CAP Laboratory Improvement Programs
Assessing Performance, Productivity, and Staffing Needs
in Pathology Groups
Observations From the College of American Pathologists PathFocus Pathology
Practice Activity and Staffing Program
Scott A. Martin, MD; Patricia E. Styer, PhD
● Context.—The PathFocus program affords the opportu-
nity for participating pathology practices to be compared
with other practices that have similar characteristics.
Objectives.—To demonstrate variability in workload
among different pathology practice settings and to deter-
mine practice characteristics that influence staffing levels.
Design.—Among 228 group practices in the PathFocus
database, group practice settings were analyzed. The prac-
tice characteristics that were highly correlated with staff-
ing levels are presented.
Results.—Activities that showed significant variation in-
clude surgical pathology (P ⴝ .003), cytopathology (P ⴝ
D uring the past several decades, a changing fiscal land-
scape in the delivery of health care in general and
in the provision of professional services of pathology and
laboratory medicine in particular has required patholo-
gists to become more attentive to the management of their
practices as economic enterprises. This responsibility is
added to maintaining the skills necessary for accurate and
prompt diagnoses and clinical consultation, for education-
al responsibilities, and for laboratory and personnel man-
agement that, heretofore, consumed most of their efforts.
Whereas decisions about professional staffing have been
formerly driven mainly by impending retirements or other
staff departures or expansion of services, more recently
the changes in the pathologists’ practice environments
have often been commensurate with rapid changes in the
institutions they serve (mergers, acquisitions, and clo-
sures). Forced ‘‘marriages’’ of pathology group practices,
redistribution of workloads, acquisition of new service re-
sponsibilities, and outsourcing of services are among the
Accepted for publication March 24, 2006.
From the Department of Laboratory Medicine, St John’s Mercy Med-
ical Center, St Louis, Mo (Dr Martin); and College of American Pa-
thologists Biostatistics, Northfield, Ill (Dr Styer).
The authors have no relevant financial interest in the products or
companies described in this article.
Presented in part at the College of American Pathologists Pathology
Practice Management 2004, Chicago, Ill, July 17, 2004.
Corresponding author: Scott A. Martin, MD, Department of Labora-
tory Medicine, St John’s Mercy Medical Center, 615 S New Ballas Rd,
St Louis, MO 63141 (e-mail: martsa@stlo.smhs.com).
Reprints not available from the authors.
Arch Pathol Lab Med—Vol 130, September 2006
.006), miscellaneous (P ⴝ .006), and professional devel-
opment (P ⴝ .003). Group practices report up to 4% of
hours devoted to clinical pathology consultation, on av-
erage, and from 20% to 25% to administration and man-
agement. There are strong positive associations with staff-
ing levels for lower-complexity Current Procedural Termi-
nology code volumes (P ⬍ .001) and higher-complexity
Current Procedural Terminology code volumes (P ⴝ .006).
Conclusion.—The settings of pathology practices carry
specific commitments of time that are different and not
equally distributed among all practice settings and strongly
influence staffing requirements.
(Arch Pathol Lab Med. 2006;130:1263–1268)
consequences of these changes that pathologists have wit-
nessed, and these changes have demanded that patholo-
gists provide logical and credible arguments to justify
their perceived staffing requirements. Faced with these ex-
pectations, there has been a relative dearth of resources
originating from pathologists or pathology organizations
to which pathologists could turn for information, direc-
tion, and support.
In this regard, a seminal article by Haber1 was pub-
lished in CAP Today in 1987. He described a simple mod-
ule-based formula that was used as a guideline to assist
with determination of staffing needs in the Kaiser-Per-
manente Medical Centers in Northern California. The util-
ity of this model in the Kaiser-Permanente system was
verified by a subsequent article published by him in 1995.2
For some pathologists practicing in hospital systems in the
United States, the formula proposed by Haber quickly be-
came a ‘‘productivity benchmark’’ to which hospital ad-
ministrators, or the consultants hired by them, incautious-
ly expected the pathologists to meet. This was despite Ha-
ber’s admonitions: ‘‘. . . these recommendations were not
and are not intended to provide standards by which other
pathology departments can or should be staffed or judged.
