Pathologists ’’ Assistants and Their Role in the Practice...

PathologistsPathologists’’ Assistants and Their Role in the Assistants and Their Role in the

Practice of PathologyPractice of Pathology

2011 ASCP Annual Meeting/ WASPaLM XXVI World Congress2011 ASCP Annual Meeting/ WASPaLM XXVI World Congress

Las Vegas, NevadaLas Vegas, Nevada

October 22, 2011October 22, 2011

Panel MembersPanel Members

Anne WalshAnne Walsh--Feeks, MS, PA (ASCP) Feeks, MS, PA (ASCP) CM CM

Director Physician & Ambulatory Program Development

North Shore-LIJ Health System

Manhasset, New York

Mamoun Younes, MDMamoun Younes, MD

Professor of PathologyProfessor of Pathology

University of Texas Health Science Center at Houston

Houston, Texas

Pamela S. Younes, MHS, HTL(ASCP), CPC(AAPC), PA (ASCP) Pamela S. Younes, MHS, HTL(ASCP), CPC(AAPC), PA (ASCP) CMCM

Assistant Professor


Houston, Texas

ProgramProgram

10:0010:00--10:30 AM 10:30 AM History of the Pathologists’ Assistant Profession History of the Pathologists’ Assistant Profession

andand

The Role of the Pathologists’ Assistant in Different The Role of the Pathologists’ Assistant in Different Practice SettingsPractice Settings

Speaker: Anne WalshSpeaker: Anne Walsh--Feeks, MS, PA (ASCP)Feeks, MS, PA (ASCP)

10:3010:30--11:00 AM11:00 AM The Relationship between Pathologists and Pathologists’ The Relationship between Pathologists and Pathologists’ 10:3010:30--11:00 AM11:00 AM The Relationship between Pathologists and Pathologists’ The Relationship between Pathologists and Pathologists’ AssistantsAssistants

Speaker: Mamoun Younes, MDSpeaker: Mamoun Younes, MD

11:0011:00--11:30 AM 11:30 AM The Training of Pathologists’ AssistantsThe Training of Pathologists’ Assistants

Speaker: Pamela Younes, MHS, PA (ASCP)Speaker: Pamela Younes, MHS, PA (ASCP)

11:3011:30--11:50 AM11:50 AM Questions & AnswersQuestions & Answers

Program: Part 1Program: Part 1

�� History of the Pathologists’ Assistant ProfessionHistory of the Pathologists’ Assistant Profession

�� The Birth of the ProfessionThe Birth of the Profession

�� Training ProgramsTraining Programs

�� The American Association of Pathologists’ The American Association of Pathologists’ �� The American Association of Pathologists’ The American Association of Pathologists’

Assistants (AAPA)Assistants (AAPA)

�� CLIA ‘88CLIA ‘88

�� ASCP CertificationASCP Certification

What is a Pathologists’ Assistant?What is a Pathologists’ Assistant?

“A pathologists' assistant is an intensively “A pathologists' assistant is an intensively trained allied health professional who trained allied health professional who provides anatomic pathology services provides anatomic pathology services under the direction and supervision of a under the direction and supervision of a under the direction and supervision of a under the direction and supervision of a pathologist.”pathologist.”

Source: AAPA Scope of Practice

The Role of the Pathologists’ AssistantThe Role of the Pathologists’ Assistant

Under the direction of a pathologist:Under the direction of a pathologist:

�� Grossing of all specimen typesGrossing of all specimen types

�� Autopsies Autopsies

�� Training of peers & pathology residentsTraining of peers & pathology residents

�� Frozen section preparationFrozen section preparation�� Frozen section preparationFrozen section preparation

�� QI/ QC/QAQI/ QC/QA

�� Laboratory managementLaboratory management

�� Regulatory RequirementsRegulatory Requirements

�� Tissue banking / researchTissue banking / research

The First Training ProgramThe First Training Program

�� 1969: The first training program was 1969: The first training program was

started at the Veterans Administration (VA) started at the Veterans Administration (VA)

Medical Center in Durham, North Carolina Medical Center in Durham, North Carolina Medical Center in Durham, North Carolina Medical Center in Durham, North Carolina

in conjunction with Duke Universityin conjunction with Duke University

Others Followed….Others Followed….

