St. Paul, MN – The American Association of Pathologists’ Assistants (AAPA) is pleased to announce the formation of the AAPA Macroscopic Examination Guidelines: Utilization of the CAP Cancer Protocols at the Surgical Gross Bench (Grossing Guidelines) Editorial Board.  The Editorial Board is composed of Pathologists’ Assistants from diverse backgrounds and areas of expertise and is committed to the success of the Grossing Guidelines.  These individuals serve as ambassadors of the Grossing Guidelines, will provide peer review and support to protocol authors, and will determine the Grossing Guidelines mission, vision, and core values as we navigate toward anticipated enhancements with our fourth edition.

The Grossing Guidelines serve patients by ensuring that the macroscopic examination of cancer resection specimens is compliant with the most up-to-date College of American Pathologists (CAP) Cancer Protocols and the American Joint Committee on Cancer (AJCC) Cancer Staging System.  They are based on specified relevant source documents, drafted by Pathologists’ Assistant experts, and supported by the information provided by the CAP, AJCC, and other peer-reviewed references.

Fourth Edition Grossing Guidelines Editorial Board

Section Authors

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The American Association of Pathologists' Assistants was founded in 1972 as a not-for-profit volunteer organization of allied health practitioners dedicated to the advocacy and advancement of the pathologists' assistant profession.  The AAPA advocates, promotes, and sustains the highest education and professional standards for the profession, for all associated educational training programs, and for individual pathologists' assistants.  It is our mission to provide our members with high quality, targeted continuing education (CE) opportunities, as well as professional development and leadership activities to include networking and support.  Additionally, the AAPA strives to promote and support high quality standards within the scope of practice for pathologists' assistants in anatomic pathology, ensuring the provision of high quality patient care.

The AAPA Macroscopic Examination Guidelines have been created for use by all those involved in the macroscopic handling of surgical cancer cases including pathologists’ assistants, pathology residents, and pathologists.  Access to the Grossing Guidelines is limited to laboratory personnel including pathologists’ assistants, pathology residents, and pathologists directly involved in grossing cancer resection specimens.  Visit the AAPA website www.pathassist.org and click on the Grossing Guidelines tab for more details.

For more information, contact Connie Thorpe, PA(ASCP)^CM, Director of Professional Development, at professionaldev@pathassist.org.

Statement

The utilization of grossing technicians, biopsy technicians, or other personnel with similar titles and training to assist with the macroscopic examination of routine, low-complexity specimens is relatively common and can be valuable in high volume anatomic pathology laboratories. In consideration of workforce shortages, grossing technicians can free up pathologists’ assistants to examine more complex specimen types, perform autopsies, and other tasks within their scope of practice. The background and education of non-certified grossing personnel is varied and unregulated leading to nonstandard levels of competency. As a result, the scope of work for grossing technicians in surgical pathology must be limited to the macroscopic examination of routine biopsies and low-complexity specimens that do not require selective sampling. This work must be done under direct supervision by those with formal education and qualifications. For a workload that supports delineation of responsibilities for grossing technicians, the AAPA offers these proposed grossing technician duties and responsibilities as a recommendation.

Proposed Grossing Technician Duties and Responsibilities

Preanalytical Tasks

• Transports specimens from surgery to the anatomic pathology laboratory
• Receives specimens in the anatomic pathology laboratory
• Enters patient information into the laboratory information system, verifying identification
• Accessions specimens and labels specimen containers and requisitions with accession/laboratory numbers
• Labels cassettes with accession/laboratory numbers
• Performs quality control and quality assurance procedures, such as preventive maintenance and temperature checks
• Conducts a daily morgue census and verifies if an autopsy has been requested
• Maintains a clean and well-organized work area
• Performs various clerical duties

Analytical Tasks

• Always maintains strict confidentiality and protects patient information
• Ensures specimen integrity upon receipt and throughout the entire macroscopic examination process
• Performs routine activities involved in the preparation of surgical specimens for histologic processing, according to delineation of privileges, policies, and procedures
• Sets up necessary equipment, supplies, and specimens for macroscopic examination
• Describes gross anatomic features of biopsies or routine, uncomplicated surgical specimens without selective sampling
• Dictates a macroscopic description for routine, uncomplicated surgical specimens without selective sampling, including anatomic site, measurements and dimensions, weight, count, color, and any abnormal findings according to written policies and procedures
• Places tissue in a correctly identified cassette for histologic processing
• Escalates non-routine or complex specimens to the pathologists’ assistant or pathologist
• Assists pathologists’ assistants and pathologists with postmortem examinations

Postanalytical Tasks

• Loads prepared cassettes into a tissue processor and starts the processor
• Maintains cleanliness of the anatomic pathology suite
• Operates and cleans laboratory equipment, instruments, and workstations
• Maintains wet tissue storage
• Stores, rotates, and disposes of all wet tissues in accordance with departmental procedures
• Disinfects and maintains specimen storage cabinets
• Disposes of hazardous chemical wastes per regulatory guidelines
• Properly labels, stores, handles, and disposes of reagents and hazardous wastes according to local, state, and federal regulations; this may include recycling or reprocessing of reagents used in the department including neutralizing formalin before disposal
• Stocks supplies and assists with clerical duties
• Maintains laboratory equipment and tracks all routine maintenance and quality controls performed
• Files, retrieves, and distributes blocks, slides, and pathology reports
• Adheres to CAP, CLIA, state regulations, HIPAA, safety, and OSHA regulations

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The American Association of Pathologists’ Assistants (AAPA) and its members are disgusted by media reports that an unqualified individual has fraudulently taken advantage of grieving families by providing private autopsy services under the guise of a being a self-proclaimed forensics expert and other inappropriate titles, including pathologists’ assistant or PA.  The AAPA would like to make it clear that this individual, Shawn Parcells, is not a qualified pathologists' assistant in any way.  His actions of performing autopsies without appropriate qualifications and without direct supervision by a licensed, board certified anatomic pathologist are against our ethical and professional standards and are outside of our professional scope of practice.

According to news stories, Shawn Parcells faces three counts of theft and three counts of criminal desecration of a body.  He is also being sued by the Kansas attorney general and Kansas Board of Healing Arts, accused of being unqualified to conduct autopsies.  Local media reported an account of a Wichita-area man who, nearly two years ago, paid a man claiming to be a "forensic pathology expert" $3,000 to conduct an autopsy on his wife and help answer questions about her sudden death.  Mr. Parcells is accused of taking thousands of dollars from grieving families and never issuing autopsy reports.  The Kansas attorney general, the Better Business Bureau, and families across the United States call Parcells a scam artist.  "To date, we have 34 that have come forward in 29 different states," says Lacey Langford, in court in Topeka for a hearing in Parcells' case.  Langford says her family became a victim of Parcells after her mother's death.  The Kansas Attorney General's Office won't even identify Parcells as a pathologists’ assistant, saying under Kansas law, he's not qualified.  The word "autopsy" was written in quotes in court documents pertaining to Parcells' case.  Kansas law says pathologists' assistants must work under the supervision of a physician.  Parcells disputes the claim that he's not qualified to do the work with training as a pathologists’ assistant.  Parcells calls the certification examination tied to accreditation "voluntary" and not necessary to do the job.  He says the PAs he knows of are not certified and this is how the industry works.  A judge upheld a temporary restraining order against Parcells, preventing him from conducting autopsies, forensic pathology, or tissue recovery in the state while both a civil lawsuit and a criminal case are pending.

