Workforce Issues Affecting Pathology

Confronting the issues surrounding the future of pathology and laboratory medicine workforce will require a team effort

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Advances in science and technology continue to dramatically affect the practice of medicine and patient care, including the work of pathologists. Innovative technologies are constantly changing the practice of pathology and, in turn, the educational requirements and qualifications needed to provide quality testing services. But what specific trends are driving these workforce issues, and how can the profession cope with these projected changes?

The College of American Pathologists has acted to address these challenges, most recently during a historic meeting of representatives from 24 professional pathology and laboratory medicine organizations convened in Washington, DC, to identify the top trends facing pathology in December 2013. I was fortunate to be one of the CAP's representatives at this event. It was an enjoyable, energetic, informative and positive day.

A Decreased Supply of Pathologists and Laboratory Professionals
First and foremost, the supply of pathologists and laboratory professionals will decrease substantially over the next 20 years. In fact, according to an analysis published in the Archives of Pathology & Laboratory Medicine, the supply of active pathologists in the United States is projected to fall from about 17,600 full-time equivalents (FTE) in 2010 to about 14,000 FTEs in 2030.

The reason for this projected decrease is simple. The number of pathologists expected to enter the profession is fewer than the number of those expected to leave.

Based on the number of pathology residency positions currently funded in US medical schools, about 600 new pathologists are expected to graduate each year. This is far below the number of pathologists expected to leave practice between now and 2030, and it will result in an estimated 3,600 fewer FTE pathologists in 2030 than were practicing in 2010. This trend reveals that the pathology workforce is the second oldest among medical specialties.

What the CAP Is Doing to Address Workforce Issues
The College has made substantial progress to address the workforce challenges ahead. CAP leaders have worked to significantly increase the CAP's presence and visibility in graduate medical education policy circles. The CAP presented pathology's case with key policy stakeholders, such as the Health Resources and Services Administration, the primary federal agency for addressing healthcare workforce issues and the Association of American Medical Colleges (AAMC). We arranged high-level presentations of our data to these audiences.

We also mobilized the national pathology societies behind joint communications to the Council on Graduate Medical Education (COGME), the federal advisory panel on graduate medical education.

In 2013, the CAP's annual policy meeting featured a discussion on GME and the future of pathology workforce with experts Sheila Burke, RN, MPA, FAAN, of the Bipartisan Policy Center; and AAMC Chief Public Policy Officer Atul Grover, MD, PhD.

On Capitol Hill, the CAP is part of the AAMC coalition opposing cuts to Medicare support of GME. The CAP supports legislation such as HR 1190, "The Resident Physician Shortage Reduction Act of 2013," introduced by Rep. Joe Crowley (D-NY), and HR 1201, "Training Tomorrow's Doctors Today Act," introduced by Rep. Aaron Schock (R-IL) and Allyson Schwartz (D-PA). Senators Bill Nelson (D-FL), Charles Schumer (D-NY) and Senate Majority Leader Harry Reid (D-NV) introduced similar legislation, S 577, "Resident Physician Shortage Reduction Act of 2013." These bills would lift the GME funding cap and expand the number of funded residencies.

Changes in the Demand for Pathology Services
The demand for pathology and laboratory services over the next 10 to 20 years will see a major shift due to changes in population age, disease incidence, new technology and consolidation. These changes, in addition to new healthcare technologies and opportunities emerging under accountable care organizations (ACOs), will likely change the demand for medical services, including pathology, and those demands are difficult to project.

Working with Our Colleagues
Looking ahead, the workforce summit stated it will be essential to communicate the distinct need and value of the entire laboratory healthcare workforce. For years, professionals such as PhD clinical scientists, cytotechnologists, histotechnologists and others have become integral members of the care team. The care team of the future should be led by a pathologist and supported by these important medical professionals.

The availability of training programs, particularly those that offer online and distance education, will be critical in developing an adequate supply of qualified pathologists and laboratory professionals.

Advocating for Appropriate Resources, Reconsidering Recruitment and Training
With the decreased supply of pathologists and laboratory professionals, attention must be brought to policymakers unaware of this instability in the pathology profession. Furthermore, those participating in the December workforce summit suggested the profession itself needs to reconsider how best to make use of its available training capacity. Attention needs to be directed both to present areas of need, such as forensic medicine, as well as future needs, such as those in pathology informatics and genomic medicine.

The CAP also is leading efforts to implement recommendations from the workforce summit on how the specialty can meet the future needs of our health care system. To address these needs, the workforce group recommended stakeholders should: 1) reassess what every pathologist needs to know, and identify new ways to ensure that pathologists acquire both general skills and subspecialized expertise, especially in key emerging areas; 2) reconsider recruitment to attract and recruit highly qualified medical and STEM (science, technology, engineering and mathematics) students into pathology and laboratory professions; and 3) reevaluate long-term training expectations to encourage lifelong learning and maintain or enhance career opportunities applicable to current health care delivery systems and payment models.

Going forward, the CAP is collaborating with our colleagues as we have a lot of work left to do.

Gene N. Herbek, MD, FCAP is the president of the College of American Pathologists (CAP). For more information about workforce issues, read the recent joint statement, "2013 Pathology Workforce Summit: Propositions on Workforce Issues Affecting Pathology and Laboratory Medicine."

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i well be in front of the succses

mohamed elawadJune 07, 2014

It was encouraging to read this article. In my observation, over the past 10 years there has been an ebb and flow of discussion about this topic.

Policy makers do not fully grasp the impact of recently mandated changes on laboratories; specifically the reduction of CPT code 88305TC. When the anticipated 20-30% drop turned out to be over 50%, most services were totally blindsided. Recovery from this financial damage is a daunting challenge.

Furthermore with 88305, the cost savings realized by CMS are at the expense of technical operations; putting the financial burden where it's least affordable. This has also given insurance companies the green light to reduce reimbursements, which has a net negative effect as well.

Control of healthcare costs is a complex issue to which there are no simple solutions. However, I think an accurate overall understanding of laboratory's role in healthcare, and it's associated value are warranted.

Over 80% of medical decisions cannot be made without lab tests. Considering total healthcare, laboratory is a tremendous bargain. Despite the problems in this country with the administration and delivery of medical services people expect high quality healthcare. The education, expertise, and facility to provide this have associated costs which very often are ones of life and death.

As we move to a different fee structure based on patient outcomes I'm hoping labs will be compensated fairly. I'm also hopeful that we can achieve reasonable cost containment and an improvement in public health across the board.

Thank you,
Thomas Jasper
Anatomic Path/Central Processing Supv.
Deaconess Hospital
Evansville, IN

Thomas Jasper,  Supervisor,  Deaconess HospitalJune 06, 2014
Evansville, IN

Very well summarized, Dr. Herbek. Pathologists and all related laboratory professionals need to be aware of these trends. We all need to contribute to the brainstorming of ideas about how to best adapt and respond. Thanks for your leadership at CAP.

Patricia Gregg,  Medical Director of Laboratory,  Lehigh Regional Medical CenterJune 06, 2014
Lehigh Acres, FL

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