Building a medical laboratory requires capital. Building a specialist pathology department requires something considerably more difficult to acquire: experienced medical professionals capable of making complex diagnostic decisions.
This distinction is particularly important in Vietnam, where historical research has documented significant limitations in the availability and geographical distribution of pathologists.
A 2014 academic report published in Pathology estimated that Vietnam had approximately 366 pathologists, most of whom worked in major cities and provincial hospitals rather than rural healthcare facilities.
The figure is historical and should not be interpreted as the country’s current pathology workforce. Nevertheless, it highlights a structural challenge that cannot be addressed simply by purchasing laboratory equipment.
More than a decade later, a study published in Modern Pathology in 2025 demonstrated how international specialist collaboration could help address limitations in access to complex diagnostic expertise.
The research involved Ho Chi Minh City Oncology Hospital and the University of Texas Health-McGovern Medical School. Over 32 months, 71 challenging hematopathology cases were reviewed through remote consultations. A definitive consensus diagnosis was achieved in 97% of cases, while average diagnostic turnaround time improved by approximately 30%.
Together, these studies illustrate an important characteristic of Vietnam’s pathology sector.
Modern laboratory infrastructure can be purchased and installed. Specialist diagnostic expertise must be developed, maintained and continuously strengthened.
For hospitals and investors, this distinction has important implications for laboratory expansion, operational performance and long-term competitive advantage.
Vietnam’s Historical Shortage of Pathologists
The challenge of limited pathology expertise in Vietnam has been documented for more than a decade.
In 2014, Duong Van Dang of Bach Mai Hospital published a report titled Pathology and Telepathology in Vietnam in the journal Pathology.
The report estimated approximately 366 pathologists nationwide and noted that most were concentrated in major cities or provincial hospitals.
The geographical imbalance created difficulties for smaller hospitals and medical facilities requiring specialist diagnostic support.
When a complex case could not be resolved locally, specimens often had to be sent to another institution.
Glass slides and paraffin-embedded tissue blocks might be transported between cities or even overseas to obtain a specialist opinion.
This process required coordination, additional time and access to external experts.
A subsequent article, Quality Practices of Anatomic Pathology Labs in Vietnam, published in Critical Values in 2016, provided further context.
The authors examined 16 anatomical pathology laboratories across Vietnam during a 2014 assessment.
They reported that large teaching hospitals in Hanoi and Ho Chi Minh City typically employed six to ten pathologists, while other centres often had only one to three. Primary-level hospitals commonly had none.
The study also identified challenges involving laboratory quality management, staff training, equipment maintenance and standardisation of diagnostic reports.
These observations describe conditions during the earlier research period. They do not establish the present workforce distribution or the current quality of Vietnam’s laboratories.
Nevertheless, the findings illustrate why pathology development requires more than investment in physical facilities.
A laboratory must have access to qualified professionals, appropriate diagnostic processes and reliable quality-control systems.
Without these elements, additional equipment may not translate into better diagnostic services.
Why Pathologists Are More Difficult to Acquire Than Laboratory Equipment
A pathology laboratory requires specialised infrastructure.
Tissue processors, embedding stations, microtomes, staining systems and microscopes form the foundation of conventional histopathology.
More advanced facilities may also invest in automated immunohistochemistry systems, molecular diagnostic platforms and digital slide scanners.
These technologies require substantial capital, technical planning and maintenance.
However, equipment procurement is generally a more predictable process than building a specialist medical workforce.
A laboratory operator can compare suppliers, evaluate equipment specifications and establish a procurement schedule.
Developing an experienced pathologist is fundamentally different.
Pathologists require medical education, specialised professional training and practical diagnostic experience.
Their work involves interpreting tissue morphology, recognising disease patterns, correlating findings with clinical information and distinguishing between conditions that may appear similar.
Complex cases often require additional expertise.
For example, lymphoma diagnosis may involve detailed morphological assessment, immunohistochemistry and selected molecular investigations.
Breast cancer pathology requires accurate tumour classification, grading and biomarker interpretation.
Gastrointestinal pathology may involve distinguishing inflammatory, precancerous and malignant lesions.
These responsibilities cannot be transferred directly to laboratory equipment.
Automated systems can prepare specimens and support analytical testing, but qualified medical professionals remain essential to interpret many results and establish diagnoses.
Capital can increase a laboratory’s technical capacity. It cannot immediately reproduce years of specialised medical training and diagnostic experience.
This difference creates an important constraint on how quickly specialist pathology services can expand.
Specialist Expertise Is Not Evenly Distributed
The shortage of pathologists should not be understood only as a question of national headcount.
Geographical distribution and subspecialty expertise are equally important.
