Lessons from the Power List: challenges

See the complete Power List online here.

Casey P. Schukow: Recruitment and visibility. I am still very young in my career, but I’ve seen many pathologists shy away from “the spotlight”. This is completely understandable – we typically work behind the scenes in the grand scheme of patient care. But, for many patients and other clinicians alike, this hides the genuine work we do and allows misconceptions of our roles in the “continuum of patient care” (as a mentor of mine would put it).

Additionally, we’re facing a critical shortage of pathologists worldwide, and if we do not do our part as an academic pathology community to meet the next generation where they are (ie, through social media and in the classroom), they will never set foot in a pathology lab and our labor shortages will worsen. Of course, this negatively impacts patient care, which is a risk we cannot take. We need to step outside our comfort zones (as much as our schedules allow) and give the next generation of physicians reasons to consider pursuing a career in pathology – whether it be practice logistics, lifework balance, compensation, etc – through presentations, rotations, and consistent professional online engagement.

Corey Post: The changing regulatory environment in which laboratories must operate. The FDA’s “Final Rule” is a prominent example, but the recent overturning of the Chevron deference also helps to highlight the major shifts occurring within the federal regulation landscape. While proper regulation of laboratory testing is essential to ensure quality patient care, proper balances must be maintained to allow for innovation and equitable access to testing.

Changes to enforcement that aren’t well understood, rolled out too quickly, or are incongruent with healthcare practice trends can cause further burdens on healthcare systems and pathology practitioners. As we move forward, I expect it will be important for pathologists to remain ahead of these changes and maintain compliance, while also serving as advocates to influence future regulations.

Cullen Lilley: As pathology continues to grow in breadth taking on new realms such as molecular genetics/omics, digital/informatic pathology, bioinformatics/data security, and even cellular therapeutics, there will also be a corresponding opportunity to bring pathology to new professionals with diverse training backgrounds and interests. We should capitalize on this by marketing these growing areas to professionals in IT/cybersecurity, bioinformatics, omics research, and beyond. Pathology and laboratory medicine sits at such a unique juncture, and I think many people in the biomedical sciences would thrive in this field, but they just don’t know about it.

Becky Stankowski: A real challenge in pathology is staffing. Our lab is usually fully staffed with PAs, histotechs, and lab assistants, but we don't have nearly enough pathologists for our workload. PAs are often involved in the training of pathology residents, and do most of the grossing (and sometimes autopsies and frozen sections) in many places across America. The pathologist shortage is an opportunity to expand the scope of pathologists' assistants in additional ways. PAs that are involved with previewing cases microscopically, attending signout and tumor boards, and communicating with surgeons and clinicians can lighten the load for surgical pathologists. PAs performing forensic autopsies in medical examiner offices would help alleviate the often critical shortages of forensic pathologists. This is definitely starting to happen in some areas, but there’s more to be done. An overhaul of current workflows and an examination of resident education standards may be needed to address this ongoing problem.

Emily Nangano: Another key challenge is the responsible integration of AI into anatomic pathology labs. While AI has the potential to significantly augment the work of laboratorians by improving accuracy and efficiency, it must be integrated in a way that enhances rather than replaces human expertise. Ensuring AI tools are implemented thoughtfully and ethically will be essential to complement the skilled work of pathologists and pathologists’ assistants, maintaining the exacting standards of care and precision required in this field.

Swati Bhardwaj: Pathology is currently leading the wave of AI applications in medicine. The specialty has generally embraced new technologies, including AI, though with some caution. How AI is integrated as a diagnostic tool will greatly impact the future of pathology. Since pathology generates vast amounts of data used by other medical fields, it's crucial to maintain control of this data and ensure it's used ethically for patient care, research, and education. To do this, clear regulations must be established by a governing body, with pathologists represented in any regulatory authority overseeing AI. Additionally, AI algorithms should have specific validation tools, similar to laboratory tests.

Swikrity U. Baskota: The biggest challenge facing the pathology field right now is the workforce shortage. Following the COVID-19 pandemic, many have considered early retirement from practice – leading to a vacuum that we are constantly struggling to fill. We must focus on creating more awareness about our field of practice, developing training programs, introducing high-school seniors to our specialty, and building resources like www.MatchToPath.com, which can come in handy while learning to get into pathology training programs.

Aaron Odegard: One of the biggest challenges in medical laboratory medicine is demonstrating our value as a crucial member of the healthcare team. Diagnostic testing continues to play an even greater role in positive patient outcomes. The laboratory has the potential to provide value beyond the walls of the hospital, extending health equity to our patients and the surrounding communities. In order to answer this call, we have to demonstrate our value to not only the rest of the healthcare team but also to the executive c-suite as a potential revenue stream for our institutions. One strategy to achieve these goals is to expand our outreach laboratory services and try innovative approaches to reach more patients (e.g., mobile phlebotomy or further extend POCT in new venues).

Christina Narakorn: There is a scarcity of eligible applicants for careers in pathology fields at laboratory and consultant level due to the limited number of educational programs and the specialized nature of the professions. Retention becomes an integral component of workforce planning with factors such as job satisfaction, working conditions, and technological adaptation being of paramount importance. Some strategies I use to tackle this challenge include personality workshops, laboratory awareness and outreach sessions, and offering hospital lab tours with individual observations.

