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Can someone please tell me their opinion of the value of a pathology assistant? how about a pathology Phd? what is the difference between a pathology phD and a pathology MD?
pathology assistant or pathology PhD
- Thread starter MSV MD 2B
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Pathology Assistant: Cuts in gross specimens 95% of their time, occasional diener when needed. Highly valued, due to reduced workload at the cutting bench for pathologists (i.e. more time to look at slides.) Scary, also, because the pathologist is responsible for their work and there are legal/billing issues regarding what level of supervision a pathologist should have in the gross lab.
Pathology Phd: Researcher. Works on specialized area of interest to further scientific understanding. Or develop new diagnostic techniques -- like different immunohistochemistry antibodies. Occassional administrative role.
Pathologist: Diagnostician. Physician. Primarily responsible for the specimens (and their whole human counterparts) and the interactions with clinicians. As far as I am aware, only pathologist md's sign out cases... Although even as I write this I can think of a few instances of phd's in a position that seems more fitting to an md: the head of chemistry at Baystate is a phd from Mayo. I think my home institution's microbiologist is a phd also.
Thoughts anyone?
Mindy
Pathology Phd: Researcher. Works on specialized area of interest to further scientific understanding. Or develop new diagnostic techniques -- like different immunohistochemistry antibodies. Occassional administrative role.
Pathologist: Diagnostician. Physician. Primarily responsible for the specimens (and their whole human counterparts) and the interactions with clinicians. As far as I am aware, only pathologist md's sign out cases... Although even as I write this I can think of a few instances of phd's in a position that seems more fitting to an md: the head of chemistry at Baystate is a phd from Mayo. I think my home institution's microbiologist is a phd also.
Thoughts anyone?
Mindy
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oh great thats just what we need... more non-doctor providers trying to take over another medical specialty.
OK, give it to me now:
which states allow path assistants/PhDs to do limited diagnoses under MD supervision?
thats the first step. After 10 years of that, the scope will get expanded, and then they will be able to look at some slides independent of an MD pathologist.
And then, another 10 years later, they will be allowed to do total diagnoses for everything in rural areas.
Eventually they will start creeping into urban areas and displace MDs.
OK, give it to me now:
which states allow path assistants/PhDs to do limited diagnoses under MD supervision?
thats the first step. After 10 years of that, the scope will get expanded, and then they will be able to look at some slides independent of an MD pathologist.
And then, another 10 years later, they will be allowed to do total diagnoses for everything in rural areas.
Eventually they will start creeping into urban areas and displace MDs.
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I have never (and again, I am quite limited to New England and New York) heard of a phd making surgical path diagnoses. That being said, there are certain laboratory areas that are so highly specialized that if diagnostic tools are available, the phd who developed and runs the lab may be responsible for the clinical material. For example if you were looking to identify surface antigens on a virus, say HIV, this may be sent to a lab run by a pure scientist.
Do not concern yourselves with pathology assistants taking over slides. Their main responsibility is to gross (i.e. take small representative chunks) of specimens. In many places, grossing and other lab maintenance duties are a full day's work. Which is why pathologists tend to welcome PAs. HOWEVER, the public and courts at large are very nervous about non-pathologists handling biopsy material and there is an undercurrent of impending regulation regarding supervision and what PAs are allowed to do. I found that I preferred to cut in most specimens myself...but especially skin biopsies where margins are so important. I think that we should acquire a standard of digitally imaging each and every gross specimen prior to sectioning. This would ensure that the pathologist would have a good idea of what the specimen looked like, if s/he did not cut it in. Also it would valuable for diagnostic, communication, and medicolegal purposes. Most pathologists I talk to feel this is a waste of time. Thoughts?
I really believe that there is no non-md replacement for pathologists. Other specialties that have such a threat, such as family and psychiatry, tend to worry that a certain alternatively trained group can actually do their job as well or better (or cheaper) than they can. Honestly, pathologists sit in a prime untouchable location between medicine and science. I do not see any third party threat to our existence. We will automate ourselves out of existence first.
