Date documenting projected shortage of pathologists

[BU Pathology]

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Summary. There is a looming shortage of pathologists based on the following data:
• The Department of Health and Human Services projects that the future need for pathologists will exceed the number available and in training (1).
• The American Association of Medical Colleges documents that pathologists are the second oldest group of physicians, the number of practicing pathologists has decreased and the number of pathologists entering pathology training has decreased (2).

The Human Resource and Services Administration (HRSA) has compiled extensive data projecting future physician needs in virtually every specialty, including pathology. These data clearly document a projected shortage of pathologists (1). More specifically, from 2005 until 2020 the report projects that there will be a need for 23% more pathologists compared to the baseline number of pathologists practicing in the year 2000 (Exhibit 42). The report projects that an additional 5400 pathologists will be needed by 2020. Despite the increased need for pathologists, the number of practicing pathologists is only projected to grow by 3% (Exhibit 51). The difference between the demand (an additional 5400 pathologists) and the supply (1000 pathologists) means that there will be a national shortage of 4400 pathologists by the year 2020. This extensive report details the methodology used to make these projections.

The HRSA report was published in 2008, so there is sufficient time to determine the accuracy of the projected trajectory. The American Association of Medical Colleges (AAMC) tracks the physician workforce and the 2012 AAMC Physician Specialty Data Book confirms the projections. In previous years the discipline of pathology had the third highest percentage of the number of providers over the age of 55 (Figure 6 in the report). We have now moved into second place. Currently 57% of pathologists in practice are over age 55. Additionally, the number of pathologists currently in practice has actually decreased, compared to virtually all other specialties which have increased (Figure 11). The number of first year residents in pathology has also declined (Figure 17).

If you are a medical student considering a rewarding career in pathology, consider these reports. The objective data collected and analyzed by independent parties show that there will be a need for more pathologists in the near future.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine & Boston Medical Center


These are the links to the original reports with the data and analysis.
(1) The Physician Workforce, Human Resource and Services Administration, US Department of Health and Human Services
http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdf
(2) AAMC 2012 Physician Specialty Data Book
https://members.aamc.org/eweb/upload/2012 Physician Specialty Data Book.pdf

 

[Thrombus]

Summary. There is a looming shortage of pathologists based on the following data:
• The Department of Health and Human Services projects that the future need for pathologists will exceed the number available and in training (1).
• The American Association of Medical Colleges documents that pathologists are the second oldest group of physicians, the number of practicing pathologists has decreased and the number of pathologists entering pathology training has decreased (2).

The Human Resource and Services Administration (HRSA) has compiled extensive data projecting future physician needs in virtually every specialty, including pathology. These data clearly document a projected shortage of pathologists (1). More specifically, from 2005 until 2020 the report projects that there will be a need for 23% more pathologists compared to the baseline number of pathologists practicing in the year 2000 (Exhibit 42). The report projects that an additional 5400 pathologists will be needed by 2020. Despite the increased need for pathologists, the number of practicing pathologists is only projected to grow by 3% (Exhibit 51). The difference between the demand (an additional 5400 pathologists) and the supply (1000 pathologists) means that there will be a national shortage of 4400 pathologists by the year 2020. This extensive report details the methodology used to make these projections.

The HRSA report was published in 2008, so there is sufficient time to determine the accuracy of the projected trajectory. The American Association of Medical Colleges (AAMC) tracks the physician workforce and the 2012 AAMC Physician Specialty Data Book confirms the projections. In previous years the discipline of pathology had the third highest percentage of the number of providers over the age of 55 (Figure 6 in the report). We have now moved into second place. Currently 57% of pathologists in practice are over age 55. Additionally, the number of pathologists currently in practice has actually decreased, compared to virtually all other specialties which have increased (Figure 11). The number of first year residents in pathology has also declined (Figure 17).

If you are a medical student considering a rewarding career in pathology, consider these reports. The objective data collected and analyzed by independent parties show that there will be a need for more pathologists in the near future.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine & Boston Medical Center


These are the links to the original reports with the data and analysis.
(1) The Physician Workforce, Human Resource and Services Administration, US Department of Health and Human Services
http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdf
(2) AAMC 2012 Physician Specialty Data Book
https://members.aamc.org/eweb/upload/2012 Physician Specialty Data Book.pdf

This is laughable. Please stop. The field is being destroyed because of garbage like this. I will send 5 reps to BU to gather your specimens. If you want a market analysis, please leave it up to the business folk. The federal government would assume we have 10 pathologists sit around a scope all day while one person signs out 2 trays with their standard of efficiency.

 

[Path or bust]

This is laughable. Please stop. The field is being destroyed because of garbage like this. I will send 5 reps to BU to gather your specimens. If you want a market analysis, please leave it up to the business folk. The federal government would assume we have 10 pathologists sit around a scope all day while one person signs out 2 trays with their standard of efficiency.

Actually didn't an academic pathology department in Massachusetts get bought out by Labcorp or Quest just this year? Tufts or Univ of Massachusetts?
I always found it very interesting that academic centers were so 'concerned' about pathology shortages. The days of academic centers not being affected by this oversupply are long gone. Some departments don't see certain types of specimens due to competition from private practices. Prostates comes to mind...

 

[Enkidu]

This is laughable. Please stop. The field is being destroyed because of garbage like this. I will send 5 reps to BU to gather your specimens. If you want a market analysis, please leave it up to the business folk. The federal government would assume we have 10 pathologists sit around a scope all day while one person signs out 2 trays with their standard of efficiency.

Thrombus, if you want to engage you have to bring something. Dr. Remick just brought a boatload of data showing that pathology is shrinking. Although it should have been obvious to everyone that pathology is shrinking simply by the average age of pathologists, which is well known around this forum. Unless pathology residents are graduating at 65, the only way that pathology can be aging is if there aren't enough new trainees to offset the population of practicing physicians.

Your argument seems to be that students shouldn't go into pathology because you personally want to earn more money. That may be an accurate reflection of your thinking, but if you want to drive your point home you may want to put up some sort of argument.