Although he calls himself a pathologists’ assistant and has referenced the AAPA, Shawn Parcells is not a member of the AAPA, nor is he certified by the ASCP-BOC.  Mr. Parcells represents none of the educational, professional, or ethical standards that the AAPA and its members uphold.

A Certified Pathologists’ Assistant is a highly trained allied healthcare professional who is qualified to provide various services in anatomic pathology under the direction and supervision of a licensed, Board Certified, or Board Eligible Anatomic Pathologist.  Although pathologists’ assistants are key partners in assisting the pathologist to arrive at a pathologic diagnosis by examining, dissecting, and sampling surgical specimens in the hospital pathology lab and by participating in autopsies, it is the sole responsibility of the Pathologist to render a diagnosis.  Pathologists’ assistants currently prepare for their roles as a mid-level practitioner in anatomic pathology by successfully completing a NAACLS accredited Pathologists’ Assistant training program leading to a Master’s degree and by passing the American Society for Clinical Pathology Board of Certification (ASCP-BOC) exam.  Prior to 2010, pathologists’ assistants who had received on-the-job training (via a 3-year supervised internship) and had successfully attained certification as a Pathologists’ Assistant from the ASCP-BOC have the same qualifications as NAACLS program-trained individuals and are also capable as mid-level practitioners in anatomic pathology.  The on-the-job training route was discontinued in 2005, and those individuals had until 2010 to pass the ASCP-BOC exam.

Mr. Parcells has never attended a NAACLS accredited Pathologists’ Assistant training program, did not receive on-the-job training through a supervised internship prior to 2010, and has never been eligible to sit for the ASCP-BOC Pathologists’ Assistant Certification exam.  Mr. Parcells may not even be qualified to perform high complexity testing in a clinical or anatomic pathology laboratory under federal CLIA regulations, which represents the minimum education requirement (CLIA requires only an associate degree and minimal laboratory training to perform high complexity testing).

The news reports from Kansas, statements by Mr. Parcells regarding pathologists’ assistants, and his involvement in other high-profile cases in the past while misrepresenting his qualifications is infuriating, is an embarrassment to those who work in pathology, and is damaging to our profession as certified pathologists’ assistants.  Mr. Parcells has no legitimate training and holds no credentials, yet claims to be a pathologists’ assistant and forensics pathology expert.  This misrepresentation of pathologists’ assistants and functioning outside of our scope of practice by this individual and others like him is an affront to every qualified pathologists’ assistant who has invested a great deal of time, effort, and money in themselves to acquire the required didactic and clinical training to become a pathologists’ assistant, prepare for the certification exam, become certified through the ASCP, and maintain their certification through the ASCP credential maintenance program (CMP) which requires completion of 45 continuing education credits per three year period (will increase to 60 credits per three year period effective 2022).  Mr. Parcells misrepresents himself to the public as being qualified and an expert but is not accountable to the institutions that provide the credentials for our profession, claiming that they are “voluntary.”  If he were a member of the AAPA, his membership would be revoked for misconduct according to our bylaws.  He would also likely lose his certification by the ASCP, if he were certified.  If he were licensed, he would lose that as well.  His response to legal actions against him in the state of Kansas is that he will simply move his business to a nearby state and continue to offer private autopsy services using whatever title he can, including pathologists’ assistant.  If state licensure for qualified pathologists’ assistants were in place in Kansas and the 28 other states where he has provided autopsy services, he would not be able to work under the title of pathologists’ assistant and he would surely not be able to perform private autopsies as a pathologists’ assistant. 

Pathologists' assistants are physician extenders or midlevel practitioners just as physician assistants or nurse practitioners are; however, pathologists’ assistants are not licensed in most states.  The profession formed in the late 1960s very soon after the physician assistant profession did.  Since pathologists’ assistants are not primary care providers, and since the profession did not have the same level of support from the American Medical Association that physician assistants historically enjoyed, pathologists’ assistants are licensed in only a few states.  New York is the most recent state to license pathologists’ assistants, with licensing signed into law in 2016.  The work pathologists’ assistants do by examining, dissecting, and sampling surgical specimens in the hospital pathology lab, and participating in autopsies is vital to patient care and to families of the deceased and those medical professionals who provided their care.  The AAPA believes that qualified pathologists' assistants should be licensed to assure quality care, to protect the public, and to provide a legal tool to stop individuals like Shawn Parcells from taking advantage of grieving families. 

About the AAPA: The American Association of Pathologists' Assistants (AAPA) was founded in 1972 as a not-for-profit volunteer organization of allied health practitioners dedicated to the advocacy and advancement of the pathologists' assistant profession.  The AAPA advocates, promotes and sustains the highest education and professional standards for the profession, for all associated educational training programs and for individual pathologists' assistants.  It is our mission to provide our members with high quality, targeted continuing education (CE) opportunities, as well as professional development and leadership activities to include networking and support.  Additionally, the AAPA strives to promote and support high-quality standards within the scope of practice for pathologists' assistants in anatomic pathology, ensuring the provision of high-quality patient care.  There are approximately 2,500 ASCP certified pathologists’ assistants practicing in hospitals and labs throughout the United States.  Approximately 50 of these are certified PAs working internationally in Canada, New Zealand, and Australia.  The AAPA as a whole represents 2,000 certified or certification exam eligible members.  The AAPA is an organizational member of the ASCP, the American Joint Committee on Cancer (AJCC), the Commission on Cancer (CoC), and the National Accrediting Agency for Clinical Laboratory Science (NAACLS).

References:

1. The Wichita Eagle: Kansas Man Accused of Tricking Grieving Families and Performing Illegal Autopsies.  https://www.kansas.com/news/local/crime/article228480939.html
   
   
2. KWCH12: Court Decision Upheld Against Man Accused of Defrauding Families in Mourning.  https://www.kwch.com/content/news/Decision-upheld-to-bar-forensic-pathology-expert-from-conducting-autopsies-in-KS-508831211.html
   
   
3. American Association of Pathologists’ Assistants: Pathologists’ Assistants Scope of Practice – updated 9/2018:  https://cdn.ymaws.com/www.pathassist.org/resource/resmgr/docs/2018_-_scope_of_practice.pdf

The AAPA understands that in order to prevent disruption of the medical laboratory workforce, laboratory personnel licensure bills often include “grandfathering provisions” to allow individuals who have established careers as laboratory personnel to continue working at their current professional levels.  At a minimum, any Pathologists’ Assistant working under a “grandfathering provision” must meet CLIA requirements for high complexity testing.

The AAPA has been informed that individuals functioning as biopsy technicians have been incorrectly granted a Pathologists’ Assistant license.  The AAPA does not wish these individuals to be prohibited from performing their duties as before and believes these biopsy technicians could still work within their scope of duties under a more appropriate license, such as MLS or histological technician. 

