Clarification of Difference Between Physician Assistant’s and Pathologists’ Assistants

[JosephG]

Hello, 

I read some previous archived messages about the differences between Physician’s Assistants and Pathologists’ Assistants.  As a practicing Pathologists’ Assistant for 20 years, I want to clarify and hopefully stop some of the unnecessary bashing that goes in both directions about the qualifications of both professions.   
 

As you know, Physician’s Assistants are able to diagnose many different disease processes and recommend or prescribe treatment.   Pathologists’ Assistants job duties include performing gross exams examinations of simple to complex surgical pathology cases and perform complete autopsies. However, a Pathologists’ Assistant is unable to sign-out a case and diagnose it for a few reasons.  First, the pathologist who is a physician needs to look at the slides that originate from the sampling of certain disease processes/surgical margins/tumors/staging/etc.   The reason Pathologists’ Assistants exist in the first place is to allow the pathologist more time to do the more complex microscopic examination and correlate it with the gross findings from the PA(ASCP).  Learning to diagnose cases microscopically requires many years of residency and fellowship in pathology to be able to do.   It is not something that can be taught in a graduate PA program.    However, most of the time the gross findings provide a complete assessment of the extent of disease and the pathologist is confirming the findings microscopically before signing the case out.

On the contrary, the types of cases a Physician Assistant may be diagnosing are considered to be the simpler cases that don’t require a clinician to be able to handle.   That is why Physician Assistant’s are able to diagnose these cases, prescribe meds, etc.    It is certainly not to say that is easy by any means or that Physician Assistant’s  lack education or skills.    It is simply that we as mid-level providers have our limits and in the case of pathology there is simply no way we could sign out all the case types as it is far too complex.    It would be like saying that a PA-C could diagnose and treat complex cases requiring the skills of a Internal Medicine doctor.    Some fields like Cytotechnlogists and even Medical Technologists can sign-out and diagnose simpler types of cases like PAP smears or routine clinical cases.   That doesn’t mean they are “better” or more capable than a PA(ASCP) because they can diagnose straightforward cases.

Pathologists’ Assistants have a very broad educational background requiring many years of learning to recognize different pathologies grossly, correlating that with the patient’s clinical history, recognizing and knowing what different disease processes not only look like but how they behave and spread in order to properly stage the extent of disease, and in the field of forensics how to figure out the cause and manner of death.   This requires studying a broad and advanced amount of information, pathophysiology, and advanced Anatomic knowledge.  We also have to go through clinical training to learn how to do all of this stuff.  It is all-encompassing and yet still is not enough to be able to microscopically confirm, diagnose, and sign-out these very complex cases.    It would be like saying a PA-C is going to be doing brain surgery on their own.   I would also like to add that Pathologists’ Assistants perform extremely high-complexity cases like head and neck specimens, oral pathology, Whipple procedures, and complete autopsies with little to no supervision    We have a lot of autonomy for the complexity of the work we do   

With that said, I am fully aware that a PA-C also takes advanced courses and has to learn a great deal of information to do what they do.    I don’t doubt or underestimate your knowledge or skills and the wonderful work you do.     You all serve a very important role in medicine.  I haven’t listed all the amazing and complicated stuff that you do, simply because I am not a PA-C and I don’t know your entire Scope of Practice.    What I do know is that there will always be limits on what we as physician extenders can do.    

What I’d love to see is more respect amongst different physician extenders instead of worrying about who is better than who.    We are in this field for the well-being and care of our patients, not to stroke our egos.    

Take care and love what you do every day!   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited May 8, 2022 by JosephG
Correct grammatical errors

[ohiovolffemtp]

3 hours ago, JosephG said:

On the contrary, the types of cases a Physician Assistant may be diagnosing are considered to be the simpler cases that don’t require a clinician to be able to handle.   That is why Physician Assistant’s are able to diagnose these cases, prescribe meds, etc.    It is certainly not to say that is easy by any means or that Physician Assistant’s  lack education or skills.

I won't presume to comment on what a Pathology Assistant can do or how far up the scale of complexity in pathology they can function.  However, this understates what physician assistants/associates can do.  I'm sitting here as the only provider in my ED and many of my colleagues do solo coverage or alternate charts with physicians.  The basic point of OTP is that PA's function at the top level of their ability, which is usually the function of how hard they pushed themselves in their training and experience after PA school, whether through residency, classes, or OTJ training.

[EMEDPA]

Agree with above- There are many PAs out there doing work, which until our profession came into existence, was previously only done by physicians.

[JosephG]

Hello,

I didn’t mean to downplay the work that Physician’s Assistants do at all.   I know you do work that was and still is performed by physicians.  I also know the work you do isn’t easy by any means and that it requires many years of education and practice to learn and become proficient in your work.  Pathologists’ Assistants do the same.   All I was trying to get across is that there are duties that physicians perform that we are all unable to do, or else we’d be physicians.  

I hope you didn’t take offense and perhaps I could have worded things differently.   My only wish is that all physician-extenders (PA-C, PA(ASCP), NP, CRNA, etc.) would appreciate the work that all of us do and to try to represent the value in mid-level providers.   

To the one person who said Physician’s Assistants should change their title, I totally disagree.  They have been around longer than us and we should probably be the one with different initials to avoid confusion.   

Edited May 8, 2022 by JosephG

[eventuallyPA]

Question, I know the difference between physician assistants and pathology assistants but is there any jobs for PA-Cs in pathology? Id assume they would have some different roles like what you were saying above based off of difference in training. I tried to research this before as it is an interesting field but could not find much. 

[JosephG]

Hello,

I don’t believe so.   The only way that could happen is if a pathologist was willing to train you and sign off on you being able to perform high-complexity testing under CLIA-88.   You would not be able to be certified by the ASCP and most employers require that, especially to gross complex cases.   You might be able to gross simple biopsies and such, but because of that you would be classified as a grossing tech and the pay would be way lower.   Hope this helps!

[eventuallyPA]

11 hours ago, JosephG said:

Hello,

I don’t believe so.   The only way that could happen is if a pathologist was willing to train you and sign off on you being able to perform high-complexity testing under CLIA-88.   You would not be able to be certified by the ASCP and most employers require that, especially to gross complex cases.   You might be able to gross simple biopsies and such, but because of that you would be classified as a grossing tech and the pay would be way lower.   Hope this helps!

that did! Though I am in PA school and want to be a PA-C, I minored in forensic science and have shadowed autopsies. I just always wondered about what roles are available in the forensic fields for PAs as it is something I enjoy learning about as well. I appreciate your response!! Thanks for the information! 

[ohiovolffemtp]

There are also some PA's that work as death investigators for coroners/medical examiners.  I believe there is at least 1 PA who serves as a coroner.

[LT_Oneal_PAC]

Dude has to be a troll. Don’t feed the troll.