Even if a country has a growing number of medical professionals, hospitals may still encounter difficulties accessing specialists in particular diagnostic fields.
A pathologist experienced in routine surgical specimens may not possess the same depth of expertise in hematopathology, neuropathology or complex molecular tumour classification.
Subspecialisation becomes particularly important when cases are rare, difficult to interpret or dependent on advanced diagnostic techniques.
Large referral hospitals generally have stronger opportunities to develop such expertise because they receive more complex cases and can support multidisciplinary consultation.
Smaller hospitals may not encounter sufficient volumes of particular diseases to maintain the same range of specialists.
This creates a structural problem.
A hospital can invest in specimen-processing equipment but may still need external assistance with advanced diagnostic interpretation.
Recruiting a full range of subspecialists may also be financially impractical when case volumes are limited.
For healthcare systems, the challenge is therefore not simply to increase the number of pathologists.
It is to improve access to the right expertise at the right time.
A 2025 Study Demonstrates Why Specialist Networks Matter
A study published in Modern Pathology in August 2025 provides a practical example of how specialist collaboration can address this challenge.
The research, titled Telepathology in Hematopathology Diagnostics: A Collaboration Between the Ho Chi Minh City Oncology Hospital and the University of Texas Health-McGovern Medical School, examined a remote consultation programme involving Vietnamese and American pathologists.
The collaboration focused on challenging hematopathology cases.
Over a 32-month period, 71 cases were submitted for specialist review.
Of these, 49 involved confirmation of an existing diagnosis, while 22 required assistance with primary diagnosis.
The researchers reported two significant outcomes.
First, a definitive consensus diagnosis was reached in 97% of cases.
Second, average diagnostic turnaround time was approximately 30% shorter than conventional on-site consultation involving local pathologists and physical glass slides.
The findings demonstrate that remote consultation can help hospitals access specialised diagnostic expertise more efficiently.
Importantly, the 97% figure refers to cases in which a definitive consensus was achieved. It should not be interpreted as a general diagnostic accuracy rate.
Similarly, the 30% improvement reflects the consultation process examined in the study rather than a guaranteed improvement across all laboratories.
Nevertheless, the results are relevant to Vietnam’s healthcare sector because they show how specialist knowledge can be shared across geographical boundaries.
The participating Vietnamese pathologists did not need every international subspecialist to be physically present at their hospital.
Instead, they could review challenging cases through a coordinated digital consultation process.
Digital Pathology Helps Share Expertise, but Does Not Replace It
Digital pathology offers one possible response to the geographical concentration of specialist physicians.
Using whole-slide imaging technology, laboratories can convert conventional glass slides into high-resolution digital images.
These images can be accessed remotely through specialised viewing platforms.
A qualified pathologist at one institution can then examine a case prepared at another institution.
This arrangement can support second opinions, difficult-case consultations and collaboration between hospitals.
For Vietnam, the potential benefits include broader access to specialist expertise and reduced dependence on transporting physical slides for suitable cases.
However, digital pathology does not eliminate the need for trained pathologists.
It changes how their expertise can be distributed.
A digital platform cannot independently resolve diagnostic uncertainty simply because an image is available online.
The quality of interpretation still depends on the medical professional reviewing the case, the condition of the specimen, supporting diagnostic information and the reliability of the digital system.
Furthermore, some investigations require additional tissue staining or molecular testing that cannot be completed through image review alone.
Digital pathology therefore represents an enabling infrastructure rather than a complete solution to workforce shortages.
It may help institutions make better use of existing specialists, but it does not automatically create additional specialist capacity.
Training New Pathologists Is a Long-Term Investment
The development of a pathology workforce depends on more than initial professional education.
Medical training establishes essential knowledge, but complex diagnostic capabilities are strengthened through supervised experience, exposure to diverse cases and continuing professional development.
Subspecialisation requires additional learning and practical experience.
This creates a long investment cycle.
A laboratory can install new equipment relatively quickly, but it may take considerably longer to develop a team capable of providing a broad range of advanced diagnostic services.
The 2016 Critical Values article identified several training-related limitations during its historical assessment of Vietnam’s pathology sector.
At that time, the authors reported that only two pathology residency programmes were available, located in Hanoi and Ho Chi Minh City, with a combined intake of approximately five residents annually.
This figure should not be treated as a description of current training capacity.
However, it illustrates the importance of educational infrastructure in addressing workforce limitations.
Increasing the number of qualified specialists requires sustained investment in medical education, clinical training, supervision and professional development.
Hospitals and laboratory organisations also need to provide opportunities for younger pathologists to gain experience under qualified senior professionals.
