Gastrointestinal/Liver Pathology

There is generally high demand for GI/liver pathologists, especially given the increasing case volumes driven by screening procedures and complex diagnoses, as well as lowering the initial recommended screening age. Challenges can include managing work-life balance due to the substantial number of cases, ensuring quality and expertise in signing out GI specimens, and addressing potential issues related to the entry of private equity investments in pathology practices. Additionally, as GI pathology is a popular subspecialty, competition can arise with multiple candidates for positions. Despite these challenges, however, the job market remains favorable with many openings available in academic and private practice settings across the country.

With a few exceptions, fellowships are generally one year.

On-call responsibilities can vary based on the practice setting, practice type (multispecialty group, academic practice, transplant center), program policies, and individual roles within the pathology team. While typical frozen section coverage is common, additional on-call duties may include reading stat liver biopsies, assessing luminal GI and liver transplant specimens for rejection, and evaluating donor liver biopsies.

The case volume is generally high, often exceeding 10,000 cases per year in large settings. This is due—at least in part—to the sizable number of biopsies taken during endoscopic procedures. Ancillary tests play a crucial role in diagnosis, with immunohistochemical stains being commonly performed on GI biopsies and resections. While specific molecular tests are less frequent compared to some other fields, they are sometimes ordered when needed.

Gastrointestinal/liver pathology interacts with a wide range of medical specialties, including gastroenterologists, hepatologists, radiologists, surgeons (general, colorectal, hepatobiliary, and transplant), oncologists (medical and radiation), internal medicine, infectious disease specialists, and trauma surgeons.

The field is supported by several specialized organizations, including the Rodger C. Haggitt Gastrointestinal Pathology Society (GIPS), the Hans Popper Hepatopathology Society, and the Pancreatobiliary Pathology Society.

In an effort to better enhance the comprehensive understanding and diagnostic capabilities within the field, this subspecialty has a wide range of pairings with other pathology subspecialties including pediatric, general surgical, and molecular genetic pathology; cytopathology (especially for pancreaticobiliary pathology); soft tissue pathology (for GI/HPB mesenchymal neoplasms); hematopathology (GI/HPB related lymphoproliferative processes); and microbiology.

Gastrointestinal/liver pathologists typically do not interact directly with patients in clinical settings. However, there may be rare instances where they are called upon to discuss pathology results—such as biopsies or resections—directly with patients. These interactions, although infrequent, can provide valuable insights and opportunities for patient education and communication.