Mindy
Do not concern yourselves with pathology assistants taking over slides. Their main responsibility is to gross (i.e. take small representative chunks) of specimens. In many places, grossing and other lab maintenance duties are a full day's work. Which is why pathologists tend to welcome PAs. HOWEVER, the public and courts at large are very nervous about non-pathologists handling biopsy material and there is an undercurrent of impending regulation regarding supervision and what PAs are allowed to do. I found that I preferred to cut in most specimens myself...but especially skin biopsies where margins are so important. I think that we should acquire a standard of digitally imaging each and every gross specimen prior to sectioning. This would ensure that the pathologist would have a good idea of what the specimen looked like, if s/he did not cut it in. Also it would valuable for diagnostic, communication, and medicolegal purposes. Most pathologists I talk to feel this is a waste of time. Thoughts?
I really believe that there is no non-md replacement for pathologists. Other specialties that have such a threat, such as family and psychiatry, tend to worry that a certain alternatively trained group can actually do their job as well or better (or cheaper) than they can. Honestly, pathologists sit in a prime untouchable location between medicine and science. I do not see any third party threat to our existence. We will automate ourselves out of existence first.
Mindy
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the path assistants i've known were great at grossing specimens. in fact, one claimed that the practice averaged 8-10 lymph nodes sectioned from a bowel specimen when the pathologists did them, but when he came on, they averaged something like 25-30. point being that when you just gross all day long, you are going to get better at it than the pathologist that does it every once in a while. to which i say hallelujah. grossing all day would kill me. the pa's i've known were great at what they did, but they couldn't diagnoses slides any better than i can as a second year (almost third) med student. i think mindy is right. path is one of the few specialties that doesn't have a thing to worry about regarding other practitioners.
A
anencephalic
As a practicing PA who is on his way to med school, I thought I'd jump in and share my views on this subject. I don't beleive that an MD pathologist's job security should be threatened by PA's now or in the future. A PA's main function is to gross and prosect, not diagnose. This is not to say that some do not routinely venture to the microscope on a regular basis. I have had the good fortune of being able to do practically everything an MD pathologist does (including dictating micros & diagnosing everything from benign to malignant cases) however, the MDs actually verify/review my sign-outs. Am I typical of most PAs? Definitely not. However, I believe that pathologists generally fall into two groups: those who utilize PAs to their maximal potential, and those who, for whatever reason, choose not to. The former obviously necessitates a great deal of trust between PA & MD, but a competent PA will most assuredly allow the MD increased time to pursue other activities. PAs face a lack of national credentialing, and there is no set definition of what a pathologists' assistant is. The most prevalent view is the one presented in this thread: an allied health professional who is a physician extender meant to complement a pathologist, not replace them. Despite this, many individuals consider themselves PAs without the requisite training/eduaction, thus there exists a huge discrepancy between the competencies from one PA to the next. The AAPA (American Association of Pathlogists' Assistants)does offer certification for fellowship, however, a current push by that organization for credentialing/licensure by the ASCP is on the horizon. This will do more to reinforce the legitimacy of PAs (much as licensure did for the primary care PAs) than it will to detract from the job security or necessity of MDs. My $0.02, for what it's worth.
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Jon,
Thank you for your input and excellent discussion--very appreciated. I am surprised that you review microscopy...but I know that my pet monkey (okay I don't have a pet monkey, but if I did) could be trained to sign out colon tubular adenomas. Even I cannot pretend you need a pathologist for primary screening purposes for many routine biopsy cases, or furthermore that physician extenders need an md to learn how to read them. I suppose its analogous to both heme and cyto, which already use a multi-teared screening process for specimens.
