By: Mick Raich, President, RCM Consulting, Lighthouse Lab Services and Vachette Pathology
Recently, while attending the Executive War College in New Orleans, my goal was to drill down on the current state of the anatomic pathology workflow and diagnose some of the issues impacting staffing. As part of that effort, I interviewed Tara Luellen, Vice President of Lab Director Services for Lighthouse Lab Services. I also listened in on an overview of the pathology market by Rich Cornell, President of Sante Consulting.
“We are seeing an all-time high of open Pathologist positions, while training programs are turning out fewer graduates and fellows each year,” Luellen said. “Demand is exceeding supply. Employers, labs, and hospitals need to pull out all the stops to attract top-level talent in today’s market.”
Cornell also noted several illuminating facts in his presentation:
- The demand for subspecialized pathologists is bigger than ever.
- There are currently about 500 pathologists graduating per year and we have about 683 open jobs. In January of 2017 there were 290 open pathology positions, and in June of 2020 there were 500 open positions.
- There are 140 hematopathology positions open and 130 cytopathology positions are open.
- Most startling, there are 100 open positions in just in New York State.
“I don’t see the job market changing for the foreseeable future and also keep in mind that the physician workforce will change over the next four years,” Cornell said during his presentation. “According to a recently published JAMA article, 75% of the physician workforce will be millennials within the next 48 months. Groups that adjust their way of thinking and recruiting and adapt quickly to change will be the real winners in today’s competitive market.”
Work volumes, aging population and other factors
But what about work volumes? An oft-cited industry figure from the 90’s noted the average pathologist at the time performed about 3,150 cases per year. However, those number have increased dramatically in the ensuing decades. A recent review of our clients shows this case volume to now be closer to 4,400 per pathologists, with some of our doctors doing as many as 5,200 cases annually.
Another factor to consider is that the U.S. has an aging population that will require more diagnostic tests. Remember, 2020 isn’t a good benchmark for diagnostic test volume due to the COVID fears keeping people away from predictive diagnostic testing. It may be until 2022 until people feel safe to go back to their typical medical processes.
We also have to weigh the fact there have been some major pay cuts in the professional fees of pathology. As of January 2022, the professional fee for the major routine CPT code 88305-26 will have been reduced by almost 8% over the past two years. Routinely slashing anatomic pathology reimbursements does little to stimulate the workforce or make it an attractive career path for new students.
Finally, if there are this many open pathology positions, what does this do to the overall anatomic pathology workflow? Are we going to see an increase in turnaround times? Or is AI going to be able to lower the actual number of pathologists reading slides?
So, what do you get when you combine lower overall numbers of pathologists, higher work volumes, decreasing revenue from payers in the fee-for-service world, and an aging population requiring more diagnostic testing? Put together, these factors may create a perfect storm of frustrations for the pathology workforce.