The denominators in the proposed workload mod-
ules . . . should not be considered to be fixed, rigid, or even
recommended, just because they work for us. . . . The
modules and denominators are based upon TPMG’s [The
Permanente Medical Group’s] mode of practice and may
not be applicable to yours.’’ 2 Haber’s model appeared to
have appeal primarily because he presented a simplistic
approach that was quickly calculable, but it was some-
Characteristics That Influence Staffing—Martin & Styer 1263
times used with disregard to differences that might occur
in settings other than the Kaiser-Permanente system.
In 1997, to respond to inquiries from the membership
and to assist them in formulating responses to these is-
sues, the College of American Pathologists created an Ad
Hoc Task Force on Pathologist Staffing that was to report
to the Board of Governors. This task force was given the
specific charge to ‘‘develop . . . a usable template with ex-
plicit data elements that can be applied to pathology prac-
tices throughout the country . . . [and] a descriptive data-
base containing elements of pathologist productivity
based upon the . . . template.’’ 3 The template was tested
through several iterations and pilot study groups. The fi-
nal product, PathFocus, was introduced in 2001. This ar-
ticle reviews some of the data obtained about character-
istics of practices that have participated in the PathFocus
program.
MATERIALS AND METHODS
The PathFocus Pathology Practice Activity and Staffing Pro-
gram is a service offered by the College of American Pathologists.
Enrollment is voluntary, and data are self-reported on question-
naire forms that are provided.
In the data collection phase, participants record detailed infor-
mation about pathologists’ activities and about characteristics of
the group practice. Pathologists in a practice identify the activities
in which they are engaged and specify the time allocated to those
activities in an average week of work. This is accomplished with
time studies during a sufficient length of time in which the data
capture all the activities that the pathologists perform. For ex-
ample, if a rotational schedule in a group practice assigns an
individual pathologist to cover certain services (such as perfor-
mance of frozen sections) only every fourth week, then 4 weeks
of data would need to be recorded to calculate accurate average
time expended in 1 week by that pathologist for that activity.
Activities for each group practice are summarized by adding up
the hours reported for various activities in a typical week for all
individuals submitting data in the group practice. To normalize
across practices of different sizes, the total hours per activity are
expressed as percentages of the total hours reported for the
group practice.
PathFocus participants also submit data describing features of
each group practice, including institution type, patient volumes,
Current Procedural Terminology (CPT) code frequencies, character-
istics of supported sites, and other practice complexity charac-
teristics. A complete profile of an individual group practice’s
characteristics is constructed and is designated its fingerprint.
Similarities of groups’ fingerprints determine a unique peer
group for each participant in the PathFocus program, permitting
matches across a wide range of features. For the analysis pre-
sented in this article, group practices are simply categorized by
a single characteristic, institution type. Practice settings are cat-
egorized as (1) hospitals without residents; (2) hospitals with res-
idents, excluding university-based practices; (3) hospital/clinic
hybrids (which may or may not have a private practice laboratory
separate from the hospital laboratory); (4) independent or com-
mercial laboratories; and (5) university-based practices.
Allocation of time by institution type is formally analyzed us-
ing 1-way analysis of variance models for activities with adequate
data among different type of practices. Results of all analyses
using 1-way analysis of variance models are presented. If the
result from the analysis using the 1-way analysis of variance
model is significant at the P ⬍ .05 error level, differences by prac-
tice type are evaluated using pairwise comparisons between
means with the Bonferroni method to adjust for multiple com-
parisons.4 The multiple comparison adjustment is made for 10
pairwise comparisons among the 5 group practice means.
One component of the PathFocus participant report summariz-
es the results from an analysis evaluating the impact of various
practice characteristics on staffing levels. This component of the
1264 Arch Pathol Lab Med—Vol 130, September 2006
Table 1. Categories of Group Practice Settings
No. of
Practice Setting Practices Included
Hospitals without residents 140
Hospitals with residents 11
Hospital/clinic hybrids 47
Independent or commercial laboratories 7
University hospitals 23
Table 2. Staffing Patterns Among Group
Practice Settings
No. of Persons in Group
Practice Setting Median Mean Range
Hospitals without residents 4 4.6 1–22
Hospitals with residents 12 14.9 3–27
Hospital/clinic hybrids 6 8.5 1–22
Independent or commercial
laboratories 3 4.4 1–11
University hospitals 7 10.3 3–34
participant report package is based on data aggregated across all
group practices in the active database and is presented herein.