If you think that the pathology market is getting worse even though the number of pathologists is shrinking, then you must think that the demand for pathologists is shrinking even faster. This might be possible if specimen number is decreasing and efficiency is increasing - but this effect would have to be huge in order to offset the natural growth in demand with an increasing population size and massive increases in healthcare coverage. And if the contraction of the pathology market is so profound, then why does the report linked by Dr. Remick specifically use pathology as an example of a market in which demand is growing faster than supply? (though the absolute *level* of demand isn't clear, it could be low, but if its growing faster than supply then the market is improving, not contracting).

Perhaps you think that it is a conspiracy by academic pathologists that influences these reports, but then you may want to bring some data to back that up.

 

[Pingu]

The Human Resource and Services Administration (HRSA) has compiled extensive data projecting future physician needs in virtually every specialty, including pathology. These data clearly document a projected shortage of pathologists (1). More specifically, from 2005 until 2020 the report projects that there will be a need for 23% more pathologists compared to the baseline number of pathologists practicing in the year 2000 (Exhibit 42). The report projects that an additional 5400 pathologists will be needed by 2020. Despite the increased need for pathologists, the number of practicing pathologists is only projected to grow by 3% (Exhibit 51). The difference between the demand (an additional 5400 pathologists) and the supply (1000 pathologists) means that there will be a national shortage of 4400 pathologists by the year 2020. This extensive report details the methodology used to make these projections.

Perhaps my math is a little fuzzy, but how the heck is the supply of pathologists only 1000 when we graduate approximately 500 residents per year? 2005 to 2020 is 15 years, which would make it a supply of 7500.

And please don't say retirement. You have to pry a scope from most older pathologists cold dead hands.

 

[pathstudent]

Perhaps my math is a little fuzzy, but how the heck is the supply of pathologists only 1000 when we graduate approximately 500 residents per year? 2005 to 2020 is 15 years, which would make it a supply of 7500.

And please don't say retirement. You have to pry a scope from most older pathologists cold dead hands.

I think he meant to say an increase of 1000 from the number now versus a projected increase increase in need of 5400.

i.e let's assume there are 20,000 pathologists now. He is saying that the data says that we will have 21,000 in 2020 but need 25,400 assuming we are perfectly outfitted right now.

And that is correct. Pathologists never die, they just slide away.

 

[Substance]

Perhaps my math is a little fuzzy, but how the heck is the supply of pathologists only 1000 when we graduate approximately 500 residents per year? 2005 to 2020 is 15 years, which would make it a supply of 7500.

And please don't say retirement. You have to pry a scope from most older pathologists cold dead hands.

That's a good question. I wonder if the data-analysts are using the age of 65 as a general retirement age, when it seem that for pathologists this is simply not true. There is a specialty selection book published in the late 1970s that was quite clear in its projections for pathology: it states that though even then a shortage had been predicted, it never comes to pass primarily because the pathologists in practice do not retire. That document you linked to says as much - aren't like 40% of all practicing paths over 65, compared to 15% of rads? Some people might take that as a lot of paths will leave the workforce soon, but I beg to differ. If they haven't retired by 65, they probably won't.

I also do not understand where the line gets drawn to call something a shortage. Cannot fewer pathologists pick up more of the slack? When is the workload too overwhelming? Can't pathologists work longer hours? Can't slides be transported to other centers with lower volume to even things out? I just don't see the danger in reducing your ranks.

The more I see of your field, the more I think it is a huge ripoff: academics want subsidized tech labor in the form of residents, and labcorps want a pathologist surplus to get workers at cut rates. Patient care isn't in the equation here. If it were, your applicant standards would be as high as rads and your numbers as low as they were for rads in the 90s.

 

[Thrombus]

I think he meant to say an increase of 1000 from the number now versus a projected increase increase in need of 5400.

i.e let's assume there are 20,000 pathologists now. He is saying that the data says that we will have 21,000 in 2020 but need 25,400 assuming we are perfectly outfitted right now.

And that is correct. Pathologists never die, they just slide away.

I am missing some assumptions

Where is the assumption for specimens/pathologist (general numbers with built in representative overall specimen variety)?

Where is the assumption for the increased and increasing efficiency of pathologists?

Where is the assumption for decreased autopsies?

Where is the assumption for dermatologists increasingly reading their own biopsies?

Where is the assumption for the current massive pasthologist oversupply, demonstrated in the cutthroat business of specimen aquisition with corporate labs assaulting the independent lab every day, ending in extreme discounting?

This study looks like garbage in = garbage out. It FAILS both the "smell test" and also any kind of academic scrutiny and journalist integrity.

 

[Enkidu]

That's a good question. I wonder if the data-analysts are using the age of 65 as a general retirement age, when it seem that for pathologists this is simply not true. There is a specialty selection book published in the late 1970s that was quite clear in its projections for pathology: it states that though even then a shortage had been predicted, it never comes to pass primarily because the pathologists in practice do not retire. That document you linked to says as much - aren't like 40% of all practicing paths over 65, compared to 15% of rads? Some people might take that as a lot of paths will leave the workforce soon, but I beg to differ. If they haven't retired by 65, they probably won't.

I also do not understand where the line gets drawn to call something a shortage. Cannot fewer pathologists pick up more of the slack? When is the workload too overwhelming? Can't pathologists work longer hours? Can't slides be transported to other centers with lower volume to even things out? I just don't see the danger in reducing your ranks.

The more I see of your field, the more I think it is a huge ripoff: academics want subsidized tech labor in the form of residents, and labcorps want a pathologist surplus to get workers at cut rates. Patient care isn't in the equation here. If it were, your applicant standards would be as high as rads and your numbers as low as they were for rads in the 90s.

There is such a lack of alarmists on this forum that we have to import some even from people who know nothing about pathology!

They are not hypothesizing any specific retirement age, they are just regressing current trends. Pathology is one of the few fields that is actually shrinking - carry that trend out to 2020 and this is the result that we get.

 

[Thrombus]

Thrombus, if you want to engage you have to bring something. Dr. Remick just brought a boatload of data showing that pathology is shrinking. Although it should have been obvious to everyone that pathology is shrinking simply by the average age of pathologists, which is well known around this forum. Unless pathology residents are graduating at 65, the only way that pathology can be aging is if there aren't enough new trainees to offset the population of practicing physicians.

Your argument seems to be that students shouldn't go into pathology because you personally want to earn more money. That may be an accurate reflection of your thinking, but if you want to drive your point home you may want to put up some sort of argument.