Applicants Applying Under the New York Grandfathering Pathway:

Applicants for licensure under the grandparenting [sic] licensure pathway must satisfy the requirements contained in section 8853 of the Education Law Article 169.  After November 27, 2019, the grandparenting [sic] pathway expires.  However, the licenses issued under it will not.

Licenses may be revoked for professional misconduct or for licenses obtained fraudulently.

From Article 169 Section 8853:

*§8853. Special provisions; eligibility

An individual who meets the requirements for a license as a licensed pathologists’ assistant except for examination and education and who has been performing the duties of a pathologists’ assistant for two of the five years prior to the effective date of this article may be licensed without meeting additional requirements, provided that such individual submits an application to the department within two years of the effective date of this article and prior to November 28, 2019.  For this purpose, the applicant’s supervising physicians, who must practice anatomic pathology, must attest to the applicant’s experience and competence.

Only supervised experience gained between November 28, 2012 and November 28, 2017 may be used to meet the grandparenting [sic] requirements.

*NB Effective November 28, 2017

After this Grandfathering Licensure Pathway has closed, the following qualifications are required:

*§8852. Requirements for licensure as a pathologists’ assistant:

To qualify for licensure as a “licensed pathologists’ assistant,” an applicant shall fulfill the following requirements:

• Education: to meet the education requirements for licensure as a pathologists’ assistant, you must either have successfully completed a bachelor’s or higher degree in a pathologists’ assistant program registered by the Department, or the substantial equivalent thereof, in accordance with the commissioner’s regulations; or have a bachelor’s or higher degree from a National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) accredited pathologists’ assistant program.
• Examination: obtain a passing score on an examination acceptable to the department; the pathologists' assistant certification exam offered by the American Society for Clinical Pathology Board of Certification (ASCP-BOC) is an exam acceptable for licensure.
• Age: at the time of application be at least twenty-one years of age.
• Character: be of good moral character as determined by the department.
• Fee: pay a fee determined by the department for an initial license and for each triennial registration period.

*NB Effective November 28, 2018

Brief New York Licensure History:

As of 2006, Pathologists’ Assistants working in the state of New York have been required to be licensed.  Initially, there was no specific category for licensure for Pathologists’ Assistants in New York state, and Pathologists’ Assistants were instead licensed in other categories.  These routes to licensure were unacceptable to the employers of Pathologists' Assistants, the New York Pathologists’ Assistants, and the AAPA.  These groups, with the aid of the Greater New York Hospital Association, lobbied New York legislators to clarify the status of Pathologists’ Assistants in New York and called for reasonable and practical regulations and licensure specifically for Pathologists’ Assistants.

In late 2016, New York governor, Andrew Cuomo signed a bill creating a licensure category for Pathologists’ Assistants.  This move ensured that only qualified individuals worked as Pathologists’ Assistants in New York.  Enacting this licensing law was to take 1-2 years to become fully effective.  During this waiting period, Pathologists’ Assistants were still required to obtain a limited license as a histological technician until the new Pathologists’ Assistant licenses were available.

As a caveat to this bill, a grandfathering period of 2-years, during which persons who have been practicing in New York for at least two of the five years prior to the effective date of the law would be permitted to become licensed if their supervising physicians attested to their experience and competence.  This has the unintended or intended consequence of allowing grossing/biopsy technicians who are not qualified Pathologists’ Assistants to apply for licensure as Pathologists’ Assistants.  After the grandfathering period is over, any new Pathologists’ Assistant applicant will be required to meet all educational and examination standards of the law in order to obtain a license.  

This provision that allows grossing/biopsy technicians without appropriate training or credentialing to be “grandfather” licensed as Pathologists’ Assistants was introduced by New York State Senator LaValle in the legislature.  He would not introduce the bill to license Pathologists’ Assistants without the loophole that now allows grossing technicians to be licensed as a Pathologists’ Assistant without the examination and education requirements (Section 8853 from Article 169). 

CLIA Regulations:

The personnel qualifications required by CLIA address only the minimal requirements, and the AAPA believes these are insufficient to fully protect patients.  CLIA requires only an associate degree and minimal laboratory training to perform high complexity testing.  The AAPA believes state licensure laws should provide higher standards as the adoption of higher standards will ensure that patients are better protected.

The macroscopic examination of pathology specimens is classified as high complexity testing as set forth in CLIA regulations.

Policy 42 CFR 493.1489 personnel qualifications for high complexity testing, equivalent laboratory training, and experience includes the following:

• Possess a current license issued by the State in which the laboratory is located, if such licensing is required; AND
• Meet one of the following requirements:
  • Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which the laboratory is located or have earned a doctoral, master’s or bachelor’s degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution;
  • Have earned an associate degree in a chemical or biological science, or medical laboratory technology from an accredited institution; OR
  • At least 60 semester hours or equivalent from an accredited institution that, at a minimum includes 24 semester hours of medical laboratory technology courses; OR
  • 24 semester hours of science courses that include six semester hours of chemistry, six semester hours of biology, and 12 semester hours of chemistry, biology, or medical laboratory technology in any combination; AND
  • Laboratory training including either completion of a clinical laboratory training program approved or accredited by the ABHES, NAACLS, or other organization approved by HHS (this training may be included in the 60 semester hours listed above); OR
  • At least three months documented laboratory training in each specialty in which the individual performs high complexity testing.

In essence, a legitimate license acquired during the grandfathering period would meet the definition of CLIA high complexity testing; however, it does not meet the definition of “Pathologists’ Assistant” in the AAPA’s view or the view of our members.

Ultimately, Pathologists’ Assistants must conform to CLIA rules for high complexity testing.  If grandfathered individuals do not meet at least CLIA requirements for high complexity testing, it would be appropriate to report these individuals to:

The University of the State of New York
The State Education Department Office of the Professions
Division of Professional Licensing Services
(see http://www.op.nysed.gov/opd/complain.htm).

At the center of this issue is patient care.  Laboratories must ensure excellent patient care and access to quality anatomic pathology services.  Quality results are difficult to ensure without adequately trained “Pathologists’ Assistants” and may pose a potential threat to the safety and quality of healthcare. 

Human resource professionals, employers, and the New York State Education Department must look to Pathologists’ Assistant ASCP-BOC certification as the benchmark for appropriately educated and adequately trained Pathologists’ Assistants.  Certifying boards enhance the legitimacy of a profession and allow the public to recognize competent staff.  If the “Pathologists’ Assistant” does not have the appropriate qualifications, these individuals could be appointed as a biopsy technician with a clear job description and a biopsy technician salary but not as a Pathologists’ Assistant.  A license does not guarantee that someone will be hired as a Pathologists’ Assistant, but it does allow a person with inadequate training and without appropriate credentialing with competency-based examination to function as a Pathologists’ Assistant, which the AAPA believes is an inappropriate consequence of this New York state law.  

The AAPA is supportive of state licensure for Pathologists’ Assistants, and state licensure legislation should ensure that Pathologists’ Assistants possess appropriate academic and clinical training through NAACLS accredited Pathologists’ Assistants programs, pass a competency-based examination conducted by the ASCP-BOC, and participate in continuing education programs.  These elements serve as important tools for enhancing quality patient care and patient safety.  Without proper training and credentialing, the likelihood of specimen mishandling and erroneous macroscopic tissue examinations will increase, which could have a significant negative impact on patient care. 