�� Additional training programs followed at:Additional training programs followed at:

�� The Veteran’s Administration Hospital of the The Veteran’s Administration Hospital of the

University of AlabamaUniversity of AlabamaUniversity of AlabamaUniversity of Alabama

�� Quinnipiac College, an affiliate of Yale University, Quinnipiac College, an affiliate of Yale University,

in Hamden, Connecticutin Hamden, Connecticut

Current Training Programs

Drexel University

Philadelphia, PA

Duke University

Durham, NC

University of Maryland

Baltimore, MD

Wayne State University

Detroit, MI

Indiana University

Indianapolis, IN

Quinnipiac University

Hamden, CT

Rosalind Franklin

Chicago, IL

University of Western Ontario

London ON Canada

West Virginia University

School of Medicine

Morgantown, WV

Training Programs

� Accredited by NAACLS (National Accrediting National Accrediting

Agency for Clinical Laboratory Science ) since Agency for Clinical Laboratory Science ) since

1993. 1993.

� All are two year MS/MHS degree programs

except Wayne State which is currently a two year

BS degree program .

The American Association of Pathologists’ Assistants The American Association of Pathologists’ Assistants

(AAPA)(AAPA)

�� Founded in 1972, notFounded in 1972, not--forfor--profitprofit

�� Premiere professional organization for Premiere professional organization for

pathologists’ assistants pathologists’ assistants pathologists’ assistants pathologists’ assistants

�� Provides education and advocacyProvides education and advocacy

�� Current membership 1,484Current membership 1,484

AAPA HistoryAAPA History

�� 1969: First training program began1969: First training program began

�� 1972: AAPA founded1972: AAPA founded

�� 1975: First Annual AAPA Convention Atlanta, GA1975: First Annual AAPA Convention Atlanta, GA

�� 1993: AAPA established an affiliation with the 1993: AAPA established an affiliation with the �� 1993: AAPA established an affiliation with the 1993: AAPA established an affiliation with the

National Accrediting Agency for Clinical National Accrediting Agency for Clinical

Laboratory Science (NAACLS) to accredits PA Laboratory Science (NAACLS) to accredits PA

training programstraining programs

�� 2004: ASCP (BOR) 2004: ASCP (BOR) –– National certification for National certification for

pathologists’ assistants through the ASCPpathologists’ assistants through the ASCP

AAPA Mission StatementAAPA Mission Statement

TheThe AAPA,AAPA, asas anan independent,independent, notnot--forfor--profitprofit volunteervolunteerorganizationorganization ofof alliedallied healthhealth practitioners,practitioners, isis dedicateddedicated totothethe advancementadvancement ofof thethe pathologists’pathologists’ assistantassistant professionprofessionandand ofof individualindividual pathologists’pathologists’ assistantsassistants throughthroughadvocating,advocating, promotingpromoting andand sustainingsustaining thethe highesthighesteducationaleducational andand professionalprofessional standardsstandards forfor thethe profession,profession,educationaleducational andand professionalprofessional standardsstandards forfor thethe profession,profession,forfor itsits professionalprofessional credentialingcredentialing partner,partner, forfor allall associatedassociatededucationaleducational trainingtraining programsprograms andand forfor individualindividualpathologists’pathologists’ assistantsassistants;; providingproviding allall AAPAAAPA membersmembers withwithhighhigh quality,quality, targetedtargeted continuingcontinuing educationeducation (CE)(CE)opportunitiesopportunities asas wellwell asas professionalprofessional developmentdevelopment andandleadershipleadership activities,activities, includingincluding networkingnetworking andand supportsupport..TheThe AAPAAAPA strivesstrives toto promotepromote andand supportsupport highhigh qualityqualitystandardsstandards withinwithin thethe scopescope ofof practicepractice forfor pathologists’pathologists’assistantsassistants inin anatomicanatomic pathology,pathology, therebythereby ensuringensuring thetheprovisionprovision ofof highhigh qualityquality patientpatient carecare..