If you think that the pathology market is getting worse even though the number of pathologists is shrinking, then you must think that the demand for pathologists is shrinking even faster. This might be possible if specimen number is decreasing and efficiency is increasing - but this effect would have to be huge in order to offset the natural growth in demand with an increasing population size and massive increases in healthcare coverage. And if the contraction of the pathology market is so profound, then why does the report linked by Dr. Remick specifically use pathology as an example of a market in which demand is growing faster than supply? (though the absolute *level* of demand isn't clear, it could be low, but if its growing faster than supply then the market is improving, not contracting).

Perhaps you think that it is a conspiracy by academic pathologists that influences these reports, but then you may want to bring some data to back that up.

1. There is no "boatload of data" here. If you think there is, you are seriously in need of some critical reading/thinking skills. It is some government report telling us there is a shortage of pathologists with someone's (probably an academic pathologist) estimate on what they think the "need" will be with some numbers plucked out of thin air based on no reasonable assumptions.👎

2. I want no one to be caught in the trap I am who wants to work as hard as they want and get paid fairly (without profit margins skimmed by someone who doesn't do the work). The only reason this is going on, is because we have an extreme oversupply of pathologists who are turned into lackeys by businessmen, hospitals, and academics (see "junior pathologist" and see if you can find a "junior dermatologist" subjected to 70K salary after 2-3 fellowships).😡

3. Few pathologists retire at age 65. Many work well into their 70's. This is from my experience. Most I know love the art of pathology and consider it their lifetime passion. Why retire?😍

4. I don't need any data to back up anything other than this challenge: Find a practice that needs help signing out cases for the going re-imbursement rate and I will find you 5 corporate pathology hawks ready to swoop in and take them out, in addition to 100+ applicants ready to take the job.😎😎

 

[Substance]

There is such a lack of alarmists on this forum that we have to import some even from people who know nothing about pathology!

They are not hypothesizing any specific retirement age, they are just regressing current trends. Pathology is one of the few fields that is actually shrinking - carry that trend out to 2020 and this is the result that we get.

Nice little quip at the start. Perhaps you should concentrate on the topic at hand instead of being a smartass.

I am more interested in figuring out why the past regression data has not worked out. A shortage was predicted as far back as the 1970s and has not yet come to pass. Why has that been? Why will the future be any different?

Furthermore, this board seems to say the exact opposite that the reports are saying: there are too many pathologists, too many training programs, too many subpar programs traning subpar pathologists, and that the work options for pathologists are poor. All things considered, all this talk of a shortage says nothing for quality. Sure you can expand pathology spots but if they fill with subpar people with bad scores and terrible credentials then that will be worse for patient care than a shortage.

The true answer seems to lie somewhere in the middle, as with most things. The fact that your field allows for other docs to employ you and make money from your work doesn't indicate any type of shortage.

Pathology needs its own Flexner report.

 

[Euchromatin]

Admittedly, I did not take oodles of time to read the entire HRSA report in-depth, but from glancing at the relevant tables and associated text that include pathology specific data, I do NOT think there is an impending shortage.

The "Supply of Total Active Physicians: 2000, Projected to 2020" (Exhibit 18) projects that there will be 22,280 pathologists in 2020. and the "Baseline Physician Requirements Projections" (Exhibit 42) projects that we will need 22,600 pathologists in 2020. That is an absolute difference of only 320 people...The baseline requirement projections "assume that patterns of health care use and delivery of care remain unchanged over the projection horizon and that changing demographics are the primary driver of changes in physician requirements"

The "Physician Requirements by Medical Specialty: High Economic Growth Series" (Exhibit 44) projects that 27,000 pathologists will be needed in 2020 (absolute difference of 4,720, similar to what BU Pathology is quoting). This more dramatic shortage projection assumes "per capita income will grow by 2 percent annually" and also uses an additional factor based on how "sensitive" a field is presumed to be to economic factors (pathology has a 0.5 factor - modestly sensitive). I have no idea how accurate this estimated sensitivity to economic factors is or whether it attempts to take into account other factors like the potential increase in the number of insured patients or effect of ACOs or anything else related to "Obamacare."

However, the table just above this one (Exhibit 43) "Alternative Requirements Projections" clearly shows that if you COMBINE the effects of economic growth and offset them by the predicted increase in physician productivity, the projected demand for future physicians is actually slightly LESS THAN the baseline need projection. Although they don't have a complete table outlining the exact numbers for each specialty for this particular scenario, you can make a quick calculation (economic growth + increased productivity results in a total difference of 20,000 fewer doctors needed compared to baseline across all specialties...pathology is about 2.4% of the total, leading to 480 pathologists LESS than the baseline projection 22,600 - 480 = 22,120) which is a projected need for 160 FEWER pathologists than the projected supply.

I'm not sure if the "baseline" projection or these more complex scenarios are going to be more accurate, but either way we are only looking a difference between need and supply of a couple of hundred pathologists, which doesn't seem very significant or worrisome to me for either an impending shortage or excess.

I certainly appreciate someone posting some hard data to discuss the issue of supply and demand of pathologists in the future, though. 🙂

 

[rollwithit]

It's always nice to see reports and analysis like this, but I would like to see something put together solely focused on the pathology population using metrics important to pathologists. I want to see specimen assumptions, utilization per pathologist, etc. Reports like this would be a great way to request government funding should it ever be needed, but if the leaders of this specialty want to make the right decisions to lead it into 2020 and beyond, decisions must be based on studies with a lot more pathology-specific data than what is included in a report meant to cover all of medicine. Of course, pathology is going to be affected by macro-level factors, but it would be nice to see a well thought out and detailed analysis of just the pathology world.

 

[WEBB PINKERTON]

Actually didn't an academic pathology department in Massachusetts get bought out by Labcorp or Quest just this year? Tufts or Univ of Massachusetts?
I always found it very interesting that academic centers were so 'concerned' about pathology shortages. The days of academic centers not being affected by this oversupply are long gone. Some departments don't see certain types of specimens due to competition from private practices. Prostates comes to mind...

UMASS sold out to Quest. I hope other hospitals dont follow suit. They are gonna contract big time if hospitals dont sell out to them. Let the corporate places die off please!

