Pathologist Workforce Study
Stanley J Robboy, MDImmediate Past President – CAPVice Chair of Pathology - Duke
© 2013 College of American Pathologists. All rights reserved.
Notice of Faculty DisclosureI have no relevant financial relationship with any commercial interest to disclose:
Stanley Robboy
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Pathologist Workforce Study
• Supply• Demand• Integrated model• Opportunities• Pathologist workforce summit
Modeling Supply
FTE SUPPLY OF PATHOLOGISTS
Current supply of
pathologists
Plus: Additions to Workforce
Less: Separations
from Workforce
Adjusted for: Working Hours by
Age, Gender
2
Results
• Imminent pathologist shortage: more pathologists will retire than residencies will graduate.
• Without significant changes in pathologist training, patients and their clinicians will experience potentially disruptive changes in current patterns of practice
Pathologists are older
0
1,500
3,000
4,500
6,000
7,500
35–4425–34 45–54 55–64 65–74 75 +
Male
Female
Age & Gender Distribution, 2009
Age Group
Num
ber o
f Pa
thol
ogist
s
5%
21%
33%30%
10%
2%
3
0
1,500
3,000
4,500
6,000
7,500
AMA Physician Age Distribution
35–4425–34 45–54 55–64 65–74 75 +
Male
Female
Pathologists vs All MDs
Age Group
Num
ber o
f Pa
thol
ogist
s
5%
21%
33%30%
10%
2%
AMA - Physician Characteristics and Distribution in the US, 2010 Edition
Path residency programs 1926-2010from1926 to
2372 in 2013
143 in 2013
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Results
Yearly Net Changes to Pathology Workforce
2010 2014 2019 2024 2030
0
200
400
600
800
1000
1200
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Total Separations Separations from retirement Additions to workforce
"Retirement cliff" coming, but residency slots remain constant
5
0
5,000
10,000
15,000
20,000
25,000
2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030
FTE
Path
olog
ists
Supply
Demand
Supply Gap, 2014-2030
Modeling Demand
Demand for
Pathology Services
Population Demographics
Disease Incidence
Sub-specialization
New technologies
Role of Informatics
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Calculations
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Service types & Base locations
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Baseline Demand Variables NAMCS09 – Analysis of Biopsies (1/2)
Age Groups
Number of Biopsies Performed (’00,000s) Total Patient Visits (MM)
Number of Biopsies per patient visit *
10,000
Relative Utilization Rates (compared to 0 – 17 female
group)0 -17 1.3 86.1 15 1.0
18 – 44 24.0 178.2 135 9.1
45 – 64 39.4 185.0 213 14.3
65 – 74 14.7 75.4 195 13.2
75 + 11.9 86.3 138 9.3
9.313.214.3
9.1
1.0
15
10
5
075+65-7445-6418-440-17
Rela
tive
ratio
s
Age Groups
Relative Utilization Ratios of Pathology Services – Female Population
Among females, the utilization rate increased with age till 64, but then showed a slight downward trend
Abnormal values
College of American Pathologists
Utilization Patterns for Pathology Svc
0.27
0.86
0.98
1.00
0.0 0.5 1.0
Uninsured
Exclusive Network HMO
All Other Managed Care
Fee-for-service
8
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Follow-up on Demand ModelSegmentation of Demand across Service Areas (2/3)
3341236347041,0031,2321,3202,412
9,841
OthersAutopsyResearchProvider Consults
TeachingMedical Administration
CPLaboratory Medical Direction
AP Total0
10,000
5,000
FTE Count
35264
8271,0741,285
1,620
2,341
AP - PulmoAP - HemAP - GUAP - DermaAP - BreastAP - GyneAP - GI
3,000
0
1,500
Segmentation of Demand FTEs in AP across Specialties – 20101
Segmentation of Demand FTEs across Service Areas – 2010
Note: 1Graph does not depict FTEs contributed by othersSource: C4C
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% o
f Tim
e Sp
ent a
nd
% o
f Res
pond
ents
Percentage of Time Spent across Services (n=1028)
We Intend to segment the supply of pathologists by services in the following manner:1. Calculate the total supply of FTE hours in the base year (Input from Phase I model)2. Distribute the total FTE hour supply into various services based on the % of time spent by pathologists in various services
from the Case for Change survey3. Convert FTE hours spent in various services into FTE count of pathologists across various services
