What Does a Pathologist Do? And How Does a Pathologist Assistant Fit In?
First off: what exactly is a pathologist? Many TV shows portray pathologists as simply performing autopsies, but this doesn’t quite capture the full picture of what they actually do. The work of a pathologist is actually a lot more complex.
Pathology is the medical specialty that focuses on the study and diagnosis of disease. Pathologists examine body fluids, tissues, and organs to identify abnormalities and diagnose conditions. In some cases, such as with autopsies, they may examine an entire body. Their work involves both gross examination (looking at specimens with the naked eye) and microscopic examination (studying cells and tissue under a microscope).
Atlas of Pulmonary Pathology by Yale Rosen via Flickr / CC BY 4.0
By analyzing cells at this level, a pathologist can determine whether the cells are responding to injury, experiencing inflammation, healing, dying, or, importantly, if there’s cancer. Special chemical stains and antibodies can be used to highlight specific parts of cells, helping the pathologist identify the type of cancer, its likely origin, and which treatments it will respond to best.
Yes, pathologists do perform autopsies, but that’s just a small part of their overall role. In fact, many pathologists don’t perform autopsies at all and focus primarily on diagnosing surgical specimens.
Being a pathologist is a lot of work. They undergo extensive training: a four-year medical degree followed by a five-year residency, and often additional specialization or fellowship training, which can take one to two more years.
But where do pathologist assistants fit into all of this?
What Does a Pathologist Assistant Do?
If you’ve looked up the role of a pathologist assistant, you’ve probably seen the term “physician extender.” While this is technically true, it doesn’t fully explain how pathologist assistants (PAs) contribute to the pathology workflow. This article can give you a more in-depth explanation.
Pathologist assistants are trained to perform the gross examination of specimens that pathologists also conduct. After examining the specimen, PAs select representative tissue samples which are then processed into slides. These slides are what the pathologist reviews under a microscope to make a final diagnosis.
Tissue placed in these cassettes turns into slides.
Histologic Slide under Microscope by Ed Uthman from Houston, TX, USA is licensed under CC BY 2.0
This division of labor is especially important in hospitals where there are fewer pathologists or where a high volume of surgical specimens need to be processed. Without PAs handling the gross examination, pathologists would be overwhelmed trying to do both the gross and microscopic work, making for very long days or delayed pathology results.
While PAs don’t make diagnoses themselves, the work we do during the gross examination is crucial for the pathologist to make an accurate diagnosis and some findings can only be assessed during grossing. In fact, PAs undergo a two-year Master’s degree program to ensure we’re properly trained for this job because it does carry a lot of responsibility. We regularly consult with pathologists and occasionally with surgeons, particularly on difficult or complex cases.
While our training is shorter than a pathologist’s, the job is much less stressful for us because we’re not the ones responsible for delivering life-or-death diagnoses. Though pathologists earn significantly more than PAs , I personally find the trade-off worthwhile.