From the President’s Desk: Workforce advocacy: everyone’s job

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Stanley J. Robboy, MD

August 2013—Many people don’t know what we pathologists do. This is concerning, especially when some of the same people are responsible for determining levels and allocation of funding for graduate medical education, keeping our training programs open, or encouraging careers in pathology. I hope this column ignites a sense of urgency around funding for pathology training and recruiting a strong workforce, for without both our patients will suffer an indefensible loss.

Pathology has a relatively low profile, in part because there aren’t many of us—fewer than 18,000 at last count, in 2010, which is 5.7 pathologists per 100,000 population. We anticipate that number could drop precipitously in the next two decades, to 3.7 per 100,000, while the variety and complexity of pathology services continue to increase. It looks like we will need 14 percent more pathologists than we are projected to have in 2020—and far more will be needed than we expect to have in 2030.

Those data come to you courtesy of a just-completed comprehensive, evidence-based assessment conducted by our CAP Workforce Project Work Group and published in Archives of Pathology & Laboratory Medicine (www.archivesof pathology.org/doi/pdf/10.5858/arpa.2013-0200-OA). (The paper reports on supply-side findings; a series of papers on the projections of demand for pathologist services is in development.)

The workforce analysis project came about as we realized that medicine was changing and we needed a plan that anticipated training and workforce needs. To that end, we built an integrated modeling tool that enabled us to project the supply of pathologists through 2030—incorporating market conditions, population demographics, disease incidence, subspecialization, new technologies, and the role of informatics.

Pathology is one of the smaller specialties, and our demographic skews older than most. Only 21 percent of active pathologists are 35 to 44 years of age while 33 percent are ages 45 to 54 and 41 percent are 55 years or older. This is obviously upside down. If the pathologist population were in equilibrium, we would have more practitioners earlier in practice, but our numbers show the reverse. And the picture has been further complicated recently by trend lines reflecting later retirement and postponed entry to the workplace by graduates electing to take one or more fellowships.

Even without the demand-side analysis, we know the general population is aging, which will increase health care needs and costs. And we know that pathology is also moving into new areas, such as genomic medicine, bioinformatics, in vivo microscopy, biorepository management, and preventive health management. Each opportunity is welcome, but staffing could become a conundrum, because beginning in 2015 we expect to begin experiencing a net outflow of pathologists. The long-anticipated “retirement cliff” is about to begin, underscoring the importance of our training pipeline.

To put this in context, it is important to understand that federal Medicare funding for residency training in all specialties was capped in 1997, a persistent frustration made worse by new pressures to create more primary care training slots. No one doubts we need more primary care physicians; our challenge is explaining to policymakers that those primary care physicians, and the nurse practitioners who are taking on expanded roles, will very much need their pathologists.