The Pathologist’s Assistant
Many of you know that I am the new President of NAACLS and that I am a Pathologist’s Assistant, the first PA to hold this prestigious position. Some of you have encountered PA’s in your laboratory practice and have at least a fleeting understanding of the roles and functions PA’s perform in the realm of anatomic pathology. The majority of clinical laboratorians probably know that PA’s exist, but little else. Consequently, I thought I would provide some history and information to fill in the gaps.
The Pathologists’ Assistant profession began in 1969 with a pilot training program at the Veterans Administration Medical Center (VAMC) in Durham, North Carolina; the program was, and still is, administered through Duke University. A short time later, additional programs were established at VAMCs in Birmingham, Alabama (University of Alabama), and West Haven, Connecticut (Quinnipiac College). These baccalaureate degree programs were the first to formally train men and women to assume responsibility for functions originally performed by anatomic pathologists and other anatomic pathology personnel. Many of the initial PA trainees were former military corpsmen with some medical training. The initial concept of the Pathologist’s Assistant, and Physician’s Assistants in general, was to utilize these Viet Nam-era military corpsmen to provide medical services in rural areas where physicians were in short supply. Within five years, these programs had morphed from bare-bone 18 month programs without college degrees to 24 month programs offering baccalaureate degrees. Curricula quickly expanded to post-baccalaureate levels and often included medical school courses which subsequently elevated the academic level of applicants. The academic expansion was partially driven by the expectations and desires of pathologists who employed PA’s. Although the Pathologist’s Assistant concept expanded rapidly, the number of training programs has remained small. There are currently nine programs with eight in the eastern half of the US and one in Canada. Two more programs are in development including a second program in Canada. Eight of the nine programs offer a Masters degree and the lone BS program is moving to a Masters degree. All PA training programs are NAACLS-accredited. Graduates of the programs are eligible for certification through the ASCP Board of Certification.
Pathology is usually separated into the broad divisions of anatomic pathology (surgical pathology and autopsy) and clinical pathology (chemistry, hematology, microbiology, etc.). PA roles are primarily in the anatomic division, working with solid tissue specimens. Surgical pathology encompasses all of the organs and tissue specimens removed in surgery plus biopsy specimens and excisions generated outside the operating room. Specimens are measured, dissected, described and portions are submitted to be made into slides for microscopic evaluation. PA’s are trained to know the normal anatomy of all organs and to recognize and describe the pathologic changes caused by various disease states. Specimen dissections follow prescribed protocols and PA’s recognize the appropriate sections to submit for microscopic evaluation of relevant aspects to fulfill diagnostic requirements. Autopsy pathology is essentially the same process on a larger, more inter-related scale. In most settings, the importance of autopsy pathology has diminished over the past 25 years due to improved diagnostic technology, changes in regulatory requirements, and loss of reimbursement funding. In the past, some PA’s worked in medical examiner or coroner systems, performing autopsies. Most of these positions have disappeared as legal liabilities have forced the use of pathologists. Most PA’s now spend the majority of their time in surgical pathology. Other roles in anatomic pathology filled by PA’s include specimen photography, tissue banking, case preparation for tumor board presentations, teaching specimen dissection techniques to pathology residents, coding of reports for billing, and research projects. Utilization of PA’s allows the pathologist to spend more time at the microscope making diagnoses.
Finally, I would like to address the relationship of Pathologist’s Assistants (PA’s) to clinical Physician’s Assistants (PA-C’s). Both professions fit under the generic umbrella of “physician’s assistants” or “physician extenders,” working under the supervision of one or more physicians. Both professions also have two year training programs with a combination of didactic and clinical training. We have separate professional associations, interestingly both with the acronym of AAPA. That is where the similarity ends. Training for the two professions is entirely different with the exception of a few basic science courses. Each profession is incapable of performing the functions of the other. PA-C’s work with physicians in a variety of clinical subspecialties; Pathologist’s Assistants work only in anatomic pathology. Clinical PA’s (PA-C’s) can bill for their services separately from their supervising physician; services provided by pathologist’s assistants (PA’s) are included in the services provided by a pathologist and are only billed by the pathologist.
In summary, Pathologist’s Assistants are valuable members of the anatomic pathology team, educated to recognize the gross or macroscopic changes in organs and tissues caused by disease processes, and trained in dissection protocols and techniques to demonstrate the extent of the disease processes. PA’s extend the capabilities of pathologists by allowing them to spend more time at the microscope making diagnoses. Among the clinical laboratory professions, PA’s have perhaps the most autonomy to exercise judgment in performing their duties. These attributes make the PA profession both challenging and rewarding. To learn more, please visit the AAPA website at: www.pathassist.org.
By Jerry A. Phipps, BS, BHS
President, Board of Directors