Licensure provides the mechanism to accept and extend the concept of certification over time so that continued personnel competency is assured through periodic self-assessment, competency evaluation, and continuing anatomic pathology education.  Licensure can be a process through which the Pathologists’ Assistants’ competency is continually maintained. 

High Macroscopic Examination Standards Must Be Upheld

The justification for licensure is to protect the public from significant harm caused by incompetent or inadequately trained members of an “occupational group.”  Since the macroscopic examination of surgical specimens forms the basis for medical diagnoses and therapies, the potential exists for serious harm from macroscopic tissue examination errors by unqualified personnel. 

Quality of the macroscopic examination of surgical specimens is influenced by the same requirements that are the foundation of personnel licensure, specifically academic education, clinical training and/or work experience, a competency assessment examination, and continuing education. 

AAPA Tenets on State Licensure

The AAPA believes that both NAACLS program-trained and prior to 2010, grandfathered on-the-job trained Pathologists’ Assistants who pass the ASCP-BOC Pathologists’ Assistant Certification Examination are qualified as competent mid-level practitioners in anatomic pathology. 

The AAPA believes that state licensure should provide a mechanism to assure that anatomic pathology services are performed with an adequate level of professional competence by requiring appropriate anatomic pathology entry level qualifications for Pathologists’ Assistants that includes training, experience, and certification as qualified and competent to perform the functions of a Pathologists’ Assistant.

The AAPA believes that minimum requirements for licensure should include graduation from a NAACLS accredited Pathologists’ Assistant program, or prior to 2010, on-the-job training and passage of the ASCP-BOC Pathologists’ Assistant Certification Examination.

The AAPA believes that through appropriately stringent competency requirements established by licensure for Pathologists’ Assistants, the health and safety of our patients is enhanced.

The AAPA believes that state licensure provides a key legal basis to restrict incompetent practitioners from providing anatomic pathology services to the public.

The AAPA believes that it is essential to define in state statutes, the Pathologists’ Assistant qualifications, certification, and scope of practice and to exclude those who have not acquired the appropriate requisites for licensure.

The AAPA believes that licensure renewal should require documentation of continuing education as a means of demonstrating continuing competence.

The AAPA appeals to the Department of Education to require the following elements for licensure of Pathologists’ Assistants in New York State under §8852 Requirements for licensure as a Pathologists’ Assistant:

• Graduate from a NAACLS accredited Pathologists’ Assistant training program or prior to 2010 grandfathered on-the-job trained Pathologists’ Assistant
• Obtain a passing score on the Pathologists’ Assistant ASCP-BOC Certification Examination
• Earn 60 continuing education credits every three years (increased from 45 effective 1/1/2022) as required to maintain certification by the ASCP-BOC Credential Maintenance Program.

As a final point, the AAPA recommends a proposal to create a restricted license for biopsy technicians where they would be limited to handling surgical pathology cases that do not require dissection or selective sampling.

References:

1. American Society for Clinical Pathology Policy Statement: Personnel Standards for Laboratory Personnel.  Policy 04-01. ASCP.2004.
   
   
2. American Society for Clinical Pathology Policy Statement: State Licensure and Laboratory Personnel. Policy 05-02. ASCP.2005.
   
   
3. American Society for Clinical Laboratory Science Position Paper: Addressing the Clinical Laboratory Workforce Shortage. August 2018.
   
   
4. Senate Bill S7932 2015-2016 Legislative Session. AN ACT to amend the education law, in relation to the licensure of pathologists' assistants. https://www.nysenate.gov/legislation/bills/2015/S7932
   
   
5. New York State Education Department, Office of the Professions. Laws, Rules, & Regulations. http://www.op.nysed.gov/prof/patha/pathalaw.htm
   
   
6. New York State Education Department, Office of the Professions. Pathologists’ Assistant License Requirements. http://www.op.nysed.gov/prof/patha/pathalic.htm
   
   
7. New York State Education Department, Office of the Professions. Pathologists’ Assistant License Application Forms. http://www.op.nysed.gov/prof/patha/pathaforms.htm
   
   
8. New York State Education Department, Office of the Professions. Professional Misconduct Enforcement, Enforcement Actions. http://www.op.nysed.gov/opd/rasearch.htm
   
   
9. New York State Education Department, Office of the Professions. Professional Discipline Complaint Form. http://www.op.nysed.gov/documents/opd-complaint.pdf
   
   
10. New York State Education Department, Office of the Professions. Professional Misconduct Enforcement, Discipline Complaint Form. http://www.op.nysed.gov/opd/complain.htm
    
    
11. Government Publishing Office [US]. 42 CFR.1489 – Standards; Testing Personnel Qualifications. https://www.govinfo.gov/app/details/CFR-2011-title42-vol5/CFR-2011-title42-vol5-sec493-1489
    
    
12. New York State Education Department, Office of the Professions. Clinical Laboratory Technology, License Options. http://www.op.nysed.gov/prof/clt/clp-technologistoptions.htm
    
    
13. American Association of Pathologists’ Assistants, Pathologists’ Assistant Scope of Practice – updated 9/2018:  https://cdn.ymaws.com/www.pathassist.org/resource/resmgr/docs/2018_-_scope_of_practice.pdf

The New York Grandfathering Licensure Pathway for Pathologists’ Assistant is obtainable until November 27, 2019.  This grandfathering pathway requires a fee and forms to be completed by the applicant and requires a signature by a New York State licensed pathologist.  After November 27, 2019, applicants for Pathologists’ Assistant licensure will need to meet the examination and education requirements set forth in Article 168 (see links below).  All AAPA members working in New York are encouraged to apply for a Pathologists’ Assistants license via the grandfathering pathway or the regular licensure pathway. 

The AAPA has been contacted by some members with concerns and complaints regarding a significant number of unqualified individuals being granted a New York Pathologists’ Assistant license during the grandfathering period.  Many biopsy/processing/grossing technicians may currently have a license as a histological technician or medical laboratory technician and should therefore be unaffected by the new Pathologists’ Assistant licensure.  Since the limited histological technician license expired on August 31, 2018, many laboratorians working as biopsy/processing/grossing technicians are applying for PathA (Pathologists’ Assistant) licensure through the grandfathering pathway and their documents are being signed by anatomic pathologists. 

The New York State Committee includes three AAPA members: Kathleen Bykowicz, PA(ASCP)^CM, Charles Fernandez-Perez, PA(ASCP)^CM, and Lysette Seegobin, PA(ASCP)^CM.  The committee also includes Dr. Mohammad Nakadar, a foreign medical graduate and ASCP certified Pathologists’ Assistant from Mount Sinai, a pathologist and a public representative. The New York State Education Department Office of Professions, the Clinical Laboratory Evaluation program, and the Committee are involved in New York Pathologists’ Assistant licensure.

