Re-evaluation of the methodology for estimating the U.S. specialty physician workforce

Increasing pursuit of subspecialized training has quietly revolutionized physician training, but the potential impact on physician workforce estimates has not previously been recognized. The Physicians Specialty Data Reports of the Association of American Medical Colleges, derived from specialty designations in the American Medical Association Physician Professional Data (PDP), are the reference source for US physician workforce estimates; by 2020 the report for pathologists is an undercount of 39% when compared to the PDP. Most of the difference was due to omission of pathology subspecialty designations. The rest resulted from reliance on only the first of the AMA Physician Professional Data’s two specialty data fields. Placement of specialty designation in these two fields is sensitive to sequence of training and is thus affected by multiple or intercalated (between years of residency training) fellowships. Both these phenomena have become progressively more common and are not unique to pathology. Our findings demonstrate the need to update definitions and methodology underlying estimates of the US physician workforce for pathology and suggest a like need in other specialties affected by similar trends.