As for the pathologist shortage, we have been hearing this crap for decades. IT IS NEVER COMING. Turnaround times are fine in this country. A lot of our work is under fire due to overtreatment of patients so that could lead to far fewer specimens. Not to mention disruptive technology on the horizon. The Mayans are more accurate than that report.

 

[MetroPath]

1. There is no "boatload of data" here. If you think there is, you are seriously in need of some critical reading/thinking skills. It is some government report telling us there is a shortage of pathologists with someone's (probably an academic pathologist) estimate on what they think the "need" will be with some numbers plucked out of thin air based on no reasonable assumptions.👎

2. I want no one to be caught in the trap I am who wants to work as hard as they want and get paid fairly (without profit margins skimmed by someone who doesn't do the work). The only reason this is going on, is because we have an extreme oversupply of pathologists who are turned into lackeys by businessmen, hospitals, and academics (see "junior pathologist" and see if you can find a "junior dermatologist" subjected to 70K salary after 2-3 fellowships).😡

3. Few pathologists retire at age 65. Many work well into their 70's. This is from my experience. Most I know love the art of pathology and consider it their lifetime passion. Why retire?😍

4. I don't need any data to back up anything other than this challenge: Find a practice that needs help signing out cases for the going re-imbursement rate and I will find you 5 corporate pathology hawks ready to swoop in and take them out, in addition to 100+ applicants ready to take the job.😎😎

Pathologists will work until they 1. die or 2. they are just too tired, I would think most pathologists will work into their 70s.

Seems like this is a discussion of two different worlds: academic and private practice pathology. Seems like the private practice pathologists are on here talking about oversupply because of loss of specimens and revenue from competing in office labs and ref labs which affect their bottom line. Academic pathologists are salaried and thus, do not feel the same pressures as private folks. Thus, academic pathologists are not as concerned about the number of pathologists that may be signing out in office labs or ref labs, the main competition of private folks. Am I right?

 

[Thrombus]

Pathologists will work until they 1. die or 2. they are just too tired, I would think most pathologists will work into their 70s.

Seems like this is a discussion of two different worlds: academic and private practice pathology. Seems like the private practice pathologists are on here talking about oversupply because of loss of specimens and revenue from competing in office labs and ref labs which affect their bottom line. Academic pathologists are salaried and thus, do not feel the same pressures as private folks. Thus, academic pathologists are not as concerned about the number of pathologists that may be signing out in office labs or ref labs. Am I right?

Academic pathologists are subsidized SIGNIFICANTLY by residents/fellows and have a vested interest in maintaining large numbers of residents. Always follow the money.

 

[Kunu]

Somebody pin this thread and when this shortage theory pans out as the bunk that it is then Dan should put his beach house or something up for an SDN lottery.

 

[LADoc00]

Hmm, I dont see a point on beating up Dan personally too much. He's just a dude like you and me.

I think he is in a VERY tough spot because his job to sell Pathology to medical students just like an Army recruiter's job is sell a life in the Army.

I also just noticed Dr. Remick was in the USAF at the height of the Cold War in the 1970s, thank you for your service.


I think we all realize that underlying assumptions used by the government auditors to produce data like this, even as far back as 1988 was heavily flawed. I could write a 50-page refutation of this data produced from those with "White Collars and cut fingernails and smooth shaved cheeks who do not need to raise their voices" but I shall summarize:
1.) the nature of Pathology is such that even with a rising average age, the retirement age for Pathologists has equally risen.
2.) the increased workload expectations, declining reimbursements and increased provider efficiency through technological advancements has nearly doubled the productivity of the average Pathologist from where it was even 10 years ago.

I do not see these the above 2 meta-trends subsiding.


I will leave you with the complete quote from the Screwtape Letters:
I live in the Managerial Age, in a world of "Admin." The greatest evil is not now done in those sordid "dens of crime" that Dickens loved to paint. It is not done even in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voices. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the office of a thoroughly nasty business concern

 

[yaah]

I don't think there is really any great way to actually assess the "true" number of necessary pathologists needed. Even that statement there contains several loaded words which can be open to argument. So data are helpful but it's hard for data to truly quantify something which has so much complexity.

That being said, I will say this again: You can't fight data and informed opinion with anecdote and assumption. That isn't going to work. It isn't going to convince anyone who matters. Anecdotes may work on the frightened and the impressionable, like people just starting their career who are looking on the internet. But no matter what you say and how forcefully you say it, anecdotes and assumption are not going to trump data.

And the truth is there is no "massive" pathologist oversupply. For this to be true, since pathologist unemployment is quite low, that would mean that there are hundreds of pathologists who are essentially being employed for no reason, getting paid low wages but unnecessary ones, since if there truly is an oversupply there is an excess of working pathologists. But yet everyone talks about how busy they are and how they don't want to hire anyone else.

Reality trumps anecdote I am afraid.

Thrombus does raise good questions about the assumptions in that study. I suspect there were flawed assumptions many years ago about the # of specimens that each pathologist can handle, the # of pathologists that every hospital needed to run labs, things like that. What are the assumptions now? There is only so much continued efficiency that can occur with current technology, but what about different technology? What are the assumptions about the future of medicine and diagnosis?

LADocs points about two recent trends are probably pretty accurate, although I would be curious to know the actual median retirement age (and average as well). The second point I also got at above.

But unfortunately, thrombus, as I have said the data that Dr Remick is presenting are actually real data complete with an analysis of the present and future trends along with demographics and practice patterns. You can't answer these data with "it's wrong" or "it's biased." No one of importance is ever going to listen to you.

 

[Enkidu]

1. There is no "boatload of data" here. If you think there is, you are seriously in need of some critical reading/thinking skills. It is some government report telling us there is a shortage of pathologists with someone's (probably an academic pathologist) estimate on what they think the "need" will be with some numbers plucked out of thin air based on no reasonable assumptions.👎

Well the data definitively show that the number of practicing pathologists is decreasing as well as the number of pathology residents. Unless you believe that demand for pathology services will actually go down as population increases and coverage broadens, then there will be a shortfall.

Decreased supply + increased demand = shortfall

It doesn't matter what their assumptions are for future demand, only that it will increase. That's a pretty safe assumption, but if you are arguing against it, then you *do* need to supply some data.