For an expanding pathology business, workforce development should therefore be treated as a strategic investment rather than simply a recruitment expense.
Retaining Experienced Specialists Is Another Challenge
Recruiting qualified pathologists is only one part of building a sustainable pathology organisation.
Retaining them is equally important.
Experienced specialists contribute clinical knowledge, diagnostic consistency and institutional relationships.
They may also supervise junior doctors, support quality assurance, participate in multidisciplinary cancer discussions and help develop new diagnostic services.
When a senior pathologist leaves, an organisation may lose more than an individual employee.
It can lose access to particular diagnostic capabilities and important professional relationships.
This creates operational risks for laboratories that depend heavily on a small number of specialists.
A sustainable workforce strategy should therefore include professional development, reasonable workloads, succession planning and opportunities for subspecialisation.
Laboratories may also benefit from structured peer review and external consultation arrangements.
These systems reduce dependence on individual practitioners while supporting diagnostic quality.
For investors, workforce stability should be considered alongside conventional financial indicators.
A laboratory with strong revenue but inadequate specialist succession planning may face significant operational vulnerabilities.
Why the Pathologist Shortage Matters for Laboratory Investors
The economics of specialist pathology differ from those of highly automated routine diagnostic testing.
Many laboratory tests can be processed through automated systems, with performance influenced by equipment utilisation, reagent costs and testing volume.
Histopathology also benefits from automation, but diagnostic interpretation remains a labour-intensive and expertise-dependent activity.
This affects the economics of laboratory expansion.
An investor establishing a new pathology centre must secure both technical infrastructure and appropriately qualified medical professionals.
Purchasing additional equipment does not necessarily increase the number of cases that can be interpreted safely.
A laboratory with sufficient specimen-processing capacity may still experience reporting delays if specialist interpretation becomes the operational bottleneck.
Similarly, a facility may possess advanced immunohistochemistry equipment but lack the required expertise to interpret certain complex findings.
This creates several important considerations for investors.
First, specialist staffing is a capacity constraint. Laboratory throughput must be evaluated against the availability and workload of qualified pathologists.
Second, recruitment can affect expansion timelines. New facilities may require substantial preparation before they can provide a full range of diagnostic services.
Third, workforce development creates ongoing costs. Training, supervision, quality assurance and professional development are necessary components of the operating model.
Fourth, expertise can influence competitive positioning. A laboratory with established subspecialists and a strong reputation may be more difficult for competitors to replicate than one whose main advantage is equipment ownership.
These factors make human capital a central consideration in the valuation and development of pathology businesses.
Could Centralised Pathology Networks Offer a Solution?
One possible development strategy involves centralising selected specialist services while maintaining local laboratory functions.
Under this model, hospitals would continue performing specimen collection and routine processing.
Cases requiring advanced interpretation could be referred to a central specialist pathology centre.
Digital infrastructure could support remote review of eligible specimens, while physical samples would still be transferred when additional testing was necessary.
Such networks could offer several operational advantages.
They may allow specialist teams to serve multiple referring institutions, potentially improving the utilisation of scarce expertise.
They could also support more consistent consultation procedures, structured second opinions and centralised quality assurance.
For smaller hospitals, network participation might provide access to services that would be difficult to maintain independently.
However, centralisation also introduces logistical and management requirements.
Specimen transport, case allocation, turnaround-time commitments, digital infrastructure and reporting responsibilities must be clearly organised.
Diagnostic accountability and applicable regulatory obligations must also be addressed.
The College of American Pathologists recommends formal validation of whole-slide imaging systems for their intended diagnostic applications.
This reinforces the principle that digital pathology networks require both technology and robust clinical governance.
Centralisation is therefore not simply a cost-reduction strategy.
Its primary value may lie in improving access to specialist services while maintaining consistent diagnostic standards.
Specialist Pathology Expertise May Become a Strategic Asset
The difficulty of developing experienced pathologists has important implications for competition in the healthcare market.
A new laboratory operator may be able to purchase equipment comparable to that used by an established competitor.
However, reproducing an experienced medical team, a consistent diagnostic record and trusted clinical relationships can take substantially longer.
This creates potential barriers to market entry.
An established pathology organisation may possess advantages that are not immediately visible on its balance sheet.
These can include a recognised group of specialist physicians, relationships with referring clinicians, internal training programmes, established consultation procedures and demonstrated diagnostic quality.
Such capabilities are difficult to acquire through equipment spending alone.
They may also influence acquisition strategies.
Instead of establishing a completely new pathology business, an investor might consider partnering with or acquiring an existing laboratory organisation that already possesses qualified personnel and established clinical relationships.
However, the value of an acquisition depends on whether those specialists and relationships can be retained.
