To the Editor.—The pathology job market in the United States has been a source of concern, controversy, and confusion. There is a paucity of data on the job market, with information predominately from surveys of graduating trainees and pathologists in practice. In response to the recently published article by Gross et al1  using the 2021 College of American Pathologists Practice Leader Survey to evaluate the job market, we reviewed the job advertisements for pathologists posted at www.PathologyOutlines.com during the 5-year time period from 2018 to 2022 and compared this with our analysis2  of jobs posted from the prior 5-year time period of 2013 to 2017. Postings for locum tenens, residency, fellowship, and nonpathologist positions were excluded. Our results are consistent with the increase in hiring identified in 2021 compared with 2017 described by Gross et al.1 

Comparing the time periods of 2013–2017 and 2018–2022, the number of job postings more than doubled (2013–2017 total, 2330 [range per year, 267–660]; 2018–2022 total, 5438 [range per year, 788–1522]) (Figure 1). In 2018–2022, there was an increase in job postings in all years but 2020. Not surprisingly, there was job market contracture in 2020 (n = 788) during the height of the COVID-19 pandemic. However, in 2020 there were still a greater number of posted jobs than in any year between 2013 and 2017. The contracture in 2020 was followed by a large increase in jobs posted in 2021 (n = 1359) and 2022 (n = 1522), more than double compared with any year between 2013 and 2017.

More jobs were posted in the fourth quarter (October–December) (689 of 2330; 29.6%) during 2013–2017, followed by the third quarter (July–September) (615 of 2330; 26.4%). This was reversed in 2018–2022, with more jobs posted in the third quarter (1523 of 5438; 28.0%) than the fourth quarter (1383 of 5438; 25.4%), suggestive of greater competition acquiring candidates who were still in training, earlier in the academic year.

For 2018–2022, 5104 of 5438 job advertisements (93.9%) were for positions within the United States and 287 of 5438 (5.3%) were for positions in Canada, similar proportions to 2013–2017 (2153 of 2330 [92.4%]; 154 of 2330 [6.6%]). The location of job openings within the United States was very stable between 2013–2017 and 2018–2022. For example, the Midwest had 22.7% (489 of 2153) of job openings in the former and 22.6% (1152 of 5104) in the latter time period. Proportional changes in job market in all geographic regions were less than 1%. The region with the most job openings was the South for both time periods (2013–2017, 659 of 2153 [30.6%]; 2018–2022, 1588 of 5104 [31.1%]).

In both time periods, about half of jobs were posted for academia and about half were for private practice. Although there were slightly more jobs in academia in 2013–2017 (1229 of 2330; 52.7%) than in private practice (1101 of 2330; 47.3%), this was reversed in the 2018–2022 time period (2534 of 5438 [46.6%]; 2904 of 5438 [53.4%]) (Figure 2). The posted job ads may still be an overrepresentation of the academic setting as the proportion is higher compared with 38% of survey respondents who accepted an academic position per Gratzinger et al.3 

In both time periods, most jobs ads stated that anatomic pathology (AP) or AP/clinical pathology (CP) was required (2013–2017, 1807 of 2330 [77.6%]; 2018–2022, 4080 of 5438 [75.0%]). From 2013 to 2017, the proportion of jobs requiring combined AP/CP was stable (857 of 2330 [36.8%]; range, 33.7%–39.6%). However, a substantial increase in the requirement of combined AP/CP was noted starting in 2019 (2018, 304 of 845 [36.0%]; 2019, 421 of 924 [45.6%]; 2020, 459 of 788 [58.2%]; 2021, 680 of 1359 [50.0%]; 2022, 808 of 1522 [53.1%]). With more job openings, this suggests a greater need for newly hired pathologists to do a broader range of clinical duties. The increase was observed in both private and academic job postings. From 2013 to 2017, most private jobs required combined AP/CP (715 of 1101; 64.9%), whereas few academic jobs (142 of 1229; 11.6%) did. Analyzing 2019 quarters 3 and 4 through 2022 showed a slight increase in AP/CP required in the private setting (1526 of 2213; 69.0%) and a large increase in the academic setting (657 of 1947; 33.7%). Few posted jobs required CP only in both time periods (2013–2017, 201 of 2330 [8.6%]; 2018–2022, 333 of 5438 [6.1%]).

The percentage of job ads that did not require a subspecialty (beyond surgical pathology) was variable but was below 30% for most of the past decade (2013, 38 of 267 [14.2%]; 2014, 87 of 351 [24.8%]; 2015, 127 of 482 [26.3%]; 2016, 101 of 570 [17.7%]; 2017, 73 of 660 [11.1%]; 2018, 74 of 845 [8.8%]; 2019, 180 of 924 [19.5%]; 2020, 204 of 788 [25.9%]) (Figure 3). However, an increase was observed in the past 2 years (2021, 519 of 1359 [38.2%]; 2022, 620 of 1522 [40.7%]). This may indicate more competition for candidates and subsequently less emphasis on the specific background of the candidate.

During both time periods, the 3 most frequent subspecialties listed in job ads were cytopathology (2013–2017, 344 of 2330 [14.8%]; 2018–2022, 1059 of 5438 [19.5%]) and hematopathology (325 of 2330 [13.9%]; 1064 of 5438 [19.6%]), followed by gastrointestinal pathology (263 of 2330 [11.3%]; 809 of 5438 [14.9%]) (Table). The next 4 most frequently requested subspecialties in descending order during 2013–2017 were dermatopathology, molecular pathology, breast pathology, and gynecologic pathology. These were the next 4 during 2018–2022 as well, but the order changed to breast pathology, gynecologic pathology, dermatopathology, and molecular pathology.

In conclusion, during the past 5 years within the United States, inclusive of before, during, and after the COVID-19 pandemic, our analysis supports a strong pathology job market. We found a markedly increased demand for pathologists compared with the prior 5-year period and in particular during 2021 and 2022. Practices that are hiring should be aware of the increase in demand and that job openings are now more frequently posted earlier in the academic year. Of relevance to trainees, more practices may emphasize general skills and combined board certification.

1.
Gross
DJ,
Robboy
SJ,
Cohen
MB,
et al.
Strong job market for pathologists
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2.
Zynger
DL,
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3.
Gratzinger
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Author notes

Zynger serves on the editorial board of PathologyOutlines.com. Pernick is the president and founder of PathologyOutlines.com.