Pathologist Salary (2026): What Pathologists Earn, How Caseload Drives Pay, and Why It's Rising

What pathologists earn in 2026

Unusually, Doximity's average sits above SalaryDr's median for pathology. A likely reason: averages are pulled up by high earners such as dermatopathologists and private-group partners, while SalaryDr's sample includes many academic pathologists. The federal figure is lower still because it counts only employees, which leaves out the partners who own private pathology groups.

The raise is the headline. Doximity's pathology average grew 9.8% from its 2025 to its 2026 report, the third-largest increase of any specialty, while overall physician pay grew about 2%.

Pathology vs. other specialties

Radiology is the natural comparison: both are diagnostic specialties with little direct patient contact. Radiology pays about $199,645 more on Doximity's averages. Dermatology overlaps through dermatopathology, the highest-paying pathology subspecialty. Against the cognitive specialties, pathology now pays more than neurology, psychiatry and internal medicine.

Hours and pay per hour

SalaryDr's pathologists report about 44 hours a week. At the $390,000 median, that's about $170 an hour, about the same as psychiatry, above internal medicine and well below radiology (about $232). Pathology call is usually by phone for frozen sections and lab questions rather than overnight in the hospital.

In SalaryDr's lifestyle survey of 61 pathologists, 92% said they would choose pathology again, with academic pathologists averaging 43 hours a week and private-practice pathologists 47.

How pathologists are paid

• •Cases become wRVUs. A pathologist's professional work is billed per specimen. The workhorse code, CPT 88305 (surgical pathology, gross and microscopic exam, such as most biopsies), carries about 0.75 work RVUs for the professional component; bigger specimens, frozen sections, special stains and consults carry more.
• •The rate. SalaryDr's pathology reports show a median of $52 per wRVU (middle half $48 to $61; 30 reports). By setting: academic about $49, private practice about $52, hospital-employed about $53.
• •What the median implies. At $52 per wRVU, the $390,000 median equals about 7,500 wRVUs, the equivalent of about 10,000 routine biopsies a year, or about 42 a day over 240 working days. Real caseloads mix simple and complex cases, but the arithmetic shows why volume and case mix drive pathology pay.
• •Lab directorship pays separately. Clinical pathology work, such as directing a hospital laboratory or blood bank, is usually paid as a stipend or Part A contract rather than per case.
• •A pending risk. In its July 2026 proposed physician fee schedule, CMS proposed reviewing the value of CPT 88305 after a state claims analysis flagged physician-days where that code alone implied more than 8 hours of work. A lower value would reduce wRVU-based pay for every pathologist who signs out biopsies; watch the final rule, usually published in early November. Our 2027 physician fee schedule guide tracks it.

A worked pathology offer

Take an illustrative hospital offer: a $300,000 base, plus $52 per wRVU above 5,769 wRVUs (the base divided by the rate). At three caseloads:

The questions that follow: what caseload the department actually produces per pathologist, and whether consults, frozen sections and tumor boards are credited. And if CMS lowers 88305's value, every biopsy earns fewer wRVUs, so the same caseload clears less of the threshold; ask whether the contract adjusts thresholds when CMS revalues codes.

Pathology pay by practice setting

Private pathology groups

Many community hospitals contract with independent pathology groups. New pathologists typically join as employees on a partnership track; partners share the group's professional billing and contract income. That's where the top of the range sits, and it's also why government wage data, which counts only employees, runs low. Ask for the partnership timeline, the buy-in (if any) and what partners earned in each of the last three years; our partnership buy-in guide covers how to evaluate it.

Hospital-employed

Health systems increasingly employ pathologists directly, on salary plus a wRVU bonus. Pay is steadier than in a group, with less upside. Hospital-employed pathologists reported the highest wRVU rate on SalaryDr (about $53), though from a small sample.

Academic

Academic pathology pays the least in cash: SalaryDr's 22 academic pathologists averaged $284,866, against a $390,000 median overall. In exchange you get subspecialty sign-out, teaching and research time, and usually a nonprofit or public employer, which counts toward PSLF; see our PSLF employer guide.

