See Me, Hear Me!

Pathology’s visibility both within and outside the healthcare sphere is becoming a subject of increasing attention – at least among pathologists! Whether or not our quest for a voice has penetrated the outside world is another question, and one I am not sure can be answered in the affirmative. Despite our critical input into various aspects of healthcare, we are considered a “small fish” and often ignored or underappreciated at the enterprise level.

The issue is fundamental: do we as pathologists have the skill set to sell ourselves in a world of bigger, more aggressive, and – most importantly – more visible medical professions: medicine and surgery? Not only in undergraduate, but even in graduate medical education, we are essentially governed by rules that are more suited to these larger fields. We typically never ride the leadership wave without support from members of these fields. Of course, none of these “more visible and acknowledged fields” can function without pathology (and radiology – the two diagnostic disciplines), but we do not get anywhere near the recognition we deserve from our colleagues in those fields. It’s not just a matter of wanting to be seen, either; the lack of visibility costs our field – and it costs our patients. Only 36.6 percent of US medical graduates opted for pathology as their future medical career in 2018, one of the lowest numbers ever (1). It is time for pathology professional organizations to work effectively with each other; otherwise, we will continue to watch the recruitment pipeline shrink, reimbursements for biopsies and other testing modules be cut, and our financial interests erode right in front of our eyes.

The author of a recent article on pathology’s invisibility in the UK newspaper The Guardian (2) claims that she is not dejected – but the killer sentence in her piece is: “I know this cannot be changed.” How did she come to that conclusion if she is, in fact, still bright and optimistic? Until now, I thought artificial intelligence (AI) was going to be the big, looming threat to pathology – but I was wrong. The big, looming threat is our inability to see the gathering storms, such as AI, and ferocious planning for cost-cutting in medicine (and we would be among the first on the chopping block, potentially seeing some of our jobs outsourced once digital pathology is firmly established – much like in diagnostic radiology).

Embedded in the subconscious of our leaders in medicine is the thought that whatever happens will not hurt them so long as they can push the can far enough. I believe we should not be worried about these clouds; we should not even be worried about some of us being able to predict the coming storms – but we should be worried about our denial and our inability or unwillingness to deal with these looming critical threats. These changes may not impact senior pathologists within their professional working lives, but I see the practice of pathology changing over the next decades, and the pipeline is not oiled enough for new pathologists to be ready to face such challenges. I ask our leaders, who are willing to go above and beyond, to bring pathology to the forefront of medicine – and we need to realize that we are, or should be, those leaders.