AAPA Member BenefitsAAPA Member Benefits

�� The premier source of continuing education for The premier source of continuing education for

pathologists’ assistants.pathologists’ assistants.

�� The AAPA is an approved provider of continuing The AAPA is an approved provider of continuing

education programs in the clinical laboratory education programs in the clinical laboratory

sciences through the ASCLS PACE programsciences through the ASCLS PACE program

�� Job Listing and HotlineJob Listing and Hotline

�� Group malpractice insuranceGroup malpractice insurance

�� Career and professional networkingCareer and professional networking


�� Annual educational conference offering CMEAnnual educational conference offering CME

�� Workshops including:Workshops including:

�� Pediatric PathologyPediatric Pathology

�� OffOff--site gross lung pathology site gross lung pathology

�� Teaching residents and medical students surgical & Teaching residents and medical students surgical &

autopsy prosectionautopsy prosection

�� Upcoming meetings Upcoming meetings

�� 2012 Miami, Florida2012 Miami, Florida

�� 2013 Portland, OR2013 Portland, OR

�� 2014 New York City, NY2014 New York City, NY


Quarterly journal Quarterly journal

“The Cutting Edge”“The Cutting Edge”“The Cutting Edge”“The Cutting Edge”

AAPA Contact InformationAAPA Contact Information

American Association of Pathologists’ AssistantsAmerican Association of Pathologists’ Assistants

1711 W. County Road B1711 W. County Road B

Roseville, MN 55113Roseville, MN 55113

11--800800--532532--AAPA or 651AAPA or 651--697697--92649264

http://www.pathasst.org

Clinical Laboratories Improvement Clinical Laboratories Improvement

Amendments of 1988 (CLIA 88)Amendments of 1988 (CLIA 88)

�� CLIA sets standards designed to improve CLIA sets standards designed to improve

quality in all laboratory testing and including:quality in all laboratory testing and including:

�� Specifications for quality controlSpecifications for quality control

�� Specifications for quality assuranceSpecifications for quality assurance�� Specifications for quality assuranceSpecifications for quality assurance

�� Patient test managementPatient test management

�� Personnel and proficiency testingPersonnel and proficiency testing

Clinical Laboratories Improvement Clinical Laboratories Improvement

Amendments of 1988 (CLIA 88)Amendments of 1988 (CLIA 88)

�Personnel and proficiency testing

� PAs: Must meet educational

requirements for high-complexity

testing testing

� Associate degree minimum

American Society of Clinical Pathology (ASCP)American Society of Clinical Pathology (ASCP)

� Celebrating 83th anniversary (1928-2011)

� Over 130,000 laboratory members in the

following fields:

� Technician Certification Technician Certification

� AT, DPT, HT, MLT, PBT

� Technologist Certification

� BB, C, CT, H, HTL, MT, M, MP

� Specialist Certification

� SBB, SC, SCT, HP, SH, SLS, SM, PA

� Diplomate Certification -DLM

� International ASCPi Certification

� MT, MLT, MP, PBT

American Society of Clinical Pathology (ASCP)American Society of Clinical Pathology (ASCP)

�� Fall, 2004: Memorandum of Understanding Fall, 2004: Memorandum of Understanding

(MOU) formed between the ASCP Board of (MOU) formed between the ASCP Board of

Certification (BOC) and the AAPACertification (BOC) and the AAPA

�� Only professional certification for pathologists' Only professional certification for pathologists'

assistants: PA(ASCP)assistants: PA(ASCP)

�� To date >95%To date >95% of AAPA members are ASCP of AAPA members are ASCP

certifiedcertified

�� Contact information:Contact information:

www.ascp.orgwww.ascp.org

ASCP Board of Certification (BOC)ASCP Board of Certification (BOC)

�� What is certification?What is certification?

