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Evolution of anatomic pathology workload from 2011 to 2019 assessed in a regional hospital laboratory via 574,093
Michael Bonert1, Uzma Zafar2, Raymond Maung3
1Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
Insights
Anatomic pathology workload significantly increased from 2011-2019 due to reporting requirements and complex work-up. Despite this, the anatomic pathologist workforce saw minimal growth, indicating a need for increased staffing.
Area of Science:
- Medical diagnostics
- Pathology informatics
- Healthcare workforce analysis
Background:
- Pathology departments face evolving demands.
- Accurate workload assessment is crucial for resource allocation.
- Workload models require validation against real-world data.
Purpose of the Study:
- To quantify changes in anatomic pathology workload.
- To analyze workload trends in relation to the pathologist workforce.
- To evaluate the accuracy of workload models.
Main Methods:
- Analysis of 574,093 pathology reports (2011-2019).
- Quantification of report length, blocks, billings, and workload units (L4E, W2Q).
- Auditing of 1,100 cases for coding accuracy (95% estimated).
Main Results:
- Workload units (L4E, W2Q) increased by 23% and 21% respectively.
- Pathologist workforce (FTEs) increased by only 1%.
- The W2Q model underweights work for large specimens by up to 2x.
Conclusions:
- Pathology work has significantly increased without a proportional workforce increase.
- Increased reporting and work-up contribute to higher workload per case.
- Local investment in the anatomic pathology workforce is recommended.
Objective:
Quantify changes in workload in relation to the anatomic pathologist workforce.
Methods:
In house pathology reports for cytology and surgical specimens from a regional hospital laboratory over a nine- year period (2011-2019) were analyzed, using custom computer code. Report length for the diagnosis+microscopic+synoptic report, number of blocks, billing classification (L86x codes), billings, national workload model (L4E 2018), regional workload model (W2Q), case count, and pathologist workforce in full-time equivalents (FTEs) were quantified. Randomly selected cases (n = 1,100) were audited to assess accuracy.
Results:
The study period had 574,093 pathology reports that could be analyzed. The coding accuracy was estimated at 95%. From 2011 to 2019: cases/year decreased 6% (66,056 to 61,962), blocks/year increased 20% (236,197 to 283,751), L4E workload units increased 23% (165,276 to 203,894), W2Q workload units increased 21% (149,841 to 181,321), report lines increased 19% (606,862 to 723,175), workforce increased 1% (30.42 to 30.77 FTEs), billings increased 13% ($6,766,927 to $7,677,109). W2Q in relation to L4E underweights work in practices with large specimens by up to a factor of 2x.
Conclusions:
Work by L4E for large specimens is underrated by W2Q. Reporting requirements and pathology work-up have increased workload per pathology case. Work overall has increased significantly without a commensurate workforce increase. The significant practice changes in the pathology work environment should prompt local investment in the anatomic pathology workforce.
