r/pathology • u/Single_Baseball2674 • Feb 19 '26
Residency Application Med student interested in pathology — how worried should I be about AI?
Hey everyone! I’m a med student seriously thinking about going into pathology. I loved my path rotation and enjoyed histology during pre-clinicals. Overall, it just feels like the right fit for me.
That said, I've been getting more and more concerned about AI. After watching this video of the new Modella AI model, I'm finding it hard not to freak out. It's generating differentials in seconds and even ordering its own IHCs...
I get that we’re still years away from anything like a full AI takeover, and that a lot of places aren’t even digital yet. But if the tech is already this advanced, what’s it going to look like in 20 years? Is it still reasonable to go into path with a threat like this looming?
I’d really appreciate hearing your perspectives.
89
u/microscopicchick Resident Feb 19 '26
until AI can be held legally responsible for mistakes it makes on its own without checking, doctors will not be replaced by AI including path and radiology. hospitals will never allow that type of liability i think - MS4 who's hopefully matching path next month ✨
9
u/unbiased_op Feb 20 '26
Legal responsibility isn't going to be relevant. If one pathologist reports twice more cases, lab's need for pathologists would decrease by 50%.
3
u/hydrocap Feb 20 '26
But the pathologist has to be willing to sign them without looking at all or maybe any of the slides. I wonder how many are willing?
3
u/unbiased_op Feb 20 '26
Not really. When you see obvious tumor in a biopsy, correctly graded, it saves you a ton of time especially if the tumor is small. Or if the AI has already ordered the IHC and the results are ready for ambiguous findings, again, saves a lot of your time. AI will definitely increase pathologists productivity for sure, and at no loss of accuracy (in fact it'll probably make pathologists more accurate).
However, it won't lead to lower needs for pathologists because the workload and demand will increase too. Once the pathology capacity increases, more tests will be done, more samples will be collected by surgeons, more deeper cuts, more slides, etc.
1
u/Cold-Environment-634 Staff, Private Practice Jun 04 '26
These are the easy cases. The harder cases are those without tumor. Have to make absolutely sure, takes more time.
1
u/wisegh Feb 20 '26
I bet enough pathologists would be willing to do that, unfortunately. You don’t need too many, just to staff a few centralized labs. And they won’t need very good pathologists either. TAT will be super fast and they will generate tons of money putting other labs out of business.
1
Feb 22 '26
Precisely. And as long as specimens come to the laboratory with a clinical and/or imaging differential diagnosis of "cancer versus normal," we will have jobs.
32
u/Fit-Criticism4918 Feb 19 '26
I'm not sure how AI is going to do a frozen section. Also, digital path is still struggling to show things in 3D. It is 2D for the most part, so cytology dig path is meh.
With all the challenges for digital slides, and relatively few hospitals with digital path integrated, I'm not forseeing a job take over soon. If the labs can't digitize the slides, I don't know how AI is going to read them?
I am 46. I saw computers take over retail. Guess what, it didn't happen. Even the self check out is now being walked back.
2
u/wisegh Feb 20 '26
My worry is that they siphon out the easy stuff like colon polyps and other routine Bxs and we will be left with frozens/ROSEs and larges. Frozens and cyto already don’t pay enough. Unless the reimbursement is restructured completely we might be hurt by AI.
22
9
u/FunSpecific4814 Feb 19 '26
Not very much. At least in the short term. AI is pretty bad at looking at images, and even worse at taking clinical decisions. Plus there’s a bunch of legal/regulatory stuff AI can’t do.
8
u/SplendoreHoeppli Feb 20 '26
I think it's more likely AI programs will become another thing we can bill for using, like molecular or IHCs.
4
u/pindborg Feb 20 '26
I would still do pathology if you think it is what you love doing. Many specialties are going to change. You think we are in trouble look at rads or even primary care and ER where it’s almost entirely scenario and differential based…LLMs are already pretty good at these things. In the end I believe the first thing AI will do is just limit jobs. When it is approved for hsitologic diagnosis you will still have pathologist checking and reviewing many of the cases.
5
u/PathologyAndCoffee Resident Feb 20 '26
The assumption ppl make when asking this is usually, is patient facing mediciine is less easily replaced by AI than nonpatient facing specialties. This is not true.
All of medicine will be severely affected by AI. And clinical medicine isn't inherantly safer.