�� ASCP recognizes an individual as having the ASCP recognizes an individual as having the

necessary competence and having met necessary competence and having met

predetermined qualifications to perform the predetermined qualifications to perform the predetermined qualifications to perform the predetermined qualifications to perform the

medical laboratory roles they seek medical laboratory roles they seek

�� Pathologists’ Assistant (PA) certification Pathologists’ Assistant (PA) certification

requires:requires:

�� Successful completion of NAACLS accredited Successful completion of NAACLS accredited

PA programPA program

ASCP Certification Maintenance Program (CMP)ASCP Certification Maintenance Program (CMP)

�� PAs must participate in the BOC CMP to renew PAs must participate in the BOC CMP to renew

certificationcertification

�� Certification is timeCertification is time--restricted to 3 yearsrestricted to 3 years

�� Requires 45 points of continuing education over three Requires 45 points of continuing education over three

year period:year period:year period:year period:

�� 1 point in safety1 point in safety

�� 20 points in anatomic pathology20 points in anatomic pathology

�� 24 points in the areas of anatomic pathology, 24 points in the areas of anatomic pathology,

management, education, or other clinical specialtiesmanagement, education, or other clinical specialties

State Licensure & Regulatory IssuesState Licensure & Regulatory Issues

�� The AAPA’s Legislative Committee monitors The AAPA’s Legislative Committee monitors

legislative & regulatory issues of interest to PAs.legislative & regulatory issues of interest to PAs.

�� The AAPA is working with the American Society of The AAPA is working with the American Society of

Clinical Laboratory Science (ASCLS) to draft Clinical Laboratory Science (ASCLS) to draft

language specific to Pathologists’ Assistants for language specific to Pathologists’ Assistants for

inclusion in their “ Licensure Guide Bill”, a template inclusion in their “ Licensure Guide Bill”, a template

bill used by individual state ASCLS chapters to bill used by individual state ASCLS chapters to

create state licensure for clinical laboratory create state licensure for clinical laboratory

professionals.professionals.

Part 2: The Role of the Pathologists’ Assistant Part 2: The Role of the Pathologists’ Assistant

in Different Practice Settingsin Different Practice Settings

�� Role of the Pathologists’ AssistantRole of the Pathologists’ Assistant

�� Scope of Practice Scope of Practice

�� Practice SettingsPractice Settings

University Medical CentersUniversity Medical Centers�� University Medical CentersUniversity Medical Centers

�� Community HospitalsCommunity Hospitals

�� Commercial LaboratoriesCommercial Laboratories

�� Medical Examiner/ Forensic FacilitiesMedical Examiner/ Forensic Facilities

�� StatisticsStatistics

Role of the Pathologists’ AssistantRole of the Pathologists’ Assistant

Under the direction of a pathologist:Under the direction of a pathologist:

�� Grossing of all specimen typesGrossing of all specimen types

�� Autopsies Autopsies

�� Training of peers & pathology residentsTraining of peers & pathology residents�� Training of peers & pathology residentsTraining of peers & pathology residents

�� Frozen section preparationFrozen section preparation

�� QI/ QC/QAQI/ QC/QA

�� Laboratory managementLaboratory management

�� Regulatory RequirementsRegulatory Requirements

�� Tissue banking / researchTissue banking / research

Scope of PracticeScope of Practice

Section A. DefinitionSection A. Definition

�� A pathologists assistant is qualified by academic A pathologists assistant is qualified by academic

and practical training to provide, under the and practical training to provide, under the

direction and supervision of a licensed, Board direction and supervision of a licensed, Board

certified, or Board eligible pathologist, the certified, or Board eligible pathologist, the

following services:following services:

Scope of Practice: Surgical PathologyScope of Practice: Surgical Pathology

Preparation, gross description and dissection of Preparation, gross description and dissection of

human tissue surgical specimens including:human tissue surgical specimens including:

a) Assuring appropriate specimen accessioning.a) Assuring appropriate specimen accessioning.

b) Obtaining pertinent clinical information and b) Obtaining pertinent clinical information and b) Obtaining pertinent clinical information and b) Obtaining pertinent clinical information and

history, including scans, xhistory, including scans, x--rays, laboratory data rays, laboratory data

etc.etc.


c. c. Grossing

� Describing gross anatomic features of surgical

specimens

Preparing tissues for histological processingPreparing tissues for histological processing


c. Grossing

� Obtaining biological samples such as blood, tissue

and toxicological material for studies such as flow

cytometry, image analysis,

immunohistochemistry, etc.

