RE: PA Job Description

From:"Charles.Embrey"

Tammy, I'm sorry but where, in anything that I said, did I say that one job is more important than the other?  For the record- I personally feel that all jobs within the histology lab are important, interrelated and crucial to getting out the proper diagnosis for the patient.  Everyone in my department from the pathologist to the lab assistant is deserving and should receive the utmost respect.  We are truly all on the same team.

Charles R. Embrey Jr. PathAssist(AAPA), HT(ASCP)
Histology Manager
Carle Clinic, Urbana Illinois 

-----Original Message-----
From: Barnhart, Tammy [mailto:Tbarnhart@primecare.org]
Sent: Tuesday, June 24, 2003 10:07 AM
To: 'Charles.Embrey'; Barnhart, Tammy; 'Soto, Roxanne'
Cc: 'histonet@pathology.swmed.edu'
Subject: RE: PA Job Description

Charles,
      I am not sure if there are state laws governing PAs in Illinois, but I do know physician assistants, nurse practitioners and nurse anesthetists must be licensed to practice.  They also require considerable more education to get that license. There is not licensing for pathologists assistants.  In fact, there is no real credentialing at all.  The AAPA offers a fellowship, but it is just a professional society and can't offer "real" credentialing.  Right now the only laws governing who can perform gross examination of tissues are the CLIA '88 rules for high complexity testing. I understand that the ASCP is considering adding a PA registry, that is a good thing!  I too, am listed on our hospitals malpractice policy, as are the med-techs and nurses.
      I do not want to "put down" the profession of pathologists' assistant, it is a very demanding and complex job that should get respect.  I have done it for 18 years.  I just am trying to explain how come, in my view, there is so much animosity between histotechs and PAs.
      And, yes, I am a some kind of super histotechnologist.  I gross, eviscerate at autopsy, photograph, organize tumor conference (in fact, do all the items you listed), microtomy, special stains, immunohistochemistry, embed, equipment maintenance, budget, hire, counsel, ...............and passed the grueling HTL exam.
      We need to work together to get the respect the histology profession deserves.  Not keep arguing over who is doing the more important job.  It is meaningless and serves no one.
 
     The last I am commenting on this tread...
 
Tammy Barnhart, BS, HTL(ASCP)
Anatomic Pathology Supervisor
Bismarck, ND
tbarnhart@primecare.org
-----Original Message-----
From: Charles.Embrey [mailto:Charles.Embrey@carle.com]
Sent: Tuesday, June 24, 2003 9:21 AM
To: 'Barnhart, Tammy'; Charles.Embrey; 'Soto, Roxanne'
Cc: 'histonet@pathology.swmed.edu'
Subject: RE: PA Job Description

Tammy, I can appreciate your comments however they may be a little dated.  PAs can be sued for malpractice and many do carry their own malpractice insurance.  As a matter of law the pathologist is responsible for his diagnosis but if it can be determined that the specimen was grossly mismanaged by the PA  he/she can be held liable in court.  My name is listed on the medical malpractice insurance policy for my hospital and I had to go through the credentialing process to practice here.  I am listed officially as a physician extender as are the physician assistants, nurse practitioners, and nurse anesthetists.  The Pathologists' Assistant assists the pathologist.  Sure he is a part of the histology team but his duties more closely reflect those of the pathologists and not the histotech.  That is why PAs are taught how to do fine needle aspiration and chart review and not how to cut and stain slides.  We are all part of the same team to help the pathologist get out the proper diagnosis. I do not, even for a minute, think that I am a pathologist but on the other hand I am not some kind of super histotechnologist.  I spent about 20 years as an HT and have been an AAPA fellow for the past four years and I can attest that the jobs are very different.  I am the Histology manager here purely because I fully understand both jobs and have the experience.  I report directly to the pathologist.  The Pathologists' Assistant has grown into a real profession and is no longer just a grossing tech. You said that you are eligible to be an AAPA Fellow.  Your background and education may make you eligible to be an AAPA Affiliate Member but you have to pass the grueling fellowship exam to be eligible to be a fellow.

