AAPA Historical Timeline

A Brief History of Pathologists’ Assistants, Their Profession, and an American Association of Pathologists’ Assistants Timeline

Gratitude

The following timeline is intended to provide our members with a history of the creation of our Association, its development and success, and how it is intimately involved with the creation and success of our profession. It is with deep appreciation that we wish to acknowledge and thank Tom Reilly, PA(ASCP)^CM for the time he devoted to researching historical files, interviewing members, and developing this timeline over the course of the last two years.

And a special thank you to Ryan Schniederjan, owner of 10Blade Productions, who did the web development.

Introduction

This general historical perspective and several early timeline items below are meant to acquaint the reader with milestones and events that led to and influenced the development and establishment of the Pathologists’ Assistant and Physician Assistant professions. The bulk of the chronological timeline, however, describes events and milestones specific to the pathologists’ assistant profession as well as the creation and ongoing development of the American Association of Pathologists’ Assistants (AAPA).

Background: A Brief History of non-physicians providing healthcare services

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] Autopsies performed on casualties of fights and wars also provided essential knowledge of anatomy. [3] Other non-physicians, such as dieners (diener derives from the German word leichendiener, which literally translates to “corpse servant”, were utilized in medieval times. [4] Interestingly, an autopsy assistant (diener) is depicted in Rembrandt’s 1656 painting entitled “The Anatomy Lesson of Dr. Jan Deijman”. [5] 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. [6]

The utilization of non-physicians to provide primary health care services in countries around the world has a long and significant history, dating back at least as far as the 1600s. Often, the need was created because of wars and large numbers of battlefield casualties. Manpower shortages also made it difficult to provide services in rural areas. In the United States, utilization of non-physicians was recognized and accepted, particularly in the U.S. Navy in the late 1790s. In 1799, the U.S. Congress passed a bill authorizing the U.S. Navy to use “hospital mates” to assist physicians in the care of navy personnel, particularly at sea. That name changed to “surgeon’s stewards” and eventually to what we are familiar with today, “hospital corpsmen”. Specialization in medical practice increased significantly post World War II, and a growing shortage in primary care givers was clearly recognized. To further compound the problems caused by the shortage of healthcare workers, millions of new potential patients suddenly gained access to healthcare services upon the creation in 1965 of Medicare and Medicaid.

In the early 20th 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. [7] Post World War II, the numbers of “routine” hospital autopsies rose significantly, consequently increasing the burden on pathologists. [7] As house staff, pathology residents, in particular, experienced a tremendous increase in the “service load” of the hospital, taking away from the time needed for them to develop into well-rounded skilled specialists. [8]

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 assistants nor pathologists’ assistants should be doing medical work. [9]

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. [10] 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. [11] Early pathologists’ assistant programs also recruited from this population, though to a lesser degree. It is worthy of note that grants from the “Pathology and Allied Science Service” of the Veterans Administration enabled the establishment of the first three pathologists’ assistant training programs. [12]

Pathologists’ assistant programs placed special emphasis on extensive training in anatomic pathology, with students acquiring high levels of technical skills and a thorough understanding of the principles of anatomic pathology. Program graduate pathologists’ assistants represent a new category of allied health professionals, with their training setting them apart from other allied health professionals in anatomic pathology such as cytotechnologists, histology technicians, and dieners. [13] The mortuary service at the University of Maryland School of Medicine was designed to utilize pathologists’ assistants. These technical assistants fill a necessary gap, bringing technical expertise to the performance of autopsies and freeing up both residents and senior pathologists to better perform their responsibilities. [14]

The critical shortage of pathologists prompted the development of a pathology assistant program, the “mortician-necropsy assistant program” at the University Hospitals of Cleveland, Ohio to train licensed morticians to perform autopsies. [15] Physician extenders, particularly in the anatomic pathology setting, were also needed in the United Kingdom during the 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. [16]
References
1. K. Rothenberg, “The Autopsy Through History,” in Forensic Science ISBN 978-1-58765-423-7, Salem Press, 2008, p. 100
2. J. L. Burton, “A Bite Into the History of the Autopsy: From Ancient Roots to Modern Decay,” Forensic Science, Medicine and Pathology, pp. 277-278, 8 September 2005.
3. J. Gulczynski, Izycka-Swieszewska, E and Grzybiak, M, “Short History of the Autopsy: Part I. From Prehistory to the Middle of the 16th Century,” Pol. J Pathol, vol. 3, pp. 109-114, 2009.
4. “Definitions,” [Online]. Available: https://Definitions.net. [Accessed 2019].
5. “Wikipedia,” [Online]. Available: https://en.m.wikipedia.org.
6. R. Virchow, Post-Mortem Examination with Especial Reference to Medico-legal Practice, Second German Edition ed., Philadelphia: Presley Blakiston, 1880, p. 9.
7. L. S. M. M. C. King, “A History of the Autopsy: A Review,” American Journal of Pathology, vol. 73, no. 2, pp. 537-538, November 1973.
8. R. Paegle and Klavins, JV, “Special Technologists for Autopsies,” Pathologist, vol. 24, pp. 297-301, 1970.
9. J. R. Wright, “The History of Pathologists’ Assistants: A Tale of 2 Educational Mavericks,” Archives of Pathology and Laboratory Medicine, pp. 1-10, 7 August 2018.
10. A. S. Ford, The Physician’s Assistant: A National and Local Analysis, New York, New York: Praeger Publishers, 1975, pp. 53-56.
11. R. Carter, “Physician Assistant History,” Perspective On Physician Assistant Education, vol. 12, no. 2, pp. 130-132, Spring 2001.
12. T. D. Kinney and K. R. Broda, “The Pathologist’s Assistant,” Human Pathology, vol. 5, no. 5, pp. 503-504, 1974.
13. W. Mergner, Vigorito, RD, Pratt, PC, Broda, KR, Enriquez, RE, Kelley, LT and Trump, BF, “Pathologists’ Assistant Training Programs: A Report,” Human Pathology, vol. 12, no. 3, pp. 207-211, March 1981.
14. W. Mergner, Sutherland, JC, Tigertt, WD and Trump, BF, “To Answer Questions: A Review of an Autopsy Service,” Archives of Pathology and Laboratory Medicine, vol. 104, pp. 167-170, April 1980.
15. J. R. Carter and Martin, Dale L, “A Pathology Assistant Program: The Role of Licensed Morticians,” American Journal of Clinical Pathology, vol. 53, no. 1, pp. 26-31, 1970.
16. W. Robertson, “The Post-Mortem Room,” The Lancet, pp. 152-153, 15 January 1972.
As history is always in motion, updates to this timeline will happen periodically. We welcome your comments, and any suggestions will be reviewed for consideration; click here to contact us.

- General timeline
  - 1898: U.S. Navy Hospital Corps
    
    On June 17, 1898, during the Spanish-American War, President William McKinley formally approved the establishment of the U.S. Navy Hospital Corps put forth by the U.S. Congress as “A convenient place shall be set apart for the sick and hurt men, to which they are to be removed, and some of the crew shall be appointed to attend them.” There were 25 “charter members” in 1898. Today, the Hospital Corps has the largest rate (rank) in the Navy and is one of the most decorated ratings in the U.S. Navy.
    
    photo credit: public domain
  - 1910: Flexner Report
    
    In 1910, Abraham Flexner’s report on U.S. Medical Schools was published. This report was commissioned by the Council on Medical Education (CME), a council of the AMA. This report became notorious for its harsh description of many institutions and the sweeping reforms that followed. Over half of the medical schools were closed as a result, and most schools reverted to men-only admissions. However, this report also led to an increase in prerequisites to enter medical training, gave medical schools control of clinical instruction in hospitals, and strengthened state licensure regulations.
    
    photo credit: public domain
  - 1911: Henrietta Phelps Lawson Jeffries
    
    Henrietta Phelps Lawson Jeffries, an African-American midwife, was put on trial in North Carolina for practicing medicine without a license as organized medicine started attempting to put unlicensed practitioners, such as midwives, out of business. However, the local communities who depended on their care pushed back. She is found not guilty.
    More about the trial
    
    photo credit: public domain
  - 1925: Frontier Nursing Service
    
    In 1925, Mary Breckinridge established the Frontier Nursing Service in the Kentucky mountains. Wendover, now a national historic landmark, is the first effort to professionalize midwifery in the U.S.
    
    photo credit: Encyclopaedia Britannica
  - 1930: Vivien Theodore Thomas, LL.D
    
    Vivien Theodore Thomas began his journey as a laboratory assistant in 1930 for Dr. Alfred Blalock at Vanderbilt University. Thomas rapidly mastered anatomy and physiology, and complex surgical techniques and research methodology. Together, he and Dr. Blalock worked on groundbreaking research and surgical techniques, including Crush syndrome (hemorrhagic and traumatic shock) and the Blalock-Taussing shunt (surgical correction of Tetralogy of Fallot). Thomas developed more cardiac surgical techniques, and later in the 1940s he assisted Johns Hopkins’ first African-American cardiac resident work on the Automatic Implantable Defibrillator. In 1976, Thomas was presented with an honorary doctorate. He retired in 1979 as an Instructor of Surgery from Johns Hopkins Medical School.
    Read More
    
    photo credit: Vanderbilt School of Medicine
  - 1940: Henry “Buddy” Treadwell
    
    Henry Lee Treadwell came to the medical field after high school by working for the local doctor, Amos Johnson, in Garland, NC. He began by working as an orderly at the clinic and started observing laboratory tests, and soon learned how to perform them. He then learned how to perform and develop X-rays and soon was also taking vitals. Soon he was performing minor surgical procedures like suturing and eventually was performing most general practice procedures. By the late 1950s Johnson was referring to Treadwell as his “assistant” and would leave the practice under his supervision while Johnson was out of town. Johnson and Treadwell practiced together until Johnson died in the 1970s. Treadwell was offered, but decided not to take, the new certification exam for physician assistants, and retired from medicine to work on his own businesses.
    
    photo credit: Physician Assistant History Society
  - 1942: PA Beginnings
    
    With World War II just beginning for the U.S., Dr. Eugene Stead, Jr. (known as the founder of the clinical physician assistant profession) developed a fast track, 3-year medical curriculum to educate physicians for military service at Emory University. This became the model for the competency-based medical curriculum developed to educate physician assistants at Duke University in 1965. The Maritime Service began a Hospital Corps School with surgeon S.S. Heilwell, which was designed to train a more skilled Assistant Purser for merchant marine ships.
    
    photo credit: Physician Assistant History Society
  - 1943: Battalion Surgeon’s Assistant
    