Staffing levels are measured by the sum of the reported hours,
excluding leave time, for all staff members submitting data. Using
stepwise regression, a subset of group practice characteristics is
identified to predict staffing levels.5 Group practice characteristics
are included in the final model if their corresponding regression
coefficients have P values less than .05.
RESULTS
The observations presented herein are based upon the
analysis of records in the current active PathFocus data-
base. These comprise a complete set of pathologists’ activ-
ity and practice characteristics forms from 228 group prac-
tices submitted from 1999 through 2004. Table 1 gives the
number of practices by institution type included in this
analysis. Within these categories, the staffing ranges are
broad (Table 2) and illustrate why even within a narrow
category, such as hospital practices without residents, an
adequate comparison of practices must take into account
other factors of practice complexity in order to make the
comparisons meaningful and realistic.
Pathologists’ activities are categorized into 9 general ar-
eas: (1) surgical pathology, (2) cytopathology, (3) autopsy
pathology, (4) clinical pathology consultation/interpreta-
tion, (5) administration and management, (6) miscella-
neous, (7) professional development, (8) teaching/train-
ing, and (9) research. The ‘‘miscellaneous’’ category in-
cludes leave time away from practice, time for travel be-
tween practice sites, and time expended in waiting to
provide a service (eg, waiting for specimens on which to
perform frozen section or cytologic immediate assessment
of adequacy and during which no other meaningful ser-
vices can be performed). By far, leave time away from
practice is the greatest contribution to the miscellaneous
category.
Table 3 gives a summary of time allocated to various
activities by practice type for all 9 general areas of pa-
thologists’ activities. For 6 of the 9 activities, results from
an analysis of variance evaluating differences among prac-
tice types are also included.
Activities that showed significant variation in the per-
centage allocation of time by practice type include surgical
Characteristics That Influence Staffing—Martin & Styer
 Table 3. Allocation of Time for Pathologists Activities by Practice Group Categories*
Percentage Time Allocation
10th 90th Overall
Group Practice Category No. Mean Percentile Percentile P value

Activities That Vary Significantly by Practice Type

Surgical pathology .003
Hospitals without residents 132 41 28 56
Hospitals with residents 11 30 20 43
Hospital/clinic hybrids 47 39 26 56
Independent or commercial laboratories 6 36 18 48
University hospitals 22 33 16 55
Cytopathology .006
Hospitals without residents 126 9 4 15
Hospitals with residents 11 6 4 9
Hospital/clinic hybrids 47 9 3 14
Independent or commercial laboratories 6 14 6 20
University hospitals 10 5 3 7
Miscellaneous .006
Hospitals without residents 134 11 5 19
Hospitals with residents 11 9 5 13
Hospital/clinic hybrids 47 14 8 20
Independent or commercial laboratories 6 16 10 22
University hospitals 22 10 3 14
Professional development .003
Hospitals without residents 134 7 2 12
Hospitals with residents 11 10 6 19
Hospital/clinic hybrids 47 6 3 11
Independent or commercial laboratories 6 5 2 7
University hospitals 22 10 7 14

Activities That Do Not Vary Significantly by Practice Type

Clinical pathology consultation/interpretation .15
Hospitals without residents 129 3 1 8
Hospitals with residents 11 4 1 6
Hospital/clinic hybrids 46 3 2 9
Independent or commercial laboratories 6 0 3 17
University hospitals 21 2 0 10
Administration and management .75
Hospitals without residents 134 24 12 38
Hospitals with residents 11 22 15 32
Hospital/clinic hybrids 47 23 13 34
Independent or commercial laboratories 6 20 13 28
University hospitals 22 25 13 40

Activities Not Formally Evaluated for Differences by Practice Type

Autopsy ...