Communication from the New York State Committee Pathologists’ Assistants:

The New York State committee is cognizant of the concerns raised regarding the licensing of unqualified individuals.   They, as New York committee members have been very concerned and frustrated with this situation.  The committee members provided some suggestions, but these matters are ultimately in the hands of the New York State Education Office of the Professions.  The grandfathering process could not have been made too narrow or with too many stipulations as that would have left some individuals without employment.  The committee had to rely on the honesty of pathologists.  Unfortunately, there is a great deal of ignorance and fear in the pathology community.  Many biopsy technicians feared that they would lose their positions, or they would be prohibited from grossing biopsies with their current licenses (medical technician, histological technician or clinical laboratory technician).

A license does not guarantee that someone will be hired as a Pathologists’ Assistant or be compensated as a Pathologists’ Assistant.  Employers must be cautious and scrutinize resumes and applicants with care for qualifications such as training at a NAACLS accredited Pathologists’ Assistant program and ASCP certification.  There also seems to be a circulating misconception that once a license is issued, it cannot be revoked.  If misuse or fraudulent acquisition of the PathA license is reported to the Office of the Professions, an investigation will be completed, and fraudulent licenses can be revoked.

While it seems a legitimate license during the grandfathering period does come down to meeting the definition of CLIA high complexity testing, that does not meet the definition of "Pathologists' Assistant" in the AAPA’s view or the view of our members.

Ultimately, Pathologists’ Assistants must conform to CLIA rules for high complexity testing.  If grandfathered individuals do not meet at least CLIA requirements for high complexity testing, it would be appropriate to report these individuals to:

The University of the State of New York
The State Education Department Office of the Professions
Division of Professional Licensing Services
(see http://www.op.nysed.gov/opd/complain.htm).

After the Grandfathering Licensure Pathway has closed, the following qualifications are required:

§8852. Requirements for licensure as a pathologists’ assistant:

To qualify for licensure as a “licensed pathologists’ assistant,” an applicant shall fulfill the following requirements:

• Education: to meet the education requirements for licensure as a pathologists’ assistant, you must either have successfully completed a bachelor’s or higher degree in a pathologists’ assistant program registered by the Department, or the substantial equivalent thereof, in accordance with the commissioner’s regulations; or have a bachelor’s or higher degree from a National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) accredited pathologists’ assistant program.
• Examination: obtain a passing score on an examination acceptable to the department; the pathologists' assistant certification exam offered by the American Society for Clinical Pathology Board of Certification (ASCP-BOC) is an exam acceptable for licensure.
• Age: at the time of application be at least twenty-one years of age.
• Character: be of good moral character as determined by the department.
• Fee: pay a fee determined by the department for an initial license and for each triennial registration period.

As the grandfathering period expires, we look forward to a New York State Pathologists’ Assistant licensure process where only those who meet examination and educational requirements will be granted a license.

The AAPA has created a detailed position statement regarding our serious concerns with granting a New York Pathologists’ Assistant license to unqualified individuals via an honor system during the grandfathering period that is not well understood by medical laboratory workers, some laboratories and pathologists.  In the position statement, the AAPA appeals to the State Education Department to require the following elements for licensure of Pathologists’ Assistants in New York State under §8852.

Requirements for licensure as a Pathologists’ Assistant:

• Graduate from a NAACLS accredited Pathologists’ Assistant training program or prior to 2010 grandfathered on-the-job trained Pathologists’ Assistant
• Obtain a passing score on the Pathologists’ Assistant ASCP-BOC Certification Examination
• Earn 60 continuing education credits every three years (increased from 45 effective 1/1/2022) as required to maintain certification by the ASCP-BOC Credential Maintenance Program.

Please refer to the links below regarding New York law, article 168.

1. Senate Bill S7932 2015-2016 Legislative Session. AN ACT to amend the education law, in relation to the licensure of pathologists' assistants. https://legislation.nysenate.gov/pdf/bills/2015/S7932
2. New York State Education Department, Office of the Professions. Laws, Rules, & Regulations. http://www.op.nysed.gov/prof/patha/pathalaw.htm
3. New York State Education Department, Office of the Professions. Pathologists’ Assistant License Requirements. http://www.op.nysed.gov/prof/patha/pathalic.htm
4. New York State Education Department, Office of the Professions. Pathologists’ Assistant License Application Forms. http://www.op.nysed.gov/prof/patha/pathaforms.htm
5. New York State Education Department, Office of the Professions. Professional Misconduct Enforcement, Enforcement Actions. http://www.op.nysed.gov/opd/rasearch.htm
6. New York State Education Department, Office of the Professions. Professional Discipline Complaint Form. http://www.op.nysed.gov/documents/opd-complaint.pdf
7. New York State Education Department, Office of the Professions. Professional Misconduct Enforcement, Discipline Complaint Form. http://www.op.nysed.gov/opd/complain.htm
8. American Association of Pathologists’ Assistants, Pathologists’ Assistant Scope of Practice – updated 9/2018:  https://cdn.ymaws.com/www.pathassist.org/resource/resmgr/docs/2018_-_scope_of_practice.pdf

https://www.kwch.com/content/news/Decision-upheld-to-bar-forensic-pathology-expert-from-conducting-autopsies-in-KS-508831211.html

We want to assure you that we are very aware of the situation and have been following the case.  Although he calls himself a Pathologists’ Assistant and has referenced the AAPA, he is not a member of the AAPA, nor is he certified by the ASCP.  Mr. Parcells represents none of the educational, professional, and ethical standards that the AAPA and members of our profession uphold.  He is functioning outside of our published scope of practice, especially considering his lack of certification, credentials, or legitimate training as an OJT.  He does not represent the pathologists’ assistant profession in any legitimate way.  We have been in contact with our lawyers to explore the possibility of protecting our title and profession, and to make sure that Mr. Parcells is not misrepresenting his association with us.  At this point the lawyer has advised that there is no legal recourse that the AAPA can take.  Because Mr. Parcells is not referring to himself as a CERTIFIED Pathologists’ Assistant and because we do not own the legal rights to the title Pathologists’ Assistant, we cannot send a cease and desist letter.  Because Pathologists’ Assistant is a “descriptive title” much like “teacher or professor”, we cannot gain the legal rights to its exclusive use.  Please be assured that we and our lawyers are watching the situation and will do what we can within our power to make sure Mr. Parcells does not tarnish the reputation of our profession.

Thank you to those who have called and emailed with your concerns.  We always appreciate our members who advocate for and protect our profession.

John began by explaining how and why the Forensic Task Force was formed, who are the members, and what is the mission of the task force.  Lou discussed why PAs are underrepresented in this field, and Monica followed up with an explanation of forensic organizations with which we should be familiar.  These included The National Association of Medical Examiners (NAME), The American Academy of Forensic Science (AAFS), and The International Association of Coroner & Medical Examiners (IACME).  Courtney then discussed what would be the realistic expectations of integrating PAs into forensics, including a reasonable timeframe and what additional training may be required.  Francesca, Lou, and Erica talked about the current staffing shortage in forensics, and what our members can do to advocate for PAs in this field.

A new feature for this Town Hall was a live poll, arranged by Ryan, to determine how many attendees currently participate in forensics.  Lou mentioned that there is a staffing shortage in other countries as well.  Hagen Schmitt, who was an attendee at the meeting, spoke about his experience in Germany and how PAs are utilized in Europe in forensics.

