What Is a Pathologist?

Chances are, you have never had a medical appointment to see a pathologist. In fact, the profession of pathology is unique in that doctors in this field rarely interact with any patients. They work behind the scenes, analyzing specimens and performing tests your primary care physician orders.

Merriam Webster (2017) defines pathology as the study of the essential nature of diseases and especially of the structural and functional changes produced by them. Pathologists are medical physicians who diagnose and treat patients by using laboratory medicine, although they may never directly interact with some patients. When you go to a doctor and they perform a medical test, the pathologist is the one behind the scenes performing the testing or analyzing the results. They then communicate those results to the patient’s physician.
For example, if you visit a cardiologist and they order a blood test, the pathologist analyzes the blood test results for abnormalities or signals of heart disorder or dysfunction. A pathologist will analyze skin or tissue that was removed in a biopsy and analyze it for signs of cancer. Any medical test you can think of has a pathologist behind the scenes analyzing the test results or directly performing the testing.

A pathologist may also manage the blood supply in a clinical center or hospital to ensure the blood is safe for patients who need it. They also investigate unknown deaths to identify a cause or a hereditary factor that may be involved. This type of medical doctor will also provide recommendations for preventing illness and maintaining the patient’s health. Not only do they perform testing when you are having symptoms, but they also analyze your annual checkup or physical test results as well.
Pathologists may also perform autopsies to identify the cause of death or to discover additional information about the effects of certain diseases. These discoveries can help the pathologist provide recommendations for family members so they can take preventative action against a genetic disorder or disease.

What Does a Pathologist Do?

Regardless of where they are employed, the majority of a pathologists’ day is spent working in a laboratory analyzing test results or performing medical testing to identify diseases or disorders. Medical diagnoses are based on examination of blood, tissues, organs and body cells. Not only does a pathologist identify the presence of disease, but they can also tell the severity and extent of the disease.

A pathologist is typically the medical director of the laboratory in a hospital or clinical center, where they supervise and manage blood banks and transfusion medicine, microbiology testing, clinical testing and forensic analysis. Microbiology labs test for bacteria, virus, fungi and parasites that can cause infections. Clinical testing consists of analyzing blood and body fluids, and forensic testing analyzes biological evidence for criminal and civil cases.

A pathologist consults with other physicians to determine the most effective drugs for certain infections or disease. The testing may be for a variety of diseases, so pathologists work with physicians from all specialties including cardiologists, oncologists and dermatologists. Anatomic pathologists work with surgeons to provide immediate diagnosis on surgically removed tissue or organs when time is of the essence.

There are other areas a pathologist may specialize in, other than blood banks and transfusion medicine. Chemical pathologists analyze blood or body fluid results for medication levels, drugs or poisons. Cytopathology and neuropathology focus on testing of cells and nerves, and derma-pathologists specialize in testing of skin diseases and disorders. Hematology, immunopathology, pediatric pathology and molecular genetic pathology are all specialized fields of pathology.

Specialized Areas of Pathology

Pathologists study the process of diseases, how it develops, what causes it and the effect it has on the body’s cells and the patient’s overall health. As mentioned above, there a variety of specialties and sub-specialties within the medical field of pathology. Many pathologists have multi-disciplinary knowledge of pathology, although some focus solely on their specialty or sub-specialty.

Anatomical Pathology

Anatomical pathologists specialize in the analysis of surgical specimens or autopsy results to analyze or identify the presence of a disease. Biopsies are performed so an anatomical pathologist can examine the gross anatomical make-up of the sample, the microscopic appearance of cells, the chemical signatures in the sample, any immunological markers present in the cells, and molecular biology of the cells, organs, tissues and sometimes whole body (Landal, 2017).

Anatomical Pathology Sub-Specialties

Anatomical pathology is broken down even further into multiple sub-specialties. Surgical pathology involves the examination of specimens removed during surgical procedures. Histopathologists prepare and examine specimens for microscopic examination. Cytopathology involves cells that have been shed into bodily fluids or have been obtained by scraping or aspirating tissue are examined, such as for cervical smear, sputum and gastric washings (Landal, 2017).

