The Causes and Consequences of Pathologist Burnout
February 14, 2023
A few months back in this space, we shed light on a growing negative trend in the clinical laboratory space with help from Dr. James Crawford. In the article, shared here and also published in Clinical Lab Products magazine, Crawford spoke in great detail about the lack of qualified medical lab technologists in the industry. He noted that the current crisis has come after years of growing concern and offered up steps that all clinical labs can take to help alleviate the problem.
Today, we focus on a separate but related issue, namely the stress and burnout that comes with being a pathologist and running an independent pathology practice during turbulent times.
Troubling Numbers for a Recent Poll
If you’re a pathologist, chances are you’ve felt burnout at some point during your career. In fact, there’s a really good chance that burnout is affecting you today. That’s according to a 2020 poll conducted by the American Society of Clinical Pathology (ASCP) and published by the American Journal of Clinical Pathology.
The poll showed that 71.4 percent of practicing pathologists reported that they had felt burnout at some time, and 32.9 percent reported it as a current issue. The poll also identified six contributing causes for workplace burnout:
- Lack of autonomy
- Bureaucracy (including regulatory and compliance issues)
- Challenges of a LIS/EHR
- Mergers and acquisitions
Other unique contributors to burnout included depersonalization due to a lack of direct patient contact, and the perception that their efforts usually went unrecognized. Consequences of burnout included inattentiveness, irritability, and “tiredness” resulting in job transitions, increased medical errors, and consequent malpractice claims.
The Role of the Pandemic and Rising Labor Costs
While researching for this blog post, we enlisted the help of a former practicing pathologist who also has an information technology background and a great understanding of laboratory information systems and the intrinsic value modern systems can bring to laboratory operations. This well-respected voice within the industry agreed to share his insight as part of a background interview, and for that, we’re grateful.
What we learned during the interview was, unfortunately, not surprising. Anxiety and stress among pathologists are on the rise as they collectively deal with a rise in cases and a lack of qualified personnel to share the workload. Some of this can be attributed to COVID, with patients now coming in for operations and biopsies that they put off during the pandemic. Another contributing factor is the red ink that hospitals and health systems continue to deal with, forcing cutbacks on staffing across the board in an attempt to make the finances work.
One unexpected byproduct of the current state of affairs also came out during the interview, and that’s the fact that participation by pathologists and informaticians in volunteer groups like the Association of Pathology Informatics is also noticeably down. This is because they simply don’t have the time to commit to volunteering as committee chairs and project participants.
Adding Automation to Anatomic Pathology Workflows and Processes
A pathologist in 2023 typically signs out 40-to-50 cases during 10-to-12-hour days. Many also work nights and weekends because surgical specimens routinely come in on a Friday and are processed overnight.
In terms of hours worked, it was generally accepted in the past that a pathologist would work fewer hours than clinicians, but that concept is changing as pathology starts to get shortchanged in terms of FTEs.
As for a solution, many believe it starts with automation. Here clinical pathology serves as a prime example of what can be accomplished with automated clinical workflows.
A chemistry lab or hematology lab requires only a few people to support the automation as specimens are clinically processed via belts and analyzers and only touched once or twice from the time they enter the lab until the time they leave and are put into storage.
The current state of surgical pathology has much less automation, but the industry as a whole is moving in the right direction thanks to advances in technology and laboratory information systems.
In the past, it was difficult to automate precise elements of surgical pathology. For instance, creating thin sections was an acquired skill. But that’s now changing with automated cutting devices, automated stainers, and advancements in digital pathology.
Just as important has been the evolution of modern LIS systems that now serve as the central hub for all laboratory data. These new modern systems feature interface engines that maximize connectivity with all laboratory analyzers and devices. They are also rule-based, enabling lab managers to build simple to complex rules and actions that replace inefficient and mistake-prone human intervention with automation. Lastly, modern LIS systems are now also designed with just-in-time functionality, allowing users to track the specimen at every stage while erasing the chance for lost or mislabeled specimens.
The fundamental question in the face of overwork and shortages of personnel is at what point of frustration does the pathology practice abandon the old way of doing things and invest in technology and automation that a modern LIS system can readily provide to ensure a successful surgical practice?
Artificial Intelligence, Digital Pathology, and Modern Laboratory Information Systems
Many believe pathology informatics is about to explode and the future is more automation and technological advancements.
Because of this, modern LIS systems like LigoLab Operating Platform are well positioned for what’s likely to be a pathology revolution in the next 5-to-7 years.
Industry experts believe that support for artificial intelligence (AI) and digital pathology will be a must for managing caseloads and that soon we’ll see a day when one pathologist will routinely be as productive as two pathologists typically are at present.
This belief is also backed by a recent report released by Signify Research that suggested the global market demand for digital pathology was likely to double by 2025.
With the adoption of this new technology, we may soon see a scenario where a single pathologist will scan and release 60-to-70 percent of his or her cases based solely on the results of digital images scanned by image analysis software. Another 20-to-30 percent of the cases will be more challenging with the software providing a diagnosis that the doctor may or may not agree with. Lastly, 5 percent of the cases will be so challenging that the software will need the human help of a pathologist for the proper diagnosis.
In closing, one can easily make the argument that an investment in the future of pathology is warranted because it continues to be the greatest bargain in healthcare. Anatomic and clinical pathology labs only take a small part of a typical health system’s budget (roughly 5 percent in most cases) and despite this small slice of the pie support laboratory test results that lead to 70-to-80 percent of all medical decisions. Clinical labs contribute mightily to the care of patients and, in relative terms, they are inexpensive.
Is Your LIS System Ready for What’s Coming Next?
For surgical pathology practices to overcome the current issues covered here, a modern rule-based LIS system that supports automation and maximized connectivity is a must. It’s clear that rigid and legacy LIS systems are going the way of the dinosaur and are being phased out by unified LIS software solutions that are both comprehensive (full of features with new enhancements developed daily) and flexible (include thousands of configurable entities that give clinical labs and pathology groups the ability to quickly introduce new tests, results, reports, and new fields). The best LIS systems also operate without multiple data silos between modules and departments and include software solutions for laboratory billing, too.
Not all LIS systems are created equally, so choose wisely and be sure to ask not only about the LIS software but also about the LIS vendor’s approach to support and upgrades. You’ll find the right LIS system for your lab will be backed by a vendor interested in your lab’s long-term success, one with low upfront costs, no hidden fees, and one that is motivated to work with you and your team to make your lab super-efficient and productive.