Suggestions on Addressing the Shortage of Pathology Professionals

Author: Professor Liu Dechun

Recently, a video has been widely circulated in the pathology community’s social circles, claiming that there is a shortage of up to 90,000 pathologists. It emphasizes the importance of pathological diagnosis and the difficulties in training pathology professionals. However, it lacks detailed discussion on how to fill such a huge gap. It is unclear whether this video is related to the recent “Symposium on the Construction and Development of Pathology in China” held in Wuhan (May 4-6), or what insights pathology experts at the conference had on addressing the shortage of pathology talent. Here, I would like to share some personal views on this issue, hoping to draw attention and resonance, and contribute to solving the shortage of pathology talent.

Leadership Level:

The shortage of pathology talent appears to stem from the high difficulty of the work, long training cycles, low compensation, and high risks. However, I believe the deeper reasons lie in insufficient leadership attention, improper professional positioning, and ineffective policy implementation. To address the shortage of pathology talent, efforts should start with the leadership departments. As for solutions at the pathology department level, I will discuss them separately in another article.

First, it is essential to thoroughly implement the guidelines on staffing in pathology departments issued by the former Ministry of Health, which recommend 1–2 pathologists per 100 hospital beds and a 1:1 ratio of technicians to pathologists. The estimated shortage of pathologists is likely based on this standard. Many in the pathology community likely agree with this staffing standard. I hope that pathology quality control management centers at all levels, with backgrounds in health administration, will seriously organize and implement this. Just like addressing environmental pollution, units that fail to meet the standards should be resolutely shut down, merged, or transformed. Pathology departments that do not meet the standards (including facilities, equipment, etc.) should be given deadlines for rectification. If they fail to meet the standards by the deadline, they should also be shut down, merged, or transformed. This will compel hospitals to increase staffing, invest more, intensify recruitment efforts, lower recruitment thresholds, and quickly supplement the pathology workforce and equipment, starting with meeting the hardware standards.

Second, there should be a significant adjustment to pathology fee standards. First, the concept of setting fee standards must be changed to increase the weight of pathologists’ knowledge, experience, skills, and risks in pricing. This will address the past drawback of pricing primarily based on equipment depreciation and consumables, fully reflecting the labor value of high-risk professions like pathology that rely heavily on intellectual activity. This will increase the income of pathology departments, the value of pathological diagnosis, and the revenue-generating capacity of pathology departments. With higher fee standards, the income of pathology professionals can be increased, making pathology departments more attractive and encouraging young doctors to join and stay.

Third, the status and setup of the pathology discipline must be fundamentally changed. Pathophysiology and clinical pathology should be separated, and research degrees should be distinguished from clinical degrees. Clinical pathology should be integrated as part of clinical medicine. Enrollment in clinical pathology graduate programs should be expanded, with a focus on pathological diagnosis training. This could even be combined with clinical physician qualifications or standardized training to shorten the training period. This would allow clinical pathology graduate students and trainees to obtain pathology practitioner qualifications, enabling them to enter pathological diagnosis roles earlier and alleviate the shortage of pathologists. It would also eliminate the awkward situation where pathology graduate students cannot obtain practitioner qualifications.

The above three aspects primarily target leadership departments, with particular hope placed on leaders of pathology academic organizations and pathology experts serving in party and government leadership roles. Over the years, their continuous efforts have yielded some progress. I hope they can build on these achievements, continue to benefit the pathology community, and promote the continuous growth and development of the pathology workforce.

Department Level:

Regarding the shortage of pathology talent, three suggestions have been proposed from the leadership level above. Now, let’s discuss solutions at the pathology department level for reference.

First, pathology departments should actively strive to allocate sufficient personnel, requesting staff from hospitals according to the staffing standards set by the Ministry of Health mentioned earlier. Some pathology departments adopt a passive attitude toward this, reportedly for the following reasons: First, because pathology department bonuses are relatively low, adding more staff would reduce per capita bonuses, affecting income. Second, current staff can barely manage the workload, and there is concern that more staff would be difficult to manage. In reality, pathology departments have many tasks. Only with sufficient staff can there be ample time for in-depth specimen observation, slide reading discussions, case analysis, academic exchanges, literature study, business expansion, further training, teaching, scientific research, and the establishment of subspecialties. Insufficient staff leads to mere survival, let alone improving professional standards or attracting talent.

Some worry about the qualifications of newly recruited staff after expansion, but the solution is to provide training and mentorship after recruitment. With insufficient staff, there are no conditions to send people out for standardized training or further education, and even sending someone to a two-day conference can be difficult. Having served as a department head for 15 years, I deeply understand the hardships of staff shortages. For example, if you want to organize departmental professional learning (such as special lectures), you need to arrange personnel and time. If everyone is overwhelmed and has no time to spare, how can such activities continue? Many typical, special, or difficult cases in the department also lack time for study, discussion, sharing, or writing papers. Isn’t that a pity? Of course, staff recruitment and introduction should also be carried out in a planned manner.

Second, pathology departments should actively expand service offerings, fully utilize policies, and increase revenue. It is understood that some pathology departments, including those in some top-tier hospitals, have limited service offerings and fail to fully utilize existing specimens for comprehensive examinations, such as special staining, immunohistochemistry, and molecular pathology. Some even minimize sampling, merely coping with diagnosis and referring cases they cannot handle externally. This not only affects departmental revenue but also diagnostic standards, which is unwise and short-sighted. Without profitability or development prospects, the department loses attractiveness, leading to a passive attitude and making it even harder to gain attention and support from hospital leadership.

Third, the construction of a humanistic environment within the department is also key to attracting and retaining talent. This includes the personal character and charisma of department leaders and academic pioneers, the atmosphere of unity and collaboration within the department, the talent梯队 and structure of the department, promotion opportunities, the projects and development space available in the department, the academic ethos and learning atmosphere, conditions for professional learning and research, the department’s facilities, equipment, and working environment, departmental revenue and distribution, the relationship between clinical departments and pathology departments, and the department’s status and influence within the hospital. All these factors impact both prospective and current employees. I believe many have experienced this, so I will not elaborate further.

Currently, not only are hospital pathology departments short of talent, but regional pathological diagnosis centers in third-party testing institutions also face manpower shortages. These centers mainly rely on poaching staff from hospital pathology departments, as independent training mechanisms have yet to be established. I believe that in the face of such a huge shortage of pathology talent, promoting medical schools to actively expand the enrollment and training of pathology professionals—such as targeted training of pathologists within clinical medicine programs, targeted standardized training of pathologists for clinical medicine graduates, or expanding enrollment in clinical pathology graduate programs—should be the most urgent, appropriate, and effective approach. A great leap forward is needed, and results will only be seen years later. Time waits for no one!