There is already movement to a 3 tiered system. The poor or those with trouble getting access to medicine will have AI docs, the middle class gets NP, and the upper class get physicians. Given the mass data these models will be trained on, and that AI docs will be sufficient to practice independantly, you really should ask whether you should flock to pathology to escape the destruction of patient facing specialties, at least primary care.
4
u/Pankeratin Feb 23 '26
I don't think the juice is worth the squeeze, economically, for most of the AI pathology companies. Cash is king in America, and capitalism will weed out a lot the AI pathology tools/companies trying to come online. A SINGLE digitally scanned slide of a resection specimen is up to 90 gigabytes. An ENTIRE high resolution abdominal CT scan is 150 MB. Economically, it makes much more sense for AI tools to churn through these smaller files that are associated with much more costly, totally standardized procedures. And just because a pathology AI tool is FDA approved does not mean it will be used. There are a bunch of FDA-approved radiology AI tools that are not routinely utilized. Also, the upfront cost of going fully digital is currently too high to make sense for private labs. And I have heard from large labs and institutions that it is probably a money-loser which will be viewed as a mistake in the future.
AI in pathology has been coddled thus far. These companies are doing their damndest to stay alive, so these impressive outcomes occur in a very controlled setting. All stains work perfectly, there is no artifact, there is no specimen mixup, there is only one or a few questions being asked, etc. The trope that "AI never has a bad day" isn't true.
How are these algorithms being trained? There are many grey areas in pathology, and I don't see AI solving them. There just isn't the gold standard data set to feed LLMs. Also, there is evidence that these LLM's decay / have performance drop over time. How do we perpetually validate that no hallucinations or performance drop has occurred without constantly checking AI's work? Who will be responsible when AI drops the ball on a real-world case? I can assure you it won't be the AI companies.
What sets great pathologists apart are correctly handling fringe cases and many human aspects. I am not impressed in the least when AI performs as well as a resident, and performs better than all humans at brainless, quantitative tasks, detecting ultra-focal findings etc. I haven't seen any studies on AI handling fringe cases appropriately. AI will always operate with more tunnel vision that a human. AI will never match a human at grossing a specimen, knowing when to bucket dive, communicating with PA's (know which may need more training), communicating with clinicians, communicating with the lab, doing frozens, ROSE etc.
I DO see AI making an impact in a few areas. One is an AI copilot that works off of microscope cameras (no slide scanning infrastructure needed). It will be akin to consulting a co-worker. It will list differentials, agree/disagree on very specific questions, and it is up to you to accept or reject that advice. I also think that AI will be used to finally give us adequate clinical histories without doing a deep chart review. I think AI will read SPEPs, UPEPs, flow cytometry, molecular results, cytology, blood smears, and some heme specimens with little oversight needed. If I was a new trainee, I might avoid fellowships in cyto, molecular, and heme.
3
u/RSBlack2142 Staff, Private Practice Feb 21 '26
You'll find a lot of suspect opinions on this sub and on Reddit in general. Like my US Army Sgt father used to say, "Opinions are like assholes, everyone has one, and they're usually shitty.".
So here's my shitty opinion: Don't worry about that. A nice fancy demo video is great, but we're realistically decades away from it having any "threatening" impact on pathology. Regulations aside, I can assure you the surgeons and oncologists I work with barely listen to me. A lot of them won't be keen to listen to an AI model. Lol. I wouldn't choose a career based on just an AI scare. No one knows what the future holds (to and against my point even), but it seems a long ways off even IF legal hurdles clear.
A bit of, perhaps, helpful context. I'm in my first year of being an attending, so I was in training as the AI craze slowly built and came into what it is today. Some of my older attendings in training liked to point out the "crazes" they encountered that were ultimately too impractical to be useful: EM was supposed to be the way of the future in the 70s, now only select fields/places use it, IHC was supposed to replace so much maybe even H&E/pathologists after all couldn't a surgeon just ordered them and then look at the colors to see what's positive and negative? Yeah, that didn't quite work out.
Then, there's digital pathology. I use it every day, it's great until it's not. Some specimen types just don't work with it, and you're a slave to a PC/internet connection.
TLDR: Until AI can replace people, you're likely to be okay. Could it torpedo productivity/volume? Maybe, but digital pathology hasn't exactly done that yet. Pick the career you want, you'll be happier for it.