� Performing special procedures including faxitron

imaging and tumor triage


d) Preparing and submitting appropriate tissue sections for:

� light microscopy (routine processing)

� frozen section

electron microscopy� electron microscopy

� immunoflourescence microscopy


e) Photographing all appropriate gross specimens

and microscopic slides.


f. Performing duties relating to the administrative

maintenance of surgical pathology protocols,

reports and data:

� filing of reports, protocols, photographic data or

slide, microscopic slides

� assisting in the completion of specimen coding

and billing


g. Assuring proper maintenance of equipment,

provision of adequate supplies and cleanliness of

the surgical pathology suite.


h. Assisting in the organization and coordination of

anatomic pathology conferences.

Scope of Practice: Autopsy PathologyScope of Practice: Autopsy Pathology


Preparation of human postmortem examination,

including:

a. Ascertaining proper legal authorization for

autopsy.


b. Obtaining patients medical record/ chart and

other pertinent data for review with the

attending pathologist.


c. Conferring with the attending pathologist(s) to identify any special techniques and procedures to be utilized in the completion of examination (e.g. cultures smears; histochemical, immunofluorescence, toxicological, viral or immunofluorescence, toxicological, viral or electron microscopic studies, etc.), and notifying all personnel directly involved.


d. Notifying the physician in charge, the funeral

home, and all other appropriate authorities prior

to the beginning of the autopsy; and coordinating

any requests for special specimen sampling (e.g.

organ transplantation, research, etc.).organ transplantation, research, etc.).


e. Performing postmortem examinations which may

include: external examination; in situ organ

inspection; evisceration; dissection and dictation

or recording of data such as organ weights,

presence of body fluids, gross anatomic findings, presence of body fluids, gross anatomic findings,

etc.


f. Selecting, preparing and submitting appropriate

gross tissue sections for frozen section analysis as

well as electron microscopy and

immunofluorescence.


g. Obtaining biological specimens such as blood,

tissue and toxicological material for studies

including flow cytometry, image analysis,

immunohistochemistry, etc.;

and performing special procedures such as

coronary artery perfusion, central nervous system

perfusion, enucleation, inner ear bone dissection,

spinal cord removal, etc.


h. Photographing the body, organs, microscopic

slides and other pertinent materials.


i. Gathering and organizing clinical information and

data pertinent to the preparation of the

preliminary summarization of the clinical history.


j. Preparing the body for release, (including

indicating the presence of biohazards such as

contagious diseases, radiation implants, etc.) and

releasing the body to the appropriate mortuary or

funeral home representative.funeral home representative.


k. Performing duties related to administrative

maintenance of anatomic pathology protocols;

photographic and microscopic slides; and

assuring the completion of coding.


l. Assisting in the organization and coordination of

anatomic pathology conference.


m. Assuring the proper maintenance of equipment,

the provision of adequate supplies.

The Role of the Pathologists’ Assistant in The Role of the Pathologists’ Assistant in

Different Practice SettingsDifferent Practice Settings

The Role of the Pathologists’ Assistant in The Role of the Pathologists’ Assistant in

Different Practice SettingsDifferent Practice Settings

� PA Practice Settings

� University Medical Centers

� Community Hospitals

� Commercial Laboratories� Commercial Laboratories

� Medical Examiner/ Forensic Facilities

Pathologists’ Assistant Practice SettingsPathologists’ Assistant Practice Settings

� University Medical Centers

� Teaching of residents, PAs, medical student

and others

� Management responsibilities� Management responsibilities

� Staffing

� Scheduling

� Budgets

� Committee responsibilities


�Community Hospitals

� Surgical & autopsy pathology

responsibilities

� May be involved in teaching� May be involved in teaching

� May cover multiple sites


�� Commercial LaboratoriesCommercial Laboratories

� Often more than one PA in practice

� May cover multiple sites

� May work different shifts� May work different shifts

� Usually no autopsy responsibilities


� Medical Examiner/ Forensic Facilities

� Less common practice site

� Autopsy only

Pathologists’ Assistants in the United States Pathologists’ Assistants in the United States

