April 14th is a special day for medical laboratories, as it marks Pathologists’ Assistant Day. This is a day to honor and recognize the important role pathologists’ assistants (PAs) play in delivering quality health care in surgical pathology and autopsy. For many years, PAs have been working silently and diligently in hospitals and pathology laboratories nationwide. However, many healthcare professionals are unaware of the PA’s existence and their crucial role in the laboratories, even though they interact with the laboratories regularly.
For those who may be wondering, PAs are highly trained laboratory professionals who interact with pathologists in a similar way to physician assistants (or associates) in clinical practices. To become a PA in the United States, one needs to successfully complete a two-year graduate program accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). Since 2005, all PAs must pass a certification examination conducted by the American Society for Clinical Pathology (ASCP).
The primary responsibility of PAs consists of performing a comprehensive macroscopic (gross) examination of a wide variety of surgical pathological specimens and submitting tissue sections for microscopic examination. Gross examination is the first and critical step in histopathological examination. For example, in the case of tumor resections, accurate tumor staging requires precise surgical margin inking, determination of its dimensions and relationship with adjacent structures, as well as retrieval of an adequate number of lymph nodes for evaluation of metastasis. Therefore, accurate microscopic evaluation requires meticulous gross examination.
PAs also have other clinical responsibilities, such as triaging tissue specimens for submission of ancillary studies such as molecular testing, flow cytometry, cytogenetics, and electron microscopy, assisting in the frozen section for intraoperative consultation, and performing prosection during postmortem examinations.
PAs can offer great value to the pathologists they work with and ultimately the patients who receive the pathology reports. One benefit is that PAs can assist in surgical pathology at a lower cost than pathologists, freeing up the pathologists to devote more time “at the microscope” and in administrative or other clinical activities. A study conducted in 2001 observed that the gross examination performance of PAs was equivalent to or superior to that of pathology trainees. Although the pathologists are responsible for rendering the final pathologic diagnosis, PAs are key partners in assisting the pathologists in arriving at the correct diagnosis.
During the past decades, PAs have also been valuable contributors to the training of pathology residents. PAs share their knowledge and skills of gross examination, specimen processing, laboratory safety, and much more. During my pathology residency training, I faced a common challenge shared by many pathology trainees: feeling hesitant to ask pathology faculty for help with grossing. I often found that faculty members were not always available on short notice, and I didn’t want to reveal my ignorance. Instead, I turned to my PA for assistance with my grossing questions. These interactions improved my grossing skills and laid the foundation for a successful professional relationship with PAs throughout my career as a practicing pathologist. It is important to note that PAs is not meant to replace the role of pathology faculty in the training and education of the trainees but to supplement it.
PAs are critical to the pathology operation, and most pathologists recognize their vital contribution to maintaining an efficient workflow, rendering accurate pathologic diagnoses, and delivering the best patient outcomes. My interaction with PAs went beyond direct supervision of their clinical activities. We worked collaboratively on various projects, including resident education, quality management, regulatory compliance, and more. One of the reasons PAs are so valuable is their expertise in handling gross tissues and familiarity with the pathology workflow. As a result, they often take on non-clinical roles in the laboratory, including administrative tasks. PAs have also played an essential role in research by triaging tissue specimens and procuring samples for tissue banking while ensuring that clinical care is not compromised. When my laboratory installed a new laboratory information system and set up our telepathology system for intraoperative consultation, PAs were heavily involved in the evaluation, design, testing, implementation, and maintenance phases.
On this special day, let us take a moment to honor and recognize the valuable contribution of pathologists’ assistants to patient care.
Join us in celebrating Pathologists’ Assistant Day!