap and no-one wants to make 1/3 to 1/2 what they could make in PP (while PP still exists).

 

[AZpath]

There is no unbiased, well researched source addressing this that I am aware of. The different views have been going at it for probably more like decade*s*, and may be incapable of backing down from their positions by now. I suspect those who assume there is a manpower bubble about to burst are not considering the big picture, including that in the face of declining reimbursements, among other things, roughly the same number of pathologists are handling higher volumes and some are likely staying in the workforce longer. There have already been trade-offs to accomplish this. And frankly, even if suddenly every path group was down 15% of their needed & funded pathologist positions, those groups would again adapt to make it work -- at least for a time, and possibly with implementation of poor practice methods which, given time, will become the new norm. Much like pathologists generally not doing their own grossing, provision of PA's, cytotechs, and so on with increasing autonomy, etc. The same is already well under way in the clinical setting, partly because of funding, partly because of antipathy by physicians, partly because of aggressiveness by mid-levels, etc. On the other hand, those on the other side saying the population is aging, the pathologists are aging, case loads are or are expected to go up, the annual crop of new pathologists isn't increasing...are probably saying accurate things, it's just not clear that that means what they claim/fear it does. What's worse, having too many pathologists such that none are able to get a good job at a decent salary and the jobs that exist are poor because groups know there are 10 more people waiting to fill your position, or having too few pathologists where some areas become underserved but the job market has groups fighting to attract pathologists?

Well should each consider our positions.

Pro
Pathology is great field and it can be a lot more fun than many areas of clinical medicine. Life style tends to be good. Salaries are still better than many specialties. ( These some darn good pros )

Cons
Here is the tricky part. Some cons are market forces aided by easy access to manpower. However, there often more than one factor at work. You have to decide

Lack of geographic mobility.
Lack of advertised positions. Advertised positions you get 25-50 plus applicants to compete with.
Networking is often required to secure a new position.
Locum works lacks a premium. Most specialties the locums net more per day than a regular position
You may need the hot fellowship to look good to prospective employers. Perhaps you need too.
Pathologist have little leverage in the market place. Hospitals don't want to pay Part A, physician owned labs want a big chunk of the profession fees, larger commercial labs give away pathology in order to gain more profitable work.
Rural areas often have plenty of pathologists too.
This has left the insurance market open to more pressure.
We are seen as commodity not a professional consultant.
Specialty not desired among American Medical Grads.

I think are valid observations , I hope based in fact. Again, often more than factor at work. The real question is can any of this be improved and how?

 

[postbacpremed87]

Well should each consider our positions.

Pro
Pathology is great field and it can be a lot more fun than many areas of clinical medicine. Life style tends to be good. Salaries are still better than many specialties. ( These some darn good pros )

Cons
Here is the tricky part. Some cons are market forces aided by easy access to manpower. However, there often more than one factor at work. You have to decide

Lack of geographic mobility.
Lack of advertised positions. Advertised positions you get 25-50 plus applicants to compete with.
Networking is often required to secure a new position.
Locum works lacks a premium. Most specialties the locums net more per day than a regular position
You may need the hot fellowship to look good to prospective employers. Perhaps you need too.
Pathologist have little leverage in the market place. Hospitals don't want to pay Part A, physician owned labs want a big chunk of the profession fees, larger commercial labs give away pathology in order to gain more profitable work.
Rural areas often have plenty of pathologists too.
This has left the insurance market open to more pressure.
We are seen as commodity not a professional consultant.
Specialty not desired among American Medical Grads.

I think are valid observations , I hope based in fact. Again, often more than factor at work. The real question is can any of this be improved and how?

Pathology is the most intellectually fascinating field in medicine. I think I would die on the wards and then I would end up in Pathology one way or another any way.

 

[tensoranalysis]

. trump made me delete this.