Over the weekend, while I was timing at my daughter’s swim meet, I was reminded of a pathologist's assistant (PA) I knew, who owned a stopwatch. This person used to stand behind pathology residents and PAs, timing how long they took to gross specimens, to ensure they were working fast enough.
This anecdote highlights the ongoing emphasis on efficiency and accuracy in surgical pathology. While these two goals are essential, the dynamics of the gross room can vary tremendously between institutions, something many pathologists may not fully appreciate, especially when their primary concern is often the bottom line.
When collecting data or averages for specimen grossing times, there are many variables that can significantly influence the outcomes. For example, the experience level and training quality of the PA can make a major difference – there is a big gap between a seasoned PA and one with just two years of experience. Additionally, the definition of when grossing time starts and stops can vary: is it when dictation begins, when the blade first touches tissue, when all cassette lids are closed, or when cassettes are scanned and placed in formalin?
Individual personality traits also play a role. A PA might be an overthinker, anxiety-prone, neurodivergent, easily distracted, or extremely focused. Generational differences and work styles can further impact efficiency. Circumstantial factors like using standard cassettes versus paraform auto-embedding blocks, paper versus electronic requisitions, or lab assistants incorrectly coding specimens also add variability. Sometimes there are too many cassettes, other times, not enough.
Environmental distractions are another significant influence. Some gross rooms are quiet and focused, while others are filled with constant chatter. Equipment issues – such as a cassette printer that needs to be tapped or shaken to advance – can slow down the process. Additionally, constant interruptions from lab or operating room staff seeking help with specimen coding or triage, along with the responsibility of teaching students or residents, can all impact productivity.
Logistical considerations are important too. The proximity of equipment like Kubtec or radiology, or access to special reagents like decal, rapid decal, or EDTA, can either streamline or hinder workflow. Style and shortcuts also matter – whether a PA uses blade handles, rinses blades between cuts on necrotic tumors, checks history on every case, or how they process GI biopsies (e.g., pouring formalin through a tea bag vs. individual wrapping), all influence time. Do they wait for ink to dry or use a mordant and wait several minutes? Do they find every lymph node or stop at 12?
Institutional practices add yet another layer of complexity. Sampling percentages, photo documentation, use of annotations or radiographic imaging (e.g., breast markers or Essure coils), whether specimens are pre-inked by surgeons, and if they are already opened or inked – all of these affect the grossing process. Do you scan cassettes yourself? Are you in a supervisory role that requires constant email checking throughout the day?
Even dictation methods make a difference. Whether you use Dragon, standard dictation, or templates, and whether you check and edit your work hours later – all of these could be considered part of the grossing time, depending on how it is measured.
In my experience, the actual surgical pathology portion of the job is not the hard part. It is all the background noise – the interruptions, logistics, personalities, and institutional quirks – that make things truly challenging.
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