 

[Thrombus]

I don't think there is really any great way to actually assess the "true" number of necessary pathologists needed. Even that statement there contains several loaded words which can be open to argument. So data are helpful but it's hard for data to truly quantify something which has so much complexity.

That being said, I will say this again: You can't fight data and informed opinion with anecdote and assumption. That isn't going to work. It isn't going to convince anyone who matters. Anecdotes may work on the frightened and the impressionable, like people just starting their career who are looking on the internet. But no matter what you say and how forcefully you say it, anecdotes and assumption are not going to trump data.

And the truth is there is no "massive" pathologist oversupply. For this to be true, since pathologist unemployment is quite low, that would mean that there are hundreds of pathologists who are essentially being employed for no reason, getting paid low wages but unnecessary ones, since if there truly is an oversupply there is an excess of working pathologists. But yet everyone talks about how busy they are and how they don't want to hire anyone else.

Reality trumps anecdote I am afraid.

Thrombus does raise good questions about the assumptions in that study. I suspect there were flawed assumptions many years ago about the # of specimens that each pathologist can handle, the # of pathologists that every hospital needed to run labs, things like that. What are the assumptions now? There is only so much continued efficiency that can occur with current technology, but what about different technology? What are the assumptions about the future of medicine and diagnosis?

LADocs points about two recent trends are probably pretty accurate, although I would be curious to know the actual median retirement age (and average as well). The second point I also got at above.

But unfortunately, thrombus, as I have said the data that Dr Remick is presenting are actually real data complete with an analysis of the present and future trends along with demographics and practice patterns. You can't answer these data with "it's wrong" or "it's biased." No one of importance is ever going to listen to you.

All this data shows is that we had: 2,020 pathologists in 2000
we had 21,580 in 2010 in exhibit 18 with modestly increased projections going forward from link 1

Link 2 says we have 15K pathologists with 1 pathologist for every 20K people.

There is no significant data here and any claims that one is "arguing with or against data" is ridiculous. Lets instead deal with reality and what is going on in state of the profession!

Despite the claim that "unemployment may be low", underemployment is great! Most I know are not signing out anywhere near their potential and most I know are seeing their profit margins skimmed off the top SIGNIFICANTLY by a 3rd party.

Our leaders refuse to deal with the commoditization of the field, something you do NOT see in fields with demand: Derm, Surgery, Neurosurgery, except in possibly dense metropolitan areas.

Many of you folks here must not ever have to deal in negotiations. Otherwise you will find you have minimal leverage as we are easily replaced.

Other realities that I consider as assumptions above are illegitmately removed from discussion by academics who promote the idea, and have promoted for decades I might add, that we are destined for an undersupply. They are either completely naive to the pathology marketplace or are intentionally misleading the field as any market analysis MUST include these variables!!!

 

[Thrombus]

Well the data definitively show that the number of practicing pathologists is decreasing as well as the number of pathology residents. Unless you believe that demand for pathology services will actually go down as population increases and coverage broadens, then there will be a shortfall.

Decreased supply + increased demand = shortfall

It doesn't matter what their assumptions are for future demand, only that it will increase. That's a pretty safe assumption, but if you are arguing against it, then you *do* need to supply some data.

From what I gather from the article the number of practicing pathologists has increased the last 10 years and is set to increase in the next 10 (using their forecast, which for all I know might be based on finding a unicorn).

I am not sure what article you are reading. This is all the data I see.

Mildly increased future supply of path's + current massive oversupply + ever increasing pathologist efficiency + ever declining reimbursements + (variable increase in demand: our one potential positive in the equation) + ever tightening budgetary policy + looming inflationary monetary policy + upcoming confiscatory tax policy = 😱😱😱😱

 

[Enkidu]

From what I gather from the article the number of practicing pathologists has increased the last 10 years and is set to increase in the next 10 (using their forecast, which for all I know might be based on finding a unicorn).

I am not sure what article you are reading. This is all the data I see.

Mildly increased future supply of path's + current massive oversupply + ever increasing pathologist efficiency + ever declining reimbursements + (variable increase in demand: our one potential positive in the equation) + ever tightening budgetary policy + looming inflationary monetary policy + upcoming confiscatory tax policy = 😱😱😱😱

The second link, page 1261. The number of "active" pathologists in 2000 was 14,271 but in 2010 it was 13,214. That's a 7.8% decrease in the number of pathologists.

On page 1381 it quantifies the change in the number of residents and fellows during that time period. In 2000 it was 636 and in 2010 it was 629, a 1.1% decrease.

Keep in mind that only a few specialties contracted in this way, including "preventive medicine" (whatever that is) and thoracic surgery. Apart from preventive medicine, pathology is also the oldest specialty. These are all signs that the supply of pathologists is contracting. Unless the demand is contracting at a faster rate, this means there will be a shortfall.

 

[Thrombus]

The second link, page 1261. The number of "active" pathologists in 2000 was 14,271 but in 2010 it was 13,214. That's a 7.8% decrease in the number of pathologists.

On page 1381 it quantifies the change in the number of residents and fellows during that time period. In 2000 it was 636 and in 2010 it was 629, a 1.1% decrease.

Keep in mind that only a few specialties contracted in this way, including "preventive medicine" (whatever that is) and thoracic surgery. Apart from preventive medicine, pathology is also the oldest specialty. These are all signs that the supply of pathologists is contracting. Unless the demand is contracting at a faster rate, this means there will be a shortfall.

the first link seemed to imply that there was a modest increase

perhaps the definition of "active" decrreased as there is not enough work to go around anymore? I don't know?

If we are training 600+ residents per year, we will have 18K pathologists given a 30 year career. Since most I know work more than 30 years, we should have way more than enough, given we have 15K pathologists now, and have too many than we know what to do with. 1 pathologist per 20K people is just absurd also. We should have one per at least 50K in my view. I would recommend to have 1 per 70-80 K so we could have some leverage. That would work out to a work force of 4-5 thousand pathologists, a number we train every 7-8 years😱😱😱

 

[Enkidu]

the first link seemed to imply that there was a modest increase

perhaps the definition of "active" decrreased as there is not enough work to go around anymore? I don't know?

