What is the best indicator to determine anatomic pathology workload? Canadian experience.

Health care resources in Canada are limited, and there is tremendous pressure to reduce laboratory budgets. It is almost impossible to acquire new pathologist positions to adequately meet service demands. There is a need to determine objectively the appropriate pathologist workload. I looked at multiple indicators (total accessioned cases, number of specimens, slides, blocks, Royal College of Pathologists [London, England] model, population served, and level 4 equivalent [L4E]) that might reflect the pathologist's work and determine which indicators are the best. L4E is a calculated weighted value based on complexity levels of individual anatomic pathology consultation. Of all indicators analyzed, L4E is the best reflection of a pathologist's anatomic pathology work because it has the best statistical values, is a direct output measurement of pathologist consultations, and uses data routinely collected in many North American laboratories.