Concerns over pathology delays amid workforce shortage

While most routine pathology tests should not be affected, GPs should flag referrals of high concern to avoid delays, says the Royal College of Pathologists.

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While workforce shortages are more likely to affect complex pathology results such as genetic or anatomical pathology reports, GPs sending off skin biopsies or referring for endoscopies or colonoscopies could also face delayed results, RCPA CEO Dr Debra Graves told The Medical Republic. 

“There is a huge shortage of pathologists in Australia,” she said. 

“In fact, it’s an international issue, not just within Australia. It’s a worldwide shortage.” 

According to Australian Pathology CEO Liesel Wett, there are “particularly acute” shortages among subspecialities such as microbiologists “who have worked 24/7 throughout the covid pandemic and are exhausted”, histopathologists who make cancer diagnoses, chemical pathologists and genetic pathologists. 

While Dr Graves agreed that shortages were affecting some specialities more than others, she said the shortages were spread “across the board” affecting all areas of pathology. 

The “fabulous” outputs of the genetic revolution which have facilitated the boom of personalised medicine and resulted in “huge” improvements in patient care have also led to an increased workload for pathologists, which the sector has not been able to keep up with, said Dr Graves. 

Thankfully the RCPA has not yet received complaints about wait times for pathology results, said Dr Graves. 

However, RCPA fellows have raised concerns about the “blow-out” of turnaround times, she added.   

Ms Wett told TMR that the shortages were not yet impacting patient results, “but there is definitely a need for the government to increase the funding into pathology services, and pathologist training for the sector to be able to continue providing the high level of services that the community has come to expect”. 

Pathology centres have adopted a suite of measures to automate services for efficiency and prioritise higher risk samples, said Dr Graves. 

But the worry was that sometimes results could be unexpected, making effective prioritisation difficult. 

For routine tests commonly requested by GPs, such as those for diabetes or iron deficiency, shortages were having effects, such as on pathologists’ workload, but they were not translating to delays in test results, Dr Graves told TMR. 

But more complex results, including those for skin biopsies, endoscopies or colonoscopies, were more likely to be affected, she added. 

Dr Graves suggested that GPs should flag any serious concerns in their notes when referring a patient to pathology.  

“Good clinical notes in these circumstances are important,” she said. 

Ultimately, the RCPA is calling for more funded training positions for pathologists, said Dr Graves, to combat these workforce shortages. 

For many years, as services have expanded, there has been a disregard for the burden of workload faced by pathologists, she said. 

“That thought process has been missing. If you’re putting on a new service, you need to think about the burden on pathologists.” 

However, there had been progress since the RCPA published its workforce review in 2018, said Dr Graves. 

“We have made some inroads: there has been increases in number of pathologists working … but it’s just not enough at the moment. 

“We’ve got vacancies everywhere, there’s just not enough pathologists to get to all the work done.” 

There were also shortages in other disciplines employed within the pathology sector, putting significant pressure on the sector, added Ms Wett. 

“The pathology sector also employs many other types of workers, and there are shortages in some of these workforces as well, for example laboratory scientists and phlebotomists, who are all highly skilled workers, necessary to provide the world-class pathology services that benefit all Australians,” she said. 

Another significant barrier to sufficient pathology services: Medicare. 

According to Australia Pathology, there has been no indexation of Medicare rebates for pathology services since 1995.  

“Unlike other medical specialist services, the vast majority of pathology services in the community are bulk billed, which is great for patients as it means they face no out-of-pocket costs,” said Ms Wett. 

“However, there have been no normal increases in the Medicare rebates for pathology for almost 30 years – the Medicare fees for pathology have been frozen since 1995, unlike the rest of Medicare which gets increased each year for inflation.  

“Pathology services are now the only Medicare items that do not receive this sort of CPI increase.” 

While pathology laboratories have partially compensated for this by increasing efficiency through automation and shifting fees to more labour-intensive areas of the process, funding remains “really tight”, hindering the ability to hire more pathologists, said Dr Graves. 

“Pathologists are often the forgotten breed but they’re really critically important to diagnoses. 

“That is why we are worried and we are trying to work with governments to get the data and to keep pushing the need for more funded training positions for pathologists.” 

The RCPA is currently undertaking another workforce study to address the shortage.