Hospitals without residents 118 3 0 5
Hospitals with residents 11 4 1 6
Hospital/clinic hybrids 44 3 0 9
Independent or commercial laboratories 2 0 0 1
University hospitals 22 2 0 3
Teaching/training ...
Hospitals without residents 134 1 0 3
Hospitals with residents 11 12 6 18
Hospital/clinic hybrids 47 1 0 3
Independent or commercial laboratories 6 1 0 1
University hospitals 22 6 0 16
Research ...
Hospitals without residents 83 1 0 2
Hospitals with residents 11 5 1 9
Hospital/clinic hybrids 31 1 0 2
Independent or commercial laboratories 3 0 0 0
University hospitals 22 8 0 18
* Mean and percentile values show the distribution of percentages of time spent in each category of activity summed over all individuals in each
group practice. Results from 1-way analysis of variance, where applicable, are summarized by the overall P value.

Arch Pathol Lab Med—Vol 130, September 2006 Characteristics That Influence Staffing—Martin & Styer 1265
 Table 4. Practice Characteristics Most Closely Associated With Staffing Levels*
Group Practice Characteristic
Annual volume
CPT 88300 ⫹ CPT 88302 ⫹ CPT 88304
CPT 88307 ⫹ CPT 88309
Practice setting
Hospital setting
Group practice uses residents
General services
Fine-needle aspiration biopsy interpretation by pathologist
Regional blood bank center
* Practice characteristics that were tested but not selected in the stepwise regression model in this iteration included (1) volumes for Current
Procedural Terminology (CPT) codes 88305, 88104, 88173, 88311, 88312, 88313, and 88342; (2) practice setting of independent or commercial
laboratory and use of pathologists’ assistants; and (3) performance of cytogenetics, molecular pathology techniques, gynecologic and nongyne-
cologic cytology services, and general blood bank and transfusion medicine services.
pathology (P ⫽ .003), cytopathology (P ⫽ .006), miscella-
neous (P ⫽ .006), and professional development (P ⫽
.003). Typically, pathologists in hospitals without residents
spend more time on surgical pathology than those in hos-
pitals with residents and in university hospitals (P ⫽ .03
and P ⫽ .04, respectively). Pathologists in hospital/clinic
hybrids and in independent or commercial laboratories
show intermediate levels of time allocation to surgical pa-
thology. For cytopathology, pathologists in hospitals with
residents and in university hospitals significantly showed
lower allocations than those in independent or commercial
laboratories (P ⫽ .05 and P ⫽ .02, respectively). Patholo-
gists practicing in hospital/clinic hybrids and in hospitals
without residents show intermediate levels.
Activities with no significant variation by practice type
include clinical pathology consultation/interpretation (P
⫽ .15) and administration and management activities (P
⫽ .73). Group practices report up to 4% of hours devoted
to clinical pathology consultation, on average, and from
20% to 25% of hours devoted to administration and man-
agement.
Because of sparse data, time allocations for autopsy,
teaching/training, and research activities are reported,
but they are not formally evaluated. Autopsy pathology
time allocation was low in all settings. Teaching/training
time is low except in university hospitals and in hospitals
with residents, with averages of 6% and 12%, respectively.
Whereas this pattern might seem intuitive, the analysis
does provide concrete data about the amount of time these
educational activities and responsibilities demand. Simi-
larly, research activity is typically quite low except in uni-
versity hospitals and in hospitals with residents, where
pathologists spend averages of 8% and 5%, respectively,
of their time in research.