Research
27%4% 277
Consults to Physicians
60%
4% 613
Teaching
50%
6% 517
Medical Administration
50%
7% 512
Clinical Pathology Interpretation
65%
7% 671
Laboratory Medical Direction
71%
14% 728
Anatomic Pathology Services
89%56%
911
90%
50%
0%
% of Pathologists Involved% of Time Spent
241974
Pulmonary
2%0%
Autopsy/Forensic
2%1%
Hematology
7%2%
GynecologicalPap SmearCytology
46%
3% 474
Immunohisto-chemistry
73%
4%747
GenitourinaryPathology
72%
5%738
OtherGynecological
Pathology
68%
6%704
Dermato-pathology
66%
6% 674
BreastPathology
74%
7%763
GastrointestinalPathology
78%
13% 797
% o
f Tim
e Sp
ent a
nd
% o
f Res
pond
ents
90%
50%
0%
Sum of % of time spent across various services is not 100%, as services
insignificant time spent are not listed here
Segment Supply of Pathologists by ServicesSegmentation of Current Supply
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College of American Pathologists
Expected Change in Time Spent Across Services Young1 vs. All Pathologists (n=1028)
Medical Administration
Laboratory Medical Direction
Consult to Physicians
Clinical Pathology Interpretation
ResearchAnatomic Pathology Services
TeachingServices
Increase
Remain at current level
Decrease
Expected Change in Time Spent
Larger percentage of young pathologists1 are expected to increase the time they spend in Lab Medical Direction, Medical Administration and Teaching
32%31%44%34%
18%20%35%
20%46%
26% 25% 25%28% 28%
Young PathologistsOverall Pathologists
61%61%51%58% 68%66%56% 61%51% 59% 62% 55%62% 57%
2%3%3%6% 10%9%5% 14%0% 12% 6% 16%6% 14%
Overall: n=512Young: n=59
Overall: n=728Young: n=100
Overall: n=613Young: n=109
Overall: n=911Young: n=159
Overall: n=671Young: n=108
Overall: n=277Young: n=51
Overall: n=517Young: n=95
Note: 1 We have included pathologists below the age of 40 years in the category ‘young pathologists’
This data will enable us to understand how percentage of time spent across services is expected to change over time, for overall population and for the young pathologists
Segment Supply of Pathologists by ServicesExpected Increase in Supply Across Services (1/3)
College of American Pathologists
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Increase
Remain at current level
Decrease
Expected Change in Time Spent
AP Services Immunohisto-Chemistry
Breast Pathology Gastrointestinal Pathology
Genitourinary Pathology
Dermato-pathology
Other Gynecological
Pathology
Gynecological Pap Smear Cytology
24%29%36%35%18%21%
46%19%
38%21% 18% 24%21% 19%
Young PathologistsOverall Pathologists
56%53%52%54% 47%62%47% 62%51% 66% 62% 53%62% 49%
12%12%6%6%
30%11%3%
14%4% 8% 10% 15%9%
23%
Overall: n=687Young: n=117
Overall: n=706Young: n=118
Overall: n=733Young: n=121
Overall: n=643Young: n=107
Overall: n=677Young: n=105
Overall: n=620Young: n=102
Overall: n=436Young: n=73
In comparison to overall pathologist population, lower percentage of young pathologists1 feel that the time they spend in Gynecological Pap Smear Cytology would decrease
Expected Change in Time Spent Across AP Services: Young1 vs. All Pathologists (n=1028)We intend to analyze how the percentage of time spent across AP services is expected to change over time
Note: 1 We have included pathologists below the age of 40 years in the category ‘young pathologists’
Segment Supply of Pathologists by ServicesExpected Increase in Supply Across Services (2/3)
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AP Demand Growth
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High Complexity Lab Growth
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Lab Medical Direction
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Service # Prioritized Services 11 Genomic consult (service to Providers)
29 International Insourcing
5, 28 Post diagnostic consult / Post dx clinic
37 In Vivo Microscopy
34 Acute care consultation
23 Patient and/or clinician education
12 Chronic disease monitoring
32 Bio-repository banking
6, 8 Mid-diagnostic consult / Predictive,therapeutic patient consult
33 Genomic data banking
10 Genomic consult (service to Patients)
22 Coordinating diagnostician
38 Institutional Informaticist
2 Ongoing wellness mng and consulting
1 Screening “risk assessment” consult
© 2012 College of American Pathologists. All rights reserved.
