AAPA’s recommended definitions for pathologists’ assistants and grossing technicians
September 2025—It has come to the attention of the American Association of Pathologists’ Assistants that some pathologists and pathology fellows assume the pathologists’ assistant profession is widely licensed, since we are comparable to the nationally licensed physician associates. This is a misconception that I, chair of the AAPA legislative subcommittee, and the AAPA Board of Trustees would like to address with the pathology community.
The macroscopic examination of anatomic specimens is a critical component of pathology. Given its variability and complexity, errors by unqualified personnel have the potential to cause patient harm. Pathologists rely on the expertise of grossing personnel to provide the essential information that guides all subsequent medical decisions, and inadequate examination or improper tissue submission can compromise diagnostic accuracy and limit treatment options.
The pathologists’ assistant profession emerged to alleviate the pathologist workload. PAs complete formal education and training through NAACLS-accredited master’s programs, which equip them with advanced knowledge of pathology and surgical specimen processing. Today, PAs and other nonpathologist personnel perform the majority of grossing tasks, raising important questions about scope of practice, training standards, and regulatory oversight.
A pathologist once told me that diagnosis begins at the bench. To ensure accurate diagnoses, grossing personnel must carefully select and submit critical sections for microscopic evaluation. Even the most skilled histology staff cannot compensate for poorly sampled tissue.
Despite the critical role of grossing personnel, regulations remain minimal. CLIA ’88 classifies grossing as high-complexity testing and requires only an associate degree in laboratory science or medical laboratory technology. Only three states currently license pathologists’ assistants, and their requirements vary significantly. California is the only state that has taken initial steps to differentiate PAs from other grossing personnel by establishing a tiered supervision system. While CLIA-qualified personnel may be adequate for low-complexity cases, such as biopsies that do not require dissection, it is concerning that grossing of moderate- to high-complexity specimens, including cancer resections, remains largely unregulated. Complex specimens require an advanced understanding of pathology because even routine specimens like appendices can harbor unexpected pathologies that inadequately trained personnel could overlook. Assigning high-complexity cases to grossing technicians introduces risk to the patient’s diagnosis, treatment, and prognosis, owing to the nonstandardized education and training of grossing technicians.
The distinct roles of PAs and grossing technicians must be defined clearly. The AAPA’s position statement (https://bit.ly/AAPA-grosstech) recommends that grossing technicians be limited to routine biopsies and low-complexity specimens that do not require selective sampling because of the lack of formal education and standardized training requirements. In contrast, NAACLS-accredited PA programs provide extensive education in pathology, anatomy, and disease processes, as well as more than 10 months of hands-on training in pathology laboratories.
PAs not only perform highly complex grossing but also review patient histories, prosect organs for autopsy, and assist in writing autopsy reports—tasks traditionally handled exclusively by pathologists. In this capacity, PAs function as physician extenders, similar to physician associates and nurse practitioners.
The AAPA recommends the following definitions:
- Pathologists’ assistants must graduate from a NAACLS-accredited program and pass the ASCP board of certification exam and are able to perform macroscopic examinations on all specimens, including high-complexity specimens requiring selective sampling.
- Grossing technicians must meet CLIA-defined high-complexity testing personnel standards, and the scope of work should be limited to the macroscopic examination of small, routine biopsies and low-complexity specimens that require entire tissue submission for microscopic examination without selective sampling.
Licensure or additional regulations should be established to define the PA profession in alignment with these definitions. By formalizing these distinctions, we can ensure the highest standards of patient care while maximizing the skills of all pathology professionals and support attending pathologists.
Details about PA licensure are on the AAPA website (https://bit.ly/AAPA-license). I and the AAPA trustees ask that pathologists support the licensure initiative, when the time comes, if they are so inclined.
Jennifer Hudson, PA(ASCP)CM
Pathologists’ Assistant
VA Northeast Ohio Healthcare System
Cleveland
On behalf of the AAPA Board of Trustees
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