Pathology: the future is now
Donald S. Karcher, MD
October 2024—When this column comes out, many of us will be on our way to our annual meeting, held this year in Las Vegas. As I planned my presidential address for CAP24, I decided to focus on the future—the future of pathology and our future as pathologists. I’ll use this month’s column to cover the same theme. (And if some of you happen to read this column before I give my address, you will in a sense be seeing the future yourselves.)
As I began to look ahead, I realized that the future of pathology and the CAP isn’t on some distant horizon. Our future is upon us, right now. Here are a few examples of what I mean.
Pathology workforce. For more than a decade, the CAP and its members have been projecting a shortage of pathologists, closely tracking the numbers as pathologists leave their practice and fewer new pathologists take their place. When we saw this shortage accelerating a few years ago, the CAP launched what we now call the CAP Future Pathologist Initiative to encourage more students to choose a career in pathology. I’m pleased to report that this program is making a difference. In the five years since it began, there has been a significant uptick in applications for pathology residency and a steady improvement in the match numbers for pathology training programs. In addition, the CAP is strongly advocating for more pathology residency slots nationally and for more residents who train on J-1 visas to be able to stay and practice in the United States. We are beginning to bend the curve on the pathologist shortage.
Scope of practice. One consequence of the shortage of pathologists has been increasing challenges to our scope of practice. This is not unique to pathology; across all of medicine, there’s been a movement among nonphysicians to do more and more things that are more appropriate for physicians to do. While I don’t want to diminish the importance of other laboratorians—every member of the laboratory team brings great value to our patients—it’s critical that pathologists be the ones leading the laboratory diagnostic effort. We are uniquely qualified for the things we do. We have extensive scientific and clinical training, we’ve mastered the cutting-edge approach to laboratory diagnosis, and we generate and interpret laboratory data in the context of the whole patient. The CAP is fighting these scope-of-practice challenges nationally and at the state level, not to protect our turf but to ensure that our patients get the best care possible.
New diagnostic technologies. Any pathologist practicing today recognizes it: We’re in the middle of nothing less than a revolution in how we diagnose disease and help guide patient management. Genomics, digital pathology, and AI are amazing tools that are allowing us to make more meaningful diagnoses than ever. I’m proud to say that pathologists have been the driving force behind molecular genomic analysis for the past four decades. We’re now able to easily analyze the entire genome on smaller and smaller specimens and with increasing accuracy, allowing us to determine the underlying genetic and epigenetic abnormalities associated with disease. We’re also moving toward genomic analysis of cell-free specimens. The first screening test using this technology was approved by the FDA for colon cancer less than three months ago, finally achieving the holy grail of peripheral blood-based cancer screening. Digital technology is helping pathologists improve workflow and turnaround time and making increasingly sophisticated image analysis a reality. And of course we can’t talk about new technologies without mentioning AI. Pathology is right in the thick of the development and deployment of powerful AI tools in medicine. All of these new technologies are helping us make better, deeper, and more actionable diagnoses for our patients.
As we face our challenges and embrace new technologies and other opportunities, I believe pathology and the CAP are on the cusp of a very bright future. Pathology is increasingly viewed as an exciting and appealing medical specialty by students and we are successfully addressing the pathologist shortage in the United States. Pathologists are more visible than ever to patients and the health care system, we’re cementing our place as the leader of the laboratory diagnostic team, and we’re leveraging truly amazing tools to help us do our jobs even better. Through it all, the CAP has been and continues to be a strong supporter and valuable partner for pathologists, helping us overcome obstacles and preparing us for that bright future that’s literally starting now.
Dr. Karcher welcomes communication from CAP members. Write to him at [email protected].