Yeah.. unfortunately it was never really a vacuum, as PhD's had already infiltrated the CP labs and were a simple fit into this role. As with other CP labs there are advantages to having an MD director, but as it's not "required" and PhD's generally earn less salary and have a greater chance of being involved in grant funded research, a non-medically trained administrator probably sees this as a no-brainer. Clinical pathologists kinda shot themselves off the ivory tower many years ago with self referrals and various apparently questionable practices (similar to what we're seeing now in AP, although more a result of urologists, GI's, etc. running their own path), and billing I guess now works differently -- bottom line being it's less profitable to be a CP, unless perhaps you're running a large lab and paying some PhD's to do the dirty work.
There's a lot of rumbling about molecular being the growing big thing, but the same could be said of immunohistochemistry not all that long ago, which has already rolled into regular practice. I have a feeling it's likely to be just another "lab test" with testing modalities managed by the lab but interpretation primarily by those familiar with a given specialty, some in path and some not (soft tissue, heme, oncology, microbiology/infectious diseases, etc.), as already seems to be the case. Until someone puts forth some extremely compelling reasons for individual clinical lab departments to all be individually directed by an MD pathologist, not just medical director oversight by any ol' MD who need not know what a lab even is, I doubt this is going to significantly change. But, who knows.
Maybe I misunderstood, but I thought only MD pathologists can truly 'signout' a test to be reimbursed by insurance or medicare? At my institution, a MD will co-sign a test out with a PHD. Now as to whether or not the MD spends more than a minute reviewing the work of the PHD I am unsure of.
Are there molecular pathologists outside of academia?
The problem is that not every test gets any kind of signout, and those that do are relatively niche or uncommon tests.. and billing more for interpretation isn't always worth the cost of an MD. Most CP results these days, once checked by the tech, go into the LIS for at-will interpretation by any clinician. Granted, I don't know what the status of "requiring" an interpretation on most molecular tests currently is, but as far as I'm aware most (by volume) provide a result, not an interpretation of peaks or electrophoresis patterns or whatever. Certainly that can change based on the nature of the specific test being performed, and it seems like newer tests get interpretations for a while until the modalities and results are well established, which should apply to some molecular studies. But I would be surprised if every infectious disease PCR had to be signed out by an MD -- in time, I suspect (though don't recommend or favor), "newer" tests will follow suit.
One of the problems is the bottleneck in training programs. While you may be able to sign out some cases as a PhD who meets all the requisite requirements, you must be a MD boarded in that specialty to be the program director of a fellowship (someone correct me if I am wrong).