Table 4 gives the results of the stepwise regression anal-
ysis predicting staffing levels from group practice char-
acteristics using the current active PathFocus database. The
6 variables present in the final model were selected from
a list of 32 candidate variables. In this set of group prac-
tices, lower-complexity CPT code volumes (codes 88300 to
88304) and higher-complexity CPT code volumes (codes
88307 and 88309) had strong positive associations with
staffing levels (P ⬍ .001 and P ⫽ .006, respectively). In
addition, higher staffing levels are positively associated
1266 Arch Pathol Lab Med—Vol 130, September 2006
Distribution of Responses in
Active PathFocus Database
P Value 10th 50th 90th
in Regression Percentile Percentile Percentile
⬍.001 732 4144 10164
.006 246 1478 6373
Yes, % No, %
.01 82 18
⬍.001 78 22
Yes, % No, %
⬍.001 57 43
.04 11 89
with the practice setting of a hospital with residents, with
the provision of fine-needle aspiration biopsy interpreta-
tion, and with regional blood bank services. This analysis
is repeated in each iteration of the PathFocus database, so
the variables selected by the stepwise regression model
change slightly with each annual update. Consistently,
surgical pathology volume statistics have shown strong
positive association with group practice staffing require-
ments. Because multiple measures of surgical pathology
are considered (namely, low-complexity, medium-com-
plexity, and high-complexity CPT code volumes) and be-
cause these volumes are themselves correlated, the partic-
ular selection of best predictors can vary from 1 year to
the next because of the effect of collinearity. The hospital
practice setting and the provision of regional blood bank
center services have also consistently been significant pre-
dictors of staffing levels. Table 4 also gives the distribution
of responses from all practices for the group practice char-
acteristics and services selected by the stepwise regression
method.
In univariate analyses, there are strong positive associ-
ations between staffing levels and the annual clinical pa-
thology billable test volumes and the annual total labo-
ratory test volumes (P ⬍ .001 for both). These associations
hold for the practice settings of hospitals without resi-
dents, of hospitals with residents (excluding university
practices), and of hospital/clinic hybrids. Data in the set-
ting of independent or commercial laboratories are too
sparse for analysis. In university hospital practice settings,
there is a positive association between staffing levels and
total laboratory test volumes but not with clinical pathol-
ogy billable test volumes. In the multivariate analysis
model, only total laboratory test volumes have a positive
association with staffing levels (P ⫽ .01), less significant
than the association between staffing and the particular
anatomic pathology CPT code volumes given in Table 4.
There was no significant association between staffing and
clinical pathology billable test volumes in the multivariate
analysis model (P ⫽ .08).
COMMENT
Models to assist with the determination of staffing levels
in pathology have come from 2 different vantage points.
The first, which we designate demographics-based models,
Characteristics That Influence Staffing—Martin & Styer
originated from physician workforce forecasts. Initially fu-
eled by projections from the Graduate Medical Education
National Advisory Committee in 1980, concerns began to
emerge about physician oversupply and, consequently,
about overutilization of physician services and increased
cost. Fear of potentially unrestrained expansion and cost
led to development of closed-panel health maintenance or-
ganizations and other managed care models, and it was
reasoned that these models for health care delivery would
control cost and be efficient. These demographics-based
models defined physician-population ratios (usually ex-
pressed as number of physicians per 100 000 population),
largely based on historical needs, that became a factor in
decisions about determining staffing needs.6 In such mod-
els, the reported pathologist-population ratios have been
in the range of 1.7 to 5.4 pathologists per 100 000 popu-
lation.6–8 Although such an approach is useful for large-
scale organizational, community, and public health plan-
ning purposes, it provides little assistance to an individual
pathology practice faced with making decisions about
staffing needs.