Mindy
Thank you for your input and excellent discussion--very appreciated. I am surprised that you review microscopy...but I know that my pet monkey (okay I don't have a pet monkey, but if I did) could be trained to sign out colon tubular adenomas. Even I cannot pretend you need a pathologist for primary screening purposes for many routine biopsy cases, or furthermore that physician extenders need an md to learn how to read them. I suppose its analogous to both heme and cyto, which already use a multi-teared screening process for specimens.
Mindy
A
anencephalic
Mindy,
While it is true that some aspects of pathology do have a tiered system of screening (i.e. cytotechs for gyn's, med techs reading CBC's & diffs), I don't believe that allowing PAs to screen micros for surg path would be an plausible expectation now or in the future. Again, their main function would be grossing surgicals and prosecting autopsies which in some institutions can be an all day affair, if not longer.
In regards to routine sign-outs (i.e. hyperplastic polyps, tubular adenomas, lipomas, osteoarthritis, etc.) one would be hard pressed to argue against the fact that recognizing these conditions can be done by individuals who are not MDs but have some degree of histology/pathology experience. Dictations for these are probably even less intellectually challenging, as these become "templated" to a point where almost no thought or effort is put into them ("sections of intact colonic mucosa show increased numbers of tubules per unit area...." or " Sections of articular bone show severe fragmentation and fissuring of the hyaline matrix with subjacent trabecular bone sclerosis..."). This is not to detract from the clinical significance of their pathology (or lack thereof), but instead represent specimens with which a high degree of familiarity has been developed.
That being said, I personally would never venture to diagnose some of the more esoteric entities out there (and there are many!)...I'll leave that to the pathologists (but that doesn't mean I won't be on the other end of the double-headed scope taking notes!
).
Aloha,
While it is true that some aspects of pathology do have a tiered system of screening (i.e. cytotechs for gyn's, med techs reading CBC's & diffs), I don't believe that allowing PAs to screen micros for surg path would be an plausible expectation now or in the future. Again, their main function would be grossing surgicals and prosecting autopsies which in some institutions can be an all day affair, if not longer.
In regards to routine sign-outs (i.e. hyperplastic polyps, tubular adenomas, lipomas, osteoarthritis, etc.) one would be hard pressed to argue against the fact that recognizing these conditions can be done by individuals who are not MDs but have some degree of histology/pathology experience. Dictations for these are probably even less intellectually challenging, as these become "templated" to a point where almost no thought or effort is put into them ("sections of intact colonic mucosa show increased numbers of tubules per unit area...." or " Sections of articular bone show severe fragmentation and fissuring of the hyaline matrix with subjacent trabecular bone sclerosis..."). This is not to detract from the clinical significance of their pathology (or lack thereof), but instead represent specimens with which a high degree of familiarity has been developed.
That being said, I personally would never venture to diagnose some of the more esoteric entities out there (and there are many!)...I'll leave that to the pathologists (but that doesn't mean I won't be on the other end of the double-headed scope taking notes!
).Aloha,
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"Other specialties that have such a threat, such as family and psychiatry, tend to worry that a certain alternatively trained group can actually do their job as well or better (or cheaper) than they can"
Mindy, I briefly interject in this thread just to note that, for the time being, I have to say that it doesn't feel like psychiatrists feel like their position is threatened, since they cannot be replaced by psychologists nor social workers. There are certain areas of overlap, just like in other medical specialties (psychotherapy, psychological testing), but where I live the comprehensiveness of the education of psychiatrists and their prominent role as case managers is not in question.
Is this happening in your country?
I would be interested in knowing, since where I live the trends from the US arrive with 5-6 years of delay, and I'd like to prepare myself for such a change
psydoc
Mindy, I briefly interject in this thread just to note that, for the time being, I have to say that it doesn't feel like psychiatrists feel like their position is threatened, since they cannot be replaced by psychologists nor social workers. There are certain areas of overlap, just like in other medical specialties (psychotherapy, psychological testing), but where I live the comprehensiveness of the education of psychiatrists and their prominent role as case managers is not in question.