Current StatisticsCurrent Statistics

� Current membership: 1,484

� # Respondents: 540 (36%)

� Respondent Membership Status:

� Fellow 92%� Fellow 92%

� Associate 2%

� Student 6%

� ASCP Certified:

� Yes 94%

� No 6%

Source: 2010 AAPA Membership SurveySource: 2010 AAPA Membership Survey

Practice SettingsPractice Settings

�� Community HospitalCommunity Hospital 43%43%

�� Academic/University HospitalAcademic/University Hospital 25%25%

�� Private Group Private Group 26% 26%

�� HMO HMO 1%1%�� HMO HMO 1%1%

�� Other Other 5% 5%

Approximately how many surgical specimens are Approximately how many surgical specimens are

processed in your practice setting per year?processed in your practice setting per year?

� 1-20,000 37 %

� 20,001-30,000 23 %

� 30,001-40,000 13 %

40,000+ 27 % � 40,000+ 27 %

What is the total number of surgical cases What is the total number of surgical cases

you gross per year?you gross per year?

� 0-5,000 18%

� 5,001-10,000 29%

� 10,001-15,000 32%

15,001-20,000 12% � 15,001-20,000 12%

� 20,001-25,000 5%

� 25,001+ 4%

On the average day, how many hours per day On the average day, how many hours per day

do you spend grossing tissue?do you spend grossing tissue?

� 0-2 8%

� 2-4 11%

4-6 30 % � 4-6 30 %

� 6-8 47 %

� 8+ 4 %

What percentage of your time is spent What percentage of your time is spent

grossing tissue?grossing tissue?

�� 00--25% 25% 9% 9%

�� 2626--50% 50% 9% 9%

�� 5151--75% 75% 26% 26% �� 5151--75% 75% 26% 26%

�� +76% +76% 56% 56%

What are your job responsibilities?What are your job responsibilities?

� Grossing 94%

� Gross photography 80%

� Frozen Section 67%

� Prosecting 44%

� Non-resident teaching 38% � Non-resident teaching 38%

� Resident teaching 32%

� Administration/ management 32%

� Tissue banking 31%

What are your job responsibilities?What are your job responsibilities?

� Supply maintenance 30%

� Preparing autopsy reports 23%

� Conference preparation 18%

� Research 16% � Research 16%

� Photomicroscopy 8%

What areas do you manage or supervise?What areas do you manage or supervise?

� Cytology 7%

� Histology 12%

� Gross Room 77%

� Autopsy 36%� Autopsy 36%

� QA/QC 19%

� Frozen section room 39%

� Other PAs 29%

� Other 20%

Are you involved in a pathology residency Are you involved in a pathology residency

program?program?

� Yes 30%

� No 70%

Are there other Pathologists' Assistants at Are there other Pathologists' Assistants at

your workplace?your workplace?

� Yes 75%

� No 25%

Are you satisfied with your career as a Are you satisfied with your career as a

pathologists' assistant?pathologists' assistant?

� Yes 95%

� No 5%

What is your base salary in US dollarsWhat is your base salary in US dollars

(EXCLUDING benefits, bonuses)?(EXCLUDING benefits, bonuses)?

� Average Salary : $ 85,000 – $90,000

� Range: $50,001 - $150,000

� 2011 starting salary for new graduates 2011 starting salary for new graduates

$85,000 (range: $70-90K)

Note: Factors that influence a PA’s salary

include experience, workload, setting and

regional cost of living.

Future Outlook for PA ProfessionFuture Outlook for PA Profession

�� Promising outlookPromising outlook

�� Increasing number of available positionsIncreasing number of available positions

�� New training programs New training programs

Questions?Questions?