Forensic pathology involves analyzing biological specimens, whether during an autopsy examination or when provided with other samples from a criminal or civil court proceeding. Derma pathologists analyze skin lesions, moles, or other growth for signs of cancer or other disease.

Clinical Pathology

Clinical pathologists analyze body fluids and tissues to identify and diagnoses diseases. A clinical pathologist may also test patients' immune functions to detect allergies and toleration of transplant organs or perform toxicological testing and analysis. Clinical pathology is also broken down into several sub-specialty fields.

Clinical Pathology Sub-Specialties

Chemical pathology is also known as clinical chemistry. A chemical pathologist mostly analyzes blood serum and plasma for the presence of medications or drugs, and to identify the levels if they are present. Immunopathology or immunopathology refers to the study of immune system disorders such as immunodeficiencies, organ-transplant rejection and allergies. Hematology or hematopathology concerns the investigation and diagnosis of blood diseases.

Molecular Pathology

Molecular pathology is a multi-disciplinary field that focuses on disease at the sub microscopic, molecular level, and it includes a mixture of anatomical pathology, clinical pathology, genetics, molecular biology and biochemistry (Landal, 2017). The broadest definition of pathology is the study of molecules in a disease state, which includes DNA, RNA and protein (UK, 2017).

Molecular pathologists may be involved in testing for infectious disease, cancer and inherited genetic diseases. For example, infections by certain viruses (e.g. cytomegalovirus and Epstein-Barr virus) can be diagnosed by molecular testing for the presence of their specific RNAs in blood, and in the field of cancer pathology, the demonstration of a specific gene mutation or rearrangement can help confirm the diagnosis of certain lymphomas and sarcomas (UK, 2017). Not only do they identify the presence of disease, but they also monitor the response of the disease to treatments being applied.

The History of Pathology

Ancient Beginnings

The history of pathology has roots in common with all other medical specialties, arising in antiquity when men reasoned about the physical ailments that afflicted them (Van den Tweel and Taylor, 2010). In addition, archaeological studies have been linked with paleopathological investigations and observations of disease dating back to prehistoric times. As a result, museums around the world contain marble and terra cotta statues expressing processes that can now be interpreted as examples of hernias, breast tumors, varicose veins, ulcers and other diseases (Van der Tweel and Taylor, 2010).

The early Egyptians where the first to document cases of disease and abnormalities. Egyptian records contain descriptions of bone injuries, lumps, parasites and other diseases. Recent discoveries and examination of mummies have found that bone tumors and tuberculosis of the spine occurred, as well as atherosclerosis, gallstones and abscesses (Van der Tweel and Taylor, 2010).

Hippocrates is credited with making lasting contributions with his discoveries of anatomy and pathology. He is responsible for the first clear descriptions of pathological factors such as wound inflammation, tumors, hemorrhoids, malaria and tuberculosis. Although animal dissection was used during this time for medical analysis, autopsies were not performed in any medical practice.

Pathology Emerges as a Specialized Medical Field

If there is a moment when it might be claimed that Pathology took wing as a separate specialty then it is to be found at the end of the fifteenth century, in the work of the Florentine physician, Antonio Benivieni (1443–1502), who recorded case histories and performed autopsies on some of his patients (Van der Tweel and Taylor, 2010). After his death, his descriptions of over 100 cases, including 20 autopsies, were published.

Jean Fernel (1497-1558) was a mathematician and astrologist who is sometimes thought of as the first dedicated pathologist. In his published work titled “Medicina”, he classified diseases into general and specialized categories and identified symptoms and signs of certain diseases. In addition, he identified cases of appendicitis and aneurysms through post-mortem examinations.

William Harvey (1578-1657) made significant contributions to the cause and identification of disease. He identified the circulation of blood throughout the body and the function of the heart in blood circulation. Harvey made significant discoveries regarding the anatomy and function of the heart, including ventricular rupture, hypertrophy and aortic valve insufficiency.