Commercial and reference laboratories

National reference labs and specialty labs (dermatopathology, GI pathology, molecular) employ pathologists on salary with productivity pay. These are for-profit employers, so years there don't count toward PSLF.

Pathology pay by subspecialty

• •Dermatopathology is the highest-paid pathology path in the data. Skin biopsy volume is high, and both pathologists and dermatologists can train in it.
• •Hematopathology and other subspecialty fellowships (GI, GU, breast, cytopathology, molecular) mostly change where you can work and what you sign out, more than the pay rate itself.
• •Forensic pathology pays below the specialty median and is mostly government employment through medical examiner offices, which counts toward PSLF.

Pathology pay and taxes by state

The federal wage survey reports pathologist pay by state. These means count only employed pathologists, so they run below the commercial surveys, but they show the geography:

What you keep varies more predictably. At the Doximity pathology average of $410,039, a single pathologist takes home:

That's about $39,700 a year more in Texas than California on the same salary. See our take-home pay guide and salary by state guide for more states.

The shrinking workforce

• •Fewer pathologists, more work. A 2019 JAMA Network Open study found active U.S. pathologists fell from 15,568 to 12,839 between 2007 and 2017, a 17.5% drop, while diagnostic workload per pathologist (adjusted for new cancer cases) rose 41.7%. Pathologists per 100,000 people fell from 5.16 to 3.94.
• •The count is disputed. A 2020 study in the same journal argued that those counts miss about 40% of practicing pathologists, mainly because of how they classify physicians. So treat the size of the decline as debated; the higher count would also mean a smaller rise in workload per pathologist.
• •What it means for pay. Tight supply is a plausible driver of the 9.8% raise in Doximity's data. It can also mean heavier caseloads, so ask about volume per pathologist before you sign.

Training and fellowships

Combined anatomic and clinical pathology (AP/CP) residency is four years; anatomic-only or clinical-only certification takes three, under the American Board of Pathology's requirements. Fellowships are close to universal: in a 2014 College of American Pathologists survey of first-time job seekers, 89% were fellowship-trained and a quarter of those had completed two or more.

A fellowship year at a PGY-5 stipend of about $81,807 costs roughly $328,232 in gross income against the specialty's average attending pay. Because employers expect a fellowship, the real question is which one: dermatopathology and high-volume surgical subspecialties pay the most. Our resident salary guide has stipends by year.

Evaluating a pathology offer

1. Caseload and case mix. How many cases (or wRVUs) does each pathologist sign out a year, and how complex are they?
2. wRVU rate and threshold. Compare with the $52 median (middle half $48 to $61). Ask what happens to the threshold if CMS changes 88305's value.
3. Directorship and call pay. Are lab directorship, blood bank and frozen-section call paid separately?
4. Partnership terms (private groups). Years to partner, buy-in, and what partners actually earned.
5. Non-salary value. Retirement match, malpractice tail, CME, and whether the employer qualifies for PSLF. Our contract red flags guide lists what to watch for.

Use our contract analyzer to compare offers, and our salary negotiation guide before you respond.

Sources

1. Doximity Physician Compensation Report 2026 (pathology $410,039, 9.8% growth) and 2025 report ($373,384).
2. Medscape Physician Compensation Report 2026.
3. SalaryDr: pathology salaries, pathology wRVU rates, pathology lifestyle survey, academic pathologists and hematopathology. Self-reported; accessed October 17, 2026.
4. Marit Health: dermatopathologist (pathology) and forensic pathologist salaries. Accessed October 17, 2026.
5. Physicians, Pathologists (29-1222), Bureau of Labor Statistics, May 2023.
6. Metter DM, et al. Trends in the US and Canadian Pathologist Workforces From 2007 to 2017. JAMA Netw Open. 2019;2(5):e194337.
7. New research shows a 40% pathology workforce undercount in nationally published reports, College of American Pathologists (on Robboy et al., JAMA Netw Open, 2020).
8. Transitions in training and practice, CAP Today (CAP Graduate Medical Education Committee job-market survey).
9. CMS proposes valuation review of 88305, Discoveries in Health Policy, August 19, 2026.
10. American Board of Pathology training requirements, via PathologyTraining.org.