Canadian Pathologists in Crisis: A Review of National Wellbeing and Workload Data
In Press (Coming 10/2025)
Abstract
Background
Canadian pathologists face a lack of workload protections, resulting in excessive unpaid overtime which contribute to medical errors, rising medico-legal risk and mental health deterioration. The impact of this crisis has included repeated public inquiries about the quality of patient care.
Method
This study is a general review of national data with an observational component. Two analyses were conducted. [1] Workforce-to-population ratio (CIHI) and medico-legal burden (measured in CMPA pathology cases per 1000 CMPA members) were correlated. [2] Comparative ranking using the CMA Wellness Survey to rank pathology against other specialties on 17 wellness indicators.
Results
Workload vs Medico-Legal Complaints
Spearman’s rank showed a moderate negative correlation, indicating medico-legal cases rose disproportionately per pathologist. This was most evident in British Columbia (127% complaint increase vs. 9.4% workforce growth) and Ontario (39% vs. 15%). Nationally, complaints rose 33% vs. a 16.7% workforce increase. In contrast, Alberta, with the highest workforce growth (27%), saw a -9% decline in CMPA complaints.
Pathologist Wellness
Pathologists ranked worst on 14 of 17 wellness indicators in the CMA wellness survey. They reported the lowest levels of psychological well-being and the highest rates of distress. The CMA identified pathologists as having a 2.44-fold increased risk of low psychological well-being compared to physicians in other specialties.
Discussion
The present analysis found that medico-legal complaints against pathologists increased all provinces but Alberta, suggesting an increase in error rates which impact patient care. Pathologists ranked last in wellness indicators, with higher rates of burnout, depression, and suicidal ideation than most other specialties. The pathology workforce crisis is driven by excessive workload, inadequate structural support, and rising medico-legal scrutiny, which collectively erode well-being. Addressing these issues requires systemic reform—workload-based contracts, mental health protections, and national data collection—to sustain both physician wellness and patient care quality.
Resources
CAP-ACP Workload Model
Alberta was the only province which saw a drop of workforce complaints of -9% which was accompanied by a 127% growth in workforce. Find out more about the CAP-ACP workload models.
The Canadian Association of Pathologists. (2018). Workload Model for Anatomical Pathology and Hematopathology
Park, P. C., Kurek, K. C., DeCoteau, J., Howlett, C. J., Hawkins, C., Izevbaye, I., Carter, M. D., Redpath, M., Lo, B., Alex, D., Yousef, G., Yip, S., & Maung, R. (2022). CAP-ACP Workload Model for Advanced Diagnostics in Precision Medicine. American journal of clinical pathology, 158(1), 105–111.
Bateman, A., Hunter, K., Wong, N., Craig, P. (2024). Best Practice Recommendations: Excessive workload management in laboratory medicine: patient safety and professional practices. The Royal College of Pathologists.
Canadian Pathologist Burnout
Khatab, Z., Hanna, K., Rofaeil, a., Wang, c., Maung, R., & Yousef, G. M. (2023). Pathologist workload, burnout, and wellness: connecting the dots. Critical Reviews in Clinical Laboratory Sciences, 6(4), 254-274
Keith, J. (2022) The Burnout in Canadian Pathology Initiative. Archives of pathology & laboratory medicine, 147(5), 568-576.