Development of Pathology in the 18th Century

Due to an increase in autopsy examinations, pathology began to provide significant contributions to the medical field. More pathologic observations were published in textbooks and journals, including identifying a patient’s medical history.

Giovanni Batista Morgagni (1682–1771), a medical student in Bologna, and student of the great anatomist Antonio Valsalva (1666–1723), gained instant fame with his books where he described over 640 autopsies, structurally correlating the symptoms of his patients with the pathological findings at autopsy, fostering the growing belief that diseases had an anatomical substrate (Van der Tweel and Taylor, 2010).

In the late 1700s, Marie Francois Xavier Bichat used his connections as army surgeon during the French Revolution to obtain permission to investigate the fresh bodies of those who were guillotined (Van der Tweel and Taylor, 2010). Without use of the microscope, he was able to identify 21 types of tissues, improving the foundation for tissue-based disease, and he correlated the clinical findings with “histology”, a term that really gained currency 50 years later (Van der Tweel and Taylor, 2010).

19th Century Advances in Pathology

The 19th century led to significant advances in medical technology due to the widespread use of the microscope to analyze tissues and cells. The field of pathology also began to involve physiology and chemistry in the study of disease.

The microscope totally changed concepts of disease from whole organs, to focus upon cells; it enabled the practice of histopathology and spawned numerous attendant advances in technique necessary for modern practice (Van der Tweel and Taylor, 2010). The way microscopic samples were processed evolved as well to include the use of dehydration, acid treatments, formaldehyde solutions and stains.

Frederich von Recklinghausen (1833-1910) was a pathologist who was one of the first to investigate bone pathology in primary and secondary bone growths. He published important studies on thrombosis, embolism, infarction, degenerations, hemochromatosis, adenomyomata of the uterus, and other many other pathologic conditions (Van der Tweel and Taylor, 2010). This led to additional discoveries in blood cell circulation and mechanisms of cell degradation and cell death.

The 20th Century and Beyond

The 20th century brought about significant advances in the field of pathology. Continued discoveries in the structure and function of cells and tissues occurred, contributing to the advancement in the diagnosis of diseases. As more discoveries are made due to advances in microscopy and scientific research continues to diagnose and prevent diseases, the pathology profession continued to be an essential function of providing medical care to patients.

The prevalence of diseases such as cancer and heart disease have led to an expansion of the field of pathology. Analyzing blood or body fluids for signs of heart disease or cancer is an essential part of providing comprehensive medical care and properly diagnosing and treating diseases. As with many diseases, early detection is key, which makes the pathologists job today even more important to a patient’s qualify of life.

How to Become a Pathologist

Because there are different specialties and sub-specialties in the field of pathology, there may be varying requirements for each, but the path for all pathology fields is essentially the same. A medical pathologist is typically either a clinical or anatomical pathologist. A medical pathologist may work in a hospital, clinic, medical school, or military or government agencies. They may also work in a research position investigating causes and effects of a disease.

To become a medical pathologist, you will need to complete an undergraduate degree, medical school and a residency program at minimum. This is over a decade of education and training, which is required for most medical fields. It will take dedication and perseverance to achieve a medical license, but it can be done.

Undergraduate Degree

An aspiring medical pathologist must first complete an undergraduate degree. While the focus should be on completing this degree, medical school requirements should be considered throughout an undergraduate program. Although there is no specific major required for acceptance into medical school, may future physicians of any specialty major in a science such as biology, chemistry or physics, while others may choose psychology or sociology or another social science.

Most students prepare to take the Medical College Admissions Test (MCAT) around their junior year of college, which is required for acceptance into an accredited medical school. Medical school is extremely competitive, so it is important to maintain a high grade point average throughout the undergraduate program. In addition, volunteering at a medical facility and participating in a variety of extracurricular activities will boost a medical school application.

Medical School

To earn a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.), a future pathologist must complete 4 years of medical school. The first two years of medical school consist of classroom education in courses such as anatomy, immunology, biochemistry, physiology, genetics and dermatology. Other classes may include pharmacology, infectious disease and reproduction. Medical law is incorporated into any accredited medical school program. Most medical school classes include laboratory settings where students practice various skills and procedures.