    With World War II continuing to wage on, a critical shortage of physicians in the battlefield began to show. The U.S. Surgeon General decided to replace one of the two surgeons assigned to Army battalion aid stations with a specially trained Medical Administrative Corps officer. This officer soon became known as the Battalion Surgeon’s Assistant.
    
    photo credit: public domain
  - 1961: AMA publishes “Expansion of Medical Professional Services with Nonprofessional Personnel”
    
    Charles Lowell Hudson, MD, was a US Army physician during World War II. In addition he was on faculty at Case Western Reserve University and practiced at University Hospitals, Cleveland Clinic Foundation, and the VA Medical Center in Cleveland. In 1961 at an American Medical Association meeting, Dr. Hudson proposed the training of non-physician individuals. He relied on his experiences with US Army and Navy corpsmen during WWII. His proposal was to train “assistants”, which would be supervised by physicians, to perform routine clinical tasks so physicians could concentrate on more complex procedures and see more patients. His proposal was published in the June 10, 1961 issue of the Journal of The American Medical Association (JAMA). Dr. Hudson later served as president of the AMA. During his term, the first formal Physician Assistant program was started at Duke University.
    
    photo credit: Cover Photo from 20 June 1966, Modern Medicine Magizine – Physician Assistant History Society
  - 1965: Social Security Amendments of 1965: Medicare & Medicaid
    
    July 30, 1965 – President Lyndon B. Johnson signed the Social Security Amendments into law, creating Medicare and Medicaid. The idea for these programs came many years before during the terms of President Franklin D. Roosevelt and President Harry S. Truman. Medicare was established as a health insurance program for the elderly and Medicaid as a health insurance program for the poor.
    Read More
    
    photo credit: LBJ Presidential Library
  - 1965: Duke University creates first Physician Assistant training program
    
    Eugene A. Stead Jr., MD, at Duke University (Durham, NC) creates the first formal training program for physician assistants. The first class consists of four former US Navy Hospital Corpsmen.
    
    photo credit: Physician Assistant History Society
  - 1967: “Surgeon Assistant” at University of Alabama
    
    The University of Alabama (Birmingham, AL) establishes the first “Surgeon Assistant” program.
  - 1968: American Association of Physician Assistants
    
    The American Association of Physician Assistants (AAPA) was established by Duke University students and alumni.
  - 1969: MEDEX
    
    The University of Washington (Seattle, WA) establishes the MEDEX programs, designed to provide healthcare to rural areas in the northwest.
    
    photo credit: University of Washington
  - 1971: AMA formally endorses the physicians’ assistant concept
    
    The American Medical Association House of Delegates adopt “Essentials for an Educational Program for the Assistant to the Primary Care Physician”.
- Pathologists’ Assistant & AAPA Timeline
- 1969 to 1979
  - 1969: Pathologists’ Assistants
    
    Thomas D. Kinney, MD, was Chairman of Pathology at Duke University in 1967, and in 1969 was appointed Director of Medical and Allied Health Education there. He was also on the advisory board of the Veterans Administration and likely influenced the decision to provide grants from the “Pathology and Allied Science Service” of the Veterans Administration to establish the first three pathologists’ assistant training programs. Kinney’s idea to establish a formal pathologists’ assistant training program was based in part on pathology manpower concerns, and at least in part on his colleague Dr. Eugene A. Stead’s creation of the physician assistant program at Duke University in 1965. Dr. Kinney’s concept was that of physician assistants specializing in anatomic pathology. [1] The VA grant helped to develop the course curriculum and to populate the first class. Training was facilitated in cooperation with the Veterans Administration Medical Center (VAMC) in Durham, North Carolina. The pilot program, a one-year certificate program, started in July of 1969. The curriculum was designed specifically so that its graduates would be fully capable to assist pathologists in anatomic pathology practices, giving rise to the “pathologists’ assistant” profession. Integral to the implementation and success of Dr. Kinney’s Duke program were A. William Musser, MD, on the Veterans Administration Medical Center side, and Kenneth A. Broda, PhD, who was the primary lecturer on the Duke University side. Dr. Broda, whose PhD track included taking many of the courses offered to the pathologists’ assistant students, can lay claim to his being the very first formally titled pathologists’ assistant. [2] Three students comprised the inaugural class: one a former US Navy Hospital Corpsman with no college experience, one with two Junior college associate degrees in the sciences, and one with a bachelor’s degree in science.
    
    Wright JR Jr. The History of Pathologists’ Assistants: A Tale of 2 Educational Mavericks, Arch Pathol Lab Med. Accepted for publication August 7, 2018
    
    Conversations with Coy Wagoner, PA(ASCP). AAPA Founding Father, graduate of first Pathologists’ Assistant class, Duke University
    
    photo credit: Duke University School of Medicine, Department of Pathology
  - 1970: And then there were two. The second Pathologists’ Assistant program.
    
    A Veterans Administration grant enables the establishment of a second pilot pathologists’ assistant program, involving the University of Alabama (UAB) in partnership with the Veterans Administration Medical Center (VAMC) in Birmingham, Alabama.
    
    “UAB/VA had its first class, two students in a one-year certificate program. The students were Larry Renner and Aubrey Dale. Larry stayed on to become the program director/administrator. Aubrey was there initially but moved to Maine to accept a different job. My class was the first of three to start the two-year program – everyone received a BS degree. Everyone but me had to make up enough other course work to complete requirements for the degree. I already had a BS, so credits were accepted from my previous education. Five of the 10 students in my class had a military background. I am a Navy Corpsman, John Mullins and Lee Weisz were Army medics (Lee served in Nam – Bronze Star), Dave Driscoll is a former Marine (Navy Cross from Nam), and Billy May was Army reserve. I do not know if Billy had military training, but he did have some radiology and respiratory therapy background. There were two classes after mine (graduated in ’73). The program closed after the class of ’75 graduated.”
    
    John Mitchell, UAB class ’73
  - 1971: And then there were three. The third pathologists’ assistant program.
    
    A Veterans Administration grant enables the establishment of a third pilot pathologists’ assistant program, involving the West Haven Veterans Administration Medical Center (VAMC) in partnership with Yale University and Quinnipiac College.
    
    “In September 1971, four students started at Quinnipiac College. The first year was mainly academics. They had three semesters the first year. There have been 47 classes of graduates from 1973 to the Pathologists’ Assistant program in 2019, with over 600 former students. We have 25 students per class, with two classes per year – the academic year and the clinical year.”
    
    What I can recall…a Physician at Duke University started a program in the early to mid sixties called the “Physician Associate”. Their program was a two-year certification program where students were trained to assist physicians in the clinical setting. These PAs (Physician Associates) learned to administer different drugs such as antibiotics, assist with diabetes patients, learned minor surgical techniques, read EKGs, and many other duties. At the end of the two-year program, they graduated with the title of PA (Physician Associate). Shortly thereafter, the American Medical Association (AMA) intervened to shut down the title of (Physician Associate) because of confusion with the term Associates who also could be MDs. The AMA finally did approve the new title of PA (Physician Assistants).
    
    By the late sixties, Duke University Physician staff started training PAs (Pathology Assistants). Finally, in 1971, the Federal Government funded three training programs in the U.S. for the Pathologists’ Assistants: Duke University, Quinnipiac University (College at that time), and the University of Alabama in Birmingham. The Federal Government funded the three programs for five years. By 1976, the Federal Government terminated the government monies.
    
    Duke University took over their Baccalaureate training program until the mid 1980s. Quinnipiac University took over their Master’s Degree program M.H.S. (Master of Health Science) and is still in full operation with 25 students per class with over 600 graduates as of May 2019. The University of Alabama closed their program down before the Federal Government funds had run out (1974).
    
    In September 1971, four students started at Quinnipiac College. The first year was mainly academics. They had three semesters the first year. Their anatomy class was only “cats” (no humans) that year. Their second year was autopsies at the VA Medical Center, mainly male cadavers. Then the students trained at Yale University utilizing deceased female and children cadavers. The second class of the first year students trained with Anatomic Pathology cadavers for their human training, and this has gone on since the beginning (to date, 47+ years)!
    
    Over the years, different Quinnipiac Program Directors were involved in the training process. By the late 1980s, Dr. Ken Kaloustian took over the Directorship until he retired in 2015. Professor Rob Cottrell has since taken over as the current Program Director. Our first Program Medical Director, Dr. Rosa Enriquez, took over in 1971 as Medical Director until her retirement in 1992. Dr. Nelson Gelfman followed up as Medical Director of the program until his retirement in 2014. Our current Medical Director is Dr. Maury Fremont-Smith, a pathologist at Quinnipiac University. Leo Kelly was the Clinical Coordinator from 1971 to May 2019. Dr. Colleen Hebert has since taken over as the Clinical Coordinator position as of July 2019.
    
    Narrative from Leo Kelly, QU class ’73
  - 1971: American Association of Pathologists’ Assistants: The Beginning
    
    A group of practicing pathologists’ assistants, seeking to organize themselves and to advance their newly emerging profession approaches the American Association of Physician Assistants (AAPA) about becoming members. The request is denied, and shortly thereafter the American Association of Physician Assistants copyrights “PA-C” as the designation for “Physician Assistant, Certified”.
  - 1972: American Association of Pathologists’ Assistants: The Founding
    
    The first five graduates of the Duke University Medical Center Pathologists’ Assistant Training Program following a series of meetings during the Fall of 1971 hold a formal planning meeting in February of 1972 to discuss the establishment of a non-profit organization that would foster the education of pathologists’ assistants at recognized medical centers and universities.
    
    The American Association of Pathologists’ Assistants was officially founded and incorporated in the city of Dayton, Montgomery County, Ohio on April 14, 1972. The first officers/founders of the AAPA signed papers of incorporation that included the “Articles of Incorporation” and the names of the officers with the office they held. They are:
    
    President – Harvey L. Gibson
    
    Vice President – Norman F. Gerard
    
    Vice President – Robert P. Heineman
    
    Vice President – Coy W. Wagoner
    
    Secretary/Treasurer – John R. McNamee
    
    By the winter of 1972, the American Association of Pathologists’ Assistants (AAPA) had been officially founded and incorporated as a non-profit organization under the statutes of the state of Ohio. From its inception, the AAPA was dedicated to advocacy for individual pathologists’ assistants and to the advancement of a then newly emerging allied health profession. From the outset, the AAPA’s major goals were to create guidelines for formal training programs, to develop a de facto certification “Fellowship” examination, to provide continuing education (CE) for its members, and to obtain national recognition for the profession and for individual pathologists’ assistants.
    
    The first official document defining the activities and governance of the AAPA as an association, the “Code of Regulations of the American Association of Pathologists’ Assistants”, was also created. The “Code” was designed to be a fluid document, able to be amended as necessary to ensure the proper governance of the association.
    