M2B Prioritized15 Services for Further Analysis
Mus
t Do
Shou
ld D
oO
ptio
nal
Later Soon Now
FE
A B C
D
G H I
• 29• 11 • 5 • 28
• 37 • 34
• 23 • 12 •32
• 6 • 8
• 10 •33
• 22
• 38
• 2
• 1
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Coordinated Care Environment Non-Coordinated Care Environment
Rank Service name FTEs in 2016
1 In Vivo Microscopy30 (Status Quo)
50 (Interpret)400 (Intervene)
2 Genomic Consult 300
Rank Service name FTEs in 20161 Acute Care Consultation 600-1000
2 Institutional Informaticist 700-900
3 Mid/Post Diagnostic Consult 375-500
Rank Service name FTEs in 2016
1 Ongoing Wellness Mng 75
2 International Insourcing 120
All Environments
© 201 CAP. All rights reserved.
New Services for pathologists
B C
A
CB A
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26© 2012 College of American Pathologists. All rights reserved.
1. Important for pathology.Pathologists, if not participating, may lose service to other physicians
2.Significant patient interaction; brings pathologists closer to patientsWill lead to increased personalization even if pathologists are not involved in endoscopic procedures
M2B Prioritized ServicesCoordinated Care/Non-Coordinated Care Environment: Top Two Services
In Vivo MicroscopyIn Vivo Microscopy
FTEs Required: -30–400FTEs Required: -30–400
1.Science making advances rapidly 2.Demand for targeted drug therapy will
increase in the future driving demand for this service. Several groups now tailoring specific chemoRx regimens to specific genomes
3.If not embraced, pharmacists (?) and other physicians may pick up service
4.In coordinated care, highly proximate action where pathologists can demonstrate value
5.Significant patient interaction6.Helps establish role for pathologists in field of
therapeutics
Genomic Consult (service to patients/providers)
Genomic Consult (service to patients/providers)
FTEs Required: 300FTEs Required: 300
1 2
Note: M2B Inputs; Grail Analysis
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Genomic medicine, Cancer
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Pathologist Efforts
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ONE PATIENT AT A TIME 2010 2014 2018 2030Anatomic Pathology 9,083 11,053 11,709 12,855Autopsy 527 527 527 527Lab Medicine (CP) 2,425 2,956 3,136 3,445Provider Consults 316 316 316 316
POPULATION SERVICESLab Medical Direction 1,950 1,939 1,929 1,902Outcome Assessment 176 176 176 176
PROFESSIONAL DUTIESMedical Education 984 978 973 959Research 474 495 517 591Teaching 878 917 958 1,094
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© 2013 College of American Pathologists. All rights reserved.
Workforce Summit 2013• Measure whether training in residency
programs aligns with skill sets needed in practice. Use survey data to modify certification testing and continuously reevaluate training.
• Develop communications (“branding”) to accomplish multiple goals for the specialty.
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© 2013 College of American Pathologists. All rights reserved.
Workforce Summit 2013
Develop products that address:• Need for lifelong learning• Need for centralized training
resources in areas not readily accessible to all programs
© 2013 College of American Pathologists. All rights reserved. 30
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