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Cancer, Pathology, and the Law of Supply and Demand

By Proscia | March 8, 2018

As cancer rates rise, the number of pathologists analyzing the biopsies and making diagnoses would naturally rise as well, right? Wrong. According to the College of American Pathologists (CAP), the number of pathologists in the US is expected to decline substantially within the next 15 years, even as the demand for patient diagnosis and management rises. In fact, the CAP estimates that there will be a 14% unmet pathology demand by 2020 and over a 30% unmet demand by 2030. While the causes of this decrease in pathologists are many and varied, including the retirement of a large generation of pathologists, one thing is clear: without a significant change to the field, healthcare providers are facing an imminent and severe staffing problem in one of the most crucial fields for cancer treatment.

So what does this mean for the pathologists and the patients they serve? An unmet clinical burden of 30% means that either it takes longer for pathologists to get through a workload, increasing the time between screening and diagnosis, or there is a decrease in the number of tests performed, resulting in less clinically-relevant information being gleaned for each patient. This is in addition to the fact that each pathologists is expected to take on 30% more work, which is no small feat given that the average work week for a pathologist is already at 50 hours.

The CAP predicts no increase in training of new pathologists, and so solutions must target efficiency of work rather than increasing the number of pathologists. In this light, the field of digital pathology holds the most promise. Efforts to move from microscope to computer based image viewing have already been successful, with most large hospitals already buying into whole-slide image scanners. The next step, then, is to implement changes to workflow utilizing the advancements in digitization wherever appropriate to reduce the time spent by pathologists on mundane tasks. This allows the pathologist to spend time on the important diagnostic elements of the process without reducing the quality of work.

Stanley J. Robboy et al (2013). Pathologist Workforce in the United States: I. Development of a Predictive Model to Examine Factors Influencing Supply. Archives of Pathology & Laboratory Medicine: December 2013, Vol. 137, No. 12, pp. 1723-1732.

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