    The first five graduates of the Duke University Medical Center Pathologists’ Assistant Training Program conducted the first official planning meeting to discuss the establishment of a non-profit organization that would foster the education of pathologists’ assistants at recognized medical centers and universities across the country. It was held in February of 1972 at the University of Kentucky Medical Center in Lexington, Kentucky. Present at the meeting were Coy Wagoner and Norm Gerard, graduates of the inaugural Duke University program. Also present were Bill Black, Harvey Gibson, and Robert Heineman, also graduates of the Duke University program.
    
    The funding for the effort to establish the “American Association of Pathologists’ Assistants” was shared equally among those present at the meeting in Kentucky. The major goals of the Association were identified, and each of the principals at the meeting took on specific assignments in an organized effort to attain them. Norm Gerard created a newsletter to be distributed to Association members and prospective members. Coy Wagoner wrote to all states’ attorney general offices to ascertain if there were any existing statutes that would either allow pathologists’ assistants to perform their jobs or potentially prevent them from performing their jobs. Harvey Gibson initiated the plan to incorporate the “American Association of Pathologists’ Assistants” (AAPA) as a non-profit organization in the state of Ohio where incorporation costs were reasonable. Robert Heineman and Bill Black created guidelines for training programs, developed a “Fellowship Examination” for potential AAPA members, and developed a continuing education (CE) program for AAPA members. These five Duke graduates were the founding fathers of the AAPA.
    
    From the first planning meeting held in February of 1972 came a proposed organization which adopted the name of “The American Association of Pathologists’ Assistants”. The Association was (and still is) dedicated to, and adheres to the same high professional, ethical, and moral ideals that guide the many other professional medical associations that exist in society. A provisional clause was included in the Association’s Code of Regulations, whereby many of the already employed, non-certified so-called pathologists’ assistants could become members of the Association if, after examination by the Association membership committee, they were found to be qualified under criteria established by the Association.
    
    It was a general consensus of the founding members of the Association, that a non-profit organization was the best vehicle to achieve the prime objective of identifying those who were qualified as certified pathologists’ assistants, and to inform the general public and members of the medical profession of the qualifications of formally trained pathologists’ assistants, and to insure that those not qualified as pathologists’ assistants would be subject to criticism and may in some instances be subject to legal remedy if the good name of the certified pathologists’ assistants is used indiscriminately by those seeking employment as certified pathologists’ assistants, when in fact they are not.
    
    AAPA Newsletter VOL. 1, NO. 1, P2-3, Aug 1974
    
    The American Association of Pathologists’ Assistants organization was formed in order to promote the individual pathologists’ assistants and to represent a small group of individuals as a unified force. The AAPA was a source of potential jobs and provided clarification of the legal standing of individual pathologists’ assistants and of the profession in the medical community.
    
    The AAPA provided its members a platform to network even before the time of computers and the internet. It provided a forum for the exchange of information between members and a sounding board for each of us to compare our job situations and the attendant obstacles that arise in each of our personal and professional careers. I personally found this to be most helpful. In most of my positions, I was the first pathologists’ assistant to be hired. This provided me with the unique experience of “breaking the ice” and showing what I could do.
    
    I found that training pathology residents in the academic positions at the University of Kentucky and the University of Virginia could potentially expand horizons for other pathologists’ assistants. Residents could see our usefulness and eventually might go on to hire pathologists’ assistants themselves once they were part of their own pathology departments.
    
    Through the AAPA, I have made lifelong friends in both the United States and in Canada, where I have been an “unofficial” member of the Canadian pathologists’ assistant delegation for years. The great locations of the AAPA conventions over the years have allowed my family to visit many places we might not have otherwise had the opportunity to see.
    
    I consider the AAPA and the pathologists’ assistant profession to be the guiding forces in my life. I left rural Indiana coal mines to become a medical professional in pathology through the Duke University PA Program, under the auspices of A. Wendell Musser, MD, a fellow Hoosier who as a mentor, saw my potential and recommended me for the first class of three in that program. That year at Duke I met my future wife of 48 years, and my life was forever changed.
    
    Coy Wagner PA(ASCP)^CM, Duke Class ’71
  - 1972: “The Pathologist Assistant: First Year Job Experience of a New Paramedical Career”
    
    The first published article co-authored by a pathologists’ assistant about pathologists’ assistants, titled “The Pathologist Assistant: First Year Job Experiences of a New Paramedical Career”, by Edward Davies, MA; Joseph Parker Jr., MD, Norman Gerard, PA, is published in “Southern Medicine”, volume 60 #4.
    Read the article
    
    Norm Gerard – Duke ’71, Founding Member
  - 1974: A fourth program established
    
    A fourth training program, and the first not to be affiliated with the Veterans Administration grant program, is established at the University of Maryland in 1974. The program is notably the first to eventually offer a Masters’ degree.
    
    Official start of program – August of 1974
    
    First class graduated in 1977
    
    Program Directors:
    
    Wolfgang Mergner, MD – 1974 to 19xx
    
    Raymond Jones, PhD – 19xx to 2008
    
    Rudolph Castellani, MD – 2008 to 2016
    
    Michael Lipskey, PhD – 2016 to present
    
    NAACLS Accreditation – initial – April of 2000
    
    NAACLS Accredited for full ten years in 2017
    
    At least one member of the class of 1979 still a practicing PA at the start of 2019 (since retired)
    
    courtesy of Carlen Miller
  - 1974: First Professional Contact
    
    The AAPA contacted the National Board of Medical Examiners (NBME) in 1974 regarding developing a national certification program for pathologists’ assistants. The following is an excerpt from a letter received by the AAPA from John P. Hubbard, MD, President and Director of the National Board of Medical Examiners (NBME), regarding national certification for pathologists’ assistants:
    
    “If at any time the American Association of Pathologists’ Assistants should wish to request the services of the National Board in the development of a certifying examination, we would be interested in hearing from you. Such a request would be brought to the attention of our Executive Committee for their consideration.”
    AAPA Newsletter VOL. 1, NO. 1 p. 4, Aug, 1974
  - 1975: The First Annual Meeting of the AAPA
    
    The first annual meeting of the American Association of Pathologists’ Assistants (AAPA) is held in the fall of 1975 in Atlanta, GA. It is primarily a business/organizational meeting. There are 35 attendees, from which are elected the first AAPA officers. It is decided at that meeting that the AAPA would henceforth administer a “Fellowship” examination.
    
    The first annual meeting of the AAPA was held in the fall of 1975 in Atlanta, GA. I believe Walt Sosinski (who was working in Atlanta at the time) set up the meeting. It was more of a business/organizational meeting rather than educational. I do not remember any lectures or seminars. We did elect the first officers from the members present – there were all of 35 of us. We also started to revise the “Code of Regulations”, established the original committees (chairs as well as members), had very heated discussions regarding formally and on-the-job (OJT) members, and decided to have a “Fellowship” exam which would be given at the next annual meeting. Students, persons not meeting the requirements for “Fellow” membership, could become “Affiliate” or “Associate” members, depending on an individual’s training and education. Members who were eligible for “Fellow” membership had a timeframe for taking and passing the exam. Those individuals who failed to meet “Fellow” membership requirements could maintain membership in the other categories but lost some privileges. Ron Findley was an OJT from Arkansas who spoke in favor of OJTs and was instrumental in their initial acceptance into AAPA membership. OJT membership remained a “bone of contention” for many years.
    
    My first connection was at the first AAPA meeting in Atlanta. Those, including me, who were involved in preparing the first exam were excused from taking it. I never had to take the certification exam. I was elected the first Treasurer of the AAPA and collected the membership dues and meeting fees and opened the first accounts. When I relinquished the position, I came up $120.00 short and put the shortage in out of my own pocket. I organized, I think, the next meeting. If not, it was the following in New Orleans. I also organized the meeting in Virginia Beach and maybe one other, but my memory fails me. Then I went to get my PhD and developed my research program while supervising the autopsy lab. The Duke Program was closed, and I did not come back on the PA scene until I was tasked with reopening the program and being its director, which I did. I was then mostly involved with program accreditation (i.e. NAACLS). I often clashed with some because I was hawkish (maybe too much for the time) on requiring a masters and eliminating OJT and affiliate AAPA membership. After NAACLS guidelines were established and we got the Duke program accredited, I dropped back to running the program, running the autopsy lab, publishing and fighting for grants for my research program. I was promoted to associate professor with tenure and then in addition made course director for the Pathology Med School Core Course. Carol and I took early retirement in 2004 and we lived and taught med school in the Caribbean for the next 13 years. We are now fully retired and live in Beaufort, NC.
    
    John Mitchell
  - 1976 to 1993: The AAPA Forges new Relationships
    
    The AAPA forges new relationships with major stakeholders in the medical community during these years, including the American Society for Clinical Pathology (ASCP), the American Medical Association (AMA), the American Society of Allied Health Professionals (ASAHP), the Intersociety Pathology Council (IPC), the Association of Pathology Chairs (APC), the College of American Pathologists (CAP), the International Academy of Pathology (IAP), and the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS).
  - 1976: AAPA Officially recognized by Professional Pathology organizations
    
    The AAPA is officially recognized by the Intersociety Pathology Council (IPC) and establishes a relationship with the Association of Pathology Chairs (APC).
    
    The Intersociety Pathology Council (IPC)
    
    The Intersociety Pathology Council (IPC) is an informal organization which serves as a communication center and provides a unified voice for the discipline of pathology in North America. The IPC, formed in 1968, is presently composed of representatives of 25 pathology organizations. IPC offices are in Bethesda, MD. IPC objectives are to serve:
    
    As a national forum for discussion of matters of interest and concern to North American pathology;
    
    As a clearinghouse for scheduling of national meetings; and
    
    As a means of facilitating communications among national pathology organizations.
    
    Reference: Intersociety Pathology Council
    
    The Association of Pathology Chairs (APC)
    
    The Association of Pathology Chairs (APC) is a non-profit society which serves as the voice of academic departments of pathology in the U.S. and Canada. APC exists to provide leadership and advocacy for the dynamic discipline of Pathology, and to enable academic departments to meet the demands of their three missions: medical education, research, and practice. The APC provides education, training, information resources, and networking opportunities for members of the five APC sections.
    
    Reference: Association of Pathology Chairs
    
    On June 23, 1976, an Ad Hoc committee of the Intersociety Pathology Council (IPC) on pathologists’ assistants, members of which included: Thomas D. Kinney, MD; Margorie Williams, MD; William J. Reals, MD; William Dolan, MD; and Fairfield Goodale, MD, requested to meet with AAPA officers.
    
