Labor force and the Pathology Assistant
The advent of the pathology assistant (PA) parallels the introduction of physician assistants (extenders) into clinical medicine. The need for PAs arises because residents cannot be treated as regular hospital employees and used for endless "service" work. The educational process cannot be divorced from service activity, yet residents must also have opportunities to study. Since cost-containment forces hospitals and practice groups to keep a tight rein on the number of pathologists, and because residents cannot be treated as an indentured labor force, the need has arisen for an intermediate figure, the PA, who enters with a bachelor's degree in science, and proceeds to certifications that allow him or her to work in the laboratory. PAs dissect specimens, assist with frozen sections, and perform autopsies. They work under the supervision of a pathologist and make no independent final determinations. That people with less medical training now do what was previously done only by pathologists does not mean that the quality of their work can be allowed to be less than that of a pathologist. However, PAs did not attend medical school, did not work on the wards, and did not undergo a pathology residency. They cannot, in fairness, be expected to act like physicians, yet there they are, doing the work that we (not so long ago) did by ourselves. We have outsourced a large slice of our territory to hospital employees who work in strict shifts and who (unlike the residents of yore) must be paid for over-time. Since they tend to be fastidious about their breaks, a cadre of four PAs with staggered 8-hour shifts and staggered lunch hours will be dissecting together for only short periods of the day. A pathology assistant can certainly be helpful to a resident, but cannot offer the perspectives of an experienced pathologist. In the 1980s, my former chairman, Herschel Sidransky, predicted that the advent of the PA would displace residents and devalue their experience in the gross room. Perhaps exceptions to this forecast exist, but I believe that on the whole, he was right.