University of Louisville Health

Pathology is one of the best kept secrets in the house of medicine. With medical school programs pivoting from a traditional-based to a systems-based curriculum, first- and second year medical students are less likely to know that pathologists are even physicians.

Phrases like “let’s send it to the lab” minimizes the physicians behind clinical laboratory tests, biopsies, and cancer diagnoses. Pathologists support each clinical laboratory result, blood product released for surgical procedures, and more.

Being a well-kept secret might have contributed to a decline of U.S. medical school graduates matching into pathology residency programs and the current pathology workforce shortage. While the COVID-19 pandemic brought the importance of pathology services and clinical laboratories diagnostic work to the forefront, it also exacerbated the staffing shortage, and employee burnout among pathologists, medical technologists and technicians, phlebotomists, histotechnologists and histotechnicians.

The Association of American Medical Colleges reported anatomic/clinical pathology as one of the five largest specialties that saw the MOST decline in physicians between 2016 and 2021, and approximately 70 percent of pathologists are age 55 or older. This data supports the 2022 College of American Pathologists (CAP) survey of more than 1,000 pathologists where:

● 65% of practice leaders said it was more difficult to hire pathologists than in prior years.

● 25% of practice leaders cited visa issues as having prevented their practice from either considering or hiring for an open position.

● The most commonly reason cited was not being able to find candidates who met their needs.

When more than 1 in 6 Americans are age 65 or older (Searing, 2023), the medical and public health laboratory workforce shortage makes it more difficult to care for an increasing number of patients. This also slows down clinical laboratory results and diagnoses turnaround times, further burdening the existing workforce.

The specialty of pathology needs reinforcement: the next generation of laboratory professionals to help take care of all our patients.

Reinforcing the Infrastructure of Pathology

In 2020, the CAP committed to a multipronged Pathologist Pipeline Initiative to create greater awareness and recruit the best and brightest medical students to pursue careers in pathology and laboratory medicine.

This includes:

● identifying and supporting champions in medical schools who are passionate about pathology, mentors medical students, and advises on pathology residencies;

● creating space for medical students to attend our national meetings;

● establishing an annual Distinguished Medical Student Award to recognize medical students who demonstrate great aptitude and interest in pathology. To create even greater accessibility, the CAP also has been:

● advocating for visa, graduate medical education, and loan forgiveness issues;

● participating in the Medical and Public Health Laboratory Workforce Coalition to “address the challenges facing the U.S. medical and public health laboratory workforce”; and,

● supporting the Resident Physician Shortage Reduction Act to increase Medicare-supported graduate medical education (GME) slots by 14,000 over seven years, if enacted.

How Would We Know If Our Efforts Are Working?

The National Resident Matching Program (NRMP) report provides a snapshot of U.S. medical school seniors and graduates applying for and matching into residency training specialties. Between 2010 and 2019, NRMP data indicated the number of senior medical student applicants and those matching into pathology residencies decreased by approximately 40 percent.

" The specialty of pathology needs reinforcement: the next generation of laboratory professionals to help take care of all our patients "

While correlation does not equal causation, the CAP’s initiative appears to be helping to bend the curve of medical student recruitment. Between 2020 and 2022, the number of senior medical student applicants and those matching into pathology residency positions increased by 8 and 13 percent, respectively.

Ensuring the Future of Pathology

The CAP is committed to ensuring the future of pathology, and helping our peers and hospital leadership better understand that timely and accurate diagnoses of biopsies and diseases is a business imperative and essential to the care of patients.

Pathologists and laboratory medicine professionals could ensure pathology’s future by treating colleagues with kindness, respect, and shared interest for our patients by answering peer physician questions. This also could include sharing with:

● patients what happens to the vials after a blood draw.

● colleagues our areas of expertise in patient care while in the coffee line at the hospital.

● children what we do by participating as speakers in school career days.

● the public our expertise through writing editorials or participating in hospital, system or national level media events on prevalent health care issues. Private practice pathologists could make themselves available as resources for:

● Medical students to rotate with them, or in a reference lab, for firsthand experience in what we do. • high school and undergraduate STEM students interested in health care and medicine.

There also are potential industry collaboration opportunities: sponsoring scholarships for students interested in pursuing pathology; supporting pathology[1]focused research; and, increasing health literacy on the role of accurate and timely diagnoses of biopsies and diseases in patient care.

Through the CAP and its collaborative partners, we all can work towards pivoting pathology from being one of the best kept secrets in the house of medicine to becoming one of the best-known resources for patient care. These efforts can positively impact the clinical laboratory workforce ecosphere, bolster the pipeline of future pathologists, and support the shortage of medical technicians and technologists.