Then it was time for questions.  Many of the questions focused on how to get into the forensics field, with some of the panelists sharing their own experiences.

We would love to hear from you on this subject!  Please use this link to view the Town Hall replay, and continue the conversation on the new Forensics forum on our website.  Your input is very important to the AAPA.

The ground work has already begun in designing a new template for the 3^rd edition Grossing Guideline protocols.  Results from the recently submitted survey assessing how we can improve the Grossing Guidelines were evaluated in November.  The information obtained from this survey was very useful and provided exciting ideas that we are incorporating into the new design.

The presentation began with John pointing out that advocacy is one of the AAPA’s core values and then reviewing the historical timeline of advocacy milestones within the association’s history.  Some of the association’s most recent accomplishments were highlighted including the revised Scope of Practice, the Grossing Guidelines, the Inspection Readiness Kit, and the AAPA PR exhibit booth travels.  In addition, the benefits of advocacy in the area of professional outreach were discussed.  Multiple examples were provided of AAPA fellow members serving as adjuncts or committee members for other associations including NAACLS, ASCP, CAP, AJCC, and the CoC.

When asked what the association has on the horizon for its advocacy efforts, Jana highlighted some future projects including a task force to examine the possibility of PAs expanding into forensics, the development of a credentialing kit, global humanitarian opportunities, and professional promotional videos.  Next, the panel talked about how to advocate for yourself as a PA including community outreach, speaking opportunities, and promotion of Pathologists’ Assistant Day.  The panel gave examples of tools available for advocacy and ways members could get more involved in advocacy.

Before opening the floor to questions, the Town Hall wrapped up with panel members giving personal examples of ways they have advocated for themselves, given students the tools to advocate for themselves, and promoted the profession.

We would love to hear from you on this subject!  Please use this link to view the Town Hall replay, and continue the conversation on the new Advocacy forum on our website.  Your input is very important to the AAPA.

The changes contained in the 8th edition of the American Joint Commission on Cancer (AJCC) Cancer Staging Manual took effect on January 1, 2018.  Since cancer staging is at the center of the College of American Pathologists (CAP) Cancer Protocols, the new staging manual meant updating every CAP Cancer Protocol.  This massive body of work by AJCC and CAP required a similar effort on our part as the Grossing Guideline protocols are harmonized to the CAP Cancer Protocols and the new TNM staging criteria.

We are tremendously indebted to the AAPA authors, AAPA editors, CAP pathologist expert reviewers, and support staff at the AAPA Central Office who devoted themselves to the work on the 2^nd edition Grossing Guidelines.  The protocols referenced above are complete and have been uploaded to the AAPA website.  The remainder of the protocols are in the final stages of review by CAP experts, an we anticipate posting all protocols, fully aligned with AJCC and CAP updates within the next month or two.

In late 2017, the American Association of Pathologists’ Assistants (AAPA) formed a task force to address revising the current Pathologists’ Assistant Scope of Practice.  This task force included a diverse group of Pathologists’ Assistants and an academic pathologist.  Pathologists’ Assistants on this task force included representatives from academia, clinical instruction, former ASCP BOC examination committee members, community hospitals, laboratory management, and grossing operations management.  This task force was formed in response to concerns expressed by the AAPA membership and the Pathologist’ Assistant Training Program Directors (APATP) that the current scope of practice did not comprehensively reflect the progression of responsibility and contemporary practice of a Pathologists’ Assistant.

Pathologists’ Assistants Scope of Practice Task Force Members: 

Connie Thorpe, PA(ASCP)^CM, AAPA Director of Professional Development, Assistant Professor Department of Pathology, Saint Louis University - Representing academia and former ASCP Examination Committee member

Beth Obertino-Norwood, PA(ASCP)^CM
AAPA Board of Trustee, Pathologists’ Assistant, Department of Pathology and Immunology, Washington University - Representing the community hospital

Steven Suvalsky,PA(ASCP)^CM 
Pathologists’ Assistant, IMMC Histopathology - Representing the community hospital

April Reineke, PA(ASCP)^CM, Pathologists’ Assistant, Reading Hospital - Representing academia and former ASCP Examination Committee member

Kelly Kester, PA(ASCP)^CM, Laboratory Manager and Instructor, Oregon Health and Science University - Representing management and academia

Krista Szafranski, PA(ASCP)^CM, Grossing Operations Manager, CellNetix Pathology, Inc. - Representing management and the private laboratory.

Pathologist Advisor: Carole Vogler, MD
Professor and Chair, Department of Pathology, Saint Louis University.

How did we approach updating the Pathologists’ Assistant Scope of Practice?
This task force carefully evaluated the current Pathologists’ Assistant scope of practice, reviewed the American Society for Clinical Pathology Board of Certification task analysis, and researched trends in the utilization of the Pathologists’ Assistant.  A revised Pathologists’ Assistant scope of practice was then created and was proposed by this task force and submitted to the AAPA Board of Trustees.  This task force and the AAPA Board of Trustees invited the APATP members to provide comment.  The APAPT members provided comment, edits were incorporated, and the AAPA membership was then invited to review this updated scope of practice and provide comment. 

Scope of Practice Background:
The following are excerpts from a paper “Changes in Healthcare Professions’ Scope of Practice: Legislative Considerations” that the task force found helpful and kept in mind while updating the Pathologists’ Assistant Scope of Practice.

Arguments for scope of practice changes should have a foundational basis within four areas:

1. An established history of the practice scope with the profession
   
2. Education and training
   
3. Supportive evidence
   
4. Appropriate regulatory environment.

Historical Basis:
The historical framework provides the basis for the essentials of the profession, including how it has developed over the years and how it is presently defined.  Changes in scope of practice should fit within the historical, evolutionary and present practice context for the profession.

Questions to be considered include:

1. Has there been evolution of the profession towards the addition of the new skill or service?
   
2. What is the evidence of this evolution?
   
3. How does the new skill or service fit within or enhance a current area of expertise?

Education and Training:
Tasks added to a scope of practice are often initially performed by healthcare professionals as advanced skills.  Over time, as these new skills are utilized by a sufficient cohort of professionals, they become entry-level skills and are taught as such in entry-level curricula.  It is not realistic to require a skill or activity to be taught in an entry-level program before it becomes part of a profession’s scope of practice.  However, the entry-level training program and its accompanying accrediting standards should provide the framework, including the basic knowledge and skills needed, to acquire the new skill once the Pathologists’ Assistant is out in the field.  Competence assessment tools should be in place to indicate whether the Pathologists’ Assistant is competent to perform the advanced skill/technique.

Questions to be considered include:

1. Does current entry-level education prepare Pathologists’ Assistants to perform this skill/technique as their experience increases?
2. If the change in scope is an advanced skill that would not be tested on the entry-level certification examination, how is competence in the new technique/skill assured?
3. What competence measures are available and what is the validity of these measures?
4. Are there training programs within the profession for obtaining the new skill or technique?
5. Are standards and criteria established for these programs?
6. Who develops these standards?
7. How and by whom are these programs evaluated against these standards?

