September 25, 2019 -- ORLANDO, FL - The outlook for pathologist jobs in the U.S. appears good, in contrast with recent pessimistic reports, according to a survey of practice leaders discussed at the College of American Pathologists (CAP) annual meeting.
CAP leaders tackled workforce issues and pessimistic sentiment among residents about the outlook for employment in pathology during a panel at the meeting, which runs from September 21-25 at the Gaylord Palms Resort and Convention Center in Kissimmee, FL, near Orlando.
Participants in the panel discussed survey results that suggest a healthy job market, with nearly half of survey respondents reporting that they are hiring pathologists. But is this enough to counteract recent reports of a declining market?
This week's panel follows on the heels of a stunning report on the pathology workforce published in May in JAMA Network Open. Investigators found that the number of active pathologists in the U.S. plummeted between 2007 and 2017 by about 17.5%.
However, results from CAP's own research paint a positive picture of the market. In a survey conducted in 2018 that reflects data acquired in 2017, 2,709 practice leaders and managers were canvassed and 346 responded, including 253 who addressed questions about the job market in particular.
Approximately 45% said they were hiring pathologists, and, of these, half were hiring for more than one position. Respondents reported a total of 249 planned open positions and 60 that were being eliminated, for a net gain of 189.
"At least among these practices, the job market seems to be growing," said David Gross, PhD, an economist and director of CAP's Policy Roundtable.
|Pathology practice leader survey responses|
|No. of positions open||+249 (243 FTE, 6 partial)|
|No. of positions eliminated||-60 (58 FTE, 2 partial)|
|Net change||+189 (185 FTE, 4 partial)|
Of the open positions, 53% were based in academia and 22% were in nonacademic settings. Gross noted the distribution and representation of respondents, as 70% or more were based in practices with 10 or fewer pathologists. The results indicate that general pathology experience is most in demand, followed by hematopathology and gastrointestinal pathology.
|What pathology practice leaders are looking for|
|Area of expertise||Practices seeking this expertise|
|General pathology, no subspecialty||42.3%|
|Cytology nongynecologic (fluids and fine-needle aspiration)||22.5%|
|Cytology gynecologic (Pap smears, liquid-based preps)||18.9%|
|Gynecologic, surgical pathology||14.4%|
Practices in the survey said the level of experience for the "optimal" candidate was from two to five years for a wide range of areas, including breast, pulmonary, genitourinary, and general pathology.
However, Gross acknowledged that the survey was not clear as to what type of experience this included: for example, whether fellowship experience would count as experience. CAP would also like to be more specific in terms of how "optimal" is defined and what it means in practice.
"We need to refine this, but this gives us information we hadn't had before," Gross said.
About one-third of respondents were unable to fill open positions for a range of reasons, including issues finding qualified candidates, problems meeting compensation requests, and geographic challenges.
Big demographic shift
About 600 pathologists enter the workforce every year. Dr. Michael Cohen, chair of the CAP Policy Roundtable and a professor of pathology at Wake Forest School of Medicine, presented data from another CAP survey showing that there has been a dramatic shift in the demographics of the workforce in a relatively short period of time.
Of those who are new to pathology, defined as having one to 10 years of experience, the proportion of women is 61.4%, compared with 38.3% for pathologists with more than 10 years of experience. Those new to the field are evenly distributed in terms of practice size, whereas among those with more than 10 years of experience, 46% work in practices with fewer than six pathologists.
Pathologists can expect an entry-level salary in the low $200,000 range, regardless of the setting, according to the survey. Respondents told CAP that their biggest concerns in terms of advocacy were related to Medicare payments, lab test payment policy, and health reform generally.
A glass half empty?
CAP is concerned about perceptions of the field among young people deciding on a specialty. Panelist Dr. W. Stephen Black-Schaffer, chair of CAP's Policy Roundtable workforce committee and a professor of pathology at Harvard University, cited some historical issues that created workforce challenges for newcomers.
In the mid-2000s, residency training requirements changed and the total training time involved was reduced by one year. Many pathologists responded by entering subspecialty fellowships, and those with fellowships subsequently had a competitive edge in the job market. Prior to the change, 30% sought subspecialty fellowships, but afterward virtually all pathologists had fellowships, Black-Schaffer noted. It proved to be a lasting trend.
There have been reports of a lack of job opportunities, and these have been widely publicized on social media, but these reports are based on small, flawed, and misinterpreted datasets, he said. Nevertheless, he fears that the pessimistic outlook on jobs among residents has potential to damage the profession.
"Be careful what you say because you may be believed," he said. "I take that to heart myself."
Pathology work will still need to be done -- but there is a risk that in the future it may be done by people who are not skilled pathologists with unique qualifications, he warned. Black-Schaffer suggested that it is "scary" to think of how pathologists and the healthcare services that pathologists provide may be degraded if the workforce is not replenished.
"It's important for us to get good, legitimate, current information and get it out to people," he said.
An attendee questioned panelists about the small size of CAP's survey on jobs, given that there are some 18,000 pathologists in the U.S. The panelists responded that CAP is eager to boost participation and response rates, and it is working with marketing and communications personnel to develop new strategies.