    The meeting was subsequently held at the Veterans Administration Central Office in Washington D.C. on September 15, 1976. Dr. Goodale opened the meeting by extending official IPC congratulations to the founding body and present officers of the AAPA on the formation of such an Association. The IPC also expressed an interest in gaining statistical information on practicing pathologists’ assistants and on the ideals and goals of the Association. Dr. Kinney said that he felt that two main goals of the AAPA should be creating criteria for approved training programs and creating a certification examination at a national level. Dr. Kinney also suggested that the “Association of Pathology Chairs” (APC) might be the organization best designed, most suitable, and perhaps even receptive to the idea of supporting the AAPA. The IPC offered their support and help whenever it might be needed.
    
    A conference on “The Future of Academic Pathology” was held at the University of Maryland on September 22-24, 1976. It was sponsored by the “Universities Associated for Research Education in Pathology”, the “Intersociety for Research Potential in Pathology”, and the “Association of Pathology Chairs”. A panel discussion was held on “Technical Training of Assistants to Pathologists.” Their conclusion was that there was a continuing and growing need for qualified pathologists’ assistants from standard degree programs. The need for more pathologists’ assistants corresponds to the present and projected shortage of pathologists and coincides with a related change in the modern approach of the pathologists. The panel recommended that the APC or IPC be asked to take the leadership role in the organization of a “Commission on Pathologists’ Assistants.” The Commission would address the issues of educational standards, program accreditation, certification, and funding.
    
    During the second annual meeting of the American Association of Pathologists’ Assistants, held on October 1-3, 1976 in Virginia Beach, VA, the definition of a Pathologists’ Assistant was officially changed to coincide with that recommended by the IPC to read: “A Pathologists’ Assistant is a professional person who is qualified by academic and practical training to provide service in anatomic pathology under the direction of a qualified pathologist who is responsible for the performance of the assistant”.
    
    Norm Gerard, Duke ’71, Founding Member
  - 1976: The First Fellowship Exam
    
    “The first ‘Fellowship Examination’ was given at the second annual AAPA meeting in the fall of 1976 in Virginia Beach, VA. The exam was put together by myself and Brent Riley. It had been decided in Atlanta the previous year to ‘grandfather’ all current ‘Fellows’ and persons meeting membership requirements prior to the exam. I do not remember how many people took the exam (no more than 10 or 12), but it was graded, and ‘Fellow’ status awarded to those who passed while at the meeting in Virginia Beach.”
    
    John Mitchell
  - 1977: Another attempt at partnership with fellow PAs
    
    The AAPA, by vote of Fellow members present at the 1977 AAPA annual meeting, decides to look once more into possible affiliation with the American Academy of Physician Assistants as an umbrella organization in order to gain strength in numbers.
  - 1978: American Academy of Physician Assistants again rejects membership.
    
    The American Academy of Physician Assistants again reject the AAPA’s request for membership (see 1971), citing the fact that pathologists’ assistants were not a fit because they were not clinically trained, and that their support and mentorship did not come from the AMA, but rather should come from the CAP and/or the ASCP.
    
    At this time, the AAPA makes a formal request to the ASCP, asking them to consider establishing a “Pathologists’ Assistant Registry”.
    
    I spoke with the Physician Assistants in 1971 regarding potential membership. We were asking because we recognized the need to increase our own membership numbers to increase our chances of eventually gaining national recognition and national certification. They told me that pathologists’ assistants weren’t clinically trained and so did not fit, that while their own support was the AMA, that support for the pathologists’ assistants should come from CAP/ASCP.
    
    The Fellow members present at the 1977 annual AAPA meeting voted to have leadership look again into affiliation with the American Academy of Physician Assistants, whom they viewed as an umbrella organization that would allow the AAPA to gain strength in numbers. The Board of Trustees (BOT) committed to investigate the proposal.
    
    The BOT communicated with the Academy in the Fall of 1977 and met with their representatives in Washington, D.C. later that year. The BOT reported in the March 1978 AAPA Newsletter that the meeting led to the decision to forgo further communications with the Academy regarding membership. The Academy cited the same reasons for denying membership as had been previously cited.
    
    Rob Heineman, Duke ’71, Founding Member
  - 1979: Issues with the VA system
    
    The AAPA (ca 1979) meets with representatives of the Veterans Administration (VA) in Washington, D.C. to express concerns that while the VA was involved in training PAs, they had no job description for them in their system or job opportunities for them.
    
    “Somewhere in the late 70s or early 80s (do not remember exactly when), I went to D.C. and met with the VA. I was not alone but do not remember who was with me. It might have been Leo Kelly. There was a concern that the VA was training pathologists’ assistants, but none were going to work for the VA. There were opportunities available, no job descriptions, no funding, zero. Typical catch 22. That obviously did not change – same as the outcome of the meeting.”
    
    John Mitchell
- 1980 to 1989
  Background: Establishing the Pathologists’ Assistant as a member of the medical team.
  
  The 1980s was a decade of advocacy for the Pathologists’ Assistant profession. During this decade, the AAPA, now several hundred national members strong in less than 10 years, was becoming a strong voice for Pathologists’ Assistants in the medical community. New relationships with other professional organizations were forged and many older relationships were made stronger. The 80s also saw more building of the AAPA structure and the release of “Professional Responsibility of the Pathologists’ Assistant”, the first scope of practice for the Pathologists’ Assistant.
  - 1980: AAPA submits application to the AMA
    
    The AAPA Board of Trustees (BOT) submits its initial application to the American Medical Association (AMA) for national recognition as a new emerging allied health profession. The AMA cites the lack of AAPA membership numbers and inadequate financial strength as the major liabilities that prevent the AAPA from successfully attaining that recognition.
  - 1982: The AAPA Exhibit Booth has a positive impact at organized pathology meetings
    
    “I was fresh out of PA school (SUNY Downstate) and months into my first job at NYU Medical Center when I had the opportunity to attend my first AAPA meeting, which I believe was in Boston. Before the week was over, I committed to chairing the Public Relations Committee (by the way, I knew nothing about PR), which was in its infancy. This required storing the huge AAPA exhibit in my basement, dragging it to FedEx to ship to conferences, and then tackling the intricate assembly of the exhibit. Then came actually manning the booth and interacting with the attendees, the majority of which were pathologists. Back then I was not particularly outgoing, but I quickly got over my fear and was proud to speak of our profession.
    
    In the beginning, the number one question was “What is a pathologists’ assistant?” and was often asked in a hostile tone. It didn’t take long until the questions evolved to “How do I get one?” often said in a hopeful tone. I take great pleasure in seeing the incredible growth and maturity of our profession. All the hard work of the early days has certainly paid off. We dreamed of one day being nationally recognized, and I am happy to say when I tell people I am a pathologists’ assistant to this day the profession is a well-recognized and respected one. As a board member of the ASCP, I attend the annual meeting each year and enjoy stopping by the AAPA booth and interacting with our members. I love to tell them about the old days and how far we have come, and they seem to enjoy my stories about the exhibit booth!”
    
    Anne Walsh-Feeks
  - 1983: Association of Pathologists’ Assistant Training Programs (APATP)
    
    The Association of Pathologists’ Assistant Training Programs (APATP) incorporated in 1983. Its first president was Kenneth Broda, PhD. One of their first outreach efforts was to present an exhibit booth at the annual ASCP/CAP meeting in October of 1983 in St. Louis. The booth displayed five focal points: a projection screen with a continual loop of AAPA statistics; a table containing current curricula from the four operational training programs; reprints of four articles about pathologists’ assistants; a protocol for PA Professional Responsibilities; and the “Minimal Essentials” document drafted by the APATP. Also displayed were the sponsors of the booth (AAPA and APATP), photographs depicting the “training of pathologists’ assistants” from the Duke University Training Program, and a poster explaining how pathologists’ assistants can help pathologists. Manning the booth were Dr. Wolfgang Mergner, Program Director at the University of Maryland, Dr. Kenneth Broda, Associate Director of the Duke University program, and Robert A. Neri, President, AAPA.
    Neri R.A.: The Training of Pathologists’ Assistants Exhibit at the Fall ASCP/CAP Meeting, October 1983. AAPA Newsletter, Vol. X NO. 4 p2, December 1983.
  - 1983: The first Scope of Practice
    
    The AAPA creates a protocol detailing the scope of “gross tissue examination and personnel qualifications” for non-physicians doing grossing. The protocol was an outcome of the “AAPA Job Description Project”. The final product of this project is a document titled “Professional Responsibilities of the Pathologists’ Assistant”.
  - 1987: AAPA applies again to the AMA
    
    The AAPA Board of Trustees (BOT) communicates with the AMA Board of Directors again in November of 1987, reiterating their goal of attaining national recognition. The AMA response is that, without the support of a national organization of physicians representing the AAPA’s subspecialty, the AMA would not feel obligated to approve the application.
  - 1988: Building new relationships
    
    The AAPA joins the American Society of Allied Health Professions (ASAHP) as a professional association member.
    
    The American Society of Allied Health Professions (ASAHP) is composed of a variety of allied health associations, educational institutions and individual allied health care providers. It is dedicated to the advancement of allied health through legislation and education. In an effort to buttress its chances of gaining recognition through an application to the American Medical Association (AMA), the AAPA contacted other medical/allied health organizations. One such organization is the “American Society of Allied Health Professions” (ASAHP), who had expressed a willingness to talk with the AAPA about the AMA application. Jeff Watterson, AAPA President at the time, was invited to speak with their Board of Directors at their annual conference in Las Vegas in November of 1988. The meeting, however, was cancelled on the basis that the ASAHP did not feel that such a meeting would not engender their support for our application to the AMA for national recognition. The ASAHP is mainly concerned with the educational development of its members, who consist primarily of deans of allied health schools from universities across the country. Jeff did see benefit, though, in joining their organization as an “Associate” member in that it might afford the AAPA a vehicle for establishing new training programs.
    
    International Academy of Pathology (IAP)
    
    In early 1988, Public Relations Chair Anne Walsh-Feeks initiated dialogue between the AAPA and the “International Academy of Pathology” (IAP). The dialogue led to the AAPA being given complimentary exhibit space at the annual meeting of the United States and Canadian Academy of Pathology in Washington, D.C., February 29 to March 4, 1988. Anne reported that the response to the AAPA exhibit booth was excellent, with many pathologists stopping by the booth with an interest in hiring a pathologists’ assistant.
    