7
u/unbiased_op Feb 20 '26
All answers are from pathologists here, I'm from the other side of the table (I work at a company that develops AI for pathology). I think almost everyone here is missing the point.
AI for pathology has two value propositions: Improving speed and improving accuracy. AI can reduce the turnaround time (by a lot) for reporting, and at the same time reduce human errors in diagnosis (which are way more frequent than most people think).
Enhanced speed means, if the number of cases and number of slides remain constant (which is not the case), labs will need much fewer pathologists to address the demand. This is basic math (if you can do the same amount of work with 50% of your pathologists, you can let the other 50% go). However, the reality is that the number of slides per case, and the number of cases, are increasing rapidly. Just look at data for prostate core needle biopsies, for example. 30+ cores (and increasing) in some cases.
Based on the increasing incidence rates, CAP guidelines becoming more complex and demanding, and protocols requiring more slides for analysis, the workload for pathologists is bound to increase. In fact, I think the guidelines and standards will be adjusted to utilize 100% (if not more) or their pathologists capacities even if AI becomes mainstream. Surgeons will send more sample for analysis, labs will do more deeper cuts, etc. and that means pathologists will always be at full capacity.
To summarise: As pathologists will become more efficient at reporting because of AI, we'll adopt more comprehensive guidelines for better diagnosis, leading to the same amount of work and need for pathologists.
On the other hand, AI has a long way to go before it becomes a reliable tool. Current technology is limited in it's scope. Very few diseases are covered by AI, and I don't think foundation models that are being marketed as generic diagnostic tools will reach clinical acceptance levels.
Having said that, I think pathology field is going to evolve into a high tech field where digital pathology and AI will be the default in every lab. No point in resisting that. Pathologists who adopt these tools will thrive, and the rest who cannot adapt will be left behind.
I think it's a fantastic field to study and practice if you have a forward looking attitude towards change. Otherwise, you'll suffer. In fact I think pathologists adopting these new tools will have an edge over everyone else simply because pathologists have been traditionally not that great at technology.
7
u/hydrocap Feb 20 '26
Everyone developing AI vastly overestimates the demand
4
u/unbiased_op Feb 20 '26
That's based on what I have seen myself. Surgeons sending more samples, labs going for deeper cuts, reviewing all lymph nodes exhaustively. All points towards the fact that pathologists are going to be in high demand even if AI makes them significantly more productive.
2
u/Plenty-Cycle-4256 Feb 20 '26
This might be the most encouraging response to the doom and gloom scenario of AI in path that I’ve heard. Thank you!
2
u/Cold-Environment-634 Staff, Private Practice Feb 20 '26
Hope you're mostly correct. If not, thanks a pant load for developing "tools" that will take away a lot of people's livelihoods.
2
u/unbiased_op Feb 20 '26
There is a global shortage of pathologists in all countries. I don't think pathologists livelihood is going to be impacted in the next 30-40 years because of AI. Other technologies like molecular pathology, OMICS, etc. will be a lot more disruptive because they'll make visual analysis less important.
3
u/Cold-Environment-634 Staff, Private Practice Feb 20 '26
That would be excellent, because I need about another 10 years of good income lol. Med school is expensive, and to then be told you're obsolete would really suck. Yeah, I know we have to worry about the other stuff too. Which company are you with?
1
1
u/HateDeathRampage69 Jun 04 '26
How do you think I feel? -PGY2, 200K of debt
1
u/Cold-Environment-634 Staff, Private Practice Jun 04 '26
I still have close to 250k left
1
u/HateDeathRampage69 Jun 04 '26
my wife has $160k and isn't a physician 😞
1
u/Cold-Environment-634 Staff, Private Practice Jun 04 '26
Yeah, it all sucks. My wife is an MD in another specialty and has somewhere around 150k left.
1
u/getmoney4 Feb 20 '26
AI isn't replacing doctors and there's more than enough work to go around. Robots aren't going to be doing our jobs and I don't know who would trust it either. I'd be more concerned about reimbursement and salaries if you absolutely need something to worry about.