Have you ever wondered if your work personality is the same as your at home personality? My career mentor encouraged me to invest in a weeklong personality facilitator course. After completion of the course, I now schedule virtual and in-person workshops to leverage personality preferences to enhance job satisfaction, productivity, and work culture. Understanding laboratorians’ personalities allows tailored recruitment and retention efforts.

Tiffany Telemaque: Laboratory science and pathology remain relatively unfamiliar as career options in society. Like many others, my discovery of the field was largely by chance, a common experience among professionals in the field. This pattern must change. Laboratory science and pathology should be promoted as viable career paths starting from elementary education. This initiative requires contributions from all laboratory professionals. Inclusivity across all aspects is essential for meaningful impact. By addressing this concern appropriately, vacancies can be reduced and burnout can be tackled to an extent.

Eric Q. Konnick: The FDA’s final rule regulating laboratory developed tests poses a huge challenge to the field of pathology. The ability of pathologists to adapt new scientific and medical knowledge to patient care could be dramatically hindered, and the financial costs to practice are likely to be greatly increased. Pathologists will be expected to comply with new regulations that are very different from CLIA requirements and have much more severe consequences if we are not in compliance. It is going to be an interesting few years while the Final Rule is implemented and lawsuits make their way through the courts.

Fatma Alzahraa A. Elkhamisy: In many medical schools in the developing world, the use of digital pathology for teaching is still not appreciated for its actual value. Until now, many pathologists, and policymakers of medical programs outside pathology, saw digital pathology as similar to data-show images, with the only hands-on experience being with glass slides and light microscope lenses. They push against the use of digital pathology slides in the practical labs. Advocates like myself work to increase the awareness of digital pathology's true capabilities and how the recent advances in AI work on analyzing digital slides and improving the accuracy of the diagnoses. We, as pathologists, need to align our efforts and utilize all resources to push the transformation to digital pathology, as it is the building block for advancing the field.

Ahmed Kalebi: The most significant challenge facing the pathology field right now is ensuring that everyone who needs our essential services can access them. Pathology laboratory testing is critical to public health, yet billions of patients and their healthcare providers lack access to these services when they need them – from preventive and promotive screening laboratory services to advanced diagnostic testing services. Unfortunately, inequity in pathology services exist across the globe, whether between high and low income countries, and within individual communities. These disparities stem from lack of accessibility, availability, acceptance, and the quality of pathology laboratory services.

Barnali Das: Harmonization and standardization of laboratory testing is the need of the hour. Clinical chemistry and immunoassay tests form a very important set of tests in a pathology laboratory, a tool that clinicians and patients alike depend on to pin down the symptoms for treatment and relief. However, this very set of tests has come into question as the acceptable ranges for biomarkers can change in relation to other biochemicals, biomolecules, and hormones, which themselves vary considerably with race, gender, age, different physiological conditions (like pregnancy, new-born), and other illnesses and interfering substances. Individual variations in thyroid-stimulating hormone (TSH), for example, can be so pronounced that each person may seem to have their own set-point. In addition, clinicians and diagnosticians have to grapple with the variability of test results. Even a broadly similar set of instruments and methods can provide different results, to as much as 40 percent, for example, in case of TSH values. 

As an executive committee member of the International Federation of Clinical Chemistry and Laboratory Medicine scientific division and chair of the ADLM India section, I have a bigger role to play to incorporate quality competence in healthcare, implement standardization and harmonization of laboratory testing, bridge the gap between diagnosticians and clinicians and connect with professionals in clinical chemistry, pathology, molecular diagnostics, and the IVD industry.

The roadmap for laboratory medicine therefore will involve strategies for harmonizing, communicating, and integrating with all stakeholders to formulate guidelines for assisting in correct measurement, diagnosis, and management of diseases.

Danny A. Milner: Everyone knows about the threats associated with the advent of digital pathology and artificial intelligence. But they aren't the real challenge. The major threat to the field of pathology today is multi-cancer early detection. This has the power to screen entire populations potentially before a cancer is detectable by routine methods. Once this is in place, functioning, and following appropriate clinical trials and studies, patients with positive signals but no obvious cancer can undergo a pan-cancer therapy for a limited period and re-test. This paradigm will remove surgeons, pathologists, and oncologists (and all of their staff) from the process and create a primary care role for the elimination of cancer. Of course, that situation is best for patients because everyone survives, no one suffers, and cancer loses its psychological hold on society. But such disruptive innovation has a creative destruction in its wake. The challenge for the field of pathology is to embrace this eventuality and determine where quality, safety, and outcomes monitoring are ideally suited for laboratory professionals to oversee is such a new paradigm.

Talat Zehra:The biggest challenge is the declining number of histopathologists while there is an increasing number of cancer cases around the globe. The situation is especially concerning in the developing world. At a time when personalized cancer treatment patients, driven by the use of comprehensive gene profiling, is becoming essential for targeted therapy, diagnosis, and prognosis, this shortage of histopathologists is worrisome. Pathologists need to be at the forefront of this molecular revolution and lead this transformation.

Umberto Malapelle: The integration of morphology and molecular and digital pathology represents the most important challenge in our field. In particular, the integration of these "different souls" is crucial to the makeup of the anatomic pathology field. So, with the aim to obtain a real integrative field, modern anatomic pathology departments should not be fearful of these innovative tools, which are key for refining "classical" morphological diagnosis.