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UK Histopathology Workforce Shortage is Widespread, Study Confirms

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NEW YORK (360Dx) – Only 3 percent of the National Health Service histopathology departments in the UK have enough staff to meet demand according to a recent census study conducted by the Royal College of Pathologists.

In total, of the 103 histopathology departments that responded to the survey, 86 said that they had inadequate staff to meet current clinical needs and 14 of the remaining 17 periodically hire temporary staff, or use other methods such as outsourcing or overtime to cope.

The study was conducted because Royal College of Pathologists, a UK professional membership organization with more than 11,000 members, had received anecdotal feedback from its members in recent years that they were struggling with a histopathologist shortage. In addition, recent national data in the UK indicated that there have been delays in the reporting of test results on histopathology samples.

"We have known for a while that the pressures have been building, but we hadn't gotten firm data to confirm our suspicions," said Jo Martin, Royal College of Pathologists president.

For National Health Service hospitals, the association estimates that the shortage translates to increased costs of £27 million ($35.5 million US) annually to pay for temporary staff to cover workforce gaps.

Martin attributes the shortage in part to the increased workload for histopathologists in recent years due to increased testing. An increase in cancer screening programs, which has led to more biopsies has contributed to a rise in demand, she said. For example, a new type of bowel cancer screening test being implemented by the National Health Service is projected lead to a 130 percent increase in histopathology samples related to bowel cancer due to improved bowel cancer detection, she said.

There has also been a rise in histopathology samples related to targeted tumor therapy, according to Martin. In addition, an increasing number of histopathologists devote a portion of their time to assisting with clinical trials, putting further strain on the workforce, she said.

"Particularly for cancer therapies, that development program is pretty dependent on the categorization of tumors to make sure that you have the right cohort," Martin said.

To mitigate a shortage of histopathologists, the Royal College of Pathologists is calling for increased funding for digital pathology, such as whole-slide imaging, that enables pathologists to review slides remotely, either from a center nearer to their home, or in some cases from home, said Martin.

"We know that in some areas people have stayed on in the workforce because of the flexibility that digital pathology can provide," she said.

The organization is also asking NHS to devote resources toward improving the information technology within laboratories. Many of the laboratory systems in the UK are 20 years older or more, Martin noted.

"In addition, we have very poor associated software support in terms of voice recognition and simple systems that help you do your work," she said.

In many cases, IT systems within the laboratory are not very user friendly, Martin said. A lack of connectivity between systems increases reporting and inputting tasks and inhibits pathologists from viewing data collectively.

"We did a small survey where 52 percent of lab respondents said that IT made them less efficient," she said.

The association is also asking Health Education England, a non-departmental public body of the country's Department of Health, to provide funding to support the training and hiring of more advanced clinical practitioners, Martin said. Introduced several years ago, the advanced clinical practitioner program trains people with science degrees in the UK to perform some of the duties of a histopathologist. Depending on the level of training, an advanced clinical pathologist can dissect specimen for analysis by pathologists, or in some cases, report specimen in a very limited field, according to Martin.

"A normal laboratory technologist would be able to do the technical part of the work. These practitioners can, in addition, take on some but not all of the responsibility of the medical staff, working together with them obviously," she said.

For areas where laboratories have particular difficulty recruiting histopathologists, the organization is also asking the National Health Service to provide funding to enable labs to offer a "golden hello," which is a salary bonus to new hires for their first few years of employment.

"It has been shown that in certain areas to attract people to areas of low recruitment, if you essentially give them a pay supplement, generally a couple of thousand pounds a year, it is not a massive payment but it is an encouragement for people to go into those particular areas," Martin said.