Is this happening in your country?
I would be interested in knowing, since where I live the trends from the US arrive with 5-6 years of delay, and I'd like to prepare myself for such a change
psydoc
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psydoc,
you must not live in New Mexico. In that state, psychologists get full prescription rights just like MD pscyhiatrists and can do anything an MD can do. This just happened like 2 years ago
you must not live in New Mexico. In that state, psychologists get full prescription rights just like MD pscyhiatrists and can do anything an MD can do. This just happened like 2 years ago
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MAcGyver,
The law you are referring to took effect in july 2002.
New Mexico is the only state in which this is possible, and the prescribing privilege is gained through an amount of classroom training and a supervised practicum. After that, the psychologist gains a "conditional prescription certificate", which will be in effect for two years in which he will prescribe psychotropic drugs under the supervision of a physician.
Psychologists do not seem too eager to follow this path, as the New Mexico Psychological Association's Task Force for Prescriptive Authority reported a survey that indicated that only 50 psychologists were somewhat interested in the program, a dozen of whom were "considerably interested".
To my knowledge, in the rest of the world, remains valid what I have said in my previous post.
In Italy, where I live, no psychiatrist has the remotest fear that his place be taken by a non-physician (though many psychologists work in the mental health system).
I am eager to know what is the situation in other countries, and I think I will take this question to the appropriate forum.
The law you are referring to took effect in july 2002.
New Mexico is the only state in which this is possible, and the prescribing privilege is gained through an amount of classroom training and a supervised practicum. After that, the psychologist gains a "conditional prescription certificate", which will be in effect for two years in which he will prescribe psychotropic drugs under the supervision of a physician.
Psychologists do not seem too eager to follow this path, as the New Mexico Psychological Association's Task Force for Prescriptive Authority reported a survey that indicated that only 50 psychologists were somewhat interested in the program, a dozen of whom were "considerably interested".
To my knowledge, in the rest of the world, remains valid what I have said in my previous post.
In Italy, where I live, no psychiatrist has the remotest fear that his place be taken by a non-physician (though many psychologists work in the mental health system).
I am eager to know what is the situation in other countries, and I think I will take this question to the appropriate forum.
-->Hi, there. I am currently trying to decide if Medical School or the PA route is right for me. I also was concerned that if I go the PA route, how I might further pursue Medical School at a later time? Can you give me any advice on why you chose to pursue medical school after being a PA? Did you have to start from the ground up in Medical school or since you had your PA, were able to bypass some of the beginning courses in medical school? Did your med school require that your courses under your bachelor's degree be within a certain time frame?
Any help is welcomed
Just so we're all on the same page, this discussion is about pathologist assistants, not physician assistants.-->Hi, there. I am currently trying to decide if Medical School or the PA route is right for me. I also was concerned that if I go the PA route, how I might further pursue Medical School at a later time? Can you give me any advice on why you chose to pursue medical school after being a PA? Did you have to start from the ground up in Medical school or since you had your PA, were able to bypass some of the beginning courses in medical school? Did your med school require that your courses under your bachelor's degree be within a certain time frame?
Any help is welcomed
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-->Hi, there. I am currently trying to decide if Medical School or the PA route is right for me. I also was concerned that if I go the PA route, how I might further pursue Medical School at a later time? Can you give me any advice on why you chose to pursue medical school after being a PA? Did you have to start from the ground up in Medical school or since you had your PA, were able to bypass some of the beginning courses in medical school? Did your med school require that your courses under your bachelor's degree be within a certain time frame?
Any help is welcomed
There is some overlap here, but ultimately they are fairly different jobs. There are pros and cons to both. That said, I wouldn't do PA school and then plan to go to med school afterward. If you want to be a doctor, go to med school now. You will not get credit for PA coursework. Why don't you explain what you are looking for in a career and where you are in life, and that may allow us to give you better advice.
