Anatomical pathologists, laboratory executives, and health technology leaders met in Melbourne recently to talk about the future of their profession.
The occasion was the inaugural Intelligent Connections breakfast, hosted by Magentus and Labflow. The guest chair was Dr Chris Douglas, founder of Histopath Diagnostic Specialists – the first anatomical pathology laboratory in Australia to adopt a 100% fully digital operation.
The Numbers Are Getting Harder to Ignore
Australia is facing a serious and worsening pathologist shortage. RCPA (Royal College of Pathologists Australasia) modelling puts the Australian pathologist and senior scientist shortfall at 20–30% by 2030[1], with some disciplines considerably worse: genetic pathology is projected to face an 80% undersupply by 2027 and 100% by 2037[2]. NSW Health projects a shortfall of 122 full-time equivalent pathologists by 2027, rising to 291 by 2037[3].
The drivers are not unfamiliar to healthcare more broadly: an ageing workforce, with nearly half of all Australian pathologists now aged 55 or older; insufficient training placements; and rising case complexity that means each report takes longer to prepare than it used to.
“We’ve got an ageing group of pathologists, and if we can keep some of them in the workforce longer, we can delay it,” Dr Douglas told the group. “But we’re also just not training enough people to replace them.”
One attendee expected to lose half of their anatomical pathology workforce to retirement in the next three years.
Digitisation Is a Workforce Strategy, Not Just a Technology Upgrade
Histopath, headquartered in Sydney, Australia, completed its move to full digital in 2025, after six years of investment. It is the clearest available evidence that digital pathology changes what a workforce can look like, not just how it operates.
The lab now has 26 pathologists reporting exclusively using digital pathology workflows from metropolitan and regional locations across Australia. Cases are scanned, allocated, and reported in a continuous digital workflow, with the entire end-to-end integration supported by Labflow’s interoperability platform, LabConductor.
“We have pathologists who work only on the weekends. Pathologists who work after hours. There’s a lot of flexibility in that,” Dr Douglas said. “And as a result of that increased capacity, turnaround time is a lot better, which means more work is coming in.”
The effect on retention is significant. Senior pathologists who might otherwise have retired are now staying in the workforce precisely because the work can come to them.
“If we’ve got somebody who wants to retire in Ballina, they can retire in Ballina but still be working, even if it’s just a small contribution,” Dr Douglas said. “They can still stay in the workforce, but to do this, we’ve really got to modernise what we do.”
While digitisation was not without its teething pains, the pathologists who converted to digital workflows are now, without exception, enthusiastic advocates. “Once they converted [to digital], they all gave the same feedback: ‘We’d never go back.’”
Regulation Failing to Keep Pace
The Health Insurance Act 1973 still requires pathologists to report from a physically accredited facility to bill Medicare. The Act was amended during the COVID pandemic, but it still didn’t fix this challenge.
Dr Douglas noted that radiologists have worked from home for years. Pathologists cannot, at least not for Medicare-funded work, without maintaining a network of branch offices to satisfy a rule that no longer reflects practice.
“It’s quite insulting, in a way, to your professionalism,” one participant observed to general agreement. Dr Douglas has addressed this by accrediting branches in each location where his pathologists work, but describes it as a costly and cumbersome workaround for a problem that shouldn’t exist.
This is a federal issue and will require federal action. Industry lobbying is underway and the government is aware, but Douglas noted that awareness and legislative change are different things.
The Public Sector Is Falling Further Behind
Sixty percent of Australia’s anatomical pathologists work in the public system. Any serious response to the workforce crisis has to include them. Yet the structural conditions for public pathology to move quickly are largely absent.
ICT teams are stretched. Capital budgets are constrained. In Victoria especially, hospital networks are navigating the digitisation question independently, often duplicating the same costly learning curve. The breakfast heard this was in stark contrast with the NHS, which made a coordinated national investment in digital pathology.
“There’s always been this big divide between public and private,” Dr Douglas said, “but we’re essentially trying to achieve the same outcome. And it’s the same funder.” During COVID, he noted, the two sectors worked together effectively on testing. “You wonder whether that’s the answer; there’s got to be some closer collaboration.”
What the Journey Actually Looks Like
Dr Douglas was direct about the difficulty of digitisation, something often absent from conversations in this space. He conceded that Histopath got it wrong with its first platform choice, damaging internal confidence in digital pathology that took time to recover.
“We made a lot of mistakes. We initially used a [reporting] platform that wasn’t very robust, and our pathologists had a bad experience. We started off giving a very bad impression to our team about what digital was like.”
The lessons he passed on included doing the homework before committing to a platform, treat middleware integration as the most critical and most underestimated component, and don’t attempt a hybrid workflow if you can avoid it.
“You’ve basically got a lab trying to run two completely different workflows. It’s very, very difficult.”
What Needs to Change
When it comes to digital pathology, the technology is not the obstacle. The obstacles are regulatory settings designed for a different era, fragmented public sector investment, and a change management challenge that requires genuine commitment.
“I think what we need to do is enable our pathologists to report more efficiently, support them to stay in the workforce longer, and provide flexibility so they can work where they want to live,” Dr Douglas said. “But we’ve got to think outside the box. We’ve got to do something different.”
Organisations that have made that commitment have come through it. Those still hedging by waiting for certainty or running hybrid workflows are falling further behind. The workforce clock is not pausing in the meantime.
This article draws on discussion from the inaugural Intelligent Connections breakfast, hosted by Magentus and Labflow in Melbourne on 20 February 2026.
References:
[1] NSW Specialist Commission for Health Care Funding
[2] Health Consult final report for the Australia pathology workforce review project
[3] Final report for the Workforce planning for pathologists in subdisciplines and known shortages project
