As the still-developing pathology profession in China struggles to meet demand, 3rd-party medical laboratory groups, and university/industry arrangements, find opportunities to fill the needs of China’s hospitals

China is currently facing a severe shortage of anatomic pathologists, which blocks patients’ access to quality care. The relatively small number of pathologists are often overworked, even as more patients want access to specialty care for illnesses. Some hospitals in China do not even have pathologists on staff. Thus, they rely on understaffed anatomic pathology departments at other facilities, or they use imaging only for diagnoses.

To serve a population of 1.4 billion people, China has only 29,000 hospitals with seven million beds. Among the healthcare providers, there just 20,000 licensed pathologists, according to the Chinese Pathologist Association. By contrast, recent statistics show that the United States has a population of 326 million people with approximately 18,000 actively practicing pathologists and 5,815 registered hospitals with 898,000 beds.

The largest pathology department in China is at Fudan University Shanghai Cancer Center (FUSCC), a hospital with 1,259 beds in operation and 50 pathologists on staff. News accounts say those pathologists are expected to process 40,000 cases this year, surpassing their 2016 workload by 5,000 cases. The FUSCC pathologists are supported by a small number of supplemental personnel, which include assistants, technicians, and visiting clinicians.

Qifeng Wang, a pathologist at FUSCC, indicated that most leading hospitals in China with average or above-average pathology staffing are experiencing similar barriers as FUSCC. Large hospitals, such as:

·       Cancer Hospital at the Chinese Academy of Medical Sciences;

·       Beijing Cancer Hospital;

·       Peking Union Medical College Hospital;

·       West China Hospital; and

·       First Affiliated Hospital of Sun Yat-sen University also deal with similar staffing shortages and excessive workloads for their pathology departments.

“The diagnostic skill level at FUSCC is not that different from that in the U.S.,” Wang told Global HealthCare Insights (GHI). He added, however, that the competent skill level of their staffers is not sufficient to handle the internal workload at FUSCC plus the additional workload referred to them from other facilities.

Though not at the top of the list, as the graphic above illustrates, China is preceded only by Uganda, Sudan, and Malaysia for the number of patients per anatomic pathologist. China has approximately one pathologist per 74,000 people. By contrast, the United States has one pathologist for every 19,000 people. Studies indicate that, globally, the number of pathologists each year is shrinking. (Image copyright: Clinical Laboratory Products)

Patients Forced to Migrate to Receive Diagnoses

Because there are so few pathologists in the vast, heavily-populated country, many Chinese patients travel to major cities to increase their chances of obtaining reliable diagnosis and care, which further overwhelms the system.

The 1,530-bed Yunnan Cancer Hospital in the western city of Kunming handles more than 4,000 cases forwarded to them from other institutions annually. The 14 pathologists at the center also sometimes travel to rural communities to provide anatomic pathology services.

“It’s the complex cases that make it hard to keep up with our workload” said Yonglin Wang, an anatomic pathologist at the Yunnan Cancer Hospital, in the GHI article. The pathologists at Yunnan often refer their more demanding cases to larger hospitals to ensure the best analysis and outcomes for the patients.

Workload, Low Pay, and Lawsuits Discourage Pathology Enrollments

A logical solution to the critical shortage of pathologists in China would be to increase the number of people choosing the profession. However, medical students in the country tend to steer clear of surgical pathology due to the excessive workload, lower pay and status, and the threat of lawsuits relating to improper diagnoses.

To address the demand, a private pathology industry is emerging in China. There are currently more than 300 private medical laboratories located throughout the country. The largest of these businesses is KingMed Diagnostics in Guangzhou. According to their website, the 3rd-party medical laboratory group focuses on medical testing, clinical trials, food and hygiene testing, and scientific research. They examine more than 4,000 pathology cases annually, concentrating on:

·       Immunohistochemistry;

·       Specialized staining; and,

·       Ultrastructural and molecular pathological diagnosis.

American Colleges Partnering with Chinese Laboratory Groups

Organizations from other countries, including the United States, also are entering the pathology industry in China.

In 2014, the UCLA Department of Pathology and Laboratory Medicine partnered with Chinese firm Centre Testing International Corporation (CTI) to operate a clinical laboratory in Shanghai. In the endeavor, pathologists from UCLA trained Chinese lab specialists on the proper interpretation of tests at the 25,000 square-foot facility. (See The Dark Report, “UCLA, Centre to Open Lab In China to Offer High Quality Testing,” May 19, 2014.)

“Because pathology has a history of being undervalued in China, the country has a shortage of pathologists trained to diagnose and interpret complex test results in specialized fields of medicine,” said Scott Binder, MD, Senior Vice Chair at UCLA Health in a statement. “Our partnership gives CTI and UCLA the opportunity to save lives by changing that.”

“Our collaboration will offer the people of China oncology, pathology, and laboratory medicine services they can trust. Many of these services are not largely available in China and are needed by physicians and healthcare providers to accurately diagnose and treat their patients,” stated Dr. Sangem Hsu, President of CTI in the UCLA statement.

As the need for pathologists increases worldwide, many countries will struggle to fulfill the demand. This may create even more opportunities for enterprising medical laboratory organizations and anatomic pathology groups who have the wherewithal and determination to make a difference overseas.

—JP Schlingman

Related Information:

China Grapples with a Pathologist Shortage

In China, More Irate Patients Violently Attack Doctors over Wrong Diagnoses and Poor Healthcare

UCLA Launches Joint Venture with Chinese Firm to Open Sophisticated Lab in Shanghai

The Pathologist Workforce in the United States

UCLA, Centre to Open Lab In China to Offer High Quality Testing

Digital Pathology Gives Rise to Computational Pathology

Pathologist Workforce in the United States: I. Development of a Predictive Model to Examine Factors Influencing Supply

Anatomic Pathology in China Is a Booming Growth Industry

Digital Pathology Enables UCLA-China Lab Connection

Lab Testing, Pathology is Fast-growing in China