The shortage of invisible doctors
By Shivayogi Bhusnurmath
Roughly four in ten Americans will receive a cancer diagnosis in their lifetime. Many of those folks will never meet the doctors most instrumental in their treatment -- their pathologists.
Pathologists operate behind-the-scenes. They help diagnose patients and provide treatment recommendations to other doctors.
The United States will need thousands more pathologists to meet patient demand over the next decade. They're likely to come from international medical schools.
International medical graduates are entering pathology in increasing numbers. Many of them are U.S. citizens who traveled abroad to receive their education. The United States should welcome them home to practice.
Pathologists examine body tissues, cells, and organs in order to study the causes and nature of everything from cancer and blood disorders to HIV/AIDS and cardiovascular disease.
Say a doctor suspects that her patient has breast cancer. She may collect a piece of breast tissue for analysis. From there, the sample goes to the pathologist, who conducts a thorough examination and makes a diagnosis. The pathologist also often conducts additional tests to determine which therapies are most likely to kill the cancer cells of that particular patient.
That work is crucial. Consider the importance of early detection of breast cancer. Women diagnosed with the disease at the earliest stage are more than six times likelier to live past five years than those diagnosed at the most advanced stage. Potential delays in that initial diagnosis could lead to delays in treatment -- and a decrease in survival rates.
That's why the pathologist shortage is so concerning. The number of U.S. pathologists decreased by nearly 18 percent between 2007 and 2017. During that time, the "diagnostic workload per pathologist" rose by almost 42 percent.
That's taken its toll. One-third of active pathologists are "burned out," according to Medscape's 2019 survey.
And many pathologists are on the road to retirement. In a 2013 study, researchers found that more than 40 percent of pathologists were 55 or older. They predicted that retirements would reach their apex in 2021.
Consequently, by the end of the next decade, the United States will be short more than 5,700 pathologists.
Graduates of international medical schools are poised to close that gap. They already account for nearly one-third of the U.S. pathologist workforce. That figure is set to increase over the next several years. Nearly 45 percent of active pathology residents graduated from an international medical school.
This year, 4 percent of international medical graduates selected residencies in pathology. That might not seem like a large number -- but it's nearly four times the share of U.S. med school graduates who chose pathology. Further, the percentage of U.S. grads selecting pathology has declined over the last five years.
Graduates of the school where I teach, St. George's University, are increasingly deciding to pursue careers in pathology. Twenty-three of our graduates just began pathology residencies in states nationwide -- everywhere from California and Pennsylvania to Texas and New York. Over the past five years, more than six dozen of our grads have entered pathology programs.
The growing demand for pathologists must be addressed. Graduates of international medical schools will be the ones to meet that need.
Dr. Shivayogi Bhusnurmath is the Dean of Academic Affairs and Co-Chair of the Department of Pathology at St. George's University (www.sgu.edu). He also serves on the executive council of the International Academy of Pathology.
