There are currently ~1,000 pathologist job openings in the United States, but only about 450 new pathologists are entering the workforce each year according to Rich Cornell, Founder & President of the Life Sciences recruiting firm Santé Consulting (Ellisville, MO). The pandemic led many pathologists on the bubble of retirement (age 55-65) to retire early, while pathology case volumes have surged since lockdowns ended, notes Cornell.
Cornell founded Santé Consulting in 2008. Santé is focused exclusively on the recruitment of pathologists, PhDs, and laboratory executives and directors. Over the course his career, Cornell has negotiated more than 1,000 physician and PhD employment agreements. Below we summarize his views on the current pathologist job market.
Can you provide the details behind the supply-demand imbalance?
Yes. There are 20,322 board-certified pathologists, including anatomic and clinical pathology and subspecialists, in the United States according to the American Board of Medical Specialties (ABMS). Of this total, the College of American Pathologists (CAP) estimates that 17,500 pathologists are in active practice.
On the demand side, the biggest online job board for pathologists, PathologyOutlines.com, currently has 706 pathologist jobs listed. This likely represents about 75% of all U.S. job openings. That means there are currently about 941 pathologist-related job openings in the United States. The number of openings has consistently been around 1,000 at any given point in time over the past two years.
On the supply side, there are 144 residency programs in the United States and 2,300 combined pathology residents and fellows, including 55% of whom are international medical school graduates. By my estimation there are approximately 450 new pathologists entering the workforce each year.
The imbalance of 1,000 job openings vs. 450 new pathologists means it can take several months or even years to fill an open position at an academic medical center or hospital-based pathology group. In the meantime, most practicing pathologists are overburdened with case volumes.
Which types of pathologists are in greatest demand?
The need is greatest for subspecialists, particularly board-certified cytopathologists and hematopathologists. Fellowship-trained breast/GYN and GI/liver pathologists are also in high demand.
Hospital-based groups have the greatest demand for bread-and-butter surgical pathologists willing to sign-out general surgical cases and cover clinical pathology as well.
Can you give some anecdotal stories of recent job placements?
We recently placed a young pathologist that had just completed two fellowships at the Harvard Medical School system and is triple board certified (clinical pathology, microbiology and immunology). He accepted a job offer from an academic medical center in the upper Midwest. He’s now a practicing pathologist and assistant professor. He received a starting salary of approximately $250,000 with a sign-on bonus of $20,000 and $15,000 for relocation expenses. He also received 30 days of paid time off (PTO) plus 10 days for continuing medical education (CME) and a $5,000 CME allowance.
In another example, we placed an older pathologist (mid-50s) from western New York. He had been medical director at a mid-sized pathology practice. He and his wife were looking for a change now that their kids were off to college. He accepted a staff pathologist job at a small hospital-based group in Wyoming with a smaller salary and fewer responsibilities. He received $15,000 for relocation expenses, a salary of $350,000, six weeks of PTO and 10 days for CME conferences. He also has the opportunity to switch to a per diem role in the future. The practice had been searching for a pathologist for several months and was willing to modify its job offer to suit the requests of the hired pathologist.
What about pathologists hired by the commercial labs (Quest Diagnostics, LabCorp, Sonic, etc.)?
We recently helped relocate a pathologist that had been practicing at an academic medical center in New York City for almost two decades. He’s an anatomic and clinical pathologist with 20 years of experience and subspeciality expertise in GI pathology. He was seeking a leadership opportunity at a commercial lab in a “blue state” with less congestion and a lower crime rate. We placed him in California with one of our commercial lab clients. His annual salary was in the low $400,000 range with a 20% bonus plan. He also received a $40,000 relocation package and a $25,000 signing bonus, plus 35 days of PTO including CME.
Can pathology assistants (PAs) help with the shortage?
I’ve seen a lot of pathology groups hire PAs to replace retiring pathologists. Once a practice hires a PA, they tend to never look back. Starting salaries for PAs are averaging roughly in the range of $125,00 to $150,000. The problem is that accredited PA programs are only collectively graduating approximately 180 to 230 students per year.
Will digital pathology plus artificial intelligence (AI) help alleviate the shortage?
AI is definitely the wave of the future. But it’s likely to take years before the average hospital-based pathology group brings it into their practice. However, in the long run, it will help relieve the shortage just as it did with radiology.
What are some things that cause employers to not make a job offer to a pathologist?
When the candidate treats someone during the interview inappropriately like being rude to an administrative assistant or clerical staff. Other reasons might include bad references, or the candidate didn’t dress appropriately or come prepared for the interview.
A job offer might also be withheld if the candidate does not express a strong interest after the interview like postponing a commitment as they continue their interviews, or not making a decision in a timely manner.
What turns off a pathologist from accepting a job offer from an employer?
The number one reason is location. Pathologists today are much more geographically driven than in years past.
Obviously, another big reason is compensation. Either the group is not willing to be forthcoming with their compensation structure or partnership track, or they simply make too low of an offer.
Median Pathologist Total Compensation* by Setting and Experience for 2021
| Years in Practice | Academic Medical Centers | Community Hospital | Independent Labs |
| < 3 years | $227,500 | $292,500 | NA |
| 4-10 years | $241,000 | $315,000 | $312,000 |
| 11-20 years | $300,000 | $369,000 | $360,500 |
| 20+ years | $376,896 | $358,000 | $350,000 |
*Includes salary and bonus Source: CAP 2022 Practice Characteristics Survey Report