How AI Can Help Address The Global Shortage of Pathologists

There's a global shortage of pathologists. Today there are slightly more than 102,000 pathologists spread over 130+ countries worldwide. There are big disparities between regions. 2/3 of the pathologist workforce is located in just 10 countries. Some regions have tens of thousands of pathologists, whereas other regions have very few. An increasing workload coupled with fewer pathologists could negatively impact patient care.?

There is no global registry of pathologists available so it's difficult to have an overview of the worldwide pathologists workforce. This year, Andrey Bychkov, MD, PhD, Director of Digital Pathology at Kameda Medical Center in Japan researched pathologists worldwide and mapped the worldwide supply. This is the first contemporary report on the global workforce of pathologists and its findings are informative.

Poster showing the global supply of pathologists presented by Andrey Bychkov MD, PhD, at the 2022 annual meeting of United States and Canadian Academy of Pathology (USCAP)

Study Overview

Dr. Bychkov collected data from around the world with the help of local pathologists. They covered 134 countries and territories and included 95% of the world population. The data was then mapped by Pathologist Magazine. These data can serve as baseline for geographic and temporal comparisons and future projections. Data sources included publications in international and local journals, communication with local professional societies, personal communication, WHO health workforce report, and the UN world population report. When possible information was validated by personal communication with pathologists from their respective countries.?

Ratio of Pathologists to Medical Doctors

There are 13.2 million medical doctors and over 102,000 pathologists worldwide. That's one pathologist for every 125 doctors.

1. In the US and Canada the ratio is 1: 50
2. In the UK the ratio is 1: 100
3. In the EU the ratio is 1: 200

70% of the pathologist workforce is concentrated in 10 countries

1. USA: 21,000+ pathologists (65/million)
2. India: 20,000+ pathologists (14/million)
3. China: 11,000 pathologists (8/million)
4. UK: 3,900 pathologists (57/million)
5. Brazil: 3,500 pathologists (16/million)
6. Russia: 3,300 pathologists (23/million)
7. Japan: 2,600+ pathologists (21/million)
8. Iran: 2,500 pathologists (29/million)
9. Turkey 2,000+ pathologists (24/million)
10. Australia 1,900+ pathologists (77/million)

Regional Density of Pathologists

North America has the highest density of pathologists with 50-65 pathologists per 1 million people. Considering North America as a model, there is a significant (4x less than needed) shortage of pathologists on a global scale. There's a moderate shortage of pathologists in Europe, a severe lack in Asia, and an extremely severe shortage in Africa.?

1) North America

The US and Canada have the highest density of pathologists with 50-60 pathologists per million population. Mexico has only about 1,800 pathologists for 131 million people. That's one pathologist for 72,777 people which is almost 5x less than in the US per population.

2) Australia and New Zealand

Australia and New Zealand have over 40 pathologists per million population.

3) Europe

Europe has a moderate lack of pathologists with 26 pathologists per million population. Some countries such as the UK, Italy, and Spain have more pathologists whereas other European countries such as France and Portugal have fewer. In the UK the pathologists shortage has led to delays in cancer diagnosis, which can take up to 6 weeks, and raises concerns about diagnostic accuracy.

4) Latin America

Overall, Latin America has a moderate lack of pathologists with 17 pathologists per million population. Argentina has a shortage but Mexico, Colombia, and Paraguay have a severe lack of pathologists.

5) Asia

Overall, Asia has a severe lack of pathologists with 6.8 pathologists per million population.

6) Africa

Africa has an extremely severe lack of pathologists with less than 4 pathologists per million population. Every country on the continent has a serious shortage of pathologists.

Pathologists per region in descending order

1. Asia: 45,000 pathologists
2. North America: 25,000 pathologists
3. Europe: 23,000 pathologists
4. Latin America: 7,000 pathologists
5. Africa: 3,000 pathologists

Percentage of the world's pathologists

1. USA (20%)
2. India (20%)
3. China (10%)
4. Brazil (4.2%)
5. Russia (4%)

Note: Data collection is still underway. To get updates please follow Andrey Bychkov, MD, PhD on LinkedIn.

“The traditional practice of pathology is on the verge of the biggest transformation the field has seen since the introduction of light microscopy."