Evidence:
There should be evidence that the new skill or technique will promote quality healthcare.  The base of evidence should include the best available clinical evidence, clinical expertise and research.  Other forms of evidence include evolving concepts in pathology, quality improvement, standards of care, cost-effectiveness analysis, and benchmarking data.

Questions to be considered include:

1. Is there evidence within the profession related to the techniques and skills involved in the changes in scope?
   
2. Is there evidence that the technique or skill is beneficial?
   

Regulatory Environment:

A consideration in proposing changes in scope of practice is the regulatory environment (ASCP, NAACLS).  Usually, it is the professional association (AAPA, APATP) that promotes and lobbies for scope of practice changes.  The regulatory board should be involved in the process and be prepared to deal with the regulatory issues related to the proposed changes.

Questions to be considered include:

1. Is the regulatory board authorized to develop rules related to a changed or expanded scope?
   
2. Is the board able to determine the assessment mechanisms for determining if an individual professional is competent to perform the task?
   
3. Is the board able to determine the standards that training programs should be based on?
   
4. Does the board have sufficient authority to discipline any practitioner who performs the task or skill incorrectly or might likely harm a patient?
   
5. Have standards of practice been developed for the new technique or skill?
   
6. How has the education, training and assessment within the profession expanded to include the knowledge base, skill set, and judgments required to perform the techniques and skills?
   
7. What measures will be in place to assure competence?
   

In conclusion, it is important to remember that a scope of practice is not a job description and is not required to cover every technique and every possible job or task a Pathologists’ Assistant may perform over their professional career and should not attempt to do so.  However, a change or update to the scope of practice should reflect the evolution of abilities of the Pathologists’ Assistant, as reflected in the revised scope of practice.  Factors relevant to scope of practice decision making are those designed to ensure that all certified Pathologists’ Assistants are capable of providing quality patient care.  Most importantly, the strength of the scope of practice lies in broad acceptance by the membership and the desire to ensure the advancement and progression of responsibility for the Pathologists’ Assistant. 

I would like to thank the membership for their detailed comments and suggestions on this modernized Pathologists’ Assistant Scope of Practice.  The AAPA Board of Trustees approved and finalized the revised Pathologists’ Assistant Scope of Practice on July 9, 2018.  With this revision we are surely establishing the contemporary practice of the Pathologists’ Assistant. 

We have exciting news regarding the AAPA’s participation in quality cancer patient healthcare!

Through our relationship with the AJCC, one of the speakers at the 2017 Fall Conference, Dr. Frederick Greene, encouraged the AAPA to become a member organization of the Commission on Cancer (CoC).  This year the AAPA has applied and been accepted into membership of the Commission on Cancer. 

Perhaps you are one of the many AAPA members working at institutions accredited by the Commission on Cancer.  The accreditation is recognized nationally as the gold standard accreditation for cancer centers.  In fact, there are more than 1,500 CoC accredited cancer programs in the U.S., which treat nearly 70% of recently diagnosed U.S. cancer patients annually.  

The CoC, a program of the American College of Surgeons, is comprised primarily of association members, and those members represent a large cohort of associations across healthcare including the American Cancer Society, the Centers for Disease Control and Prevention (CDC), the American Joint Committee on Cancer (AJCC), the American Hospital Association (AHA), and many other administrative, allied health, clinical, advocacy, government and research organizations. 

The CoC was established in 1922 and their mission statement is as follows:

“The Commission on Cancer is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care.”

They achieve their mission through data-gathering and analysis, conducting surveys, monitoring treatment patterns/outcomes, and developing educational initiatives.  All of the member organizations are active in participating in these activities.

AAPA inclusion as a member among these associations is a tremendous validation of our profession.  In addition, it acknowledges that the core distinctives of our association are becoming evident with major stakeholders in healthcare. 

In a practical sense, AAPA membership means that PAs are sitting at the table with other important members of the healthcare team.  The representatives of these organizations will hear our ideas and contributions to quality patient care.  We will participate within various activities often aimed at establishing, maintaining, and assessing institutional quality standards for our patients.  We are honored to be accepted as a member and excited to take another step, increasing our visibility and influence in the greater healthcare setting.   

As a part of the application process, the AAPA appointed a representative to the CoC — Erika Paulsen, MS, PA(ASCP)^CM.  Erika is proud to represent our community to this important organization and is an ideal representative of the pathologists’ assistant profession.

Liz began the presentation by reviewing the differences between certification, credentialing, and licensure.  John presented the AAPA's position on licensure, and the reasoning for it: when done correctly, state licensure provides a legal credential for only qualified individuals to practice within our scope.  Minimum competency is demonstrated by passage of the ASCP certification exam and participation in a certification maintenance program.  Liz commented on how national licensure is not an option, and discussed which states currently have PA licensure (NV, NY, and WV), along with the pathway to licensure in each of those states.  Dennis explained the vision of the AAPA for state licensure going forward, including using our current ASCP CMP program in place of a renewal exam.  Mike and Charlie discussed the history of PA licensure in New York, some of the hurdles that have been encountered so far, and some recommendations for improving the process.

Then it was time for questions.  There were many great questions from the attendees, some of which focused on New York.  Finally, Liz gave a summary of PA licensure, and reiterated the point that the best way to influence the process is to get involved early.  So if members hear about licensure of PAs in their state, we urge them to contact the AAPA.  We are also working on developing a Licensure Kit, drawing from our experience of a few states requiring licensure now, to aid in dos and don’ts when pursuing licensure in future states.

We would love to hear from you on this subject!  Please use this link to view the Town Hall replay, and continue the conversation on the new Licensure forum on our website.  Your input is very important to the AAPA.

The AAPA has a solution: our Inspection Readiness Kit!

To assist pathologists' assistants, pathologists, and laboratory directors in achieving a successful CAP inspection, and to clearly define performance expectations, the AAPA now offers guidelines for personnel requirements competency assessment of pathologists' assistants, and for pathologists' assistants who perform macroscopic tissue examination. 

This kit includes provisions from the Anatomic Pathology and Laboratory General Accreditation Checklists of the College of American Pathologists that have been licensed by the AAPA.  This kit addresses only those Accreditation Checklist items directly related to pathologists' assistants.

Click here to learn more.

For more info, see the full article with details in 2018 Issue 2 of The Cutting Edge

Explore our brand new website, specially designed to increase the visibility of the PA profession and advocate for our members and all pathologists' assistants.

Share these pages with your colleagues, employers, family, friends, and anyone interested in learning more about what you do and why you choose to be a member of the AAPA.

Become a PA

Employ a PA

Get Involved

Don't forget that the entire AAPA website is now mobile friendly and fully accessible through the Member Community app! Download it today (member log-in required).

The presentation began with some background on why this decision was made, and how the ASCP had a role in it.  This included a comparison of CE requirements between PAs and other similar level medical practitioners.  Following that was an in-depth discussion of the changes, including how and when they would affect AAPA members.  Beth and John then gave a few examples of how the process would work, using their own certification renewal cycles, and that of new student graduates in 2018 and 2019.  These examples were illustrated with the accompanying slideshow.  They also described how the AAPA would provide the additional credits to members which would fulfill these new requirements. 

