Pathology in 10 years

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HiHi1234

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Hello all, I am not very knowledgeable with anything about pathology but I am wondering if this field will still be around 10 years down the road, or maybe 20, 30 years...

The reason why I ask is because it seems like all the technology is heading towards imaging and stuff and less about microscopy. Will there be less demand for pathologists over time or is there something that pathologists can do that will never be replaced?

Thanks for answering!
 
Been following this forum for about a half dozen years and this is probably my favorite post ever.
 
This question is somewhat ridiculous, but yes this field will be around for as long as medicine exists. As far as anatomic pathology and tumors, things may change with the advent of molecular pathology and cytogentics; however, I do not forsee the H&E ever going away.

Clinical outcome data is all based on morphology and molecular/cytogenetics will take years to catch up and generate enough clinical data to change treatment protocols. Ideally characterization of tumors will be based on genetic profiles through whole genome sequencing, but whole genome sequencing has not been successful thus far and even if it is, the informatics required for interpretation to is no where even close. However, limited health care resources will prohibit complete genetic characterization of every tumor and "triaging" tumors for molecular testing will continue for many years to come.

If you are asking will the H&E or microscopy ever go away, the answer is not anytime soon. I do not foresee microscopy going away for a very long time. Although, it is likely the field will become more "CP", it is not likely not to happen within the next 10-20 years. I am just a first year, but this is my impression of the way things will go. Others may have different opinions...
 
Hello all, I am not very knowledgeable with anything about pathology but I am wondering if this field will still be around 10 years down the road, or maybe 20, 30 years...

The reason why I ask is because it seems like all the technology is heading towards imaging and stuff and less about microscopy. Will there be less demand for pathologists over time or is there something that pathologists can do that will never be replaced?

Thanks for answering!
Not in your lifetime or probably ever. Advances may be made in tumor genetics but there are still questions to be answered by the pathologist looking at glass. Reactive conditions, margins, quality control, etc. The better question: will we be fairly reimbursed for our work?
 
Pathology will cease to exist within 5 years. Book it.
 
I agree that much of the progress and research being done in medicine is with imaging or molecular genetics, and not new ways to characterize tumors based on morphology. Pathology is no doubt an expanding field and even our leadership (CAP) continues to stress the importance of the field to adapt in changing times. I think that this, in some ways, scares medical students interested in pathology or trainees because many are attracted to the field because of morphologic diagnosis and signout. We don't want to master all of these skills only to learn that we have to change how we do things.

Still, for those interested in a job based on traditional pathology, I am confident that you will be able to make a career out of this. Even in the age of personalized medicine, the best way to make a diagnosis of a malignancy will be by biopsy with molecular studies used as only a triage method. Clinicians may increasingly push for molecular characterization of their tumors, but I think we are a long ways off from bypassing the entire H&E/IHC process. Morphology and/or cytology is relatively cheap and gets the job done in most cases anyway.

Additionally, once a diagnosis is made and the patient goes to surgery, there will always have to be someone to gross the specimen in and examine it microscopically. Pathology still has a big role in staging cancers (which after all is the most important prognostic factor).

We will also still have all of those medical biopsies which imaging/molecular usually don't have as much of a role in making a diagnosis.

It's an expanding field, an in 50-100 years it may look a lot different, but for those training now I wouldnt worry about being out of a job halfway through your career...
 
I think this is similar to asking if internal medicine won't be around because the physical exam is being replaced. The microscope will become more of a triage tool just as a well trained clinician still needs to eyeball a patient. I am sure that one day everyone will be scanned and chemically analyzed by their alarm clock - but not soon.

If you are asking this type of question about pathology and are interested, you should spend more time in our speciality. Before long the answer will be obvious. Don't feel bad though, barely a week goes by without an attending from FP or IM - says something like "any autopsies today" - or "you take call- what for".
 
A lot of cancer screening guidelines are under fire big time. There is a ton of waste and overtreatment in the system that will be eliminated. It's good people are finally questioning whether or not many tests are necessary. Its too bad the guidelines created a false market.

Also, you cant overlook the drop in smoking in this country. Quite a bit of pathologist revenue, and health care revenue in general, still comes from smoking related disease.
 
A lot of cancer screening guidelines are under fire big time. There is a ton of waste and overtreatment in the system that will be eliminated. It's good people are finally questioning whether or not many tests are necessary. Its too bad the guidelines created a false market.