The second approach, to which we apply the term met-
rics-based models, focuses on some measurable characteris-
tics that can be used as indicators for staffing require-
ments. The Kaiser-Permanente model described by Haber2
is an example. Other models have been proposed that pri-
marily tie staffing levels to some service parameter or
workload level. In an article published in a Canadian As-
sociation of Pathologists newsletter, Waldorf 9 stated,
‘‘Many attempts have been made in the past to relate pa-
thologists’ activity to workload. These usually fail because
the situations to which they are applied are not compa-
rable.’’ Yet, in that same reference there is a seemingly
contradictory guideline: ‘‘Divide the number of surgical
specimens per year by 3500 to give the number of pa-
thologists needed to handle all laboratory physician activ-
ities.’’ 9
Highly elaborate workload guidelines for anatomic pa-
thology and clinical laboratory activities have been pub-
lished in the United Kingdom by the Royal College of
Pathologists.10,11 In the 1992 surgical pathology module, for
example, the annual maximal workload of 4000 surgical
pathology cases (not individual specimens) per general
hospital full-time employee was recommended. This fig-
ure was halved (2000 pathology cases) for teaching hos-
pital settings. Notably, with increasing trends toward spe-
cialization, concerns were expressed ‘‘that the annual
workload guidelines based on specimen numbers are un-
able to reflect accurately the variety of work and the var-
iable complexity of different types of specimens. . . .’’ 10
Hence, in 2002, the workload guidelines were changed
from specimens per annum to workload units per hour,
and an attempt was made to incorporate specimen com-
plexity into their calculations. For a variety of surgical pa-
thology specimen types, matrices were developed that
ranked numerically gross examination and microscopic
examination complexity. Using workload units derived
from this approach, it was then presumed that reasonable
workload distributions could be made and that staffing
levels required to perform the work could be calculated.
A detailed discussion of that methodology is beyond the
scope of this article, and the reader is referred to the au-
thors’ publications for more information.10,11 The principal
value of their efforts, in our opinion, is the recognition that
Arch Pathol Lab Med—Vol 130, September 2006
specimen complexity does, indeed, influence staffing re-
quirements for surgical pathology.
This is the flaw in metrics-based models. Simple nu-
meric workload volumes and formulas derived from them
cannot be universally applied to all practice settings. Ev-
ery publication promulgating workload statistics to define
staffing requirements has made this point directly or with
disclaimers about the particular model used. Efforts to
capture the dimension of complexity in surgical pathology
have been few and have had limited success. As Tomas-
zewski et al12 stated, ‘‘Measures which adequately reflect
complexity in surgical pathology cases have not been de-
veloped,’’ and the excellent study published by those au-
thors demonstrates the difficulty in doing so. Without spe-
cifically attempting to define measures of complexity, per-
haps the most successful incorporation of that character-
istic into workload distribution is described in the article
by Black-Schaffer et al13 of their experience at the Massa-
chusetts General Hospital. Assignment of workload ac-
cording to areas of subspecialty interest and expertise re-
sulted in greater equity of workload distribution and im-
proved practice efficiencies.
The global database of information from enrollees in the
PathFocus program gives a broad-brush portrait of pa-
thology practice characteristics that influence staffing lev-
els. The broader and more robust the database, the more
useful this information may be. Such an overview is, how-
ever, of limited utility in evaluating the circumstances of
a specific practice relative to the entire global data. To be
useful as a self-assessment tool requires that practices
with similar sets of characteristics (ie, closely matching fin-
gerprints, such as service volumes, case complexity, insti-
tution type, and educational and training responsibilities,
to name a few) be the peers among which direct compar-
isons should be made. That is precisely what the detailed
analyses of the PathFocus program are designed to do. The
PathFocus program makes no attempt to set workload
benchmarks or staffing targets but permits groups to see
where they are relative to similar groups and with respect
to many parameters. It is neither intended nor expected
that the PathFocus database data provide a directive as to
the number of pathologists appropriate for a particular
group practice setting; they do identify how similar prac-
tice settings manage comparable workloads. In this pre-
sentation of data, we have chosen to characterize practices
only according to broad settings that are commonplace
and relatively different and to which most readers can
relate. These groups are certainly not unique or mutually
exclusive in all respects; however, the analysis does show
that there are demonstrable differences even among the
broad categories of practice settings that can influence
staffing needs. Even within a single practice setting, such
as university hospitals, this study illustrates that ranges
for most characteristics are wide, and, in reality, only spe-
cific comparisons using the capabilities of fingerprinting
provide sufficient data to make analysis of individual
practice characteristics more meaningful and applicable.
Thus far, the anecdotal benefits of this self-evaluative pro-
cess have been reported.14 Pathologists participating in
PathFocus have seen opportunities for redistributing work-
load among staff and for correcting missed opportunities
for coding and billing for certain services. When differ-
ences between the comparative data of the participant and
of the peer group are identified, there may be opportu-
nities for focused quality improvement studies.
