NSH Poster Podcast (2025): The High Cost of Understaffing: A Case Study in Surgical Pathology Consequences

Poster Title: The High Cost of Understaffing: A Case Study in Surgical Pathology Consequences

Authors: Emily Nangano, MS, PA(ASCP)cm; Gillian Bass; Rob Terranova

Abstract: Laboratories are the diagnostic backbone of healthcare, yet staffing decisions are often driven by budget constraints rather than operational needs. This case study examines the real-world consequences of delayed staffing action within the anatomic pathology department at a large academic medical center. Faced with a predicted shortfall in grossing coverage due to reduced resident support and unchanged PA staffing levels, institutional leadership opted against proactive hiring. As a result, grossing FTEs fell from 6.5 to 3.5, and histology staffing experienced a drop to 3 technicians from the usual 9 due to attrition and burnout.

This staffing collapse led to turnaround time delays of up to 6–8 weeks and forced the lab to outsource specimen processing. Over the following seven months, the institution spent nearly $4 million on reference lab services. Staff morale declined sharply, clinician trust eroded, and senior PAs and histotechs resigned. Even after additional staff were hired, it took more than a year to stabilize operations.

This poster presents supporting data, including FTE changes, outsourcing costs, and turnaround time impacts. It also explores how temporary, qualified locum tenens staffing solutions—such as Pathologists’ Assistants and histotechnologists, and cytologists—can help bridge coverage gaps and prevent costly disruptions. Ultimately, this case underscores the critical importance of timely, proactive staffing strategies. The hidden costs of under-resourcing the laboratory go beyond dollars—they affect staff well-being, institutional reputation, and patient care outcomes.