We’ve spoken with pathology groups that have lost staff pathologists to remote-reading opportunities. The recruitment problem starts before the replacement search does: the practice is offering a work arrangement that some of its own physicians have decided to leave.
Consider a six- to eight-pathologist group losing one or two colleagues. That is a hypothetical example, but the coverage question is concrete: who takes on their work while the group recruits, and what will make the next candidate choose this practice?
For a private-group president, the difficult decision is how much the practice can adapt while meeting its hospital commitments. Two issues deserve particular attention: where pathologists work and how their subspecialty interests fit the group’s case mix.
A hospital-serving group cannot simply promise everyone a remote position. It still needs a workable plan for responsibilities requiring onsite presence.
But a fully remote job and a fully onsite schedule are not the only arrangements worth examining. Could the group rotate a remote-reading day among eligible pathologists? Could that day follow the assignment of suitable cases, with onsite responsibilities explicitly covered?
The question is whether the schedule works for the whole group. If one person’s remote day repeatedly adds to another’s onsite burden, the arrangement needs redesigning. Partners should examine who covers what, how responsibilities rotate, and what happens when someone is absent.
A remote day is an option to evaluate, not a benefit to advertise before the practice can deliver it. Where it is feasible, it gives leadership something specific to discuss with current physicians and candidates who want flexibility.
The technology discussion can become tangled with the debate about artificial intelligence. Here, the proposal is narrower: scanning glass slides so a pathologist can review digital images remotely. CAP describes digitization as enabling remote examination, with or without AI tools. The pathologist can remain the person interpreting the case. Source: College of American Pathologists.
Buying a scanner alone does not establish a remote-reading service. The practice needs an appropriate workflow and infrastructure, and CAP emphasizes validation of whole-slide imaging for its intended diagnostic use. Clinical leadership must also establish that the proposed arrangement meets applicable requirements. Source: CAP’s whole-slide imaging validation guidance.
Digital capability may also give a small group another way to arrange coverage. With an appropriate subcontracting agreement and validated workflow, another pathology group could review suitable cases remotely during vacations or other absences. That could reduce the reading workload on the remaining physicians, while the practice maintains coverage for responsibilities that require onsite presence.
Evaluate the infrastructure against three potential uses: a remote rotation for staff, outside subspecialty support, and planned vacation coverage. Which are feasible for the practice, and what would each cost?
Put the technology and operating costs beside the practice’s own experience with departures, vacancy coverage, recruiting expenses and partner workload. Ask current pathologists whether a workable remote rotation would materially affect their interest in staying. Do not assume the answer—or count a prevented departure as guaranteed savings.
A group may decide the investment does not work today. That decision should account for staffing needs as well as equipment costs.
Flexibility also concerns the work itself. In our recruiting conversations, small groups need subspecialty expertise but cannot always offer enough volume for a physician to work exclusively within that subspecialty.
A dermatopathologist may prefer an all-skin practice, while the group needs someone who will also handle other surgical cases. Similar tensions can arise when a practice needs several areas of expertise across a small team.
Before recruiting, examine actual case distribution. How much relevant work could the incoming physician reasonably receive? How would that allocation affect the other partners? Would the proposed mix still hold during vacations or another vacancy?
If the answer is approximately 50–75% subspecialty work with the balance in other appropriate surgical cases, explain that clearly. Those percentages are an illustration, not a recommended benchmark or a promise to make without supporting volume.
Then recruit for interest in that combination, alongside the competence required for the assigned work. A physician who wants a mixed practice is a different prospect from one who views general sign-out as a temporary concession. The distinction belongs in the first substantive conversation.
When case volume cannot support a dedicated subspecialist, a group could evaluate contracting selected work to an outside practice while maintaining an onsite team suited to its hospital responsibilities. Digital pathology can support access to outside subspecialty expertise. Source: College of American Pathologists.
An occasional second opinion and outsourcing routine primary sign-out are different arrangements. Define the proposed scope, turnaround expectations, diagnostic accountability, access to the outside physician and hospital requirements before assessing whether it fits.
The financial tradeoff matters. Paying another group to read cases may reduce the margin the practice retains on that work. Sending cases out may also reduce the subspecialty volume available to current partners or a future recruit. Compare the proposed fees and remaining internal workload with the cost and coverage a hire would provide; do not assume outsourcing saves money.
For selected work, an external arrangement may offer expertise without requiring the practice to build a position around volume it cannot sustain. The onsite staffing plan must still cover the hospital's full needs.
Before approving your next hire, compare three options:
For each, compare hospital coverage, total cost, partner workload and the offer you can credibly make to candidates. Which arrangement can the group sustain during normal operations, vacations and another vacancy?
Our conversations with practices that have lost physicians to remote opportunities make this worth addressing before another resignation. The goal is an arrangement the group can deliver and the pathologists it needs have reason to choose.
Planning a hire for a small pathology group? Connexis Search Group can discuss your proposed case mix, onsite needs and candidate expectations before you launch the search. Discuss your pathology hiring need.
