Whether to be a generalist or a specialist in pathology in todays scenario. Adresses the future of pathology and the options which lie with today's younger generation.

1. Dr.Avinash Phadke
President & Mentor-Pathology
SRL Diagnostics Pvt Ltd

2. PATHOLOGY- WHAT IS IT TODAY?
 Pathology has no longer remained just histopathology or autopsy or even clinical path for that
matter
 It has grown to reach a stage where it includes a host of specialties like
hematology,microbiology,biochemistry, mol path,genetics histopathology as well as
Accreditation,administration, logistics,vendor relations,stock and people management in
certain situations.

3. PATHOLOGY- WHAT IS IT TODAY?
 No one person can be an expert in all these fields.
 One has to look at the need of employers today to better understand what one’s options are
 Point of care testing, Regulatory issues,corporatization, brand consciousness and
technological advances(Theranos) will change the face of pathology over the next 5 – 10
years

4. What are the possiblecareer paths
 1.STUDY FURTHER TO SPECIALISE IN A FIELD OF INTEREST I.E
HISTOPATH,CYTOLOGY,FLOW CYTOMETRY,MOL PATH,GENETICS
 2.WORK IN A PRIVATE LAB EITHER IN A HOSPITAL OR IN A STAND ALONE LAB.
 3.WORK IN AN INSTITUTION WHICH HAS AN ACADEMIC BENT OF MIND.
 4.START OWN LAB
 5. GIVE USMLE ETC AND MOVE ABROAD
 6.JOIN ANCILLIARY JOB LINES LIKE PHARMA COMPANIES IN THEIR DIAGNOSTIC
DIVISION
 7.CHANGE LINE COMPLETELY AND DO AN MBAHEALTH CARE ADMINISTRATION
 8.GET ADDITIONAL QUALIFICATIONS IN ACCREDITATIONS LIKE NABL,CAP ETC

5. 1.STUDYING FURTHER IN A SPECIALITY OF CHOICE
 For example, Histopathology has always remained the coveted field in the mind of
pathologists since it is one of the few divisions of path requiring a lot expertise of the
pathologist.
 For a person to get trained in histopathology, he/she needs to do so at either institutions like
TMH, with Dr.Borges or with a lab with a workload of >80-100 samples daily with a wide
variety of cases. The latter would mean learning on the job
 Noone would give signing authority to a histopathologist unless they are 3-5 years post M.D
and have been adequately trained.
 Most lucrativebusy lines: GI Pathology since GI biopsies are the commonest biopsies today
 Salaries: 80-1.0 for a fresher. 1.0-1.5 for a 3-5 year post M.D/ Salary capped at around 2.0

6. Standalone
histopathologist:challenges
 Standalone histopathology practice-
 The increasing disparity in standard of Histopathology practice
between the fully developed histopathology setup and single
standalone setup with proper setup is worrisome.
 Other challenges hinder the practice of Histopathology.These
range from challenges of human resources, financial, lack o
facilities like IHC, molecular studies lag in technological
advancement, lack of quality assurance programs.
 Increasing cases of litigation among others.
 For areas like skin, neurology, kidney , competant reporting
without additional personnel becomes a challenge.

7. 2.WORK IN A PRIVATE LAB EITHER IN A HOSPITAL OR IN A STAND
ALONE LAB I.E “GENERAL PATHOLOGIST”
 This option is a good option for those who do not want to specialise in any particular field but
will handle the lab in a holistic manner.
 This involves the following:
 1.clinical pathology including all tests of hematology,immunology,microbiology,infertility, and
more specialised tests like mol path and genetics.
 He/She needs to have a broad overview of every report that goes out form the lab.
 2.AccreditationISO certification: This is an essential part of training for any pathologist since
due to growing stringent government regulations which might make accreditation mandatory,
a pathologist who is an expert in documentation will be valued more than one who is not.

8. 2.WORK IN A PRIVATE LAB EITHER IN A HOSPITAL OR IN A STAND
ALONE LAB I.E “GENERAL PATHOLOGIST”
 3.Administration: including staff management,Logistics of samples, I.T issues, vendor and
stock management. Knowledge of these is a must. Dealing with patients is very important
 4.Basic idea of Business working and financial figures.
 5.Some niche is a must even for this pathologist either in Accreditation or a particular branch
like infertility,electrophoresis etc.
 6.Advantages: Salaries can go upto upwards of 2.0 lakhs a month.
 7.Disadvantage: ?Jack of all trades. Lots of stressful admin issues

9. 3.WORK IN AN INSTITUTION WHICH HAS AN ACADEMIC
BENT OF MIND
 This is an excellent option for those who are interested in research in Mol.Path, Hematology,
Genetics or even histopathology.
 Institutes like TMH and KEM offer great career options and are at the forefront of research in
lines like Hematology,Histopathology,Cytology and Molecular pathology.
 Exposure to excellent teachers and a good, secure working environment.
 The job also includes teaching and working with undergraduates and post
graduates.
 No medicolegal issues directly on to the pathologists.
 He/she can master a particular department or system, because of lot of
superspecialised work.