    The AAPA would go on to maintain a relationship with the IAP, and in the fall of 2004 I presented a lecture on the AAPA and our profession to the Royal College of Pathologists (RCP), their Australian counterpart, the Royal College of Australian Pathologists (RCPA), and other organizations at the IAP annual meeting in Brisbane, Australia. It was an excellent opportunity for the AAPA to continue its outreach program, this time to an international group of pathology organizations.
  - 1988: The AAPA formally requests support from the CAP
    
    The AAPA BOT submitted a packet of information to the Executive Director of the College of American Pathologists (CAP) included within which was a formal request for CAP’s support of the AAPA’s application to the American Medical Association (AMA) for recognition as a newly emerging allied health profession. The packet and request were presented to the CAP Board of Governors in June of 1988. The request, however, was denied by the Board of Governors, who cited in part, a lack of unanimity among individual pathologists as to the appropriateness of non-physician pathologists’ assistants performing some of the pathologists’ duties.
- 1990 to 1999
  Overview: Setting the Strategic Plan: National Recognition
  
  The 1990s were highlighted by the AAPA’s continued efforts to gain support from the major pathology professional groups, to achieve national recognition, and to follow their established goal to create guidelines for formal training programs. They applied to the AMA for recognition as a new emerging healthcare profession, developed the “Guidelines for Establishment of an AAPA-Approved Training Program”, interacted with CAHEA regarding CLIA ’88 regulations determining the ability of PAs to legally perform their duties, advocated for their members regarding potential licensure issues, partnered with NAACLS to develop an accreditation process for pathologists’ assistant training programs, created the AAPA “Professional Responsibilities of Pathologists’ Assistants”, and created a national committee for the certification of PAs.
  - 1990: The AAPA asks for support again
    
    The AAPA presents a new resolution to the CAP House of Delegates in the fall of 1990 asking again for support for their application to the AMA for national recognition as a new emerging health profession. The CAP House of Delegates maintains their decision to deny such support.
  - 1991: Resolutions on National recognition and AAPA-Approved Training
    
    The AAPA BOT creates the “Guidelines for Establishment of an AAPA-Approved Training Program” document.
    
    The AAPA creates a new resolution to submit to the CAP House of Delegates requesting CAP’s support for two new AAPA applications to the AMA, one for recognition as a new emerging health profession and another for accreditation of pathologists’ assistant training programs under the Committee on Allied Health Education Accreditation (CAHEA).
    
    The AAPA forms an Ad Hoc committee on national recognition.
  - 1991: The first Central Office
    
    “Just some AAPA trivia for your enjoyment. Our first Central Office was set up in my sister Kathy Tulley’s basement in Malverne, Long Island, NY in 1991. As a busy mom of four young children she ran a medical transcription business in her home. She generously offered to answer our newly created toll-free number, 800-532-AAPA, which she did for a number of years until we created a ‘real’ central office.”
    
    Central Office
    The first AAPA “Central Office” was associated with the Allied Health Museum in Dayton, Ohio. It was utilized essentially from the beginning, but its activities were relatively limited. The first official “Central Office” was contracted to Kathy Tulley, Anne Walsh-Feeks’ sister, on Long Island. Kathy managed the Central Office for two years and helped the AAPA through some growing pains. In 1993 the AAPA chose a new Central Office, “Peripheral Services, Inc.” in Rochester, NY, run by Nancy Carleton and her son Dave. In addition to handling the usual but increasing association management needs of the AAPA, both had experience as consultants in various aspects of organizational management, such as membership development, public relations, accounting, and publications. In December of 1995, “The Management Advantage” in Bloomington, MN became the AAPA’s new Central Office. The firm’s owner and President, Mary Schnarr, had extensive experience working with small associations. After three years, though, Mary successfully sold the company to “Office Enterprises, Inc.” of Roseville, MN. The AAPA’s account was successfully transferred to “Office Enterprises, Inc.” (OEI) in the winter of 1998 without any change to the AAPA in cost or level of services. OEI’s owner, John Arlandson, was an attorney and had owned the firm for three years. John offered to be available to the AAPA for legal advice, and indeed, helped the AAPA with advice on several legal matters. With OEI, we built a dynamic database which enabled us to better keep track of membership information and to reliably track dues status. OEI interacted well with our website, particularly in keeping up with our job hotline advertisements. The AAPA officially transitions to a new Central Office, “Association Development Services, Inc.” in December of 2008.
    
    Anne Walsh-Feeks
    Tom Reilly
  - 1992: Clinical Laboratories Improvement Amendments (CLIA)
    
    Brief overview: The Clinical Laboratories Improvement Amendments (CLIA) was originally enacted in 1967 when error rates of laboratory testing, particularly in the area of cytology, became very high and personel were overworked. The act originally covered independent and hospital laboratories.
    
    In 1987 and 1988, Congress enacted two laws (OBRA-87 and PHS Act) which supplement CLIA ’67 expanding HHS’s authority to regulate laboratories. The law was debated, revised, and debated again until the final CLIA ’88 regulations were published in 1992. More revisions would come, which finally go into effect in 2003.
    Read More
  - 1992: CLIA and the AAPA
    
    CLIA ’88 supplants CLIA ’67. The AAPA creates an Ad Hoc committee on CLIA ’88. CAP and ASCP advise AAPA not to pursue a political campaign to change the CLIA ’88 regulations as written.
    
    The AAPA sends a letter to the Healthcare Financing Administration (HCFA) to comment on the proposed CLIA ’88 regulations, specifically on the language describing personnel standards for laboratories performing high complexity testing, and to request the wording to be changed to allow laboratories to hire pathologists’ assistants to perform high complexity testing.
  - 1992: Association of Pathology Chairs contacts the AAPA
    
    The Association of Pathology Chairs (APC) contacts the AAPA to obtain information on the pathologists’ assistant profession. They express concern about projected pathology manpower shortages and are interested in the role pathologists’ assistants play in pathology laboratories.
  - 1993: New AAPA structure and Strategic Plan
    
    In 1993, the AAPA Code of Regulations is revised to create governance and fiscal efficiencies. Along with this, the AAPA BOT creates a “Strategic Plan” outlining short-term, mid-term, and long-term goals.
  - 1993: CLIA ’88 goes into effect and Licensure in the State of Nevada
    
    The Clinical Laboratories Improvement Amendments of 1988 (CLIA ’88) establish that program-trained pathologists’ assistants meet and exceed the personnel and proficiency testing requirements for high-complexity testing. The inspection guidelines for CLIA ’88 are changed to allow pathologists to continue utilizing pathologists’ assistants as they had in the past.
    
    The state of Nevada contacts the AAPA regarding state licensure for pathologists’ assistants. Information provided by the AAPA is utilized by the Nevada State legislature to create such licensure for pathologists’ assistants.
  - 1993: National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) & the AAPA
    
    Representatives of the AAPA are invited to attend a Training Program Process Workshop in Chicago, IL. From this, the AAPA establishes an affiliation with the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), and together they develop an accreditation process which remains in effect today as the standard for accreditation of pathologists’ assistant training programs. Details may be obtained from the NACCLS website.
    NACCLS website
    
    1990
    AAPA Board of Trustees (BOT) hosts representatives of four existing Pathologists’ Assistants (Path A) training programs in a first joint meeting during the Providence, RI AAPA Fall Conference on Oct. 7, 1990. This group of educators forms the American Association of Pathologists’ Assistants Training Programs (APATP). The AAPA Education Committee begins procedures and policies with the APATP on essentials for educational standards of Path A training.
    1992
    The first AAPA-approved training programs are recognized by the BOT, consisting of Duke University (Durham, NC), University of Maryland (Baltimore, MD), Wayne State University (Detroit, MI), and Quinnipiac University (Hamden, CT).
    1993
    Representatives of the AAPA are invited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) to attend a Training Program Process Workshop in Chicago, IL. The AAPA establishes an affiliation agreement with NAACLS. Together they begin discussions towards an accreditation process of training programs for pathologists’ assistants, which remains in effect today and is the standard for accreditation of Path A programs.
    1994
    Representatives of the APAPT (Duke University [Durham, NC], University of Maryland [Baltimore, MD], Wayne State University [Detroit, MI], Quinnipiac University [Hamden, CT], and St. John’s University [Jamaica, NY]) meet with representatives of NAACLS in Alexandria, VA during the AAPA Fall Continuing Education Conference.
    1995
    Cynthia Wells, PhD, Chair of NAACLS Board of Directors, and Olive Kimball, PhD, NAACLS Executive Director, attend the AAPA Fall Continuing Education Conference in Tucson, AZ to address the AAPA Board of Trustees, Committee Chairs, conference attendees, and the APATP members. A NAACLS “Training Program Process Workshop” for all APATP members and those interested from the AAPA is given by NAACLS volunteer Charles Ford, PhD, during this Fall Conference. The AAPA membership votes in Tucson to accept the NAACLS proposal that establishes training program accreditation. Each Path A training program will become standardized and reviewed by a committee of Path A peers and other NAACLS volunteers.
    1996
    NAACLS Board of Trustees creates the Affiliated Professional Review Committee (APRC). This initially includes AAPA Fellow members and, later, a Path A training program representative. Jerry Phipps, PA(ASCP), Steve Suvalsky, PA(ASCP), Charles Ford, PhD (Educator), Irene Roekel, MD (Pathologist educator), and Dan Angelucci (NAACLS staff) are the first APRC members. All AAPA-approved training programs are allowed to wait for their current approved status to expire then fulfill the necessary requirements needed for becoming NAACLS Path A-accredited. According to the NAACLS and AAPA agreement, an accreditation will be awarded to a Path A training program when the standards are met and maintained according to policies and procedures developed by APRC and approved by NAACLS Board of Trustees. NAACLS requests two representatives appointed by the AAPA BOT to serve on the Affiliated Professions Review Committee (APRC). The chair of this Committee would attend NAACLS Board of Trustees meetings and serve as a liaison between the AAPA and NAACLS. The final approval of the “Essentials for Pathologists’ Assistant Training Programs” by NAACLS occurred in the fall.
    1997
    APRC reviews and suggests accreditation and re-accreditations to NAACLS Board of Trustees for Path A training programs. The first NAACLS accredited Path A Training Programs are awarded to:
    
    Duke University, Durham, NC, April 30, 1997
    
    Quinnipiac University, Hamden, CT, October 10, 1997
    
    1998-2007
    Initial accreditation of Path A training programs continues:
    
    Wayne State University, Detroit, MI, April 30, 1998
    
    University of Maryland-Baltimore, Baltimore, MD, April 30, 2000
    
    Ohio State University, Columbus, OH, October 31, 2000
    
    Rosalind Franklin University, Chicago, IL, April 30, 2002
    
    Indiana University, Indianapolis, IN, October 31, 2005
    
    Drexel University, Philadelphia, PA, October 31, 2007
    
    2007
    APRC is dissolved after 10 years following the AAPA BOT petition to NAACLS to include an AAPA Fellow on the NAACLS Board of Trustees. The Affiliated Professions Review Committee (APRC) and the Clinical Lab Science Programs Review Committee (CLSPRC) are combined to form the Review Committee for Accredited Programs (RCAP). Two AAPA/APATP representatives are on the RCAP and an additional AAPA/PathA educator representative volunteers on the NAACLS Board of Trustees.
    2009-2019
    
    (as of August 1, 2019 currently 10 active NAACLS accredited Path A training programs)
    Popularity of the Pathologists’ Assistant profession grows with demands throughout the United States and international requests for program accreditation details. Additional initial accreditations of Path A training programs are granted:
    
    West Virginia University, Morgantown, VA, October 31, 2009
    
    University of Calgary, Calgary, Alberta, Canada, October 30, 2014
    
    Loma Linda University, Loma Linda, CA, April 30, 2018
    
    University of Toledo, Toledo, OH, September 27, 2018
    
    Eastern Virginia Medical School, Norfolk, VA, April 30, 2019
    
    In the early 1990s, the internal AAPA Program Approval process was functioning as designed, and all existing PA programs achieved Approved status. The AAPA Board of Trustees (BOT) was pleased with the process and outcome but recognized that an in-house accreditation might be problematic for student aid access and future professional development. Consequently, the BOT investigated established accrediting agencies for the purpose of developing a more independent and credible accreditation process. In the end, they chose the National Accrediting Agency for Clinical Lab Sciences (NAACLS) because of familiarity with their processes and protocols, as well as their familiarity with other medical lab science professions and the Pathology community in general.
    
