The way we provide healthcare is influenced by ongoing experiences, increased knowledge, new discoveries and scientific as well as technological advances. The rapid pace of important developments that have taken place in recent years have significantly influenced our choices of the ways we provide our health service. Like other medical specialties, pathology and its practice have had to respond to the rising needs and challenges within the health service in general and those facing the speciality in particular. This article addresses some of the challenges, particularly those which are unique to pathology. It discusses the choices that are available to different pathology departments depending on their individual circumstances.