If you’re wondering what a Pathologists’ Assistant (PA) does all day, here’s a hint…
It’s not autopsy!
Here’s roughly how a typical PA workday breaks down at a hospital-based academic centre.
workday
Frozen sections are performed within lab time and are included in the ~85% laboratory total.
Surgical grossing
~70–75%- Fresh specimen intake, preparation, and documentation
- Examining complex resections — breast, GI, endocrine, head and neck, etc.
- Correlation of gross pathology with clinical history and imaging results
- Specimen photography and mapping
- Block selection and creation of grossing reports
- Routine biopsies and smaller specimens
- Maintenance and operation of routine laboratory equipment
Frozen sections
~10–15%- Intraoperative consultation support
- Rapid gross examination
- Margin assessment
- Rapid tissue freezing and cryostat sectioning
- Fresh tissue prep for next-day grossing
Autopsy
~15%- Routine external examination, evisceration and internal examination of bodies, including removal of brain and spinal cord
- Specialty evisceration techniques
- Cause of death correlation with pathologist
- Body closure
- Cleanup and routine maintenance of the autopsy suite
- Tissue retention and storage
Of course, autopsy is part of the job, and you receive training in it as a student. But both in school and on the job, you don’t do as much of it as you might think.
The bread and butter of a PA’s job is grossing surgical specimens. This is the preservation, examination and dissection of surgical tissue, followed by preparing pieces of that tissue for further examination by a pathologist. As a PA, you will use your hands and eyes to look at tissue. Afterwards, a pathologist will use a microscope on the tissue pieces that you have prepared for them.
This means that if you love the idea of autopsy, you grew up watching CSI and fantasize about performing forensic autopsies all day and solving mysteries… I’m here to crush your dreams.
Ha! No, I’m not cruel and vindictive (unless you steal my lunch), but I do want you to realize that if you go into this career path with that goal, you’ll probably be disappointed. If you’re singularly focused on performing autopsies day in and day out, or on being involved in forensic cases, you’re much better off looking for a job at a medical examiner’s office. The autopsy techs who work there don’t need the certification that many employers require for hospital-based PAs, and they aren’t necessarily PAs who have gone through a NAACLS-certified training program and completed a Master’s degree. If you chose to get your Master’s to become a PA, you would absolutely be qualified to work at the Medical Examiner’s Office, but many of these offices will train people on the job to perform autopsies. Going through PA school if all you want to do is autopsy is kind of like going fishing with dynamite — it’s overkill.
From a purely practical standpoint, if your main interest is autopsy, you’re better off skipping the two years of Master’s training, the cost of school, possibly relocating, and the lost earnings over those two years. You’d be better off applying directly to a medical examiner’s office and going from there.
On the other hand, if the idea of working in a surgical pathology lab and handling surgical tissue seems interesting, then maybe this is the right path for you. If you work at a hospital that performs autopsies as well as has a surgical pathology lab, the majority of your time will still be in the lab and not in the morgue. My hospital is like this and at least 80 or 85% of my time is spent in the lab, which is 7 to 8 hours a day of handling, dissecting, and examining surgical tissue. A subcomponent of my time within the lab is also performing frozen sections. This might take up 10 to 15% of my time on any given day, but it can vary day to day. Some days I could spend one or two hours doing frozens; other days no time at all. It varies based on how many staff are in the lab that you’re working at and what kind of a workload has been scheduled in the ORs. Some surgeries require a lot of frozen sections, whereas others don’t need them at all.
Most of the training you receive through a Master’s program is geared toward the grossing and laboratory side of the job. The first year of didactic training covers general and systemic pathology, histopathology, and gross and microscopic anatomy, with some coverage of photography, laboratory information systems, and a smaller focus on autopsy. The second year is almost entirely focused on grossing within a surgical pathology lab. You’ll have some rotations dedicated to hospital-based (medical) autopsies as well as forensic autopsy, but you easily spend 75% of your training time in the surgical pathology lab grossing specimens – and even more time there once you’re working in the field.
So if you’re thinking about becoming a PA, picture most of your day at the gross bench – not in the morgue. The work is hands-on, varied, and closely tied to patient care, with frozen sections sprinkled in throughout the week and autopsy as a smaller piece of the puzzle. It’s a career for people who want to spend their time examining surgical tissue and helping pathologists arrive at a diagnosis. If that sounds like a fit, a career as a PA might be exactly what you’re looking for.