New Research Led by CAP Members Shows a 40% Pathology Workforce Undercount in Nationally Published Reports

Members of the College of American Pathologists (CAP) found a massive undercount of pathologists in a database of working US physicians that the Association of American Medical Colleges (AAMC) maintains and is referenced in recent published works on the pathology workforce. The CAP members wrote about the undercount in an article published by the Journal of the American Medical Association (JAMA) Network Open today and further call for previous works citing the data to be corrected.

The JAMA Network Open article “Re-evaluation of the US Pathologist Workforce Strength” by Stanley J. Robboy, MD, FCAP, et al., explored unintended flaws in the methods used by various entities, and why most recent workforce counts have understated by about 40% the number of actively practicing pathologists in the US. The authors recommend that AAMC alter how it reports pathology workforce numbers so that it includes all physicians the American Medical Association masterfile who are actively practicing pathologists. Currently, the AAMC database does not include in its count those pathologists who are also trained any of the various pathology subspecialties, such as cytopathologists, dermatopathologists, hematopathologists, forensic pathologists and eight others.

The authors estimated that AAMC’s current methodology, as reported in a May 2019 JAMA Network Open article “Trends in the US and Canadian Pathologist Workforces From 2007 to 2017” by David Metter, MD, FCAP et al., excluded about 8,000 pathologists. The article used the AAMC database and reported a decrease in the US pathologist workforce in absolute and population-adjusted numbers from 2007 to 2017. The article stated that US pathologist supply decreased 17.5% while Canadian pathologist supply, based on the Canadian Medical Association Physician Masterfile, increased by 20.5% during that time period.

“The AAMC does not report data at the subspecialty level, but also does not recognize that its data source, the AMA Physician Masterfile, replaces the pathology primary specialty by the latest reported training,” Robboy, et al. wrote. “Thus, if an anatomic/clinical pathologist receives later training in hematopathology, the physician’s primary specialty field is replaced with the subspecialty hematopathology and the physician is no longer counted by the AAMC as a pathologist.” As the percentage of residents taking additional training in a subspecialty (fellowship) has been rising, now documented at 97% of all residents, the AAMC database in essence reflects the retirement of older pathologists who were trained and practiced as generalists.

The authors recommend that all previously published reports, presentations, and other uses of the data from the AAMC be reexamined. Statements based on the AAMC data that report a pathology workforce shortage or decline must be reconsidered.

It is noteworthy that recent surveys on the pathologist workforce have shown the job market for pathologists to be healthy. For example, according to a study published in the Archives of Pathology and Laboratory Medicine earlier in 2020, 45.5% of leaders of pathology practices responding to a CAP survey had sought to hire at least one pathologist in 2017. In Academic Pathology (2020), Charles F. Timmons, MD, PhD, FCAP et al. reported findings demonstrating a strong and strengthening pathologist job market: a 2017 survey by the Program Directors Section of the Association of Pathology Chairs showed 96% of residency graduates obtaining post-fellowship employment within three years and 97% within five years, while a 2013 survey showed 92% obtaining post-fellowship employment within three years and 94% within five years.

The July 2020 JAMA Network Open article is available online. The authors who are members of the CAP include Dr. Robboy (a former CAP president); Jason Y. Park, MD, PhD, FCAP; James M. Crawford, MD, PhD, FCAP; Rebecca L. Johnson, MD, FCAP (CEO, American Board of Pathology); Michael B. Cohen, MD, FCAP, Donald S. Karcher, MD (current CAP Governor), FCAP; Robert D. Hoffman II, MD, FCAP; and W. Stephen Black-Schaffer, MD, FCAP. Other authors are David J. Gross, PhD (Director, CAP Policy Roundtable); Elizabeth Kittrie, MMHS (Bureau of Health Workforce, Department of Health and Human Services Health Resources and Services Administration); and Tony Smith, MLS (CAP Senior Manager of Membership Services).

About the College of American Pathologists

As the world’s largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. As a 501(c)(6) membership organization, the CAP is the only entity representing pathologists with unrestricted advocacy capability and a political action committee, PathPAC. For more information, visit yourpathologist.org to watch pathologists at work and see the stories of the patients who trust them with their care. Read the CAP Annual Report at cap.org.

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