    In November of 1993, the BOT commissioned Steve Suvalsky and me (Jerry Phipps) to participate in a NAACLS Accreditation Workshop in which the entire accreditation process was explained in a step-wise fashion for programs pursuing their initial accreditation, as well as those programs needing to renew accreditation. This experience provided us with information on how the Essentials/Standards were established, interpreted, and utilized to demonstrate evidence of compliance. This information was reviewed by the BOT and the Program Directors group (APATP) and, after all concerns were addressed, a decision was made to proceed with development of a PA Accreditation process with NAACLS. For their part, NAACLS agreed to change its administrative structure and some policies and procedures to accommodate the AAPA and the PA accreditation process, placing PA accreditation within a new Affiliated Professions Review Committee (APRC) and removing control over selection and terms of AAPA representatives to the APRC. The AAPA would not have a seat on the NAACLS Board but the APRC Chair would attend NAACLS Board meetings and serve as liaison between the AAPA and NAACLS. With these agreements reached, development of the PA Accreditation process could begin.
    
    The first task was to develop a set of Standards (then Essentials) that each program would have to meet as a minimum. To accomplish this task, NAACLS created a committee in Spring of 1994, pairing Steve and I (Jerry) with two veteran educators with extensive NAACLS experience, Charles Ford, PhD, and Irene Roekel, MD (Pathologist/educator, University of Kentucky); and Dan Angelucci (NAACLS staff). The committee used Essentials from other professions and those from the AAPA Approval Process as templates to draft PA Essentials, making adjustments for issues unique to PAs and their training programs. This was a lengthy process of drafts, consultations with involved parties, and revisions until July 1995 when we were satisfied with our result. The final task was to present our proposal to both the AAPA and NAACLS for their approval.
    
    The 1995 AAPA Conference was held in Tucson, AZ in early September. NAACLS President, Dr. Cynthia Wells, and CEO Dr. Olive Kimball were in attendance to support the PA Accreditation effort and provide information. Charles Ford, PhD, led a NAACLS “Training Program Process Workshop” for all APATP members and interested AAPA members. The proposal was presented at the Business Meeting and, after significant discussion, the AAPA Membership voted to accept. The final step in the process was the NAACLS Board vote to accept and adopt the process, which occurred at their Board meeting later in September. Over the next few months, the APRC was formed and began operations in 1996. At this point, the four existing programs (Duke University [Durham, NC], University of Maryland [Baltimore, MD], Wayne State University [Detroit, MI], and Quinnipiac University [Hamden, CT]) had AAPA Approval status and were permitted to wait for that status to expire before they were required to go through NAACLS accreditation. Wayne State University was the first program to enter and successfully navigate the new accreditation process in Spring of 1996.
    
    The APRC ran relatively smoothly from 1996 to 2006, with its members serving on NAACLS joint committees, reviewing programs, and making recommendations for accreditation to the NAACLS Board, which grants all accreditation awards and establishes all policies and procedures. During this 10-year period, PAs were the only profession in the APRC, and the only profession without a seat on the NAACLS Board. The AAPA BOT elected to petition NAACLS for a Board seat, with any necessary re-alignment of Review Committees and functions. After consideration of the merits and feasibility of the petition, NAACLS agreed and initiated the changes in 2007. The APRC was dissolved and PA accreditation was added to the former CLSPRC (Clinical Lab Science Programs Review Committee) to form the RCAP (Review Committee for Accredited Programs), which reviews and makes accreditation recommendations for programs in all professions involved. PAs have two representatives on RCAP: a PA practitioner and a PA educator (a Pathologist is also on the RCAP). In September of 2007, I was elected to the NAACLS Board, serving two four-year terms including two years as Vice President and two years as President. Jim Moore is currently finishing his first term as AAPA representative on the NAACLS Board.
    
    Steve Suvalsky
    
    Jerry Phipps
  - 1994: “Professional Responsibilities of Pathologists’ Assistants”
    
    The AAPA’s “Professional Responsibilities of Pathologists’ Assistants” document is submitted to an Ad Hoc committee of the American Society for Clinical Pathology (ASCP). The document is reviewed and subsequently accepted by the ASCP.
  - 1994: CAP granted peer inspection authority
    
    The Health Care Financing Administration (HCFA) gives deemed status to the CAP, giving them authority for peer review using its laboratory accreditation program, thus granting peer reviewed labs as meeting federal standards in lieu of routine government inspections.
  - 1995 to 1997: Essentials for training, Going Digital, and Certification
    
    1995 marks the final approval for the “Essentials for Pathologists’ Assistant Training Programs”.
    
    1996: The AAPA goes Digital! The AAPA creates its first AAPA internet home page.
    
    1997: The AAPA BOT opens dialogue with the National Certifying Agency (NCA) regarding the certification process and NCA’s potential role in the process.
  - 1998: National Committee for Certification of Pathologists’ Assistants
    
    The AAPA BOT votes to create a national committee for the certification of pathologists’ assistants and subsequently officially sponsors the partially formed “National Committee for Certification of Pathologists’ Assistants” (NCCPA).
    
    In 2000, the “National Commission for the Certification of Pathologists’ Assistants” was formed and held its first meeting in Toronto in conjunction with the annual AAPA meeting. The Commission was comprised of representatives from the AAPA, including the AAPA Fellowship Examination Subcommittee Chair and the Association of Pathologists’ Assistants Training Programs, as well as members of most of the major stakeholders in the practice of pathology, including the American Society for Clinical Pathology (ASCP), Association of Pathology Chairs (APC), and Association of Directors of Anatomic and Surgical Pathology (ADASP). Also invited were representatives from the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), American Board of Pathology (ABP), Federation of State Medical Boards (FSMB), the World Association of Societies of Pathology (WASP), Canadian Association of Pathologists, and the College of American Pathologists (CAP).
    
    The Commission was charged with assuring the development and implementation of a national and ultimately international certification process for pathologists’ assistants. In order to facilitate this process, the Commission invited three consultants to present it with information about:
    
    establishing the Commission
    
    developing a credentialing program
    
    creating a certification examination
    
    The first step was to perform an extensive review of the AAPA Fellowship Examination database to determine if:
    
    it was psychometrically sound
    
    it contained a sufficient quantity of examination items
    
    it covered the breadth of knowledge necessary to satisfy the critical elements of a certification examination
    
    The second step was to perform a needs analysis, which is a detailed study of the healthcare industry (completed in 2001) to determine the potential scope of a certification program, the perceived need and validity of such a program, and the cost-benefit evaluation of a certification program. Upon this foundation, the Commission would develop an initial business plan (completed in 2002) to determine the short and long-term viability of a certification program.
    
    In 2003, the Commission began to work with multiple vendors to request proposals for the support activities related to a certification program, such as legal, association management, and examination development. Included among these vendors were the ASCP Board of Registry and the American Board of Pathology who were approached as “sole source” and“exam only” vendors.
    
    Following the completion of all the above activities, the Commission developed two final business plans. The first was for an independent certification program to be overseen by the AAPA and the second for a joint certification program between the AAPA and the ASCP Board of Registry. The plans for the two business models were presented to the AAPA Board of Trustees in the fall of 2003.
    
    In December of 2003, the AAPA Board of Trustees, after careful review of the Commission’s findings, elected to partner with the American Society of Clinical Pathology Board of Registry. In 2004, the AAPA Board of Trustees and the ASCP Board of Registry developed a Memorandum of Understanding (MOU) outlining the first national certification program for Pathologists’ Assistants and the development of a membership category for pathologists’ assistants in the ASCP. Finally, the first national certification examination for Pathologists’ Assistants was held in Boston in September 2005 in conjunction with the annual AAPA meeting.
    
    Jim Moore
  - 1998: ASCP & CAP present findings on Pathologists’ Assistants
    
    An ASCP/CAP Ad Hoc Committee on Pathologists’ Assistants, after a two-year period of considering the scope and practice for pathologists’ assistants, presents their findings at the spring 1999 ASCP/CAP Meeting.
  - 1998: Website 2.0
    
    The AAPA creates and launches a new and professionally registered internet website: [www.pathologistsassistants.org](https://www.pathologistsassistants.org).
  - 1999: CAP studies global inpact of Pathologists’ Assistants
    
    The CAP conducts a study on the global impact of pathologists’ assistants on anatomic pathology. They are apprised of the AAPA’s efforts to develop a national certification process. Discussions regarding their possible support begin in early 1999.
  - 1999: The ASCP/CAP review on the Pathologists’ Assistants is presented to the AAPA.
    
    A review of the scope and practice for pathologists’ assistants is presented by the ASCP/CAP Ad Hoc Committee on Pathologists’ Assistants at the ASCP/CAP 1999 Fall Meeting. A subsequent report based on the discussion of the review is favorable to the AAPA, with recommendations, one of which is to develop a national certification process.
    
    “As the AAPA got traction in our quest for national recognition, we developed relationships with CAP and ASCP. The CAP seemed most interested in understanding our scope of practice, especially with respect to CLIA ’88. I participated in a number of meetings at CAP’s Washington headquarters as we refined what ultimately became our ‘Scope of Practice for Pathologists’ Assistants’ document.”
    