�� Contact Information:Contact Information:

Anne WalshAnne Walsh--FeeksFeeks

email: email: [email protected]@nshs.eduemail: email: [email protected]@nshs.edu

Phone: (516) 823Phone: (516) 823--83398339

The relationship between

pathologists and pathologists’

assistants

Mamoun Younes, M.D.Professor of Pathology


Houston, TX, USA

PA in Anatomic Pathology

• FS

• Biopsies

• “Routine” surgical pathology

• Autopsy• Autopsy

• Teaching

• Quality assurance/management

• Billing, coding, compliance

• Administrative duties

In the Frozen Section RoomIn the Frozen Section Room

PA First thing a.m. …

• Review OR schedule

• Highlight cases with potential FS

• Search computer database for relevant previous path

• Writes case # and DX on OR schedule next to pt. • Writes case # and DX on OR schedule next to pt.

name

• Calls Histology lab: send slides and copy of path

reports to FS room

Pathologist first thing …

• Copy of the OR schedule already has the previous path case numbers, dates and diagnoses written next to each patient name, and previous slides ready for review.

• on occasions, we have alerted the surgeon for potential mishaps

PA most helpful when ..

• 3 or more specimens come in together or within minutes of each other

• surgeon walks in, wanting his/her specimen to be done first

It is not practical or cost-effective to have several pathologists come help in FS room

The PA appropriately grosses specimens, takes pictures, correctly identifies and labels margins, pictures, correctly identifies and labels margins, identifies potential lesions and submits appropriate sections for FS.

• Cut and stain frozen sections when the histotech

is overwhelmed.

• After the frozen section is done, may gross large • After the frozen section is done, may gross large

specimens in FS room

• specimen photography

• freezing tissue samples for tissue banking

The PA on BiopsyThe PA on Biopsy

• Train residents on grossing biopsies, how

to submit larger polyps, skin ellipses, ..

• Some may have PAs do a lot of biopsies;

in other practices only help if needed

“Routine” surgical pathology“Routine” surgical pathology

• Initially the PAs train the residents and Fellows

• Later, they gross side by side, different

specimens; PAs provide help when neededspecimens; PAs provide help when needed

• Search for additional lymph nodes

• re-examine the specimen and submit

additional sections, as needed, if findings additional sections, as needed, if findings

in sections submitted by resident do not

match or correlate with gross or history

• Help draft grossing room and frozen

section room procedures, help with

grossing manuals, ..grossing manuals, ..

Autopsy

• performing the prosection themselves

• teaching and assisting • teaching and assisting

• In most instances, the pathologist goes to

the autopsy suite after prosection is

completed to examine the findings, review

the organs, and do on site clinical the organs, and do on site clinical

pathological correlation

Teaching

• Grossing, autopsy, photography, quality

assurance, coding and compliance to all

incoming residents and fellows.

• In some institutions, PAs are given Faculty

positions, starting at the “Instructor” level.

Quality assurance (QA)

• Select cases for review: random selections and targeted selections

• Distributing cases for review by • Distributing cases for review by subspecialty

• Collect and report results and track performance.

• At end of review, results are given to pathologist

in charge of QA for further action

• QA results are forwarded to our clients as • QA results are forwarded to our clients as

aggregate statistics.

Billing, coding, and compliance

• review ALL path reports for billing errors and corrections before they go out to the billing company.

• Also check these reports for errors in diagnosis, typographical errors, omissions, inappropriate typographical errors, omissions, inappropriate sampling, uncommon diagnosis rendered by a generalist without consulting a specialist, or diagnosis unexpected from history or contradict previous DX: cases picked up for QA review (targeted review)

Integrating PAs into pathology

practicepractice

Before a PA starts working for you

• make sure he/she received adequate

training.

• Know their strengths and weaknesses

When they start working for you

• Observe them carefully when they start the job

• Go over their gross description • Go over their gross description thoroughly

Team work:

• be open minded to learning from their • be open minded to learning from their

experience, but also tell them how you like

them to do things according to the way

you practice (if necessary).

• have them sit with you at the microscope if

they express interest to correlate with the

gross.

• If interested but have no time to sit at the

microscope, give feedback

• the more you educate your PA, and the

more he or she feels part of the team, the

better job they will do for you and your

patients.

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