Thanks Olena. This (your explanation) is perhaps good if all community pathologists and all teaching hospital pathologists decided and managed to stay where they are and lived happily ever after. The reality is that numerous circumstances impose changes on us, which invariably lead to

The reality is that every now and then numerous circumstances impose changes on us, which invariably lead to staff shortage in one sector or another. Many community hospitals are in severe shortage of pathologists and when they get temporary locums they discover that most of them nowadays are subspecialized (some do skin only, or breast only or oligo-specialised in GI and lymphoreticular...and so on) which makes it totally impractical to employ some locums as it would be very inefficient on economic and productivity aspects. 

Many community hospitals are in severe shortage of pathologists and when they get temporary locums they discover that most of them nowadays are subspecialized (some do skin only, or breast only or oligo-specialised in GI and lymphoreticular...and so on) which makes it totally impractical to employ some locums as it would be very inefficient on economic and productivity aspects. 

My own personal experience tells me that it is relatively easy to move to a community type general anatomical pathology job to a sub-specialised post in a teaching hospital and rapidly adjust to the change in case mix, but not the vice versa. 

After all, I personally think that subspecialization in anatomical pathology was entirely driven by the rapid subspecialization in other medical, oncological and clinical surgical specialities.  

Just a thought! 

I agree with Olena, insofar as the subspecialization is indeed a sub-specialization, and not an autonomous science. For example, Gross Pathology, Histopathology and Cytopathology, being autonomous sub-specialities of Anatomical Pathology. They give information that is qualitatively different, and can be apparently contradictory, but provide a qualitative depth of knowledge that prides the clinician with a "better picture".

Some "sub-specialisations are not really subspecialities (such as the histo-immunochemist, or the onco-pathologist - they bring added information, but not  granularity. They are different branches, as their working together provides accrued accuracy.

These branches function like evolution trees. They produce clads or branches.

For example, gross pathology can inform that a tumour has not invaded a certain structure, histology can inform that there are tumour cells in both structures, one being microscopically invaded, and cytopathology can inform that this microinvasion is by a less differentiated clone of the "tumour" and requires the revision of the mother tumour classification, from adenocarcinoma to adeno-squamous...

But this means that the three must be independant and privide reports from different laboratories that do not wait for each other's result. Trying to "normalise" the three results in a loss of granularity and information and creates a less accurate response, and ultimately, loss of information and poorer therapeutic results.

At least, this is a practical way of making sure that relatively nuanced variation is included in protocols, adapted to the clinical entity, - rather than "one size fits most" .