Is there still a need for the general surgical pathologist?

As the work of surgical pathologists becomes increasingly complex and specialized, we must ask whether there is still a need for the generalist. The answer to this question depends on a variety of factors within a given laboratory, including laboratory setting (service versus academic), specimen volume and composition, and level of staffing. The major advantages to maintaining staff expertise in general surgical pathology include flexibility of scheduling and improvement in the overall quality of diagnostic work. However, academic teaching departments inevitably require a higher level of subspecialization to accommodate research and teaching obligations. The advantages and limitations of maintaining staff expertise in general surgical pathology are discussed in light of the system that has evolved in the author's own hospital-based laboratory, in which expertise in general surgical pathology is required of all staff pathologists in addition to the development of expertise in one or more subspecialty areas. Current trends toward managed care will demand that most of us maintain our general skills. Failure to do so may lead to consolidation of services and elimination of jobs.