Also, you cant overlook the drop in smoking in this country. Quite a bit of pathologist revenue, and health care revenue in general, still comes from smoking related disease.

-Cancer screening recommendations based on the USPTF are hardly followed, which is a good thing for American health. Mammograms, colonoscopies, and PSAs have all been proven to save lives with number needed to screen ranging from ~800 to 1400. The problem is that they are hardly cost effective. Even if US healthcare takes a more rationed turn, however, they will continue in high numbers (see european countries)

Smoking may be going down, but population age, obesity, and all its related issues are going up. There will be plenty of demand for healthcare.
 
It -might- change in a significant way in my lifetime (50+ more years, with some luck), but to be honest, I suspect it will take longer. A few very specific methods for very specific tumors or sites -might- crop up without the need for traditional AP, but there's just nothing in the pipeline that I'm aware of that I think has a reasonable chance to replace glass slides in a major fundamental shift kind of way. Stains might change, slides might be scanned in, new tests will arrive, old tests will fade, etc., but AP/CP will remain and I believe the basic methodology is very likely to remain for a long time still. Not necessarily because there's nothing better to be done, but (in part) because such a titanic shift is essentially impossible these days -- despite all the lip service paid to "research", real risk taking innovation is pretty crippled, but that's a tradeoff we take in exchange for a fairly stable, predictable, and reasonably trustworthy health system (compared to the Good Ol' Days of unregulated practitioners and pharmacologicals, anyway).

If by "imaging" you mean various radiology methods, this is a common query from the mainstream media/layperson, but for all radiology has done and can do, it's nowhere remotely close to replacing AP, much less CP. Its pathology related strengths are still mainly to locate suspicious areas for AP evaluation; it can certainly help narrow the differential, of course. As for the so-called in-vivo microscopy imaging interpreted by non-paths, it's barely out of fetal development, though also gets a lot of press -- but it remains to be seen whether it will be just another way to waste money or can reliably perform..in limited situations..on par with AP/CP, financially as well as diagnostically and in outcome measures. In some cases it has its own "new" niche while not taking anything from pathologists, such as in-vivo examination of coronary arteries or retinas, but realistically still has a way to go.
 
I was told that we will need a lot more pathologists because in ten years there will be an explosion of complex testing and it will take pathologists to put the data together and explain to the oncologists, surgeons and other physicians what the results mean of the tests that they ordered. Plus we also need a lot more pathologists because we are going to try to cut costs by limiting complex testing. So the government, for profit and for profit "not for profit" hospitals will need pathologists to review requests for K-ras mutations and what not and then we will approve them or disapporve them. Then if we approve them, we will get the results and explain to the oncologist what the results mean (as if they don't already). That's the future of pathology.

Or better yet we will be part of some huge ACO drinking some kool-aid about "value over volume" doing just as much work as we do now but for 1/2 the money.

But my hope is that in 30 years, I am still writing "88305" on pieces of paper, turning them in, and getting paid by the government or insurance or whoever.
 
I probably should have clarified -- I do suspect more and more of CP will be replaced by PhD's and scripted automated resulting. So-called "complex testing" requiring a pathologist interpretation is a farce. Even now, with these methods in their least well recognized or understood infancies, when interpretive assistance should be at its highest, pathologist interpretation doesn't seem to be called for (not that it isn't needed, it's just not being called for nor evidently forced). CP results will continue to be largely interpreted either by algorithm or by clinician. However, that would not be new. (Not that they -shouldn't- be interpreted by an MD/CP, merely that that boat has already sailed and the power structure as it stands doesn't care. It doesn't matter if the results are or aren't useless, they are exciting, and pathologists just poo-poo on the party by pointing out their weaknesses when asked. Ergo, less asking.) Anyway, CP will retain a major role in title, but in practice many positions will continue to be filled by non-MD's. AP hasn't hit that problem, and although it theoretically -could-, I don't foresee it soon.
 
Yeah I don't buy the whole issue about pathologist interpretation of complex testing. Let's face it, the clinicians often know as much if not more about the genetics of the tumors they treat. They are the ones asking for molecular and genetic testing on tumors before we start recommending it. Sure, there will be some molecular pathologist that signs out the complex test at some large reference lab, but it won't require some additional interpretation from the community pathologist before being reported.
 
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