by Dr. Alae Kawam

Hiring a new generation of young pathologists: What we want employers to know.

It is a challenge to hire a pathologist these days. Most organizations seek a seasoned pathologist to cover the most demanding services with low pay and little autonomy. The experienced pathologists that organizations seek are starting to retire, while others have realized they have other goals or just want to shift the direction of their lives. The ideal pathologist is a rare find.

Freshly minted pathologists are easier to come by but hiring them can be challenging. Most organizations are not willing to adjust to the demands of a new generation, not realizing that the requirements are only a reaction to the circumstances created by the previous generation. A higher cost of living, massive debt, financial and job insecurity, mental health struggles, severe loneliness and lack of community, and systemic inefficiencies all contribute to the plight of millennials.  However, a recent trend in increasing pay and adjusting benefits shows a desperate attempt to hire a new generation.

Since COVID-19, the job market has changed, organizations have shifted their priorities, and new concepts around working in healthcare have emerged. These are now being defined by an incoming workforce who have difficulty wrapping their heads around ‘the old ways.’ For a millennial, whose priority is self-care, financial stability, and boundary setting, functioning in a large healthcare organization is much more demanding and requires a lot more effort on the part of the organization.

The shift in philosophy

Many of us millennials and Gen Z-ers have adopted the mindset of ‘we are just cogs in a machine’ within the workplace. The COVID-19 pandemic highlighted how people were being fired or furloughed, all without regard to the financial stability of the employees—the people who were on the ground to keep the organization afloat. What we learned was that the highest priority of any company was financial stability, not protecting the people who were the foundation of it. It is important to keep a company financially stable, but the people who keep things running are important too! The mindset shifted from, ‘us’ to ‘me’ and ‘work hard’ to ‘work enough.’ If we are to be treated like replaceable cogs, then, in our minds, it makes sense to play that role. Or, in millennial terms, ‘set a boundary at work.’

We find fulfilment in work, however some of our frustrations also stem from systemic inefficiencies, redundancies, and preventable errors. We are hopeful that the technology our generation has brought will be utilized to its fullest potential to create efficient, high volume profitable systems that the older generation aimed to establish. However, we are aware of how organizations are falling behind in adapting technology (automation and digital pathology- both are designed for the increase in volume) and are frustrated at the expectation that the new generation will bear the burden without systemic support or technological advancements. Leadership is slow to move, so we have a slight wariness when it comes to decisions made on our behalf. Unlike previous generations who valued loyalty to leaders, and felt protected by them, we value our autonomy- because in our experience leaders will value profits, not the wellbeing of the people. The natural response is ‘protect myself.’ Hence, autonomy defines the philosophy.

We can agree on one thing- we both want to see increased profits, we just need the tools from our organizations to do it. Because the workload is much more than it used to be and regulations have increased, it necessitates systems designed for efficiency. We hope to see decisions made in that direction! From a marketing standpoint, the consumers are from our generation as well- we understand them in ways that the previous generation might not. We really are a valuable tool for growth.

Generational Differences

This new generation of pathologists is hyper-focused on ‘protecting their peace’. Additionally, this involves setting boundaries between life and work and keeping workplace conflicts to a minimum (both things that can be addressed with remote work options). We do not see the workplace as a family, nor do we see it as our highest priority. We prioritize well-being—proper sleep, nutrition, exercise, and healthy relationships. Weekends are for rest, not extra time for work (a major difference between this generation and previous ones, where weekends were thought to be a time to catch up on work). Workloads should be designed to be completed within the workday. For us, anything that requires more time is not a symbol of dedication but a form of exploitation.

We also value flexibility—we are interested in getting work done on our own terms rather than strict office hours. We don’t mind stepping away from the office during the day to take care of personal things—whether it’s a run to the post office or an exercise class. There is an expectation that workplaces can be mindful of that!

Communication Differences

Efficiency is key! Please do not schedule an hour-long meeting to discuss what can be an email.
Do not call us unless it is a major patient-impacting issue.
Electronic communication is preferred over in-person interaction.
In-person interaction is for human connection, not business.

The Requirments

Investments in efficient systems. Remote sign-out options, or digital pathology, were a part of our education as residents. However, that does not seem to be the case in mainstream pathology practices. Most organizations do not even have slide scanners, and neither is making a streamlined workflow on their radar. This creates a serious rift between our expectations and reality.

Additionally, as a generation riddled with student debt and rising inflation rates, fair pay is a must.

With the burnout epidemic, there is also an expectation of wellness resources or at least employee assistance programs.

Final requests

Please get rid of paper requisitions.

Young pathologists are eager to be on the team. We do not see hierarchy well; we see even leaders as equals; we really are focused on the team’s growth. Help us foster a culture of equity. We really are a generation of equity (diversity and inclusion as well)!

We are unfortunately cynical, but we wish we were not. We learned that our superiors were managers, not mentors (a severe case of expectation and reality mismatch), who were also at the mercy of their superiors- we are mindful of systemic hierarchies and how they can impact our superiors.  We are open to two-way mentorship and can work together for growth. Please either give us opportunities for growth or direct us to places we can grow—and be frank about it.

Burnout is real, and yes, we recommend time off, reflection, and therapy for it. We can tell boomers and Gen X are burnt out; they just won’t admit it. Just make therapy free—and distribute the workload more evenly.

The volumes, administrative and regulatory tasks have increased. Organizations intend growth- and we love being part of successful business! We just do not want to sacrifice our wellness. We believe in balance and sustainable workloads. There is more work- and we need more people to take on the load. Pushing people to their limits daily is the perfect setup for burnout and quiet quitting (bad for any business). Employee retention is important for an evenly distributed workload.  We promise more people hired will be beneficial- decreased turnaround time, increased tests to bill and overall better patient care.

We hope you can see our perspective, frankly, the ‘old days’ are gone, hospitals and laboratories need pathologists; the ideal pathologist does not exist in today’s market. It is a hard pill to swallow, but hiring this generation is the only option.

We are physicians, not service providers. I took an oath to serve patients. All I ask is to be given resources to help me be the best doctor I can be.

We are pathologists, the greatest asset to the organization, not a major liability. Please treat us as such.

My intentions here are to open a dialogue, learn, and educate. I am open to correspondence!

About the Author

Dr. Alae Kawam is a surgical pathologist based in New Jersey.  She is passionate about leadership, diversity, equity, inclusion (DEI), combating burnout, and advancing digital pathology. She completed her undergraduate degree at Drew University (2014), and medical training at New York Institute of Technology College of Osteopathic Medicine  (2018). She completed her residency and fellowship in Surgical Pathology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Pathology. She envisions bringing world-class, patient-centered pathology care to remote hospitals throughout the United States and beyond. When she’s not making strides in her field, she enjoys reading, writing, and weightlifting.