If we are training 600+ residents per year, we will have 18K pathologists given a 30 year career. Since most I know work more than 30 years, we should have way more than enough, given we have 15K pathologists now, and have too many than we know what to do with. 1 pathologist per 20K people is just absurd also. We should have one per at least 50K in my view. I would recommend to have 1 per 70-80 K so we could have some leverage. That would work out to a work force of 4-5 thousand pathologists, a number we train every 7-8 years😱😱😱

I'm not sure what "active" meant, but I guessed that it was distinguishing between physicians in practice vs physicians in research or administration or whatever.

I doubt that they're trying to say that some proportion of physicians is simply chronically unemployed, though I guess that might be included in the "inactive" group.

I bet it relates to licensure or some metric like that.

Edit: as for your calculations relating to the number of pathologists trained, that is the maximum that could go into active practice in the US. However, since the number of active pathologists decreased to a greater extent than the number of trainees, we know that a significant portion of trainees don't enter active practice. They may be doing research, or practicing in their home country, or being stay at home parents - I don't know.

 

[Tissue issue]

Here's some data- straight from the ASCP- http://www.ascp.org/PDF/Fellowship-Reports/Fellowship-Job-Market-2012.pdf.

The conclusions on page 18 are particularly interesting.

 

[MetroPath]

Here's some data- straight from the ASCP- http://www.ascp.org/PDF/Fellowship-Reports/Fellowship-Job-Market-2012.pdf.

The conclusions on page 18 are particularly interesting.

As noted previously, 139 residents formally applied for job openings in 2012. A significant
number (39%) received a single employment offer, but 43% failed to receive any offer. About
one-fifth of residents received multiple offerings (see related pie chart)

In the 2012 survey, 51 of the 139 residents who were actively seeking jobs did receive offers
to become an attending at their current training program.

 

[Enkidu]

Here's some data- straight from the ASCP- http://www.ascp.org/PDF/Fellowship-Reports/Fellowship-Job-Market-2012.pdf.

The conclusions on page 18 are particularly interesting.

This data is pretty grim, I think. A significant number of fellows aren't getting job offers, it seems.

Although it does make pediatric path sound alright. They're getting good paying jobs, it seems. Doesn't sound like a bad gig either... except for the dead babies, I guess.

 

[Path or bust]

As noted previously, 139 residents formally applied for job openings in 2012. A significant
number (39%) received a single employment offer, but 43% failed to receive any offer. About
one-fifth of residents received multiple offerings (see related pie chart)

In the 2012 survey, 51 of the 139 residents who were actively seeking jobs did receive offers
to become an attending at their current training program.

Uh hum, this is not data we want to hear. There will be a shortage of pathologists! Why are you arguing against the data!! 🙄

 

[MetroPath]

Uh hum, this is not data we want to hear. There will be a shortage of pathologists! Why are you arguing against the data!! 🙄

One of my friends is triple boarded and got one interview in the Chicagoland area. Good job market??

 

[LADoc00]

If someone dug up my old posts from WAY BACK, I actually posted this data (ie- 40%+ of residents failing to get a job offer) from other sources when the ASCP was still in denial.

And to quote Malcolm X: I am for truth, no matter who tells it.

 

[pathstudent]

This data is pretty grim, I think. A significant number of fellows aren't getting job offers, it seems.

Although it does make pediatric path sound alright. They're getting good paying jobs, it seems. Doesn't sound like a bad gig either... except for the dead babies, I guess.

Peds path is a great path. Good people work in it lots of good jobs in big cities. Most jobs are academic or semi private-academic. A few are pure private practice.

Yes but autopsying dead babies is never pleasant. But you get over it quick and it just becomes "whoa what a cool case"

 

[path24]

Less pathologists in 2010 then 2000 and pathologists still struggle to find jobs.

We are currently in the shortage period (2005-2020) and pathologists still struggle to find jobs. Shouldn't we start feeling the effects?

The baseline of 2000, there was an oversupply of pathologists.

A significant number of pathologists practive in their 70s+.

I could once again list of the current realities for pathology (ex. employed by GIs, no job security..etc).

This isn't remotely happening or going to happen. Something magically doesn't happen in 2020. The current oversupply, large underemployment, and increased efficiency will easily take care of any "shortage" (aka only 40 pathologists applying for a job).

BU needs to face reality and quit hoping for a shortage that has been supposedly coming for 20+ years. Don't play on med students hope and be honest about the situation pathology is in.

No good or bad medical students deserve the crumbs the pathology profession has to offer.

 

[Johnny Sunshine]

This seems meaningless to me. I see no conclusive data.

These projections are based on data from the past, which in a tech-heavy field like pathology is simply useless. The number of pathologists needed for CP-related issues has collapsed, due to a combination of automation, shifting of responsibilities to PhD and technicians, and the general advanced state of the field. Efficiencies in other areas have similarly continually cut back on the "required" number of pathologists. Assuming the world of medicine will need the exact same proportions of pathologists in 2020 as it did in 1990 is misguided.

It would be nice to believe the OP's assertions, but I'm not convinced. If anything, I suspect over the years that pathologists will be increasingly cut out of the loop wherever possible. Purely speculating here, but I wouldn't be surprised if at some point technicians may be able to sign out negative small surgical cases or even biopsies, with the pathologist only signing the flagged cases (as well as a certain minimum percentage of "negative" cases of course, for quality control and technician oversight purposes).

We can't just coast along, doing what we've been doing for decades, and passively take whatever the medical field passes our way. Medicine changes, and other fields change to keep up. So must we. Unfortunately, they seem to be preemptively blocking some of our more promising routes (the recent CMS decisions on molecular, for example).

And if it is true that pathologists have a low unemployment rate, I would like to know the specifics of that. I suspect a low rate is only because they find it easier to take yet another fellowship, or take a PA job to gross, or return to a lab to utilize their PhD, etc., rather than being "jobless".

 

[2121115]

This seems meaningless to me. I see no conclusive data.

These projections are based on data from the past, which in a tech-heavy field like pathology is simply useless. The number of pathologists needed for CP-related issues has collapsed, due to a combination of automation, shifting of responsibilities to PhD and technicians, and the general advanced state of the field. Efficiencies in other areas have similarly continually cut back on the "required" number of pathologists. Assuming the world of medicine will need the exact same proportions of pathologists in 2020 as it did in 1990 is misguided.

