The Pathology Job Market Outlook in 2019 – A Mixed Bag
Plus a few tips on landing your first real Pathology job
Everyone from PGY-3 to PGY-5/6/7 has their eyes on the next big step in their career – for some the most daunting – their first employment as a real, grown-up Pathologist. Predictions for the job market seem as varied as predictions for next year’s winter, and range from dire to recklessly optimistic. Almost everyone knows someone who jumped into a great job right out of residency; and almost everyone knows someone who is going into their third fellowship without any solid job prospects. Most residents and fellows are wondering, “What does all this mean to me?” And that’s nothing to be ashamed of. No matter how many great mentors you might have had in residency, no matter how great your family support might be, the only thing that is going to land you a good job is you – your work ethic, your accomplishments, your job hunting efforts, and your persistence.
What can you expect going into the job market today?
As Pathologists, we pride ourselves on gathering hard, scientific data to render diagnoses. We are the gold standard for most diagnoses in medicine, and laboratory data contributes significantly to about 75% of all medical diagnoses.
So why, then, do we settle for soft, unreliable survey data when it comes to our own livelihoods? Short answer: because it's the best we have. The Archives of Pathology Laboratory Medicine regularly puts out papers on the Pathology labor market and projects outlooks for future years. Their analyses are thorough and conclusions interesting to read, but much of their findings are based on survey data, one of the weakest forms of data in medicine and criticized by some for being intrinsically unscientific.
Their most compelling datum point, from 2010 American Board of Pathology data, is the number of known living board-certified Pathologists, 23,012.1 From this, the authors calculated that in 2010 there were 16,657 actively practicing board-certified pathologists. The number of total active Pathologists is estimated to be up to 7% higher, as not all Pathologists are board-certified.
From these figures are derived various estimates of full time equivalent (FTE) positions based on survey data from Pathologists. As the name suggests, FTE is a figure that takes into account part-time and locum tenems Pathologists. Demand for Pathology FTE positions, estimated at 17,568 in 2010, is projected to have grown to 19,927 by 2018 and to grow to 20,395 in 2030.2 These estimates are based on projected patient need taking into account the ramifications of the 2010 federal health care legislation, which itself has an uncertain future.
What remains certain is continued protection of the occupation of Pathology by state governments. Whether one believes medical licensing is unconstitutional, the fact remains that Pathologists remain in a de facto state-protected guild as a result of medical licensing. This protection offers significant job stability by utilizing the force of law to limit labor supply. A signficant countervailing force is the national compulsion of wage price controls for Pathologists through the use of the Current Procedural Terminology (CPT) code, which restricts demand. The rate of supply is determined exclusively by the capacity and occupancy of residency programs, which has remained stable (0.1% growth rate) at 2,400 positions.1 Meanwhile, CPT codes in Pathology remain subject to the viscissitudes of state control. The notorious 2012 CPT price control year-over-year decrease of -32% for the 88305 code is a prime example of the dramatic unpredictability of this variable.
That such a price control could be instituted without widespread shortages of Pathology services offers strong evidence against a current demand that significantly outstrips supply. After all, such a decrease in compensation, in a scarce Pathology labor market, should have the effect of increasing scarcity as those who are able (Pathologists nearing retirement, Pathologists married to a high-earning spouse) would voluntarily leave the profession or reduce hours.
However, if the projections of net FTE increases in Pathology are true, in the background of a relatively stable supply of Pathology labor, it follows that state-imposed price controls will necessarily need to be adjusted upwards to prevent shortages in Pathology. We have seen this occur recently in the specialty of Family Medicine, as the long-touted scarcity of primary care phyisicans has finally begun to culminate in increased wages for Family Medicine physicians.3 Such an eventuality in Pathology, however, may take many years or even decades to unfold.
Based on survey data from 2012-2016, the percentage of fellows who accepted a non-fellowship Pathology position has been stable from 61-73%, with 71% of job-seeking fellows accepting a position in 2016.4 However, this figure includes fellows who had already planned a second year of fellowship, either in the same fellowship or in a different fellowship, but who had also applied to at least one non-fellowship position.
What do I do?
What does all this mean for the resident or fellow searching for work? The harsh truth is that the data collection is incomplete and of poor quality. While as Pathologists we love to obtain and rely upon solid data, it simply is not available. Instead, the job data collection process relies on individual Pathology residents and fellows. It is up to you to ask everyone you meet – at your current institution, at your former institution(s), at conferences, on online forums – who's hiring? It's incumbent upon you to let residency and fellowship directors, as well as attendings, know your employment needs, and to search online job postings such as CareerMD regularly.
Getting a job in Pathology or any other profession is much like selling a house or buying a car. Many of us would have no problem spending many evenings and weekends cleaning and fixing up a house to sell, or researching and shopping around for the exact car we want, so why skimp on promoting one's own career and livelihood? Get out into the world of Pathology and medicine – meet every Pathologist you can. Put your name out there on academic papers and make sure your institution advertises your position, CV, and contact information on its website. Join LinkedIn, CAP, ASCP, USCAP, and other networking and professional organizations. If all else fails, make appointments to speak with Pathology groups, hospitals, and outpatient medical laboratories, even if they are not publicly hiring (many of the better jobs are filled long before appearing on public job postings).
Are you limiting yourself to a certain city, state, or region? While some Pathologists have family or other obligations for staying in a certain area, mobility will always offer an employment advantage. Any Pathologist having difficulty finding work should seriously consider moving wherever the work is. While we are professionals, we are subject to the same laws of supply and demand that everyone else is. Avoid focusing exclusively on high-supply areas such as large cities and subtropical climates. Not only can you find employment looking for high-demand areas, but you can find employment with better compensation and benefits than you would find in high-supply areas.
Lastly, when you get your interviews, remember one simple fact. You got the interview because you have what they need on paper; all you need to do is show that you are easy and enjoyable to work with. Employers want in their colleagues the same positive qualities that you do.
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1. Robboy SJ, Weintraub S, Horvath AE et al. Pathologist Workforce in the United States: I. Development of a Predictive Model to Examine Factors Influencing Supply Arch Pathol Lab Med—Vol 137, December 2013.
2. Robboy SJ, Gupta S, Crawford JM et al. The Pathologist Workforce in the United States: II. An Interactive Modeling Tool for Analyzing Future Qualitative and Quantitative Staffing Demands for Services. Arch Pathol Lab Med—Vol 139, November 2015.
3. Merritt Hawkins Corporation. 2017 Review of Physician and Advanced Practitioner Recruiting Incentives. Accessed at https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/2017_Physican_Incentives_Review.pdf
4. Gratzinger D, Johnson KA, Brissette MD, et al. The Recent Pathology Residency Graduate Job Search Experience: A Synthesis of 5 Years of College of American Pathologists Job Market Surveys. Arch Pathol Lab Med—Vol 142, April 2018.