Pathologists' assistantA pathologists' assistant (PA or PathA) is a physician extender whose expertise lies in gross examination of surgical specimens as well as performing hospital, medicolegal, and forensic autopsies.[1] Their education is analgous to physician associates, consisting of a didactic and a clinical component and concluding in a master's degree. Certification of pathologists' assistants is through a board exam by the American Society for Clinical Pathology (ASCP). In the United States, the profession is represented by the American Association of Pathologists' Assistants (AAPA). Pathologists' Assistants in the United States are currently only required to be licensed in three states: Nevada, West Virginia, and New York.[2] In most other states, the scope of PAs falls under CLIA high complexity testing which requires an associate degree.[3] General overviewPathologists' assistants work under the indirect or direct supervision of a board certified anatomical pathologist, who ultimately renders a diagnosis based on the PA's detailed gross examination and/or tissue submission for microscopic evaluation. Requirements to become a certified pathologists' assistant include graduation from a National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) accredited education program and successfully passing the American Society for Clinical Pathology (ASCP) certification exam, which is not legally required to perform gross examinations in most states.[2] Some states such as West Virginia, Nevada, and New York require a license for pathologists' assistants.[2] All pathologists' assistants are allied health workers who need to be CLIA 88 compliant to perform these high complexity tasks with indirect/direct supervision of a pathologist.[1] With ongoing changes in health care, a growing population of retiring pathologista, and a decreasing number of pathology residents, well trained PAs are in high demand due to their extensive level of training and contribution to the overall efficiency of the pathology laboratory.[1] In addition to the major responsibilities outlined above, a pathologists' assistant may also perform the following tasks (for a complete list, refer to AAPA Scope of Practice[4]):
While many PAs are employed in hospitals, they may also gain employment in private pathology laboratories/groups, medical examiner's offices, morgues, government or reference laboratories, or universities, and may be self-employed and provide contract work.[1] History of profession[5]The idea of physician extenders was conceived in 1966 by physician-educator Eugene A. Stead at Duke University, where the first physician assistant program was established. Three years later, also at Duke, Chairman of Pathology, Dr. Thomas Kinney established the first pathologists’ assistant program. As of June 2025, seventeen accredited programs have been established across the United States and Canada and six others are in various stages of accreditation.[5] Education[2]While curriculum may vary somewhat from program to program, all accredited pathologists' assistants programs are two-year masters degrees that include didactic and clinical training, similar to physician associate programs. The didactic year includes education in surgical and autopsy pathology, anatomy, histology, and laboratory operations. Students are then placed in a clinical setting with affiliated hospitals and/or medical examiner's offices to learn surgical and autopsy dissection.[2] Pathologists' assistant programs are accredited by NAACLS and attending an accredited program is the only route to certification by the ASCP-BOC.[6] Pathologists' assistants that have passed the ASCP certification exam use the post-nominal letters "PA(ASCP)". PA programs collectively graduate approximately 245 students a year. As of 2024, over 3000 pathologists’ assistants have been certified. Universities offering pathologists' assistant degrees include:
As of 6/13/2025, the programs above have the following status with the National Accrediting Agency for Clinical Laboratory Sciences:[7] |*| Accredited |**| Serious Applicant Status |***| Submitted documentation to become accredited Education and certification[5]Pathologists' assistants have been employed in pathology labs for over 40 years. Formal training programs slowly appeared (there were four nationwide in the late 1990s). NAACLS began accrediting PathA programs in the late 1990s, and then programs slowly continued their transitions from bachelor's to master's programs as their number increased. Prior to ASCP certification, which came about in 2005, the AAPA had a fellowship status that program trained pathologists' assistants or on-the-job trained (OJT) pathologists' assistants (who could do specific coursework and three years of active employment) could join only based on passing a rigorous exam that parallels the current ASCP certification exam. The OJT route was eliminated at the end of 2007. The professional association uniting PAs is the American Association of Pathologists' Assistants. Part of their duties as an association is to provide continuing medical education credits (CME) in order to keep members current on advances and procedures in the field that must be completed every three years in order to maintain ASCP certification.[5] In popular cultureThe 2020 novel The Grave Below features a pathologists' assistant as a prominent character. References
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