Amid current economic pressures and geopolitical instability, lab leaders face a growing number of challenges that might keep them awake at night – the most pressing of which were recently highlighted in the PNPL's recent survey on pathology pain points.
Communication breakdowns, lack of succession planning, non-favorable contracts.... Karim E. Sirgi has seen it all. As a consultant, he works with pathology practices struggling with all these priority problems, and more. In response to the PNPL survey, we asked Sirgi about his experience of pain points in the lab, and how he helps lab leaders to address the problems in their practices.
As a practicing pathologist, how did your personal pathology pain points evolve and shift over the course of your career?
Early on, my pain points were clinical and operational – turnaround time, staffing the bench, keeping up with test volume. Later, I became more involved with leadership roles, both in my own group and with national specialty organizations. Then the pain points moved up a level: recruitment and retention, succession planning, governance, and decision-making. I might be consolidating relationships with the medical staff, hospital administration, and other critical stakeholders one day, and re-negotiating Part A contracts that didn't reflect the group's actual value the next.
Today, in my practice management and leadership consulting work, most of what keeps me up at night is strategic – mainly, digital pathology and AI adoption, and whether the next generation of pathologists even wants to run a practice the way we did.
What are the biggest pain points among the pathology labs you meet through your consultancy work?
Among the groups I work with, fair workload distribution and evaluation of a pathologist’s “productivity”, group governance and decision-making, staff retention, and physician recruitment come up in nearly every engagement. Those are hard problems to solve because there's no quick fix. Right behind that is succession planning: too many groups have no real plan for when their most senior partners retire.
Did you find anything surprising about the PNPL pain points survey results?
I was surprised that merger and acquisition (M&A) did not make it to the top tier. M&A activity has been associated with a lot of anxiety for a very long time.
The other surprise was that laboratory staff recruitment and retention was ranked as a lower priority than pathologists' recruitment and retention. In my experience, the two problems present the same level of challenge.
What factors are conspiring to create pain points right now?
A few forces are compounding at once:
A shrinking pipeline of pathologists relative to demand.
Hospitals and payers pushing harder on contract terms as margins tighten.
Digital pathology forcing capital and workflow decisions that groups aren't informed or staffed well enough to make.
Layer on billing complexity – PCCP, technical component payments, lack of reimbursement for digital pathology tools, RCM reporting – and you get pain points that used to be separate problems now landing on leaders' desks at the same time.
Which of those factors are within lab leaders’ powers to change?
Succession planning and staff retention are almost entirely within a group's control – they fail from lack of attention. Recruitment and digital pathology adoption are harder because they depend on market conditions and capital, but leaders still control the strategic thinking, timeline, and how well they prepare for both.
Part A negotiations and technical component payments are the least controllable in the short term since they depend on the hospital partner or payer, though preparation and data still shift outcomes at the margin.
Could you share a success story where you have helped a lab remove one or more of its pain points?
I can share many of these stories, but I'll focus on one. A large group of more than 55 pathologists across multiple geographies and hospital sites came to me with a cluster of chronic pain points. Governance and decision-making were vague and there was a near-total absence of transparent, consistent communication. That was leaving younger pathologists and lab staff feeling neglected and disrespected – enough that some were leaving. Internal disagreements were arising over digital pathology and AI adoption, and there was no consensus on how to respond to interest from M&A parties.
In cases this complex, I start with a detailed survey of the pathologists and lab staff leadership, then work outward to other levels of the organization and relevant outside stakeholders to understand the real scope of the challenges. I bring those findings back to leadership, which most often leads to a weekend group retreat, during which we work through the issues together and land on realistic solutions with a clear timeline.
That's what happened here, and it brought major relief on all four fronts – confirmed both verbally by the group and in writing, including recommendations shared on my website and LinkedIn.
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