JAMA Study: 17% Fewer Pathologists Since 2007

Researchers expect a deficit in the workforce supply of pathologists for as long as two decades

CEO SUMMARY: The number of pathologists working in the United States declined by 17.53% from 2007 to 2017, according to recent research published in the Journal of the American Medical Association. When adjusted for the U.S. population, the researchers said the workforce of pathologists is smaller than that of other countries and those other countries have experienced significant adverse events in clinical lab quality, along with delays in diagnosis, particularly for cancer patients.

FEWER PATHOLOGISTS ARE WORKING IN THE UNITED STATES TODAY compared with the number in practice in 2007, according to research published online on May 31 in the Journal of the American Medical Association (JAMA).

“Between 2007 and 2017, the number of active pathologists in the United States decreased from 15,568 to 12,839,” wrote the study’s authors. That’s a decrease of 17.53%. “In contrast, Canadian data showed an increase from 1,467 to 1,767 pathologists during the same period,” they said. That’s an increase of 20.45%.

In addition to analyzing the number of pathologists working in the two countries, the researchers also reported on the number of cancer cases per year as a way to assess pathologists’ workload and the effect an over-stretched workforce could have on patient care.

When the researchers adjusted for new cancer cases per year, the diagnostic workload per U.S. pathologist rose by 41.73%. Over the same period, the Canadian diagnostic workload increased by 7.06%, the research showed.

Also, after the researchers compared the number of pathologists in United States against the U.S. population, they concluded that the U.S. pathologist workforce is smaller compared than that of other countries that have experienced major adverse events in clinical lab quality and delays in diagnosis.

In other words, patient care is in jeopardy because specimen volume has risen by more than 40% while the number of pathologists has failed to keep pace and has actually declined by almost 18%. The increased workload and the decline in the number of pathologists raises concerns about delayed diagnoses and an increased possibility of diagnostic errors.

“Pathologist shortages in the Canadian and UK health systems have resulted in suboptimal patient care, including delayed cancer diagnoses and diagnostic errors,” the researchers wrote. “A 2017 survey conducted by the UK Royal College of Pathologists found adequate staffing in only 3% of National Health Service histopathology departments.

“This inadequate staffing has resulted not only in diagnostic delays but also in increased costs due to the need to hire temporary workers or outsource services,” they said. “Because of the potential consequences of a pathologist shortage, a comprehensive understanding of the current and future pathologist workforce is imperative.

“When adjusted for each country’s population, the number of pathologists per 100,000 population showed a decline from 5.16 to 3.94 in the United States and an increase from 4.46 to 4.81 in Canada,” the authors added. “As a percentage of total U.S. physicians, pathologists have decreased from 2.03% in 2007 to 1.43% in 2017.”

Demographic Shifts

For Rich Cornell, President and Founder of Santé Consulting, a recruitment firm specializing in laboratory medicine with a core concentration in pathology, a shrinking workforce is visible throughout the profession. In his work as a recruiter for AP and CP positions, Cornell has seen shortages among pathology groups nationwide.

“As members of the baby boom generation retire, the number of pathologists is declining, and those same boomers, as patients, need more anatomic and clinical pathology testing,” he said.

Also, while medical schools have increased enrollment, the number of those choosing pathology is not growing proportionately so that they are not replacing their older counterparts in sufficient numbers, he added.

After reviewing the JAMA study, he suggested that researchers should have used data on the number of pathologists from the American Board of Medical Specialties. ABMS shows there are 26,321 board-certified pathologists in the United States, including those in all subspecialties, of which approximately 19,000 are boarded in Anatomic and Clinical Pathology. “The data would have been that much more accurate if the researchers had used the ABMS numbers,” he commented.

AMA Masterfile Best Source

In an interview with The Dark Report Jason Y. Park, MD, PhD, the lead author of the JAMA study, said the researchers considered the AMA Masterfile to be the best source of data because it’s updated regularly. Many years may pass before some organizations that collect data on the pathologist workforce will purge their lists, such as after a retirement or death, he said. Park is an Associate Professor in the Department of Pathology at the University of Texas Southwestern Medical School in Dallas and the Clinical Director of the Advanced Diagnostics Laboratory at the Children’s Medical Center in Dallas.

“If you look at the workforce for physicians overall, including for pathologists, the AMA Masterfile is the best even though it’s still considered to reflect an overage in the numbers,” Park said.

Tighter Job Market

Those concerns aside, Cornell acknowledged that the research coincides with what he has seen in the job market. “Organizations seeking to hire pathologists need help recruiting and hiring specialists in pathology and in all of the subspecialties. Everyone is having a hard time finding good, talented pathologists,” he concluded.

Contact Rich Cornell at 636‐777‐7885 or rcornell@santellc.com.

Number of U.S. Pathologists Falls, Even as Number of Canadian Pathologists Increases

BETWEEN 2007 AND 2017, THE CHANGE IN THE NUMBER OF PATHOLOGISTS practicing in the United States and Canada was studied by a research team of seven pathologists from five institutions in the two nations. Figure 1 and Figure 4 below are reproduced from the study published online by the Journal of the American Medical Association (JAMA) on May 31. It was titled, “Trends in the US and Canadian Pathologist Workforces From 2007 to 2017.” The commentary under each figure is quoted from the JAMA study.

A) The total number of pathologists in the United States decreased in each year from 2007 to 2017, for an overall decrease of 17.53% (from 15,568 to 12,839). In contrast, numbers of US anesthesiologists and radiologists showed overall growth in the same 10-year period.
B) In Canada, the total number of pathologists grew 20.45% (from 1,467 to 1,767), which was comparable to growth observed in numbers of Canadian anesthesiologists and radiologists. The total number of US physicians increased by 16.61% (from 765,688 to 892,856). The total number of Canadian physicians in this period increased by 30.30% (from 63,819 to 83,159).

The numbers of pathologists in the United States and Canada were adjusted for the new cancer diagnoses of the respective countries from 2007 to 2017. In 2007, there were 92.81 and 109.00 new cancer cases per pathologist in the United States and Canada, respectively. In 2017, there were 131.54 and 116.69 new cancer cases per pathologist in the United States and Canada, respectively.

Source: JAMA Network Open. 2019;2(5):e194337. doi:10.1001/jamanetworkopen.2019.4337

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