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Pathologists were not immune from the challenges medical professionals faced in 2020 because of COVID-19 restrictions, but their average incomes changed little compared with 2019, according to results from the Medscape Pathologist Compensation Report 2021 .

About one third (35%) of pathologists reported having some decline in compensation in 2020, methotrexate and pregnancy but their average income of $316,000 was down only slightly from the average of $318,000 reported in 2019. Their average incentive bonuses also slightly decreased, at 13% of their total salary, or about $42,000, down from 15% in 2019.

That places pathologists in the middle of the field of specialties for incentive bonuses, which range from $116,000 (orthopedics) at the high end to $24,000 for psychiatry. Medscape surveyed nearly 18,000 physicians in more than 29 specialties for this year’s annual report.

Lasting Effects on Earnings From COVID?

Of the pathologists reporting that the pandemic affected their income, 46% expect their income to return to normal in 2021, whereas 38% expect the recovery could take up to 5 years. The remaining 16% responded, “I will never return to my pre-COVID income.”

In commenting on the report, Jonathan Myles, MD, chair of the College of American Pathologists’ (CAP) Council on Government and Professional Affairs, noted that the compensation changes are consistent with what CAP has observed. “Given the substantial drop in anatomic pathology and clinical pathology volume earlier in the year, this isn’t a surprising result,” he told Medscape Medical News.

“Our CAP surveys had about 39% of respondents reporting reductions in base salary in 2020, which is comparable to the 35% reported by Medscape.”

However, “about 13% actually reported increases in salary in 2020,” he said. 

Myles found the suggestion that some physicians continue to struggle in wake of the pandemic somewhat surprising.

“For pathologists, at least, our CAP surveys showed that the recovery was beginning as early as last September, and by the end of the year, anatomic pathology testing volume was, on average, down only about 9% compared to 2019, and non-COVID clinical pathology testing volume was down an average of only 4%,” he said.

Fairly Compensated?

About 64% of pathologists report they feel fairly compensated, up slightly from 62% in 2019, placing the field at the higher end of the scale (7th position; oncology is number one at 79%).

Meanwhile, a gender gap persisted in 2020 in pathologists’ incomes, with men earning on average 22% more ($343,000) than women ($281,000), according to the report. Of note, that gap is significantly lower than the 31% gap reported among physicians overall, down from 33% in 2019, and Myles noted that trends show more women entering the field.

“Pathology is seeing a demographic shift as more women enter the specialty,” he said. “For instance, 52% of pathology residents are women now.”

Paperwork Burden is High

With an average of 19 hours per week spent on medical work — including paperwork, EHRs, and documentation — outside of patient visits, pathologists are on the higher end of specialists, fifth from the top (infectious disease tops the list, at 24.2 hours per week), and their average work hours per week overall increased to 49 hours, vs 47 in 2019.

Yet, counter to the trend of declines in the average number of patients seen per week in most other specialties amid COVID-19-related restrictions, the average number of patients seen per week in pathology increased by as much as 11% in 2020, from 76 in 2019 to 84 in 2020.

In contrast, pediatricians reported the largest declines in patient visits, dropping to an average of 64 patients per week vs 78 patients in 2019.

Myles noted that recent CAP polls on the issue have suggested relatively wide ranges of workloads.

“Our CAP surveys show that concentrating on the average hides what’s really going on,” he said. “In (one) CAP survey (n = 670), 20% of respondents worked more hours during the pandemic, and 24% worked fewer hours.”

“Those working more hours worked an average 11.9 hours more per week, while those who worked fewer hours per week were working 10.5 hours less,” he explained. 

“In other words, a substantial number of pathologists were working substantially harder, but they were balanced out by a substantial number who were working fewer hours.”

Job Satisfaction: Most Would Pick Pathology Again, if Given Choice

For as many as 6 of 10 pathologists, the most rewarding part of the job is “being very good at what I do / finding answers, diagnoses,” while the most challenging aspect of the job, listed by 19%, is “difficulties in getting fair reimbursement from or dealing with Medicare and/or other insurers.”

About three quarters of pathologists (76%) expressed that, if given the choice, they would pick a career in medicine again, similar to the responses of 77% of physicians overall, and 85% report that they would choose pathology again, also placing them in the middle of the list, with internal medicine and public health/preventive medicine at the bottom.

Interestingly, those percentages have increased substantially since Medscape’s 2013 Compensation Report, in which only 51% of physicians said they would choose medicine again as a career.

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