The utilization of non-physicians to provide services in anatomic pathology, specifically in the performance of the autopsy (the word autopsy derives from the ancient Greek "autopsia" which means ("to see with one's own eyes") dates as far back as ancient times. [1]Around 3000 BC the ancient Egyptians, utilizing non-physician embalmers, were one of the first civilizations to remove and examine human internal organs in the religious practice of mummification. [2] Other non-physicians, such as dieners (diener derives from the German word leichendiener, which literally translates to "corpse servant"), were utilized in medieval times. [3] Interestingly, an autopsy assistant (diener) is depicted in Rembrandt's 1656 painting entitled "The Anatomy Lesson of Dr. Jan Deijman". [4] In the mid nineteenth century Rudolf Virchow notably espoused a systematic approach to the performance of autopsies. He noted that in his experience autopsies were at that time being performed with no regular method, principally by young and untrained surgical assistants. [5]

In the early twentieth century the autopsy was viewed as an invaluable tool in the education of physicians, particularly regarding the correlation between clinical history and autopsy findings. A hospital's accreditation was often based upon its autopsy rates. [6] Post-World War II, the numbers of "routine" hospital autopsies rose significantly, consequently increasing the burden on pathologists. [6]

Projected manpower shortages among the ranks of primary care physicians and pathologists in the United States during the 1950s and 1960s brought about the establishment of training programs in the mid and late 1960s for both physician assistants and pathologists' assistants. These programs were the foundation upon which two similar, but distinct professions were built. It is worthy of note that a major concern voiced by both clinicians and pathologists at the time was that neither physician's assistants nor pathologists' assistants should be doing medical work. [7] The manpower shortages and projected shortages in the mid-to-late 1960s came at a time when thousands of military corpsmen and medics were returning from service in Vietnam to civilian life. [8] The early physician assistant programs relied on this ready-made population of well-trained ex-military corpsmen as a pool of candidates for their training programs. [9] Early pathologists' assistant programs also recruited from this population, though to a lesser degree.

Physician extenders, particularly in the anatomic pathology setting, were also needed in the United Kingdom during this 1960s. One British pathologist's answer to the manpower shortages was to suggest in a 1972 correspondence to the Lancet, the introduction of "necropsy technologists", who after training and under the supervision of a pathologist, would be a part of a post-mortem pathology team in much the same way that surgical pathology is so successfully dealt with. [10] collapse