Then it was time for questions.  Several questions had been previously submitted, and these were answered first.  Several more questions were asked by the live audience in Portland.  Many of the questions focused on the advanced cancer credits, and how the AAPA would provide them.  During the session, all attendees present for the Town Hall at the Spring Meeting responded by a show of hands that they were in agreement with the increase in credits from 45 to 60 to maintain ASCP certification.

We would love to hear from you on this subject!  Please use this link to view the Town Hall replay, and continue the conversation on the new CMP Requirement Changes forum on our website.  Your input is very important to the AAPA. 

The licensing of PAs in NY is a complex process and has evolved over many years.  A state committee has been established that includes three AAPA members: Kathleen Bykowicz, PA(ASCP)^CM, Charles Fernandez-Perez, PA(ASCP)^CM, and Lysette Seegobin, PA(ASCP)^CM.  The committee also includes a pathologist and public representative.  In conjunction with The NY State Office of Professions, the Education Department, the Clinical Laboratory Evaluation program, the state committee, and some pathologists’ assistants working in NY, we know the following:

The Grandfather Licensure Pathway is available until November 2019, and it is the only pathway available.  This Grandfather pathway requires a fee and forms to be filled out by the applicant and requires signature by a New York state licensed pathologist.  After Nov. 2019, applicants for PA licensure will need to meet the testing and education requirements set forth in Article 168 (see links below).  All AAPA members working in NY are encouraged to apply for a license during the grandfathering period.

Because the limited histology license will expire in November of 2019, many laboratorians practicing as biopsy/processing/grossing techs are having this paperwork signed and applying for grandfathering to be licensed in NY as PathA (PA).  Concerns have been raised regarding this practice, and the NY state committee is well aware of it.  Many biopsy/processing/grossing techs may currently have a license as a histotechnician or medical laboratory technician and should therefore be unaffected by this licensure.

As noted above, the grandfather pathway will expire in November of 2019, and only pathologists' assistants who “obtain a passing score on an examination acceptable to the Department of Education” (according to article 168 and likely to refer to the ASCP certification examination) will qualify for a New York state PathA license.  Again, we encourage all PAs working in NY or planning to do so in the future to apply for a NY license while the grandfather pathway is open until November 2019.  It is important to recognize that the required grandfather period in this process of NY state licensure is short, and that the final outcome will be a New York state license for pathologists’ assistants. 

Please refer to the links below regarding New York law, article 168.

1. https://law.justia.com/codes/new-york/2016/edn/title-8/article-168/8850/
2. https://law.justia.com/codes/new-york/2016/edn/title-8/article-168/8852/

Since then, the AAPA has reviewed how these proposed changes could negatively affect Pathologists' Assistants, and has developed and sent an official AAPA response letter to CMS.  Additionally, an AAPA template response (download as a Word doc) has been developed to assist you in sending in your own individual response, and a CMS fact summary was developed to give you more background on this issue.

NOW IS YOUR TIME TO ACT.  

1. Read the CMS fact summary to educate yourself on this issue.
2. Use the AAPA template response (download as a Word doc) to contact CMS.  Public comment on this matter is open until March 12, 2018, at 4 pm CDT (5 pm EDT).  All PAs should take advantage of this opportunity!
3. Encourage your fellow laboratorians to support us in this endeavor by submitting their comments, as we are not the only ones conducting high complexity testing.

Remember: The AAPA is the only professional organization that advocates specifically for pathologists' assistants.

A slideshow accompanied the questions and responses throughout the evening.  Many excellent questions were submitted and discussed.  Most sought to determine why the AAPA is interested in creating an international membership category, who would qualify for membership, what benefits this membership category would have, what restrictions might be placed on such members, and what would be the next steps in the process. 

We would love to hear from you on this subject!  Please use this link to view the Town Hall replay, and continue the conversation on our new international membership forum on our website.  Your input on the possibility of opening an international membership category is very important. 

In the summer of 2016, the AAPA was requested to respond, as a member institution, under the American Society of Clinical Pathology Board of Certification (BOC) Board of Governors (BOG) in support of sending a letter to the Centers for Medicare and Medicaid Services (CMS) concerning proposed revisions to Personnel regulations under 42 CFR 493.  The AAPA and many other organizations and laboratorians added their signature to this letter to urge CMS to rescind this policy.

We strongly encourage you to read the proposed changes at https://www.gpo.gov/fdsys/pkg/FR-2018-01-09/pdf/2017-27887.pdf, which state in part, that an associate or bachelor’s degree in nursing is the equivalent to an associate or bachelor’s degree in biological sciences for purposes of performing moderate and/or high complexity testing under CLIA. 

NOW IS YOUR TIME TO ACT.  Public comment on this matter is open until March 12, 2018.  The AAPA is actively attempting to discern how these proposed changes could negatively affect Pathologists' Assistants, and will promptly submit an appropriate response concerning the proposed revisions.  All members are encouraged to submit their own comments.  I, along with the AAPA Board of Trustees, will be crafting a template to assist you.  Please encourage your fellow laboratorians to support us in this endeavor by submitting their comments, as we are not the only ones conducting high complexity testing.  

https://www.federalregister.gov/documents/2018/01/09/2017-27887/request-for-information-revisions-to-personnel-regulations-proficiency-testing-referral#open-comment

The AAPA will continue to monitor licensure in New York and all states, providing details to members as they become available.  If you would like to help in this effort by monitoring licensure activity in your state, please fill out a volunteer form at http://www.pathassist.org/Volunteer, and we will be in contact with you.

What: The ASCP recently announced new CMP requirements for Pathologists’ Assistants.  They include:

• 1 point in laboratory or patient safety (i.e. quality control, quality assurance)
• 20 points in general anatomic pathology
• 15 points addressing macroscopic examination and staging of cancer cases (i.e. advanced cancer anatomic pathology) NEW!
• 1 point in medical ethics NEW!
• 23 remaining points in areas of anatomic pathology, management, education or other clinical specialties

When: We have a long time to prepare for the new requirements.  The new requirements will go into effect with all CMP cycles that BEGIN on or after January 1, 2019.

• 2017 – 2019 certificate maintenance cycle – follow current requirements
• 2018 – 2020 certificate maintenance cycle – follow current requirements
• 2019 – 2021 certificate maintenance cycle – follow NEW requirements

Where: Where can you get these new credits?  Well, with the AAPA of course!  Currently the AAPA offers 15 free credits a year included with your membership.  By 2019, the AAPA will offer 20 free credits per year, ensuring these credits fulfill the new advanced cancer credit, the new ethics credit, and the required safety credit.  By simply renewing your membership annually, you will have access to all the credits needed to fulfill the new standards.

Examples of where to obtain the new advanced cancer credit include:

• AAPA membership: 20 credits offered per year beginning in 2019 to cover the new requirements.
• AAPA conferences: Multiple lectures offered to fulfill the new advanced cancer credit requirement.
• Hospital Cancer conferences: Most hospital cancer conferences and tumor boards will have all the elements to fulfill the advanced cancer credit.
• Author a paper or write a chapter:  Papers submitted that include cancer cases and staging information will count as CE for the advanced cancer credit.  (Hint: If you authored a chapter for the grossing guideline, it is worth 7 credits!)