    During the 1980s and 1990s, the AAPA worked to consolidate and expand its relationships with major stakeholders such as ASCP, NAACLS, CAP, and ASAHP. We were also attempting to gain support from CAP for our application to the AMA for recognition as a new emerging health care profession. Despite the conspicuous lack of support from CAP, we continued our independent efforts to simultaneously grow as an organization and mature as a profession. During the early 1990s, we created a protocol detailing the scope of “gross tissue examination and personnel qualifications” for non-physicians doing grossing. The protocol was further refined, resulting in the creation of a document titled “Professional Responsibilities of the Pathologists’ Assistant”. This document was submitted to the ASCP for their review in 1993 and was subsequently officially accepted in 1994.
    
    Other AAPA efforts during this time frame included interaction with NAACLS regarding a collaborative effort to develop an accreditation process of pathologists’ assistant training programs, interacting with the HCFA to comment on proposed CLIA ’88 regulations governing personnel requirements, providing information that guided the Nevada State Legislature create licensure for pathologists’ assistants, and creating a national commission for the certification of pathologists’ assistants.
    
    The “Professional Responsibilities of the Pathologists’ Assistants” document mentioned above would prove to be the basis for another important step taken by the AAPA, and an important collaborative effort between the AAPA and the CAP. Beginning in 2003, Anne Walsh-Feeks and I, representing the AAPA Board of Trustees, met multiple times with CAP at their Washington D.C. offices to discuss the development of a joint statement clarifying the professional responsibilities of pathologists’ assistants and scope and practice issues. We presented our case to CAP and, after a series of meetings, were ultimately able to collaboratively create and publish the first official “Scope of Practice for Pathologists’ Assistants”. I remember that these meetings were very collegial, positive and productive, which marked somewhat of a “sea change” in our professional relationship. The AAPA released a revised “Scope of Practice” in 2018.
    
    Anne Walsh-Feeks
    
    Tom Reilly
- 2000 to 2009
  Background: Goals being reached!
  
  The early 2000s saw several long term AAPA goals fulfilled, including partnering with ASCP to create a national certification examination and continuing education program for PAs, partnering with CAP to create the first official “Scope of Practice for Pathologists’ Assistants”, and attaining CME Provider status through the P.A.C.E. Program. Reaching these goals helped immeasurably in the pursuit of the long elusive goal of achieving “National Recognition”.
  - 2000: National Commission for Certification of Pathologists’ Assistants has first meeting
    
    In 2000, the “National Commission for the Certification of Pathologists’ Assistants” was formed and held its first meeting in Toronto in conjunction with the annual AAPA meeting. The Commission was comprised of representatives from the AAPA, including the AAPA Fellowship Examination Subcommittee Chair and the Association of Pathologists’ Assistants Training Programs, as well as members of most of the major stakeholders in the practice of pathology, including the American Society for Clinical Pathology (ASCP), Association of Pathology Chairs (APC), and Association of Directors of Anatomic and Surgical Pathology (ADASP). Also invited were representatives from the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), American Board of Pathology (ABP), Federation of State Medical Boards (FSMB), the World Association of Societies of Pathology (WASP), Canadian Association of Pathologists, and the College of American Pathologists (CAP).
    
    The Commission was charged with assuring the development and implementation of a national and ultimately international certification process for pathologists’ assistants. In order to facilitate this process, the Commission invited three consultants to present it with information about:
    
    establishing the Commission
    
    developing a credentialing program
    
    creating a certification examination
    
    Jim Moore
  - 2000: NAACLS has first meeting on accreditation of PA programs
    
    The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) holds its first official meeting on accreditation of pathologists’ assistant programs in rooms provided by the AAPA at their annual conference in Toronto in the fall of 2000.
  - 2001: AAPA becomes a P.A.C.E Provider
    
    The AAPA attains CME Provider status through the P.A.C.E. Program to provide members with approved credits for qualifying seminars/workshops at educational conferences.
    
    I took over the CME recording activities from Maryalice Achbach at the Fall 1994 Annual Meeting in Alexandria, VA. Back then the files were on 3×5 cards (!!!) – one card per AAPA member with their CE activity written on it, mainly for informational purposes only. Quizzes were published in the Quarterly AAPA Newsletters beginning with the Winter 1994 issue, with pull-out mail-in post cards sent to me for grading and recording. This format continued through the Winter 2001 Newsletter issue.
    
    CE Award Certificates (hand-done calligraphy by me for a few years until I got computer-literate and got a calligraphy font CD!) were initiated in the early 1990s for those earning 45+ credits yearly. And there was the incentive of attending the Annual Meeting Award Banquet for free at the following meeting if you earned a certificate. Credits were not required to maintain AAPA membership, and certification was not available at that time. Meeting attendance was only recorded based on registration. Attendance was recorded by initialing sign-in sheets that were passed around during individual lectures. The Honor System was used, as the sign-in sheets included all lectures for the entire meeting (what was I thinking?). Recording of individual lecture attendance began in 2000, with one sign-in sheet per lecture being passed around during the lecture. Members were responsible for sending in CME worksheets to me for compiling into their individual records annually. The AAPA accepted any hospital-based activity that members documented. I was swimming in paperwork! CE recording became more accurate with the advent of me finally learning Excel and using spreadsheets.
    
    Rae Rader was the key figure in the AAPA becoming an approved CE provider through the ASCLS P.A.C.E. Program. She researched and initiated the whole process, with me becoming the approved AAPA Administrator of the program. I hand-wrote the P.A.C.E. Certificates and applied P.A.C.E. stickers to each certificate for each for a couple of years until ASCLS-approved providers began using their own documents with digital stickers (thank goodness)!
    
    Automation of lecture attendance began in 2005, with the clipping of name badges and scanning in to each lecture. The AAPA Central Office was key in researching and securing the use of scanning systems. They also were key in compiling the data collected, which was then forwarded to me for compiling.
    
    The Central Office developed CE tracking and record keeping thru the CE Journal on the AAPA website in 2008. The Newsletter quizzes became web-based in 2000. Quiz answers were entered online and recorded automatically in each member’s CE Journal. Members could add their self-tracked credits manually. Eventually self-tracking was phased out and now, only AAPA-sponsored CE events are recorded.
    
    The AAPA became aligned with the ASCP for certification in 2004. The ASCP CMP requires 45 approved credits per three-year cycle. Members can now record their AAPA-approved activity directly into the ASCP BOR website in order to maintain their certification.
    
    Basically, my CE role now is as the ASCLS P.A.C.E. Program Administrator. I renew/maintain our annual provider status, make sure the AAPA provided CE activities follow the ASCLS P.A.C.E. CE guidelines, and send in AAPA CE activities in a quarterly report with the help of the AAPA Central Office, who now maintains the CE database.
    
    Kathy Washnigton
  - 2003: The AAPA and NCCPA invited to CAP Headquarters in Washington DC
    
    The CAP invites the AAPA and the NCCPA to attend a mutual fact-finding meeting at CAP’s headquarters in Washington D.C. The CAP subsequently agrees to maintain open lines of communication with both organizations.
  - 2003: Certification Commission gives final recommendations
    
    The National Commission for the Certification of Pathologists’ Assistants (NCCPA) submits its final recommendations to the AAPA BOT in the fall of 2003. The recommendations include opting for: independent certification; the ASCP/BOR certification program or exploring other options. They also recommend that the BOT take additional time to consider all of the options.
  - 2003: AAPA BOT votes on certification
    
    The AAPA BOT votes unanimously in December of 2003 to pursue a partnership with the ASCP to create the first official national certification examination for Pathologists’ Assistants. A Memorandum of Understanding (MOU) between the AAPA and the ASCP/BOR is initiated.
  - 2003: AAPA BOT, CAP, and Scope of Practice
    
    AAPA BOT members initiate a series of meetings with CAP to discuss a collaborative effort to create a “Scope of Practice” for pathologists’ assistants.
    
    The AAPA’s “Professional Responsibilities of Pathologists’ Assistants” document is utilized by the AAPA and CAP as the basis for the creation of the first official “Scope of Practice of Pathologists’ Assistants” document.
  - 2004: AAPA BOT Representative addresses IAP members in Australia
    
    An AAPA BOT representative addresses members of the International Academy of Pathologists (IAP) at the IAP Congress in Brisbane, Australia regarding the state of the pathologists’ assistant profession and of the history of the AAPA.
  - 2004: National Certification: AAPA BOT and ASCP BOR sign MOU
    
    The AAPA BOT and the ASCP BOR sign a Memorandum of Understanding (MOU), forming a firm foundation for the creation of a joint program for the national certification of pathologists’ assistants. The MOU defines the relationship between the AAPA and ASCP and outlines each organization’s responsibilities.
    
    The AAPA, in partnership with the ASCP Board of Registry (ASCP BOR) creates the first national certification program for pathologists’ assistants. It is the first “professional” certification program offered by the ASCP. Working together, the AAPA and ASCP also create the first official certification examination for pathologists’ assistants. The official designation for a certified pathologists’ assistant is PA(ASCP).
    
    Background: The National Commission on Certification of Pathologists’ Assistants (NCCPA) was initially formed as a group in 1998 by the AAPA Board of Trustees (BOT) in keeping with its long-term strategic plan. The BOT’s intent was to create a stand-alone Commission whose primary charge was to conduct a feasibility study regarding the creation of a national certification program for pathologists’ assistants and report back to the Board with its findings. This effort was entirely funded by the AAPA, and the Commission worked closely with the Board for a period of five years in the pursuit of this goal.
    
    After five years of due diligence, the Commission presented its two final proposals to the AAPA Board of Trustees during its annual meeting in Phoenix, AZ in the winter of 2003. The Board’s options were to opt for an Independent Certification Program, for the American Society for Clinical Pathology Board of Registry (ASCP BOR) Certification Program, or to choose neither program and to look for other options. A special BOT teleconference was held on December 14, 2003 to make a final determination based on the Commission’s recommendations. During that meeting the Board voted unanimously to pursue the ASCP BOR Program for Certification of Pathologists’ Assistants. The final, and perhaps most compelling, factor influencing the Board’s decision was the overwhelming support for the ASCP BOR Program shown by the AAPA membership in attendance at the Phoenix annual business meeting.
    
    Kory Ward-Cook of the ASCP BOR and Jim Moore of the Commission worked together to create the initial draft of a memorandum of understanding (MOU) between the ASCP BOR and the AAPA. Anne Walsh-Feeks and I had the pleasure of meeting with the ASCP BOR Board of Governors (BOG) Executive Committee in Chicago on February 1, 2004 to discuss and refine the initial draft of the MOU. I signed off on the final MOU on behalf of the entire Board at our annual meeting in Chicago, and the Board immediately immersed itself in the effort to work with the ASCP BOR to complete the many tasks that would ensure the success of this partnership.
    