Christian Zapf, Head of Imaging Software & IT at Siemens Healthineers

Progress is Accelerating in the AI in Pathology Space

• In May 2022 Ibex Medical Analytics, a pioneer in AI-powered cancer diagnostics, and Hartford HealthCare launched a clinical research and innovation initiative to help physicians deliver high-quality diagnosis and improved care for breast cancer patients. Hartford HealthCare has more than 400 locations serving more than 17,000 people daily.
• In April 2022 PreciseDx announced that their AI algorithms were able to detect Parkinson's pathology in image patches from biopsy samples with 99% sensitivity and 99% specificity compared to expert annotated ground truth and surpassed human pathologists with an accuracy of 0.69 versus 0.64 in the prediction of clinical Parkinson's disease status. This groundbreaking study was a collaboration with The Michael J. Fox Foundation.
• In April 2022, PathAI and?GlaxoSmithKline announced a strategic multi-year partnership that will leverage PathAI’s technologies in digital pathology. The companies plan to harness the power of machine learning to predict which patients will benefit from therapies in key high need areas.
• In March 2022 Paige launched Paige Breast Lymph Node, a new AI software tool that helps pathologists detect if breast cancer has metastasized to lymph nodes, concurrent with pathologists’ own interpretive review. It is designed to enhance diagnostic accuracy for the most subtle metastatic foci and has over 98% slide level sensitivity to detect metastases of any size.
• In March 2022 Pramana announced its first commercial agreement with Mayo Clinic. The multi-year collaboration includes an industry-leading initiative to digitize 5 million slides – one of the largest digitization efforts in the world to date, at an unprecedented rate. Pramana uses a whole slide image acquisition system, fed by a robot and analyzed by proprietary AI algorithms. A single scanning cluster is capable of scanning over 1,000 slides per day.
• In March 2022 Roche announced a new collaboration with Bristol Myers Squibb. As part of the collaboration, Roche will integrate a novel algorithm developed by PathAI into its digital pathology workflow software. The AI-powered algorithm will be used to analyze clinical trial samples and generate biomarker data.?AI will enable very precise diagnoses that will lead to personalized treatment options for patients with solid tumors.
• In March 2022 Verily?announced a partnership with Lumea. The collaboration brings together Verily’s AI algorithms with Lumea’s comprehensive end-to-end digital pathology platform with the objective to develop products which can diagnose, prognose, and guide prostate cancer therapy selection with improved objectivity and efficiency.
• In March 2022 PathAI and Cleveland Clinic announced a 5 year strategic collaboration. The partnership will combine PathAI’s AI-based platforms with Cleveland Clinic’s clinical expertise and multi-modal data to unlock a broad implementation of next-generation pathology diagnostics. Cleveland Clinic will leverage PathAI’s quantitative pathology algorithms to conduct new translational research and for use as clinical diagnostics in multiple disease areas.
• In March 2022 Proscia and Visiopharm announced a partnership to deliver AI-powered pathology to drive insight in cancer diagnosis. The companies will leverage Visiopharm’s clinical AI applications including breast IHC markers, breast metastasis detection, and colon metastasis detection.
• In March 2022 Proscia and Siemens Healthineers announced a multi-year OEM agreement. With Proscia’s Concentriq Dx platform, Siemens Healthineers is entering the digital pathology market.
• In November 2021 Ibex Medical Analytics announced the first deployment in Switzerland of its AI solution. Kantonsspital Baselland deployed Ibex's platform to help pathologists improve accuracy and efficiency during primary diagnosis of breast and prostate cancer. Pathologists at KSBL will use the Galen platform to streamline workflows and improve accuracy during primary diagnosis via automated case prioritisation, cancer heatmaps, grading and other productivity-enhancing tools.?
• In September 2021 in a historic milestone, the FDA cleared Paige Prostate. This is the first?ever AI-based pathology product approved for clinical use.?Paige Prostate?is the first and only AI-based pathology product to receive FDA clearance for in vitro diagnostic use in detecting cancer in prostate biopsies. This allows pathology labs to use Paige Prostate to help make diagnosis more accurate, more reproducible, and more efficient.?

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Copyright ? 2022 Margaretta Colangelo. All Rights Reserved.

This article was written by Margaretta Colangelo. Margaretta is a leading AI analyst who tracks significant milestones in AI in healthcare. She consults with AI healthcare companies and writes about some of the companies she consults with. Margaretta serves on the advisory board of the AI Precision Health Institute at the University of Hawai?i?Cancer Center @realmargaretta