It would be nice to believe the OP's assertions, but I'm not convinced. If anything, I suspect over the years that pathologists will be increasingly cut out of the loop wherever possible. Purely speculating here, but I wouldn't be surprised if at some point technicians may be able to sign out negative small surgical cases or even biopsies, with the pathologist only signing the flagged cases (as well as a certain minimum percentage of "negative" cases of course, for quality control and technician oversight purposes).

We can't just coast along, doing what we've been doing for decades, and passively take whatever the medical field passes our way. Medicine changes, and other fields change to keep up. So must we. Unfortunately, they seem to be preemptively blocking some of our more promising routes (the recent CMS decisions on molecular, for example).

And if it is true that pathologists have a low unemployment rate, I would like to know the specifics of that. I suspect a low rate is only because they find it easier to take yet another fellowship, or take a PA job to gross, or return to a lab to utilize their PhD, etc., rather than being "jobless".

Are you actually a pathologist? Some of your comments make me wonder if you actually know anything about pathology.

 

[WEBB PINKERTON]

This seems meaningless to me. I see no conclusive data.

These projections are based on data from the past, which in a tech-heavy field like pathology is simply useless. The number of pathologists needed for CP-related issues has collapsed, due to a combination of automation, shifting of responsibilities to PhD and technicians, and the general advanced state of the field. Efficiencies in other areas have similarly continually cut back on the "required" number of pathologists. Assuming the world of medicine will need the exact same proportions of pathologists in 2020 as it did in 1990 is misguided.

It would be nice to believe the OP's assertions, but I'm not convinced. If anything, I suspect over the years that pathologists will be increasingly cut out of the loop wherever possible. Purely speculating here, but I wouldn't be surprised if at some point technicians may be able to sign out negative small surgical cases or even biopsies, with the pathologist only signing the flagged cases (as well as a certain minimum percentage of "negative" cases of course, for quality control and technician oversight purposes).

We can't just coast along, doing what we've been doing for decades, and passively take whatever the medical field passes our way. Medicine changes, and other fields change to keep up. So must we. Unfortunately, they seem to be preemptively blocking some of our more promising routes (the recent CMS decisions on molecular, for example).

And if it is true that pathologists have a low unemployment rate, I would like to know the specifics of that. I suspect a low rate is only because they find it easier to take yet another fellowship, or take a PA job to gross, or return to a lab to utilize their PhD, etc., rather than being "jobless".

Midlevels will only make us more productive. If you think they will be signing out negative cases, you are crazy.

I'd worry more about this disruptive technology and the turf battles that will follow.

http://www.darkdaily.com/converging...athologists-and-physicians-1203#ixzz2EC2FttAM

Pathology better be going interventional if it wants a future. The days of sitting in an office miles away are numbered.

 

[LADoc00]

Peds path is a great path.

Peds path is great except 40% dont have jobs after their fellowship is over, right? Did you read that report? That is awesome, I guess if you can find a job. BUT never ask for too much $$ because if you do, there are always another nearby starving Peds Path boarded doc willing to work for less! I bet I could get a full time Peds Pathologist for LESS than what I would have to pay for a histotech or path asst. in my region (45-50/hr). I bet I could get a Ped Pathologist for the equivalent of 40 bucks/hr just looking at the numbers from that ASCP report.


I would ask Yaah "anecdotes dont trump data" how you could POSSIBLY square the supposed Government report on supply with the ASCP's own survey?

There are the data sets and they seem to be in complete contradiction.

We need tons more Pathologists yet the ones we have dont have jobs...mkay...

 

[rollwithit]

Here's some data- straight from the ASCP- http://www.ascp.org/PDF/Fellowship-Reports/Fellowship-Job-Market-2012.pdf.

The conclusions on page 18 are particularly interesting.

The fellowship section sucks. "How many jobs did you formally apply"? What the hell does that mean? You had a connection and informally got your job over the years, or you aren't looking at all because you had already planned on completing another fellowship?

Regardless, the qualitative questions asked later in the section don't pose a rosy picture of the job market at all. There's a lot of people out there that perceive the job market as crap. There are either too many pathologists being trained, to many crappy pathologists being trained, or some combo of the both.

 

[gungho]

I will leave you with the complete quote from the Screwtape Letters:
I live in the Managerial Age, in a world of "Admin." The greatest evil is not now done in those sordid "dens of crime" that Dickens loved to paint. It is not done even in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voices. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the office of a thoroughly nasty business concern

Whoa, LADoc00, I am duly impressed-a Screwtape quote and an Oswald Spengler reference (albeit in another thread), all within 1 week.

 

[WEBB PINKERTON]

Whoa, LADoc00, I am duly impressed-a Screwtape quote and an Oswald Spengler reference (albeit in another thread), all within 1 week.

LADoc00 must be having a slow week at work. Sure posts a lot. Lot of it accurate.

 

[pathstudent]

Didn't t the Mayans predict the date for the massive shortage of pathologists as 12-21-12.

 

[Entgegen]

Didn't t the Mayans predict the date for the massive shortage of pathologists as 12-21-12.

That actually made me chuckle a bit.

 

[Autopsy101]

Didn't t the Mayans predict the date for the massive shortage of pathologists as 12-21-12.

Like

 

[yaah]

I would ask Yaah "anecdotes dont trump data" how you could POSSIBLY square the supposed Government report on supply with the ASCP's own survey?

There are the data sets and they seem to be in complete contradiction.

We need tons more Pathologists yet the ones we have dont have jobs...mkay...

Umm, because the data aren't really that helpful or relevant? And note, of course, that I didn't say the government report was that helpful either - what I said was that the assumptions it was using may or may not be that accurate, that prior assumptions turned out to be improper, and that the main issue for this thread was the unfortunate fact for most people on this forum that that was actual data and not anecdote. And we get very little real data. It is regrettable that we get very little real helpful data.

Because that data appears to be only for people who tried to get jobs right out of residency, it's not really relevant to most trainees. That data set about the 139 residents I wouldn't even pay much attention to. In my experience, residents who try to get jobs right out of training, no fellowship, fall under one of three categories:
1) People who already have an in for a private job based on family or personal connections.
2) Researchers who are only going to have minimal actual practice
3) People who have poor skills, poor communication, etc.