Charles R. Embrey Jr. PathAssist(AAPA), HT(ASCP)
Histology Manager
Carle Clinic, Urbana Illinois 


From: Barnhart, Tammy [mailto:Tbarnhart@primecare.org]
Sent: Tuesday, June 24, 2003 7:23 AM
To: 'Charles.Embrey'; 'Soto, Roxanne'
Cc: 'histonet@pathology.swmed.edu'
Subject: RE: PA Job Description

I really hate to wade into this conversation, I'll regret it I'm sure.  However, I have been to many labs where the relationship between the PA and the rest of the staff is terrible and effects productivity and efficiency.  In fact, almost every lab I have visited that has a PA seems to have the same problem.  As I talked to staff about how come there is this conflict, I have gotten the same answer time and time again. "The PA thinks he/she is a Pathologist and refuses to help others when they are not busy" or "I am a PA, I am paid too much to be doing that type of work". Charles, I appreciate what you say in your response, about taking care of the gross bench.  But I think the problem is illustrated by your comment on malpractice.  A PA cannot commit true malpractice, all their work is signed off on by a Pathologist.  Only the Pathologist can commit malpractice.  A PA does not need to carry individual malpractice insurance.  What you have implied is that you are a physician. The PA does have a unique relationship with the Pathologist.  This will sometimes lead to resentment by the rest of the staff at no fault of the PA. Although I am a HTL, I have also performed PA duties (sometimes being the sole PA) for many years.  I am eligible to be a fellow with the AAPA.  I now manage a lab that has had a PA for over 20 years.  When I first arrived, there was that classic resentment from both sides.  The PA would be swamped and get no help from staff, or the lab would be nuts and the PA would take a 2 hour lunch.  It was a mess.  Although the original PA could not tolerate the transition of reporting to me vs the Pathologists and no longer works here, we now a system where the "main" PA is responsible for the bulk of the gross (getting help when needed), but is cross-trained to help with histology duties as needed.  The degreed staff is cross-trained to help with gross when things get busy or the PA needs a vacation.  In other words, we are a team.  Yes, some are paid better than others.  I try to match the education and pay to duties, but the reality is the work must get done and the patient and Pathologist don't care how much money you are taking home.
 
I believe there is a attitude among some PAs that they are not really a member of the Histology lab, but one of the Pathologists' team.  The problem with that attitude is that unlike the Pathologists, they spend their day in the histology lab interacting with the rest of the staff.  Like it or not, they are part of the histology team.  Until they accept the rest of the staff's jobs as being equally important to patient care, the conflict will continue and productivity will suffer.
 
Apologies to all I have offended and all those great PAs out there.
 
Tammy Barnhart, BS, HTL(ASCP)
Anatomic Pathology Supervisor
St. Alexius Medical Center
Bismarck, ND
tbarnhart@primecare.org
-----Original Message-----
From: Charles.Embrey [mailto:Charles.Embrey@carle.com]
Sent: Monday, June 23, 2003 2:10 PM
To: 'Soto, Roxanne'
Cc: 'histonet@pathology.swmed.edu'
Subject: RE: PA Job Description

I'm sorry to hear of your difficulties.  It sounds like your PAs have gotten a little spoiled and lazy.  When I first took my job here the techs had one person assigned to help the pathologist gross in much the same way as you described (they even had the tech turn the specimen order forms over as they grossed).  I stopped that practice and pretty much gross alone.  I make extra cassettes if I need them and close my own cassettes.  Anyone grossing should double-check the case number and name.  If a PA is grossing cases without checking the info then he is committing malpractice.  The lab aids do set up the cases but that is all they do.  I clean my own instruments between cases and hope that I would never ask to be "Babysat" as your folks are.  It embarrasses me that things like that happen.  As far as the processors most PAs have very limited knowledge of histology itself and have never processed tissue, cut slides or done any staining.  It's just not in the training.
Don't worry, as much as I would like to call your PAs up on their actions, I won't post this on the PA webserver.
Chuck
-----Original Message-----
From: Soto, Roxanne [mailto:RSoto@covhealth.org]
Sent: Monday, June 23, 2003 12:04 PM
To: 'Charles.Embrey'; 'Rushing, Roxane'; 'histonet@pathology.swmed.edu'
Subject: RE: PA Job Description

I have been following this posting on the PA duties and I have a question.  I have read the job description that Charles sent and I am very confused about this.  Can you tell me what exactly the PA's do at your sites?  We are a multi-sited system and we have 4 PA's and 2 sites have 2 PA's in the morning and the other 2 sites have 1 in the afternoon.  The PA's that we have do not always verify the accession number is correct or that it matches the reqs (as this is a lab aide job and they are PA's and it is not their job to verify the lab aides work).  We have to have a Lab Aide work with each PA, side by side, to close cassettes, clean instruments between specimens, etc.  So, I have to pay these lab aides for full time work to stand by the PA all day to basically make and close the cassettes.  I even had one PA tell me that they were unfamiliar with the processors.  They do no filing, no maintenance of equipment, no cleaning.  We even have 1 site that if a PA calls out sick we need to send a histologists to be there all day to act as a lab aide because they can't, or won't, do it one their own.  Is this typical?
 
