The historical evolution of pathology as a full-time specialty in medicine is viewed as a response of pathologists to changes in the level and pattern of demand for their services. The development and decline of morphologic pathology, changes in academic pathology and the evolution of clinical pathology from a medical specialty to an industry with an extensive division of labor are all examined in this perspective. It is shown that pathology as a medical specialty is most successful within a limited range of demand, neither too low to support full-time specialization nor too high to lead to deprofessionalization through routinization of the work activities of pathologists.