Comparison of Three Methods for Measuring Workload in Surgical Pathology and Cytopathology

Objectives: Pathologist workload in the United States has traditionally been measured by relative value units (RVUs), which is often criticized for providing an inaccurate estimate of actual work. This study compares three methods for measuring workload.

Methods: Surgical pathology and cytopathology workload for 1 representative month at Stanford Health Care was assessed using three different methods: RVUs, Royal College of Pathologists (RCP) point system, and University of Washington-Seattle (UW) slide count method.

Results: Pearson linear regression analysis showed a strong positive correlation of RVUs with the RCP (0.93, P < .01) and UW (0.86, P < .01) systems. The correlation between the RCP and UW systems was weaker (0.70, P = .05). The RCP system rated gastrointestinal, genitourinary, and breast workload lower than the RVU system while medical liver/renal and cytology were valued higher. The UW system overvalued breast workload.

Conclusions: RCP is the most advanced and well-developed system for evaluating workload. It provides more weight for higher complexity specimens, while RVUs favor specialties with higher volume of small specimens, and slide counts favor specialties with extensively sampled large specimens.