A pathologist is a medical doctor who specializes in the study of disease by examining tissues, cells, and bodily fluids. They play a role in healthcare by diagnosing conditions, guiding treatment plans, and contributing to medical research. The educational path to become a pathologist is an extensive journey spanning more than a decade, requiring specific degrees and hands-on training.
The Foundational Bachelor’s Degree
The first step toward a career in pathology is earning a four-year bachelor’s degree. While medical schools do not require a specific major, aspiring pathologists often choose degrees in fields like biology, chemistry, biochemistry, or biomedical sciences. All prospective medical students must complete a series of prerequisite courses, which includes one year each of biology, general chemistry, organic chemistry, and physics, all with laboratory components. Some institutions may have additional requirements, such as mathematics or biochemistry.
Admission to medical school is highly competitive. Applicants need a high grade point average (GPA), often 3.6 or higher, and a strong score on the Medical College Admission Test (MCAT). The MCAT assesses problem-solving skills and science knowledge, with the average score for admitted students being around 511.
Earning a Medical Degree
After earning a bachelor’s degree, the next step is a four-year medical school program. Aspiring pathologists can pursue one of two medical degrees: a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.). Both degrees qualify an individual to practice medicine, including the specialty of pathology, in all 50 states.
M.D. programs follow an allopathic approach, focusing on diagnosing and treating diseases using medications and surgery. D.O. programs follow an osteopathic approach, which emphasizes a holistic view of the patient and includes additional training in osteopathic manipulative treatment (OMT). Despite this difference, the core curriculum in both M.D. and D.O. schools is largely similar, covering subjects like anatomy, pharmacology, and pathology itself.
The first two years of medical school are dedicated to classroom and laboratory instruction. The final two years are spent in clinical rotations, where students gain practical experience in various medical specialties. During this time, students must also pass national board examinations—the USMLE series for M.D. students and the COMLEX-USA series for D.O. students—to demonstrate medical competency.
Completing a Pathology Residency
After graduating from medical school, a physician must complete a residency program to specialize in pathology. Residency is a period of supervised, hands-on training within a hospital or medical center where new doctors apply their knowledge to patient cases. A pathology residency lasts three to four years, depending on the specific track chosen.
There are two primary tracks within pathology residency: Anatomic Pathology (AP) and Clinical Pathology (CP). Anatomic Pathology focuses on the diagnosis of disease through the gross and microscopic examination of tissues, such as biopsies and surgical specimens, and through performing autopsies.
Clinical Pathology centers on the laboratory analysis of body fluids like blood and urine. CP residents learn to manage and interpret tests in areas such as clinical chemistry, hematology, microbiology, and transfusion medicine. Most aspiring pathologists enroll in a combined AP/CP program, which takes four years and provides comprehensive training in both areas, offering the broadest career options.
Optional Subspecialty Fellowship Training
Upon completing a residency, many pathologists pursue further specialization through a fellowship. This optional training involves an additional one to two years of intensive focus on a specific niche within pathology. Fellowships allow pathologists to develop a high level of expertise in a particular area, which can lead to specialized career paths.
Forensic Pathology
Forensic pathologists are responsible for determining the cause and manner of death in cases that are sudden, unexpected, or violent. This subspecialty involves performing autopsies and working closely with law enforcement and the legal system. This one-year fellowship provides training in toxicology, wound analysis, and courtroom testimony.
Dermatopathology
Dermatopathology is focused on diagnosing diseases of the skin. Pathologists in this field examine skin biopsies to identify conditions ranging from inflammatory rashes to skin cancers like melanoma. This one-year fellowship provides training in interpreting the microscopic patterns of skin disorders.
Hematopathology
Hematopathology is the study of diseases of the blood, bone marrow, and lymphoid tissues. Hematopathologists diagnose and classify conditions such as leukemia, lymphoma, and anemia by examining blood smears, bone marrow biopsies, and lymph node samples. This one-to-two-year fellowship involves advanced techniques like flow cytometry and molecular diagnostics.
Neuropathology
This subspecialty is dedicated to the study of diseases of the nervous system and brain. Neuropathologists diagnose conditions such as brain tumors, Alzheimer’s disease, and multiple sclerosis by examining tissue from the brain, spinal cord, and nerves. This two-year fellowship provides experience with both surgical specimens and autopsy cases.
Pediatric Pathology
Pediatric pathology concentrates on the diagnosis of diseases that affect embryos, fetuses, infants, and children. These specialists handle cases that are often distinct from adult diseases, including congenital anomalies, inherited metabolic disorders, and childhood cancers. This one-year fellowship covers the developmental aspects of disease in young patients.
Licensure and Certification Requirements
To legally practice medicine, a pathologist must obtain a full and unrestricted medical license from the state where they intend to work. An institutional or training license held during residency is not sufficient for independent practice.
Beyond licensure, the standard for demonstrating expertise is board certification. After completing residency, pathologists are eligible to take the primary certification examination administered by the American Board of Pathology. Candidates can seek certification in Anatomic Pathology, Clinical Pathology, or both.
While licensure is a legal mandate, board certification is a voluntary process that has become a professional necessity. It is often required for hospital credentialing and by insurance companies. For those who complete a subspecialty fellowship, separate board certification exams are available in areas like dermatopathology, hematopathology, and forensic pathology, allowing for official recognition of their advanced expertise.