For years, the conversation around digital pathology has centered on AI, interoperability, and the transition off glass. Those are important parts of the story, and they deserve the attention they get. But after years of working closely with pathology groups, I keep noticing a different theme rising to the surface when a group starts talking seriously about going digital: the ability to work more flexibly.
In many of these conversations, remote work is not a matter of convenience. It is becoming part of how a group thinks about recruitment, retention, and coverage. It is not the reason every group goes digital. But it is one of the most common ones I hear, and for some groups, it is the deciding factor.
The workforce challenge is real
Anatomic pathology sits at the sharp end of a staffing shortage that runs across the entire laboratory. The ASCP 2024 Vacancy Survey of Medical Laboratories in the United States found that while openings have eased somewhat since the 2022 peak, they remain well above pre-pandemic levels, and anatomic pathology carried the highest vacancy rate at any department surveyed, at 28.5%.
Pathology is also one of the few physician specialties whose active workforce has been shrinking, even as oncology volumes, and the biopsies that come with them, keep climbing. There are fewer pathologists, more cases, and a widening geographic mismatch between where the work is and where the specialists are.
Those numbers match what I hear in the field. In some markets, the subspecialty talent simply is not there to recruit locally. In others, the candidates exist, but a growing number of them were trained on digital from the start and are looking specifically for labs that already work that way. A group that can only offer a fully on-site position rules itself out with many of these candidates before the conversation starts.
What remote work actually looks like in pathology
It is worth being clear about what this actually looks like day to day, because it covers a wider range than the phrase “remote work” suggests. At one end are pathologists who split the week, reading from home some days and covering intraoperative frozens on others. At the other end are pathologists who sign out entirely from home. Both are real, and a group can build around either.
What makes this possible is that digital pathology changes everything downstream of the scan. Parts of the practice remain physical: grossing, frozen sections, intraoperative consultation, and rapid on-site evaluation of cytology all require hands-on tissue and a person in the building. But those responsibilities can be held by whoever is on-site that day, which frees other pathologists to review and sign out cases from wherever they are. A group with enough people to cover the on-site work can let some of their team members work fully remotely without anything falling through the cracks.
Not every pathologist wants to work the same way, and the strongest remote models account for that. They preserve what makes in-person practice valuable, like residents and junior attendings learning alongside experienced pathologists, while giving people the flexibility to read from wherever they are.
The rules have finally caught up
For a long time, the regulatory picture was itself a reason to hesitate. That has changed. CMS made permanent the exception that lets pathologists review digital surgical pathology remotely under their primary lab’s CLIA certificate, without standing up a separate certificate at home. The exception covers digital images, not glass. A pathologist reading physical slides under a microscope at home is treated as a separate lab site and still needs its own CLIA certificate. The practical upshot is that remote surgical sign-out is now something a group can build a real staffing model around, not just a pandemic-era workaround.
That shift ripples outward. I have watched it let groups recruit well beyond a single metro area, hold on to experienced pathologists who would otherwise have walked, cover staffing gaps without flying someone in, and share subspecialty expertise across sites that could never each justify a dedicated specialist. For some labs, that is the single strongest practical argument for going digital at all.
What groups are actually looking for
When a group evaluates platforms, the conversation is rarely only about scanning slides. The questions turn practical fast. Can a pathologist sign out comfortably from home for a full day? Is the viewer fast enough to use across every case, without panning at high power, becoming its own source of fatigue? Does it integrate with the LIS and EHR? Can two people read the same case from two cities? And underneath all of them, the strategic question: will this make the group easier to staff five years from now? Those are really one question asked several different ways. Does this platform make remote work sustainable? Not every platform clears that bar.
That distinction is not a detail. A slow viewer, or a workflow stitched together from systems that do not quite speak to one another, does not merely irritate people. It quietly kills the whole premise, because remote sign-out that is more painful than driving into the office is not something anyone keeps doing. The bar is responsiveness, clean integration, and a workflow that holds up from the first case of the day to the last. Meeting that bar is what we set out to do when we built Fusion AP, and it is the standard I would tell any group to hold every platform to, ours included.
Northwest Arkansas Pathology Associates is a good illustration. They adopted Fusion AP specifically to support remote sign-out, with pathologists reading fully from home, while facing exactly this kind of recruiting pressure. The region has grown quickly, and with that growth came competition and a cost of living that made relocation a hard sell for the specialists they wanted. Their problem was never a shortage of good pathologists in the abstract. It was the shortage of good pathologists willing to move to one place for an on-site job. Opening up remote sign-out lets them recruit from a far wider map.
The detail I find most telling is one I hear again and again from groups in this position: it was not only that the applicants were stronger, but it was that there were suddenly so many more of them.
Digital Pathology Is Ultimately About Adaptability
The lesson I keep returning to is that digital pathology is not just a technology purchase. It is an operational decision about how a practice intends to survive and thrive amid the next decade of shortages, rising volumes, and shifting expectations about where work gets done. A qualitative study of eight European laboratories in Virchows Archive found the same thing from the inside: the labs that had gone digital were often better positioned to attract pathologists, precisely because they could offer flexible and remote arrangements.
Digital pathology will not solve a workforce problem on its own. However, it can help by giving a practice more ways to recruit, collaborate, and put expertise where it is needed without requiring everyone to be in the same building. How much of this a practice actually captures depends heavily on the platform underneath it, which is why the decision to go digital and the decision about which platform to trust are directly linked.
And more and more, flexibility is not something groups come to appreciate after going digital. It is what brings them to the table in the first place.