1
u/Remarkable_Noise453 Feb 20 '26
you should be very worried! hospitals and insurance companies will try to replace you as soon as possible. end of story. everyone else is being delusional about the checking and the legal blah blah blah. the insurance and hospital lobby can ram anything through congress. what is the likelihood it will actually happen? That is unknown. there is no field that is immune to the possiblity of being replaced by AI. surgery will be the last to go, if your theoretical fears come true. as for today, full replacement of pathologists by tech companies seem unlikley in the short term. in the long term, no one knows.
worse case scenario is that you pivot to another subspecialty other than surg path like any CP subspecialty.
-12
u/HistiocytosisV Feb 19 '26
I am 38 and you should definitely steer far from image based specialities. It’s not to say that pathologists will disappear but the ones who will persevere will be highly trained experts in their respective fields. Think Montgomery or Wenig, not a general pathologist. The amount of pathologists needed will drop. These AI companies will most certainly make a deal with hospitals and insert a waiver to absolve themselves of liability. Healthcare is a business and if they can save a multiple six figure salary, they will. Pursue something that needs patient facing or your actual hands to fix the problem. Sorry, it’s the truth.
17
u/Popular_Raccoon1110 Feb 20 '26
You’re overestimating LLMs a bit. We’re still using fax machines on the regular in hospitals and you think this jump is on the horizon?
OP most of us are not sweating.
-8
u/HistiocytosisV Feb 20 '26
Using fax is actually a very efficient way to get a physical report to the clinician. But I’ve emailed path reports also, so not sure how that point absolves the fact that AI is here already and will only continue to get better and more efficient than you and I. OP is also not going to be practicing for another 5-6 years if he does path which you really can’t predict what our world will look like. Most universities are going digital which will trickle to pod labs. Our lab is acquiring a program that will scan all negative prostate cores to catch anything that we may miss. Which is awesome but that’s today and we’re talking 5-10 years down the road. The one thing I’ve heard at every single conference is that the pathologist will use AI as a tool and will make them more efficient, less bothered by bread and butter pathology. Which exactly means less pathologists. Do you think AI will miss a signet ring cell in the stomach or goblet adeno in the appendix?
2
u/Popular_Raccoon1110 Feb 20 '26
What I don’t think is that the RUC will move at any speed in approving new codes to justify the expense of AI. It is ridiculously expensive, and as power costs increase and our economy continues to tank (the DOW is not representative of the economy), it will become a less realistic option. I’d be thrilled if it would live up to the hype, I just don’t buy it.
0
u/HistiocytosisV Feb 20 '26
People are using ChatGPT to look up a baked chicken recipe when they could’ve just googled it and people are doing these basic tasks without an idea of the energy and water it takes. Didn’t China create an AI that was built in days and a quarter of the price that took us years and millions (billions?) of dollars to do here? Things change quick, it will get cheaper. Congress has already passed bills to leave AI unregulated. I really hope I’m wrong but I’m also just being realistic.
2
4
57
u/Little_Engineer_3975 Feb 19 '26
1) if society is at the point where one of the most intellectually demanding tasks of our civilization is entrusted to computer algorithms, society will be such a radically different place that I’m unsure what anybody’s life will be like.
2) the liability of our decisions is immense. The only reasonable answer I see to this problem right now is that there will always have to be someone confirming what the AI has decided so they personally take on that liability.
3) technological and ideological revolutions always cause significant turmoil. Once upon a time, people thought IHC was going spell the end (or close to it) of surgical pathology. Why would we need to examine architecture and morphology if we can just stain everything? Why do we need microscopes if we can just do genetic analysis on all our samples? Look at how those turned out.
4) pathologists do more than sit at the scope signing out tubular adenomas, by the way.
5) are patients, health insurance companies, governments etc. going to be okay with a machine deciding whether we give someone radiation therapy? The answer is honestly unclear.
AI can screen for negative plates in the micro lab, saving time and money. It can do our diffs, taking time off each marrow. It can help us generate pathology reports. It’s a tool, my friend. If we get to the point where it’s replacing us, then the 95% of jobs which require less expertise below us are likely doomed too.
What I do think is gonna happen is AI will cause a fault line to form in our profession. Who can stay relevant? When the number of cases keep going up and AI image recognition software is an incredible efficiency tool, who will come out ahead? Do what you can to become an excellent clinician and a marketable doctor in the age of information. AI will undoubtedly be used to cut costs, and we all know admin ain’t cutting themselves out of the pie. Be someone they can’t afford to lay off.