Pathologists Will Prevail

摘要

Many thanks to Gross and colleagues3 for their article in this month's Archives of Pathology & Laboratory Medicine entitled “The State of the Job Market for Pathologists.” Their study included 253 practice leaders from around the country and, based on the data collected and assessed, concluded that “the demand for pathologists is strong, at least at the current time.”3 Their article follows several others in the last few years that have examined the pathologists' job market, and some factors that may influence it. In 2013, Robboy and colleagues4 predicted a decline in the number of pathologists beginning in 2015; and in 2015, Robboy and colleagues noted that—based on “an aging population, advances in biomedical technology, and changing roles in capitated, value-based and team-based medical care systems”—“[i]n the future, pathologists will likely have to assume new roles, develop new expertise, and become more efficient in practicing medicine…”5 In 2017, Gratzinger and colleagues found that “[p]athology residents and fellows seeking their first position[s] have faced a relatively stable job market during the last 5 years, with most accepting positions with which they were satisfied.”6 A 2019 analysis of the 2013–2017 pathology job market in the United States by Zynger and Pernick7 also supported a stable job market. And a 2019 article by George and colleagues, examining 2012–2016 data from the College of American Pathologists (CAP) Graduate Medical Education Committee's annual job search survey, concluded that “[t]he pathology job market appears stable with no precedent for geographic hardship.”8 And pleasingly, a 2019 article by Shyu and colleagues, examining aggregate data from the CAP Medical Education Committee's job market surveys between 2015 and 2018, shows “equivalent results between men and women looking for their first nonfellowship position[s] in pathology. There were no significant differences with regard to difficulty finding a position, overall satisfaction with the position accepted, salary, benefits, or access to partnership track.”9This is great news; and these articles have all provided conclusions based on assessment of data that was available to the authors; and those conclusions, based on the data analyzed, are sound. However, although these articles support the contention that pathologist jobs are prevalent, there are those who, from personal experience, believe otherwise.We all want there to be a continuing positive job market outlook for pathology trainees in the future. I believe there are 3 major national (indeed international) challenges that pathologists will need to address soon for the profession to continue to succeed and thrive, and for residents' and fellows' job outlook to remain positive. These are (1) scope of practice creep, (2) consolidation and centralization of hospitals, and (3) artificial intelligence (AI) and digitalization. For pathologists' ultimate success, these all must be considered and addressed.Scope of practice creep has not been adequately addressed by pathology's academy. Yet, there is discussion regarding scope of practice creep that is relevant to pathologists.10 Scope of practice creep is continuing in medicine because of “[b]usiness forces, of course…[a]lso, health care plans will pay for it.”11 “Rather than train more doctors, it's quicker and cheaper to grant lesser-trained professionals similar privileges. There's a standard rationale that's given: (1) We're not competing; (2) We work under supervision; [and] (3) We know when to refer.”11 But again one may ask, “[w]hy don't we just train more physicians? Because the cost of training more physicians will break the hospital's bank.”11 “Medicare reimbursements have not kept up with these training costs…[and] the organization which accredits training programs—the Accreditation Council for Graduate Medical Education (ACGME)—imposes limits on the number of consecutive hours that a doctor in training may work. This duty hour