One more thing----please do not copy this and put it on the PA list-server, as I do not want, nor do I need, any more problems with our PA's.
Roxanne
-----Original Message-----
From: Charles.Embrey [mailto:Charles.Embrey@carle.com]
Sent: Monday, June 23, 2003 10:54 AM
To: 'Rushing, Roxane'; 'histonet@pathology.swmed.edu'
Subject: RE: PA Job Description

PROFESSIONAL RESPONSIBILITIES OF PATHOLOGISTS' ASSISTANTS
Based on the AAPA Code of Regulations and reviewed by a committee of the American Society of Clinical Pathologists (ASCP) in 1994

At the direction and under the supervision of a Pathologist(s), a Pathologists' Assistant may perform the following tasks and assume the responsibility for duties including the following:

bullet Preparation, gross description and dissection of human tissue surgical specimens including:

A. Assuring appropriate specimen accessioning.

B. Obtaining clinical history, including scans, x-rays, laboratory data, etc.

C. Describing gross anatomic features, dissecting surgical specimens, and preparing tissues for histologic processing.

D. Obtaining biological specimens such as blood, tissue and toxicological material for studies such as flow cytometry, image analysis, immunohistochemistry etc., and performing special procedures including Faxitron imaging and tumor triage.

E. Photographing all pertinent gross specimens and microscopic slides.

F. Performing duties relating to the administrative maintenance of surgical pathology protocols, reports and data, including the filing of reports, protocols, photographic and microscopic slides; assuring the completion of specimen coding; and billing.

G. Assuring proper maintenance of equipment, provision of adequate supplies, and cleanliness of the surgical pathology suite.

H. Assisting in the organization and coordination of anatomic pathology conferences.

bullet Preparation of human postmortem examinations including:

A. Ascertaining proper legal authorization for autopsy.

B. Retrieving the patient's medical chart and other pertinent data for review with the attending pathologist(s).

C. Conferring with the attending pathologist(s) to identify any special techniques and procedures to be utilized in the completion of the postmortem examination, (e.g. cultures; smears; histochemical, immunofluorescence, toxicological, viral, or electron microscopy studies etc.), and notifying all personnel directly involved.

D. Notifying the physician in charge, the funeral home, and all other appropriate authorities prior to the beginning of the autopsy; and coordinating any requests for special specimen sampling (e.g. organ transplantation, research, etc.).

E. Performing postmortem examinations which may include: external examination; in situ organ inspection; evisceration; dissection and dictation or recording of data such as organ weights, presence of body fluids etc., and gross anatomic findings.

F. Selecting, preparing and submitting appropriate gross tissue sections for frozen section analysis as well as for light, electron and immunofluorescent microscopy.

G. Obtaining biological specimens such as blood, tissue and toxicological material for studies including flow cytometry, image analysis, immunohistochemistry etc.; and performing special procedures such as coronary artery perfusion, central nervous system perfusion, enucleation, inner ear bone dissection, spinal cord removal, etc.

H. Photographing the body, organs, microscopic slides and other pertinent materials.

I. Gathering and organizing clinical information and data pertinent to the preparation of the preliminary summarization of the clinical history.

J. Preparing the body for release (including indicating the presence of biohazards such as contagious disease, radiation implants, etc.), and releasing the body to the appropriate mortuary or funeral home representative.

K. Performing duties related to administrative maintenance of anatomic pathology protocols; photographic and microscopic slides; and assuring the completion of coding.

L. Assisting in the organization and coordination of anatomic pathology conferences.

M. Assuring the proper maintenance of equipment, the provision of adequate supplies, and the cleanliness of the autopsy suite.

bullet Performing such administrative, budgetary, supervisory, teaching, and other duties as may be assigned.
-----Original Message-----
From: Rushing, Roxane [mailto:RRushing@pathgroupla.com]
Sent: Monday, June 23, 2003 10:22 AM
To: 'histonet@pathology.swmed.edu'
Subject: PA Job Description

Do any of you have an official P.A. job description that you would share? (Not lab assistants, Pathologist Assistants, P.A.)

--e-mail or fax to 225-766-6050

 

Thanks in advance,

Roxane Rushing

Pathology Group of La.

 



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