Every pathology report begins long before a slide reaches the microscope. In anatomic pathology, the accuracy and consistency of the gross examination directly shape the final diagnosis – yet this critical first step remains one of the least standardized areas of the laboratory.
Pathologists bear the full responsibility for the downstream effects of grossing work – including tumor staging, patient prognosis, and treatment plans – regardless of who performed it. To fully protect both patients and pathologists, individuals responsible for grossing must be properly trained, qualified, and held to consistent professional standards. And those standards are best ensured through licensure of pathologists’ assistants (PAs).
PAs are advanced-practice providers in anatomic pathology. In the US, PAs must complete a NAACLS-accredited master’s program. Training includes comprehensive education in gross morphology, pathology, anatomy, staging, and specimen-specific tissue sampling, along with extensive clinical rotations. To obtain and maintain certification, PAs must pass the ASCP Board of Certification examination and complete sixty continuing education credits every three years to ensure ongoing competency.
Licensure transforms these expectations into enforceable standards by establishing a legal threshold for competency, safety, and accountability. It ensures that only those who meet these standards perform the full scope of PA practice. For pathologists, licensure provides a defensible framework that aligns responsibility with training and credentialing.
Without licensure, labs may delegate grossing responsibilities to personnel who, while permitted under CLIA 1988 to perform high-complexity testing, lack the advanced education and training necessary for proper gross examination. Grossing technicians provide valuable laboratory support but receive no formal education in anatomic pathology, hold no national credentials, and have no standardized training or continuing education requirements.
Errors in grossing complex specimen can result in misdiagnoses, inadequate staging, unnecessary surgeries, costly repeat procedures, and inappropriate treatment – outcomes that place pathologists at significant medico-legal risk. This liability is not theoretical, as illustrated by a recent Philadelphia case in which a laboratory error resulted in a $35 million verdict following an unnecessary hysterectomy. In these situations, it is the pathologist whose name appears on the final report who is ultimately held accountable.
Licensure mitigates the risk of errors by ensuring selective tissue sampling and complex specimen are grossed only by qualified, regulated professionals. As well as protecting patients from harm, the system reduces exposure for pathologists and institutions alike. In today’s regulatory environment, focused on quality and patient safety, reliance on unregulated grossing personnel is no longer acceptable.
Importantly, licensure does not alter or expand PA scope of practice. PAs are not physicians and cannot diagnose, sign out cases, or bill for diagnostic work. They perform technical tasks within boundaries already defined by CLIA, CAP, and state regulations, under pathologist supervision. In states with PA licensure, supervisory structures remain unchanged. Licensure simply guarantees that the supervised professional meets standardized qualifications, is accountable to an external regulatory board and practices within clearly defined, enforceable practice parameters, providing pathologists with an added layer of protection and clarity.
While pathology faces a projected 30 percent decline in workforce, the demands of personalized medicine continue to grow. Rising case volumes and advances in molecular, genetic, and specialized diagnostic techniques have significantly expanded the scope and complexity of pathologists’ workload, leaving less time for gross examination. Utilizing well-trained, licensed PAs for grossing and processing specimen allows pathologists to focus on diagnostic responsibilities that guide clinical decision-making. Licensure ensures pathologists have a safe, reliable workforce with consistent qualifications at a time when pathology cannot afford inefficiency.
Concerns about hiring limitations have not materialized in US states with PA licensure. NAACLS-accredited programs have doubled, producing more than 230 graduates annually, and job demand for PAs remains strong. Licensure stabilizes hiring by protecting the PA title, preventing misrepresentation, and centralizing credential verification. It establishes clear, differentiated pathways for non-PA grossing personnel, reducing ambiguity and risk for pathologists and employers.
Licensing aligns PAs with the broader healthcare system, where nearly all professions involved in high-risk diagnostic processes are regulated. The absence of PA licensure leaves a vulnerable gap in the diagnostic chain that exposes pathologists to liability without any safeguards. Licensure is not an expansion of PA authority or an administrative burden; it is a risk-reduction strategy and the natural evolution of a profession integral to safe, accurate patient care.
In a field where specimens truly deserve standards, licensure is the mechanism that delivers them. Patients deserve assurance that their tissue is handled by qualified, licensedprofessionals, so that diagnoses, treatment decisions, and prognoses are reliable.
Pathologists deserve a workforce they can rely on. And the PA profession deserves the recognition and regulation that reflect its expertise, complexity, and significance in modern medicine.
For more details on PA licensure, visit the AAPA’s resource page: Why Licensure.
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