A business whose diagnostic capabilities depend almost entirely on one or two individuals may carry considerable concentration risk.
Investors should therefore distinguish between institutional capabilities and expertise tied to particular employees.
A sustainable pathology business needs systems that allow professional knowledge to be transferred, maintained and developed over time.
What Investors Should Examine Before Entering Vietnam’s Pathology Market
An investor evaluating a specialist pathology business in Vietnam should look beyond laboratory infrastructure and projected specimen volumes.
A thorough assessment should address several areas.
| Investment consideration | Key questions |
|---|---|
| Specialist workforce | How many qualified pathologists are available, and which subspecialties do they cover? |
| Workforce stability | How dependent is the business on individual specialists? |
| Diagnostic capacity | Can medical interpretation keep pace with specimen-processing volume? |
| Training and succession | Are there structured mentoring, recruitment and development programmes? |
| Clinical relationships | How established and sustainable are referral relationships with hospitals and specialists? |
| Quality assurance | Are diagnostic review, validation and reporting procedures consistently implemented? |
| Digital infrastructure | Can specialist expertise be shared securely across multiple facilities? |
| Expansion potential | Can the business grow without compromising medical quality or turnaround times? |
These factors help determine whether a pathology organisation can expand sustainably.
They also highlight why simple comparisons based on equipment value, laboratory size or revenue may provide an incomplete picture.
For specialist diagnostic businesses, the quality and depth of the medical workforce can be among the most important components of enterprise value.
The Future of Vietnam’s Pathology Workforce
Vietnam’s historical pathology workforce limitations and the findings of the 2025 telepathology study point toward a common conclusion.
Expanding specialist diagnostic services requires a coordinated approach to people, infrastructure and clinical collaboration.
Investment in new laboratories remains important.
Hospitals need reliable specimen-processing systems, advanced testing capabilities and appropriate information technology.
However, these investments must be matched by improvements in medical education, professional development and access to specialist consultation.
Digital pathology offers an opportunity to connect existing expertise across institutions, but it cannot independently replace qualified physicians.
For laboratory operators, the most sustainable strategy may therefore combine workforce development with selective investment in advanced equipment and digital infrastructure.
For healthcare investors, this creates a market in which barriers to entry are not determined solely by capital requirements.
The greatest competitive advantage may belong to pathology organisations that can attract experienced specialists, develop new talent and maintain dependable clinical relationships across a growing referral network.
Such capabilities are difficult to reproduce quickly.
A competitor may purchase a similar scanner, staining system or laboratory information platform.
Building an equivalent medical team and earning the confidence of referring clinicians is a more demanding process.
Conclusion: The Most Valuable Laboratory Asset May Be Its People
Vietnam’s shortage of specialist pathologists illustrates a fundamental challenge in healthcare investment.
Physical laboratory capacity can be expanded through capital expenditure, but advanced diagnostic capability depends on qualified medical professionals.
The 2014 estimate of approximately 366 pathologists provides historical evidence of the workforce challenge, while the 2025 Modern Pathology study demonstrates how remote collaboration can improve access to specialist expertise.
Neither study provides a current national workforce count or proves the commercial viability of a particular investment model.
Together, however, they highlight why human capital must be central to any strategy for developing specialist pathology services.
For investors, this distinction matters.
The long-term value of a pathology business may depend less on the equipment it owns than on the medical expertise it can consistently deliver.
The biggest barrier to entering histopathology may not be the cost of building the laboratory. It may be the time required to build the people, knowledge and clinical trust behind it.
References
- Duong Van Dang (2014). Pathology and Telepathology in Vietnam. Pathology, 46(Supplement 2), S8. DOI: 10.1097/01.PAT.0000454071.25311.33.
- Nguyen, H. L., Nguyen, N., & Hassell, L. (2016). Quality Practices of Anatomic Pathology Labs in Vietnam. Critical Values, 9(2), 22–25. DOI: 10.1093/crival/vaw006.
- Ly, U., Nguyen, Q., Nguyen, D., et al. (2025). Telepathology in Hematopathology Diagnostics: A Collaboration Between the Ho Chi Minh City Oncology Hospital and the University of Texas Health-McGovern Medical School. Modern Pathology, 38(8), 100779. DOI: 10.1016/j.modpat.2025.100779.
- Evans, A. J., Brown, R. W., Bui, M. M., et al. (2022). Validating Whole Slide Imaging Systems for Diagnostic Purposes in Pathology: Guideline Update from the College of American Pathologists. Archives of Pathology & Laboratory Medicine, 146(4), 440–450. DOI: 10.5858/arpa.2020-0723-CP.