10. 4.START OWN LAB
 This used to be the preferred option in the oldered generation but nowadays it is not very
viable in tier 1 cities.
 Let us understand why:-
 Expenses in a :
 1.Rental:1.5 lakhs(monthly)
 2.Machine purchase: 50-70 lakhs
 3.Staff salaries:50,000(monthly)
 4.Electricity ,water etc:20,000(monthly)
 5.Reagents: 25% of gross income

11. 4.START OWN LAB
 5.ancilliary equipment,license and expense:50,000
 6.Total expenses 70-80 lakhs initially with a monthly expense of around 2.5 lakh + reagent cost
depending on turnover
 7. per patient billing 700 rupees. To get a monthly profit of 3 lakhs one would need a turnover of 10
lakhs which would mean 50 to 60 patients a day. Therefore to get the investment of 80 lakhs back
one would need this over 4-5 years to break even.
 Other factories of administration, staff issues remain the same.
 Legal issues to be handled single handed , no backup.
 In tier II and III cities because of low rent and manpower costs, this is still a viable option

12.  Difficult to practice in metropolitan cities as
more and more institutionalized practice in
increasing, single GPs, small nursing homes are
perishing. Hence the feeders are decreasing to
standalone labs.
 Will have to select a good IT programme optimum in
pathology work, accounts, reception, stock etc.
 Will have to tie-up with two –three good labs for a
second opinion or recheck of the results.
 Constant change in the technology will happen and
the lab will have to keepup with the change always.

13. 5. GIVE USMLE ETC AND MOVE ABROAD
 This is a good option because of standard of living,high salary etc
 Drawbacks: difficult to get admission in pathology, Medicolegal issues

14. 6.JOIN ANCILLIARY JOB LINES LIKE PHARMA COMPANIES IN
THEIR DIAGNOSTIC DIVISION
 This is another option for those who do not mind a change in their career paths
 Corporate setup with focus on financials, targets, sales etc
 Working as a consultant in the clinical trial based companies .
 Not much clinical exposure
 Financially quite sound
 Saturdays not working

15. 7.CHANGE LINE COMPLETELY AND DO AN MBAHEALTH CARE
ADMINISTRATION
 This is an additional qualification for doctors who again don’t mind a change in their line.
 They will enter either hospital administration, or a corporate setup related to health care

16. 8.GET ADDITIONAL QUALIFICATIONS IN ACCREDITATIONS LIKE
NABL,CAP ETC
 This is a must irrespective of whether it is an institution, or a standalone lab, a hospital lab or
a corporate.
 It gives you an edge over the other pathologists since there are so many pathologists passing
out each year and the number of labs is dwindling.

17. Subspecialisation: Choice or Necessity?
 Subspecialisation remains largely a choice that is dictated by a variety of factors including
the laboratory setting (service versus academic), specimen volume and specimen
composition as well as level of staffing.
 For example, subspecialisation cannot be afforded by departments that are staffed by less
than six consultant pathologists.
 Also, if they have a low number of biopsies or range of materials, the significant increase in
costs and staff cannot be justified.
 On the other hand, subspecialisation should be seen ultimately as a necessity for large
academic and teaching departments with heavy workloads.
 In this case, it will accommodate and improve research and optimise teaching obligations,
in addition to the other benefits of subspecialisation.

18. Pathologists: role and responsiblities
 The pathologists’ growing administrative duties have increased their work load and
responsibilities in addition to the clinical duties referred to above.
 The former include the requirements to comply with various regulatory bodies for both the
medical and non-medical aspects of the provision of the pathology laboratory service.
 Issues such as accreditation; external and internal quality assurances; continuing professional
development activities; various performance indicators including appraisal and job planning;
continuous internal and external audit activities and revalidation and participation in clinical
governance activities are just some of the essential tasks expected of medical professionals
nowadays.
 Regardless of whether we like them or not, believe in them or not, we have to carry them out.
 They are necessary because: 1) they justify our confidence in our practice; 2) they justify the
confidence of our service users and managers; 3) they safeguard the standard of our practice,
and 4) they ensure continuous pathology service improvement.

19. Where are we headed in pathology?
 The time has come now to shed all our old thoughts of how a pathologist functions in the
private space and try and break out of our comfort zones.
 Point of care testing will be a game changer and will change the way labs function over the
next 5-10 years
 More corporatization is inevitable and people are now looking to get their tests done from
branded setups.
 Regulations will be something to keep a look out for
 Clinicans are shifting from Private practicenursing homes into larger hospital based setups.
Therefore the pool of referring doctors for private labs is shrinking
 The hospitals will continue to grow faster than individual labs
 Pathologists need to understand that to gain an edge over the others, work experience is
very important along with accreditation experience and overall administrative experience
 Some niche area of interest should be developed