Characteristics That Influence Staffing—Martin & Styer 1267
 The most recent College of American Pathologists Prac-
tice Characteristics Survey Report cites for the year 2004 an
average of 7.7 hours per week (16% of an average 49.4-
hour workweek) spent in performing clinical pathology
services (including laboratory management and supervi-
sion) for which bills are not submitted to patients or their
insurers.15 Furthermore, in that survey 18% of pathologists
report spending more than one fourth of their time per-
forming these activities. For comparison, it is notable that
in the PathFocus database the average time spent in ad-
ministration and management is higher in all practice set-
tings and varies from 20% to 25% (range, 12%–40%) (Table
3). Perhaps one of the greatest benefits of PathFocus is the
opportunity to participate in a disciplined comparative
collection of solid objective data about the time commit-
ments necessary to fulfill the obligations and expectations
of providing medical direction and management of a lab-
oratory (ie, activities that vary significantly by practice
type). The amount of time required for these services is
not insignificant.
PathFocus was developed through the efforts of members of the
College of American Pathologists Ad Hoc Task Force on Pathol-
ogist Staffing. The physician participants have included Mary E.
Kass, MD (chair); Michael L. Cibull, MD; C. Terrence Dolan, MD;
Henry A. Homburger, MD; Scott A. Martin, MD; Jeffrey S. Ross,
MD; Thomas M. Sodeman, MD; Mark S. Synovec, MD; Henry
Travers, MD; Richard J. Zarbo, MD, DMD; and Matthew A. Zar-
ka, MD.
1268 Arch Pathol Lab Med—Vol 130, September 2006
References
1. Haber S. When do you need another pathologist? CAP Today. October 1987:
40.
2. Haber SL. Kaiser Permanente: an insider’s view of the practice of pathology
in an HMO hospital-based multispecialty group. Arch Pathol Lab Med. 1995;119:
646–649.
3. Kass ME. Report of ad hoc task force on pathologist staffing. In: Course
DG31; Pathology Staffing and Productivity. ASCP-CAP Fall Meeting; October 20,
1998; Washington, DC.
4. Fisher LD, van Belle G. Biostatistics: A Methodology for the Health Sciences.
New York, NY: Wiley & Sons; 1993.
5. Weisberg S. Applied Linear Regression. New York, NY: Wiley & Sons; 1985.
6. Weil TP. How to determine the need for MDs by specialty. Physician Ex-
ecutive. 1997;23:42–49.
7. Mulhausen R, McGee J. Physician need: an alternative projection from a
study of large, prepaid group practices. JAMA. 1989;261:1930–1934.
8. Weiner J. Forecasting the effects of health reform on US physician workforce
requirement: evidence from HMO staffing patterns. JAMA. 1994;272:222–230.
9. Waldorf V. Verne’s Rules of Thumb. Canadian Association of Pathologists
Newsletter; 1996; Ontario, Canada.
10. Royal College of Pathologists. Guidelines on staffing and workload for his-
topathology and cytopathology departments. 2nd ed. June 2005. Available at:
http://www.rcpath.org/resources/pdf/GuideHistoCytoWorkload0605.pdf. Ac-
cessed May 11, 2006.
11. Royal College of Pathologists. Medical and scientific staffing of National
Health Service pathology departments, June 1999. Available at: http://
www.rcpath.org/resources/pdf/workloads.pdf. Accessed June 15, 2004.
12. Tomaszewski JE, Abraham S, Bell K, et al. The measurement of complexity
in surgical pathology. Am J Clin Pathol. 1996;106(suppl 1):S65–S69.
13. Black-Schaffer WS, Young RH, Harris NL. Subspecialization of surgical pa-
thology at the Massachusetts General Hospital. Am J Clin Pathol. 1996;106(suppl
1):S33–S42.
14. Lusky K. Apples to apples to oranges: comparing lab practices. CAP Today.
June 2003:14–18.
15. College of American Pathologists. 2004 Practice Characteristics Survey Re-
port. Northfield, Ill: College of American Pathologists; 2005:10–11.
Characteristics That Influence Staffing—Martin & Styer