A small rural hospital is preparing for the retirement of a pathologist who has served the community for decades. The physician plans to leave in approximately six months, and the hospital is beginning its search.
On paper, the assignment looks straightforward: replace one retiring pathologist.
In our recruiting conversations, a different picture is emerging. This physician reads a broad range of cases at high volume, supported by part-time colleagues. The compensation arrangement rewards production, and the physician enjoys both the work and the additional earnings.
Finding another person with that combination of breadth, productivity and willingness to take on the workload may be difficult. Our initial assessment is that replacing this physician could require two hires. The final staffing decision needs to account for actual workload and the part-time support that will remain.
For hospital leadership, the consequential decision comes before the candidate search: Does the hospital have one position to fill, or a workload that needs to be divided differently?
In a January 2025 workforce letter, the College of American Pathologists cited research showing that 51.3% of pathologists were ages 50–69 in 2020. CAP's summary of the underlying CAP–AAMC research reported that the numbers in the under-40, 40–49 and 50–59 age groups remained roughly constant over the study period, while the older cohorts grew. CAP workforce letter; CAP research summary.
These are historical age data, not a count of scheduled retirements or a prediction of when any individual will stop practicing. They support taking succession seriously before a departure becomes imminent.
A long-serving physician can become the foundation of a hospital’s coverage model. As the practice evolves, that person may take on more cases, develop broader experience and establish a working rhythm that suits them exceptionally well.
The arrangement can work for years. Retirement exposes how much of it depends on that individual.
A successor may be qualified for the clinical work while preferring a different volume or schedule. Someone comfortable with the volume may have a narrower case mix. Add the requirement to relocate to a rural community, and the hospital is asking several important preferences and capabilities to align in one candidate.
Leadership should examine whether all those requirements truly belong in one position before making them the conditions of a successful search.
An established pathologist may need a compelling professional and personal reason to leave an existing practice and relocate. An early-career candidate may consider the opportunity but want a different balance of case mix, workload, support and flexibility. Neither preference can be assumed from age alone. The recruiting question is which candidates would choose the actual role the hospital can offer.
The retiring physician’s income may look like a compelling recruiting advantage. But when earnings depend on production, candidates need to understand what it takes to earn that amount.
What is guaranteed? What depends on volume? How much work does the current physician choose to take on? What happens to earnings and coverage during time off?
In this hospital’s situation, the physician welcomes additional work and its financial rewards. That is a personal preference the hospital cannot assume a successor will share.
An offer built around those historical earnings needs an equally clear explanation of the workload behind them. Otherwise, the hospital and candidate may be evaluating two different versions of the opportunity.
Two hires would bring additional expense. They would also require a deliberate division of cases, responsibilities and compensation. Splitting the departing physician’s income in half would not, by itself, establish two attractive positions.
Before choosing a recruiting approach, leadership should compare:
The comparison should account for case complexity, coverage hours, time off and any medical-director or administrative duties the retiring physician holds. Annual case totals alone do not describe the entire job.
The purpose is to decide which arrangement the hospital can sustain and realistically recruit for.
Hospitals facing this transition should also evaluate whether digital pathology could broaden their coverage options. CAP's 2024 practice survey summary reported that 28% of responding practice leaders said their practices digitized slides using whole-slide imaging, and 10% reported remote sign-out for primary diagnosis. These are adoption measures, not evidence that every hospital can move the same work offsite. CAP survey summary.
For a rural hospital, the planning question is whether suitable cases could be shared with outside pathologists without requiring every physician contributing to coverage to relocate. An arrangement might support selected subspecialty work, vacation coverage or a feasible remote-reading rotation for employed physicians. Those options could change the breadth and volume expected of the onsite replacement.
This means scanning slides for human interpretation; it does not require using AI to interpret them. The hospital would need to assess scanning capacity, staffing, connectivity, costs and outside coverage agreements, with clinical leadership defining what must remain onsite. CAP emphasizes validating whole-slide imaging for its intended diagnostic use. CAP validation guidance.
With only six months before retirement, a digital project should run alongside a concrete coverage plan. Until the workflow and coverage are operational, they cannot be counted as a solution to the vacancy. For more on these choices, see our discussion of small-group flexibility and remote reading.
With retirement approximately six months away, the hospital needs to decide how long it will pursue a one-person replacement before reconsidering the role.
If well-qualified candidates consistently question the same workload or case-mix expectations, leadership should treat that feedback as evidence about the position. Continuing the same search without revisiting those expectations consumes the remaining transition time.
Establish a review point early. Decide what candidate feedback would trigger a revised staffing plan and what coverage will be available if a successor cannot start before retirement.
An exceptionally productive pathologist may have served the hospital very well for decades. The next chapter should be built around roles the hospital can fill and physicians can sustain.
Preparing for a retirement or struggling to define the replacement role? Connexis Search Group can help you assess the recruiting implications of your case mix, workload, compensation and location before you commit to a search.
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