Trends in the US and Canadian Pathologist Workforces From 2007 to 2017

Abstract

Importance: The current state of the US pathologist workforce is uncertain, with deficits forecast over the next 2 decades.

Objective: To examine the trends in the US pathology workforce from 2007 to 2017.

Design, setting, and participants: A cross-sectional study was conducted comparing the number of US and Canadian physicians from 2007 to 2017 with a focus on pathologists, radiologists, and anesthesiologists. For the United States, the number of physicians was examined at the state population level with a focus on pathologists. New cancer diagnoses per pathologist were compared between the United States and Canada. These data from the American Association of Medical Colleges Center for Workforce Studies' Physician Specialty Data Books and the Canadian Medical Association Masterfile were analyzed from January 4, 2019, through March 26, 2019.

Main outcomes and measures: Numbers of pathologists were compared with overall physician numbers as well as numbers of radiologists and anesthesiologists in the United States and Canada.

Results: Between 2007 and 2017, the number of active pathologists in the United States decreased from 15 568 to 12 839 (-17.53%). In contrast, Canadian data showed an increase from 1467 to 1767 pathologists during the same period (+20.45%). When adjusted for each country's population, the number of pathologists per 100 000 population showed a decline from 5.16 to 3.94 in the United States and an increase from 4.46 to 4.81 in Canada. As a percentage of total US physicians, pathologists have decreased from 2.03% in 2007 to 1.43% in 2017. The distribution of US pathologists varied widely by state; per 100 000 population, Idaho had the fewest (1.37) and the District of Columbia had the most (15.71). When adjusted by new cancer cases per year, the diagnostic workload per US pathologist has risen by 41.73%; during the same period, the Canadian diagnostic workload increased by 7.06%.

Conclusions and relevance: The US pathologist workforce decreased in both absolute and population-adjusted numbers from 2007 to 2017. The current trends suggest a shortage of US pathologists.

Figure 1.. Decline in Number of US Pathologists from 2007 to 2017

A, The total number of pathologists in the United States decreased in each year from 2007 to 2017, for an overall decrease of 17.53% (from 15 568 to 12 839). In contrast, numbers of US anesthesiologists and radiologists showed overall growth in the same 10-year period. B, In Canada, the total number of pathologists grew 20.45% (from 1467 to 1767), which was comparable to growth observed in numbers of Canadian anesthesiologists and radiologists. C, The total number of US physicians increased by 16.61% (from 765 688 to 892 856). D, The total number of Canadian physicians in this period increased by 30.30% (from 63 819 to 83 159).

Figure 2.. Pathologists per 100 000 Population, United States vs Canada

The numbers of pathologists in the United States and Canada were adjusted per 100 000 population of the respective countries from 2007 to 2017. In 2007, there were 5.16 and 4.46 pathologists per 100 000 population in the United States and Canada, respectively. In 2017, there were 3.94 and 4.81 pathologists per 100 000 population in the United States and Canada, respectively.

Figure 3.. Numbers of Pathologists per 100 000 Population and Percentage Change by State

A, The number of pathologists per state (including the District of Columbia) in 2016, adjusted for 100 000 of population, shows variation from 15.71 for the District of Columbia to 1.37 for Idaho. B, The change in pathologists from 2012 to 2016 was mostly negative, with only 9 states showing zero or positive growth. In contrast, all states (including the District of Columbia) showed growth in overall physician numbers (range, 3.02%-12.86%). Most state populations grew (range, 0.13%-9.28%), with only 5 states showing declining populations.

Figure 4.. Increasing New Cancer Cases per Pathologist, United States vs Canada

The numbers of pathologists in the United States and Canada were adjusted for the new cancer diagnoses of the respective countries from 2007 to 2017. In 2007, there were 92.81 and 109.00 new cancer cases per pathologist in the United States and Canada, respectively. In 2017, there were 131.54 and 116.69 new cancer cases per pathologist in the United States and Canada, respectively.