Summary
Pathologists are physicians who play a crucial role in patient care, providing accurate diagnoses and guiding treatment decisions. Despite often working behind the scenes, pathologists are essential to modern medicine, contributing to advancements in precision medicine and molecular diagnostics. To ensure optimal patient outcomes, pathologists must assert their value as physicians and advocate for their recognition within the healthcare community.
We are physicians too
April 2026—The traditional image of a physician is universal: someone in a white coat with a stethoscope. Pathologists have never quite fit into that image, have we? Our version of the stethoscope is a microscope (at least we don’t have to wear it around our neck).
Across the medical community, and even among some pathologists, people think of pathologists as different from our more patient-facing physician colleagues. But we’re not. Fundamentally, we are physicians—physicians who practice pathology. People refer to us as diagnosticians, or as the doctor’s doctor. Using these distinctions to set us apart from other physicians can create a misconception about pathologists, individually and collectively, as well as confusion for the patients we serve.
Look around your lab. Are there panoramic windows with a great view? How about glass walls with direct line of sight to patient care areas? If your lab is like most pathology facilities, it’s probably deep in the basement. Since we often don’t see patients directly, we tend to be relegated to remote locations. And in some ways our reputation as peers to our fellow clinicians has been diminished too.
Noting that we are physicians, with just as much knowledge and expertise to offer our patients as our patient-facing colleagues, is not about our egos. It’s about being seen as equal and valued members of the clinical care team so we can better contribute to stellar patient care.
Pathologists have always been essential to medicine, but today the results and diagnoses we produce are more important than ever. In an era of precision medicine, or molecular medicine, our responsibilities for providing accurate diagnoses, matching patients to the right treatment, and monitoring response to treatment are critical. This isn’t even that new: We’ve been using CAP/ASCO-established HER2 criteria to treat patients with breast cancer for almost 20 years now. We continue to roll out the use of HER2 expression for other types of cancer, and there’s a wealth of other biomarkers we use regularly to ensure that patients are getting the treatments and interventions most likely to help them. Our role as physicians requires us to use these tools appropriately and to create scientifically based standards for their use in patient care.
Consider some of the other recent advancements in medicine for which pathologists have a direct role to play: evaluating markers for the selection of immunotherapies; providing the grading, staging, and biomarker status information needed for molecular tumor boards; and running the susceptibility testing that shows not only which bug a patient has but also which drug is effective in treating it.
These are just the latest examples. Pathologists are responsible for handling transfusion medicine, performing bone marrow biopsies and fine-needle aspiration, and analyzing frozen sections to determine whether a surgeon has to keep cutting. We contribute more patient-specific data to electronic health records than any other type of clinician. Our insights guide decision-making for a majority of clinical care choices. We may not always sit in the room with our patients, but make no mistake: We have a very direct impact on their care.
Our fellow patient-facing physician colleagues should be reminded of this. Hospital executive teams need to understand our value to health care delivery as well. And we need legislators at the state and federal levels to see us as equal to other clinicians because their perceptions of our value influence reimbursement rates, scope of practice, and other matters that affect our ability to care for patients.
But we can’t expect those around us to come to this realization on their own. First, we need to accept our status as full-fledged physicians with pride and confidence. We are just as valuable as every other member of the medical team caring for any of our patients. When we clearly see our own value, we can better convey it to our peers. It’s up to us to tirelessly raise awareness of our profession and our capabilities.
One practical dimension to this goal of improving our status is being able to attract the best and brightest medical students to our specialty. At Louisiana State University Shreveport, where I work, the number of our own medical students applying to our pathology residency program has steadily increased in recent years. I believe that’s because we’re doing a better job of showing students that pathologists are as important as any other physician specialty.
Whether it’s for medical students, our peers, or members of Congress, the message is simple: Pathologists are full-fledged physicians too. We’re no more important than other specialists, but we’re no less important either.
Dr. Zhai welcomes communication from CAP members. Write to him at [email protected].