I think the data on current graduates and job prospects are severely lacking. For some reason no one is really able to put together a good survey of the landscape. ASCP tries, but their data seems to be woefully incomplete. I think part of the problem is that it is hard to keep track of fellows when they change programs and change contact, and it always depends on who responds to the survey.

Tell me this, would you take any survey of residents who look for jobs without doing any fellowships to have any legitimate representation of the current situation? It did 30 years ago. But now pathology has become exponentially more complex and specialized, and almost everyone does some kind of fellowship to focus more. This isn't limited to pathology either, the percentage of radiologists who don't do a fellowship is miniscule too.

 

[yaah]

The fellowship section sucks. "How many jobs did you formally apply"? What the hell does that mean? You had a connection and informally got your job over the years, or you aren't looking at all because you had already planned on completing another fellowship?

Regardless, the qualitative questions asked later in the section don't pose a rosy picture of the job market at all. There's a lot of people out there that perceive the job market as crap. There are either too many pathologists being trained, to many crappy pathologists being trained, or some combo of the both.

Yep, that's pretty much my impression too. It was a worthy effort but the conclusions they have been drawing the past few years are a bit of a stretch. It takes groups of people with non-ordinary career paths and goals and extrapolates that to everyone else.

We constantly get people on these forums badmouthing the ASCP survey because they think it is painting "too rosy of a picture," which it isn't, when instead they should be badmouthing it for having a relatively poor design and drawing sloppy conclusions. They have limited resources to work with, to be sure, and are commended for trying, but as we can see in this thread people continue to draw sweeping conclusions from it.

The ideal survey would be one of pathologists who are about 2-3 years out of all training (fellowship included). Then, at that point, you can ask the questions about how many jobs you applied for, how many interviews you got, salary, if you have already changed jobs, if you got a job you wanted, etc. I don't really know why this is so hard, especially now because the ABPath requires you to have contact information on file.

 

[path24]

"We've received an overwhelming number of responses! I could not believe the response we got: probably 200 responses! It was very effective and I am happy to recommend you because I know your site works, and I will use it again." Ms. C, 26 November 2012, New Mexico

Nice quote from pathoutlines.

Shortage never....oversupply forever!!! Join up med students be one of the 200! (No way is it 200 unqualified candidates...its a ton of good qualified candidates). Hopefully next year 300 apps for a job!!

 

[LADoc00]

Because that data appears to be only for people who tried to get jobs right out of residency, it's not really relevant to most trainees. That data set about the 139 residents I wouldn't even pay much attention to. In my experience, residents who try to get jobs right out of training, no fellowship, fall under one of three categories:
1) People who already have an in for a private job based on family or personal connections.
2) Researchers who are only going to have minimal actual practice
3) People who have poor skills, poor communication, etc.
.

Stop. Just stop. Go back and reread the document starting on page 23. The ASCP has the data for trainees WITH COMPLETED FELLOWSHIPS. With fellowship training, the job success rate isn't much different. 40%+ failure to get at least 1 offer for some fields. It's a crazy 31% for hemepath!

You typed all the that which I guarantee took 10x longer than just reading the whole .pdf file.

"Your experience" is also quite limited given you went to 1 training program for everything and have I assume the same job you got after that.

None of your 3 categories is even close to correct.
1.) Researchers dont wake up one day and apply to work in a community hospital doing surgical pathology.
2.) there are boatloads of people with 2+ fellowships and bottom of the barrel communication skills.
3.) all the physicians who come a military training background usually have NO fellowships, even though they literally have a decade+ more sign out experience than almost anyone in the job market.

So your no fellowships=crap candidate insinuation is completely and utterly bunk.


I just want to clear before people on this forum begin again the throwing of stones from their glass internet houses...

 

[LADoc00]

"We've received an overwhelming number of responses! I could not believe the response we got: probably 200 responses! It was very effective and I am happy to recommend you because I know your site works, and I will use it again." Ms. C, 26 November 2012, New Mexico

Nice quote from pathoutlines.

Shortage never....oversupply forever!!! Join up med students be one of the 200! (No way is it 200 unqualified candidates...its a ton of good qualified candidates). Hopefully next year 300 apps for a job!!

There will be no shortage in the future of clamoring desperate hands to board the La Amistad.

I have a new plan, lets call it do a "fellowship with the L.A. Doc", I give you a generous 50K/year salary, just like UCSF and through weekly one on one session at a local pub I will let you in on the secrets of survival in this post-Obamacare landscape. Of course for your salary, you will be pushing glass and meat from 7-7 M-F, but I would guess I could get a hundred applicants for this and good academic ones too.

 

[lipomas]

I think you guys need to stop paying such selective attention to that survey.

The only fellowships it talks about are peds path, forensics, hemepath, transfusion med, and neuropath. What % of the overall graduate population does that even represent? Hemepath is popular but # of hemepath fellowships has exploded it seems in the past few years and lots of subpar people are jumping into them. It's the new cytopath. 3 of the others are niche fields which are either mostly academics (peds and neuro) or they are like transfusion med which can be a niche field or can be a filler for someone to fill a year.

LADoc you say a lot of good stuff on here but you're kind of grasping at straws to make this survey seem terribly relevant. Did you actually read it? The numbers they are using are pretty low and they are not representative. It's like taking a survey of hospital employees, limiting your analysis to two departments, and then generalizing it to everyone.

I'm the in the real world I haven't really met too many pathologists who don't do a fellowship these days, unless they have been in practice >15 years. Do a lot of these people exist outside of pure researchers? Maybe I'm naive.

 

[lipomas]

The ideal survey would be one of pathologists who are about 2-3 years out of all training (fellowship included). Then, at that point, you can ask the questions about how many jobs you applied for, how many interviews you got, salary, if you have already changed jobs, if you got a job you wanted, etc. I don't really know why this is so hard, especially now because the ABPath requires you to have contact information on file.

Yes we really need this survey. Can't ABPath do it? CAP could try but they would fail at it because they would make it too complicated and it would go to the wrong address for half the participants.

Drawing sweeping conclusions based on surveying people who complete peds path and TM fellowships is pretty weak.