The challenges facing the pathology department
Posted 7th January 2019 by Jane Williams
It was a pleasure to welcome key opinion leaders to a discussion on accelerating the impact of AI through 100% digitization of the pathology workflow. Chaired by Peter Hamilton, Head of Research at Philips Digital & Computational Pathology, barriers to adoption, what drives the need and how do we reap the benefits were all on the agenda.
If you weren’t able to make the panel discussion, this six-part blog series will uncover what was discussed. Alternatively, you can watch the recording here.
Peter Hamilton There’s considerable media attention in the UK and elsewhere about the challenges facing pathology. The CRUK Report on Pathology highlighted the shortage of pathologists, the ageing population, the broadening of screening programs and the increasing complexity of tests as placing huge pressures on the workforce. Indeed, the Royal College of Pathologist has recently published a report highlighting only 3% of labs have enough staff to deal with the workloads they’re facing. How worried should we be?
Jo Martin We’re worried but hopeful. We’re worried because unless we do significant work to relieve the burden, we’re looking at probably a 25% deficit in reporting ability across the UK, not just England. Developed nations are very short of pathologists.
As you say, 97% of departments don’t have enough histopathologists for the workload and that workload is rising. We know that the prevalence of cancer is going up, and we know that with the extension of screening programs, we’ll have more work. We also know that with every sample, we have to do more with it and that all again adds to the burden. We know that in some areas, we’ve got an ageing workforce who are leaving, and we don’t have enough trainees to fill the spaces. That all sounds pretty miserable, but we see making pathologists’ lives easier as a key way to help us.
Making our technology more efficient will help and the prospect of being able to report across a network and even from home, so there are people who will continue to work and who can work in difficult personal circumstances if they have the technology that can enable it.
Peter Hamilton What are the challenges that are really facing your lab today David?
David Snead We are one of the labs that Jo mentioned that is short of pathologists. We have been for some time now, having had several vacancies which we’ve either not been able to fill, or as we fill them, lose other colleagues either to retirement or moving on. It’s putting enormous pressure on the service work of the department. At the same time, like everywhere else, we are asked to deliver more.
Generally speaking, that leads then to additional work for histopathology in particular. I’ve been the clinical leader of that service for some time, and I can have quite a difficult relationship with our financial department who struggle to understand how our workload continues to escalate.
We came to agreement when we calculated cellular pathology activity in terms of slides produced. In terms of specimens that we’ve been receiving, our workload has gone up by about 2% a year. Common in most labs, but over the last 10 years, that 2% increase in workload has led to a doubling in the slide production of the lab. All those slides equate to a piece of work for a pathologist and even if most straightforward sides are going to take a couple of minutes, it all adds up to additional time on a pathologist.
Digital pathology is an important part of the solution. It provides an important degree of flexibility in how it would work and we move around either within the organization or increasingly between organizations.
That flexibility allows us to make the best use of the expertise that we’ve got. It allows us to get expertise from people who are near retirement or have just retired or are happy to carry on. They are very important because they have the experience. We want to maintain contact with them and continue to use them. Those are successful strategies, which we hope to exploit further with digital pathology.
Peter Hamilton What about the introduction of additional tests such as the FIT tests for colorectal cancer screening? How do those impact on the workload that pathologists have to deal with?
David Snead It all adds up and I think cancer in particular, as well argued in the cancer research publication, the earlier you aim to diagnose cancer, the more difficult that diagnosis is to make, and that follows for colon cancer, lung cancer, or any of the tumour types.
The early stage of the cancer is always more difficult to diagnose because the tumour is small. You get less access to it and so on. It’s not just an increase in the number of samples you get, but it’s the complexity that goes with those samples that is important.
Jo Martin We know that with FIT testing, the acceptance/uptake rate will go up 15% across all populations, so it’s a very good thing to introduce, but we know that the impact on histology with the sensitivity that’s being done, will probably mean a 130% increase in workload for that screening program – a serious increase.
Peter Hamilton How does this compare with other stressors that the NHS is currently struggling with?
Neil Mesher The challenges are clearly across the board. You mentioned the 2% increase in pathology – a doubling in different activity levels. We know a core part of our business is also radiology which depends on the individual modality, a 7% increase per annum in demand. 7% sounds like it’s okay – a mid to high single digit we can cope with, but if you look at the reality of a 7% increase and then compound that up, that means that your demand doubles every 10 years.
I don’t know many parts of the NHS that are able to cope with a doubling of the demand, using existing ways of working over that kind of time period. For us, there is a clear need to start thinking differently about how we deliver healthcare. Part of that is through digitization and AI, as an example.
Peter Hamilton Clearly, there are big challenges ahead of us in the UK. Juan, do you face similar challenges in Spain?
Juan Retamero This country is unique in many ways, but unfortunately not in that regard. Those are problems that we’re unfortunately too familiar with in Spain, so we see a dwindling number of pathologists, increasing numbers of diagnostic burden, easily 5% every year.
Our residents don’t seem to be too inclined to pathology. Everybody wants to be a cardiac surgeon but not a pathologist. I think the bottom line is that we need better tools to do this job. We need better tools, and in our experience, digital pathology provides a viable alternative for that.
David Snead is Consultant Histopathologist and Clinical Service Lead, Coventry and Warwickshire Pathology services, Jo Martin is President of the Royal College of Pathologists, Juan Retamero is Pathologist at Granada Hospital and Neil Mesher is CEO of Philips UK and Ireland. With thanks to Philips for sponsoring this discussion.