This is a companion article to the feature, “Histotechnology Takes Aim at Automation.”

Every year, the American Society for Clinical Pathology (ASCP) conducts a series of fellowship and job market surveys that provide valuable information on national trends regarding medical education, residency training, and the pathology job market. The annual surveys are closely reviewed by pathology residents and fellows.1

“Residency and fellowship program directors use these comprehensive data to make improvements in their educational programs where needed,” says Karen Frank, MD, PhD, FASCP, chair of the ASCP resident in-service examination committee. “This report also helps ASCP identify opportunities to provide new resources to fill specific knowledge gaps.”

The job market survey provides upcoming fellows with information from their peers regarding interviews, job offers, salaries, and anticipated job responsibilities for their future first job following fellowship training.

The surveys also examine trainees’ attitudes toward pathology fellowships, the number of fellowships to which they planned to apply, medical school preparation for residency programs, and preparation for independent work. For the 2015 survey, the vast majority of residents said they planned to pursue fellowship training, and 44% chose two or more fellowships to meet career goals and compete in the job market. Respondents identified their top five fellowship choices as surgical pathology, cytopathology, hematopathology, gastrointestinal/hepatic pathology, and dermatopathology.

However, the 2015 edition of the ASCP surveys also found that about 40% of fourth-year pathology residents do not feel prepared to practice the “business side” of pathology.

Such a finding is no surprise to Mansoor Nasim, MBBS, MD, PhD, FCAP, assistant professor of pathology and laboratory medicine at Hofstra North Shore LIJ School of Medicine, and vice chair of the histotechnology committee of the College of American Pathologists (CAP). “We need to implement a new MBA/PhD program in laboratory management that will expose candidates to integrated training in finance, automation, quality assurance, information technology, molecular pathology, laboratory ergonomics, operations, regulatory requirements, and hospital management,” he says.

“And we also need to create a PhD program for anatomic pathology technologists who will become the source of new pathology lab supervisors, managers, and directors for the next generation of leadership in histotechnology.”

In addition to providing faster delivery of test results and reduced overhead costs, Nasim predicts, the pathology lab of the future may need to make do with a smaller number of pathologists, made possible in part by staffing increases in the subspecialization of anatomic pathology. “The implementation of automated systems may delay the need for a time, but there is no doubt that we will need high-quality, trained personnel.

“The old model of thinking is not going to be sustainable,” says Nasim. “A new value-added histotechnologist will need to be created.

“We need a new type of technologist, perhaps drawn from candidates who could be on a biomedical engineering track, as the coming wave of automated equipment will require maintenance and service,” Nasim adds. “And these new technologists should also have been trained for operations management.

“Such a high bar may seem somewhat far-fetched,” says Nasim. “But in the coming laboratory environment, those who dare are the ones who will go far.”

Meanwhile, current residents continue to express concern over the adequacy of their training to meet the demands of today’s lab environment. As in previous surveys, the 2015 ASCP surveys found that confidence in signing out cases is still a concern among many residents. Among responding fourth-year residents, 66% said they feel ready to sign out cases upon graduation, knowing colleagues are available for backup. Yet more than a third of the respondents indicated they are not ready or need a transition period upon graduating.

This transition period is provided during fellowship training. The report cited a lack of graduated responsibility during training as a potential contributing factor to the lack of confidence in independent sign out.


  1. Frank K, Wagner J. ASCP fellowship and job market surveys: a report on the 2015 RISE, FISE, FISHE, NPISE, PISE, and TMISE surveys. Chicago: American Society for Clinical Pathology, 2015. Available at: Accessed August 1, 2015.