During the last two years of medical school, students are trained in a medical facility under the supervision of a licensed physician. This training typically occurs in a hospital, which allows a medical student to rotate between various medical specialties such as psychiatry, internal medicine, neurology, pediatrics and surgery. Students also participate in continuing education through medical seminars and educational sessions.

Complete a Residency Program

Before a medical school graduate can obtain a license in the United States, they must complete a residency program, which allows for an additional 1 to 3 years of training. If a graduate chooses to focus on a sub-specialized field, they receive additional training in that area during their residency. Some residency programs offer training in both clinical and anatomic pathology as well.

As with medical school, a residency program may include rotations throughout various areas of pathology, such as microbiology or transfusion medicine, forensic pathology, pediatric pathology and so on. Throughout the residency program, the resident pathologist will have the opportunity to review pathology test results, interpret them and consult with other doctors to identify a diagnosis and treatment.

To receive a D.O. degree, a student must also complete a 1-year fellowship program, which involves additional training in their chosen area of specialized pathology.

Medical Licensure

Although each state has its individual requirements for medical licensing, the process is typically the same. Medical school graduates who have completed a residency program are eligible for medical licensure in most states. A national licensing exam must be passed, in addition to a state or regional test, where applicable. Each state has its own regulations, so it is important to know the requirements you must meet to be eligible to practice pathology in the state you choose.

Applicants with a D.O. degree complete the Comprehensive Osteopathic Medical Licensing Examination (COMLE), while those who hold an M.D. degree must pass the U.S. Medical Licensing Examination (USMLE). Most states require pathologists to complete continuing education to maintain their medical licensing. Along with the examinations, a licensed physician must also take an oath of ethics.

Board Certification

Although board certification is not required to practice pathology in the United States, it is an optional certification that can allow for networking within the profession and for maintaining continuing knowledge of medical and technological advances within the field of pathology. The certifying organization for pathologists is the American Board of Pathology (ABP), which is a division of the American Board of Medical Specialties (ABMS).

A medical pathologist must meet certain requirements before obtaining board certification. The candidate must have a medical license and have three years of training in a pathology residency program. There is also a written and clinical examination to become board certified. To maintain certification, the pathologist must continue to seek medical training and attend educational seminars throughout the year. Periodic testing and evaluation is also required to maintain certification.

Job Prospects

The Bureau of Labor Statistics (BLS) reports an expected increase of 14% by the year 2024 for all physicians and surgeons in the United States. The median annual salary for medical pathologists is just over $191,000. Due to the increase in cancer and other diseases, pathologists will be needed to analyze and diagnose those diseases.

Although many pathologists are extremely satisfied in their profession, they do work long hours and spend time in a laboratory analyzing specimens and writing reports on the results and recommendations for treatment. In addition to the education and training needed to become a pathologist, additional skills needed to be successful include diagnostic abilities, compassion, attention to details, manual agility, written and oral communications, knowledge of medical software and accounting and data retrieval software.

If you are looking for a job that offers extensive interaction with patients, a pathologist is not the right medical profession for you. Most pathologists rarely interact with their patients, because the patient communication is through the primary care physician or the medical specialist coordinating patient care, such as the internist or cardiologist. While this occupation can be stressful, it does offer a significant salary to compensate.

References

Van den Tweel, Jan G. and Clive R. Taylor. A brief history of pathology. Virchows Archives. 2010 Jul; 457(1): 3-10

Mandal, Ananya, MD. Types of Pathology. Life Sciences Medical News, November 2013. Retrieved October 5, 2017 from: https://www.news-medical.net/health/Types-of-Pathology.aspx

The Association of Clinical Pathologists. Molecular Pathology. Retrieved October 5, 2017 from: http://www.pathologists.org.uk/page.aspx?id=130

Study.com. How to Become a Clinical Pathologist, 2017. Retrieved October 5, 2017 from: http://study.com/articles/Become_a_Clinical_Pathologist_Education_and_Career_Guide.html