Pathology has evolved significantly, encompassing various specialties and requiring expertise in diverse areas beyond traditional roles. Career options have expanded to include further specialization, working in private or academic labs, starting one's own practice, or transitioning to roles in related fields, highlighting the need for accreditation and administrative skills. The future of pathology will be impacted by advancements such as point-of-care testing and corporatization, necessitating pathologists to adapt to changing demands and focus on niche areas.

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