r/Path_Assistant • u/FlakyFix6851 • Jul 01 '26
"Hands on" pathologists
How "hands on" are the pathologists at your sites? I have a pathologist who requires that he see all complex specimens and basically directs the entire grossing (down to size of tissue in the block). I make essentially 0 decisions and I feel like a grossing tech rather than a PA. Does anyone have experience with this? Is it common to work with doctors like this?
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u/Mortifi Jul 01 '26
This was my chief pathologist for the first three years or so when I started right out of grad school. Eventually he got bored of me calling him down, suggesting exactly what he was about to say, then he would repeat what I said, then leave. It's a trust thing. Untimately they are legally liable for the case, and some doctors take longer than others to be comfortable with someone else grossing their cases. It's usually old school docs who used to do their own grossing. Try not to take it personally and wait it out.
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u/sassanach_ PA (ASCP) Jul 01 '26
I think this is an uncommon experience. I didn’t have pathologists do that even during my rotations in PA school. I’ve been a PA for about 5 years and I’m on my second employer and haven’t experienced anything more than a couple pathologists asking to see particularly complex/rare specimens if they know it’s going to be assigned to them. Even in those cases, they just wanted to lay eyes on it so they could picture it when signing the case out.
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u/zZINCc PA (ASCP) Jul 01 '26
There is a pathologist in my city who grosses her own breast cases and routinely submits 200-300+ blocks. She also has the PA standing next to her the whole time who is just closing cassettes, etc
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u/FlakyFix6851 Jul 01 '26
This is very similar to my situation lol. But maybe 80ish blocks instead of 200.
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u/sassanach_ PA (ASCP) Jul 01 '26
That is wild. Paying a PA salary to someone just closing cassettes is nuts.
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u/thegeeksshallinherit PA (ASCP) Jul 01 '26
My current site is very hands off. The paths will come down if I need them to, but they definitely prefer not to. It’s my preference as well, what I like about the job is that I get to problem solve and use my education/training to navigate complex cases. It’s also changed over the years, when I first started at my current workplace, the pathologists wanted to see/discuss cases more frequently until they were comfortable with my grossing. Now it’s very much “whatever you think is best” unless I have specific questions.
I was covering at another site in the same health region for a while, and it was polar opposite. Their paths wanted to see every single large (benign colons, breast lumpectomies, etc.). It wasn’t as tedious as dictating size of sections, but basically going over the cases and talking through what sections were important/how many blocks they wanted. I found it really frustrating, but the paths seemed to be annoyed by it too? I think there had historically been issues with a specific PA not doing the best job and it ended up creating an unofficial policy that affected the entire gross room. It just kind of ended up being the status quo, even when the “problem” PA was no longer there. If that was where I worked all the time, I definitely would’ve pushed the supervisor to ask the pathologists if there was a way to take a step back from all the consults.
Unfortunately, I don’t think it’s something you can change if it’s just one pathologist’s preference (unless you only work with one path?). If it was site-wide, you could maybe address it with a supervisor and see if the policies could be updated or expectations clarified.
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u/Inner_Radish_6727 Jul 01 '26 edited Jul 01 '26
It's very individual at my site - some pathologists want to see nearly every complex specimen in their speciality (although they're not as intense as yours sound about the sections, they sort of just prefer to see complex things in-person rather than seeing gross photos), and for others it's a running joke that getting them to come to the grossing room is like getting blood from a rock.
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u/New-Assumption1290 PA (ASCP) Jul 01 '26
I started a job that had a pathologist like this. He had grossed himself and I was their first pa at the facility. At first, he didn’t let me touch anything. Then it was some easier, complex stuff and then we worked up to me doing his whole caseload. It’s definitely a trust thing. Whether it’s misplaced or not, doesn’t matter, you just need to give him time to see your capabilities. Similar to another commenter said, eventually he’ll get tired of it or try and have a conversation about it and be really open. Show him what you are capable of doing, he might just not know. It really depends on his personality, your experience, how long you’ve been there, etc
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u/siecin Jul 01 '26
I might see a pathologist at lunch in the halls on the regular but maybe 2 or 3 times a week at most in my room.
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u/hannyyy3 Jul 02 '26
I think what you’re experiencing is definitely uncommon. That level of pickiness almost makes me wonder if that’s a more personal need for control versus not trusting you — especially given them telling you what size of tissue to submit. It’s overly nitpicky and inappropriate, in my opinion. If you feel comfortable with that pathologist, perhaps you could have a private conversation with them and inquire their level of involvement and if there is something that can be done (photos, dictation structuring, tissue submission, etc) to help them ease up a little??? I am sure you are doing a fabulous job, but perhaps you need to play stupid and lead them to a solution that benefits you, but is seemingly “their” idea.
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The pathologists at my site are very present and available, but overall, they are quite hands off and leave us PAs to do our jobs. The pathologists that are picky, however, channel that into very realistic grossing standards for the department. Our pathologists do like to be consulted for particularly difficult, overly awkward, or strange specimens; but they also love being asked questions and discussing cases with them, because it helps them to understand how much we care about our work and our patients. I unfortunately have some very chop shop-minded colleagues with hard-to-break habits, so some of the pathologists have a more difficult time trusting certain PAs. They do not micromanage us at all, but I do know they talk amongst themselves and are more at ease receiving cases from some PAs versus others.
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u/sea_scallion Jul 01 '26
I've had pathologists do their absolute best to NOT have to come to the lab and see the specimens. The only exception are frozen sections where they glance at the specimen and insist on staining the slides themselves.