    During the timeframe that we were meeting with CAP in Washington D.C., we were also meeting with the ASCP, who had expressed an interest in involving pathologists’ assistants in their certification process. The AAPA membership was supportive and in short order we moved ahead with a letter of intent followed by the creation of the ASCP BOR (now BOC) Pathologists’ Assistant Examination Committee. We met in Chicago over a number of weekends and I have fond memories of the hard work followed by collegial and delicious dinners in some wonderful Chicago restaurants. I along with other PAs and physicians learned how to create a psychometrically sound certification exam. We learned how to write questions and, once the exam had been finalized and implemented, how to evaluate responses to specific questions. This was, for most of us, a very enlightening process and to this day I am quite the critic when I read exam questions, since I know the dos and don’ts of question writing.
    
    ASCP, from the beginning, embraced our members and many of us had the experience of participating on committees. Since I had an interest in Health Policy, I was appointed to the committee that advised on governmental issues. I became an associate editor of the journal Lab Medicine, something I continue to do to this day. ASCP, recognizing the value and contributions of their non-physician members, revised their bylaws, which allowed a non-physician to be a member of the Executive Committee of the Board of Directors. I had the honor of being chosen the first laboratory professional treasurer of ASCP and am in my second term in this role. I am honored to be able to continue to represent the pathologists’ assistant profession.
    
    Tom Reilly
    
    Anne Walsh-Feeks
  - 2004: Final AAPA fellowship exam and grandfathering fellows
    
    The final AAPA Fellowship Examination is administered in the fall of 2004 at the AAPA annual conference in Chicago, IL.
    
    Beginning in November of 2004, AAPA Fellow members who had previously passed the AAPA Fellowship Exam are given the opportunity to be grandfathered into ASCP certification. The window to apply for grandfathering is established, with a deadline of December 31, 2005. After December 31, 2005, all individuals, including qualified AAPA OJT members seeking certification, are required to pass the new PA certification exam administered by the ASCP.
    
    The partnership with the ASCP Board of Registry to create the first national certification program for pathologists’ assistants brought to the forefront the issue of how to deal with On-the-Job trained persons working as PAs. The AAPA had already created an “Affiliate” membership category for OJTs, and a path for them to become Fellow members. In light of the new certification examination, the AAPA Board of Trustees determined a path for OJTs to apply for AAPA membership, and for them to become AAPA Fellows so that they might ultimately be eligible to sit for the certification examination. In short, the Board determined that OJTs applying for AAPA Affiliate membership must have completed rigorous application requirements, including those specifically for their training on the job. Essentially, the “training requirement” must have been completed before a required three years of contiguous work experience could commence. This set of AAPA requirements was associated with a three-year plan for the phase-out of OJT eligibility to sit for the certification examination.
  - 2005: Inagural ASCP certification exam & Study Course
    
    The inaugural ASCP certification examination for pathologists’ assistants is administered in September of 2005 at the annual AAPA Continuing Education Conference in Boston, MA.
    
    As of December 31, 2005, 730 AAPA Fellows are grandfathered into ASCP certification.
    
    The first AAPA Exam Study Course is offered and the Fall Conference lectures recordings are offered for the first time.
  - 2006: Continued Outreach efforts
    
    “The Board continued to develop and maintain relationships with CAP, ASCP, and ASCP BOR. In addition to considerable communication by e-mail and phone, we had face-to-face meetings with CAP and ASCP at least twice per year in their Washington, D.C. offices. Our representatives on the ASCP BOR BOG and on the Certification Examination Committee also met regularly. The Board also established contact with additional professional organizations, and subsequently joined several, including the following: The Institute for Quality in Laboratory Medicine (IQLM), the Professional Partnership Advisory Council (PPAC), and the National Association of Advisors for the Health Professions (NAAHP).
    
    Tom Reilly
  - 2007: ASCP CMP is launched and the AAPA governance and bylaws are updated.
    
    The Pathologists’ Assistant-specific certification maintenance program (CMP) is launched by the ASCP. Details may be obtained from the ASCP.
    ASCP Website
    The AAPA creates new governance and membership structures, and additionally creates a set of bylaws to replace its outdated AAPA Code of Regulations.
  - 2008: First Executive Director position
    
    The AAPA creates its first paid Executive Director (ED) position. The ED is tasked to maintain, promote, and ensure that the AAPA remains the preeminent professional association for pathologists’ assistants.
    
    The position of Executive Director (ED) was created in 2008, if I recall, to balance the responsibilities of the Central Office and the Officers of the AAPA. The ED position would be responsible to handle matters that required attention but were above the Central Office’s level of responsibility and did not require the attention of AAPA Officers. [The AAPA] never had one before, so this was, in effect, an experiment in association management by a member of the association who reported to the Board of Trustees (BOT) and was not an employee of the association management firm. The ED was someone who was a liaison between the BOT and the Central Office, and someone responsible for implementing the new governance structure and maintaining BOT policy and procedure. I believe the position was for ¼ time, roughly 10 hours per week. Salary was approximately ¼ of the average PA salary at the time. There were no benefits, and for tax purposes, my salary was accounted for on a 1099. Setting aside money for taxes and social security was my responsibility.
    
    There were some contentious “events” to deal with, including issues with the creation of a new AAPA logo, and a person who thought he was something he was not and who threatened legal action are two that come to mind. The Central Office was very cooperative and helped to make the ED position effective. Initial work with the committee chairs was a challenge as might be expected with any volunteer organization, but that and other challenges along the way were successfully met. Overall, the ED experiment obviously proved to be successful in that a replacement was named after I retired.
    
    Although the notification of the creation of the Executive Director (ED) position was sent in a broadcast e-mail to our membership in January of 2008, the position was created in meetings at our annual conference in Montreal in the fall of 2007. The potential for its creation was a part of the discussions driving our major governance restructure project. Though the notification garnered interest from a few members, based on qualifications, the BOT’s choice to fill the ED position was essentially a no-brainer. The Board announced in late January of 2008 that John Mitchell was their clear choice.
    
    John’s qualifications include a long and storied career as an ASCP-certified Fellow member of the AAPA. He graduated the University of Alabama PA Program (one of the first three VA grant programs) and, significantly, went on to earn an MS in Business Administration. John was the first elected President of the AAPA, had a hand in creating the first AAPA “Fellowship Examination”, helped to develop our “Code of Regulations”, did significant outreach to major pathology organizations, met with officials from the Veterans Administrations at their offices in Washington D.C., helped to establish the first official AAPA Central Office, was involved with the AAPA’s early attempts to partner with NAACLS to create program accreditation, was a Board member and its Chair as well. In recent years, John excelled in his role as a “Special Projects Manager” Adjunct to the Board.
    
    John’s responsibilities as Executive Director included the managing of all AAPA standing committees, coordinating Central Office activities with respect to the daily operations of the AAPA, acting as liaison between the Board and Central Office, and essentially being the Association Manager for the AAPA. His administrative skills also aided the Board in its efforts to accomplish its goal of major governance restructuring. John essentially created the job description for the ED position and when he left it was well established and effective. Upon John’s retirement, the Board assigned the ED position to Michelle Sok of our Central Office (ADS), and Michelle is ED to this day.
    
    John Mitchell, First Executive Director
    
    Michelle Sok, Second & Current Executive Director
  - 2008: A new Logo, production upgrade, and a new Central Office
    
    A new official AAPA logo is created.
    
    The audio-visual presentation for AAPA annual conferences is ramped up significantly, with a ten-person team handling the AV responsibilities.
    
    The AAPA contracts with Association Development Services as a new Central Office.
  - 2009: New AAPA BOT and Leadership structure
    
    The AAPA BOT/Leadership structure is reorganized to create a more efficient model.
    
    The AAPA BOT creates the position of “BOT Adjunct” to describe Board-level AAPA members who function as liaisons with participating societies, or who maintain consultation with the BOT for transition in vital roles such as Chief Financial Officer.
- 2010 to 2019
  Background: All the hard work on relationships brings strength to the AAPA voice.
  
  2010-2019 has seen the AAPA continue to interact with professional organizations such as the CAP, ASCP, ACS, AJCC and others, becoming a member organization of the Commission on Cancer, further solidifying its standing as a viable health care profession. It has also maintained its commitment to advocate for its members, establishing “Town Hall Meetings”, and increasing the number of annual educational meetings. It also created and released editions 1 and 2 of the AAPA Macroscopic Examination Guidelines: Utilization of the CAP Cancer Protocols at the Surgical Gross Bench (Grossing Guidelines).
  - 2010: Other Certification routes close
    
    On January 1, 2010, The OJT route to certification is officially closed and admittance to the AAPA Affiliate member category is also officially closed. The only path to become eligible to sit for the ASCP certification exam is now to graduate from a NAACLS-accredited training program. All future AAPA members must also be trained by a NAACLS-approved training program.
  - 2010: Beyond the Bench
    
    The AAPA offers a new CME source “Beyond the Bench”, a pathologists’ assistant specific publication of various pathology topics. The compilation of articles with quizzes supplements CME offered through AAPA educational conferences and newsletter articles with quizzes.
    
    Beyond the Bench Logo
  - 2011: Strategic Plan goals: The Cutting Edge and the Grossing Guidelines
    
    The AAPA Newsletter is reformatted as a full-color, peer-reviewed journal publication and renamed to The Cutting Edge.
    
    Work on the Grossing Guidelines begins as an ad hoc committee to explore a professional and useful publication to help pathologists’ assistants with grossing standards, similar to the CAP Protocols.
    
    New Journal Format
  - 2012: New Education opportunities for members and students
    
    The first AAPA Spring Meeting is offered.
    
    The first AAPA Student Delegate program is offered.
  - 2013: The American Joint Committee on Cancer(AJCC) & Student Liaisons
    
    The AAPA becomes a member organization of the American Joint Committee on Cancer (AJCC).
    
    The AAPA establishes “Student Liaisons” to better serve and interact with students from all training programs.
  - 2014: New Member benefits!
    
    The first “PA Day” is celebrated on April 14.
    
    The AAPA offers 15 free CEs as a benefit of membership for the first time.
    
    AAPA Conference travel grants are first offered.
    
    2015 PA Day Logo
  - 2015: Committee structure is updated and the booth exhibits at a new meeting!
    
    The AAPA Committee organizational structure is updated to a “super committee” structure. This move increases efficiency of Central Office staff and volunteers alike. As a part of this, the Student Committee is formed to let students actively participate in AAPA membership and focus on benefits geared to PA students.
    
    The AAPA begins to exhibit at American Pathology Chairs (APC) meeting, increasing awareness of the profession and rebooting a long standing relationship with the APC.
  - 2016: Master’s degree standard and New York State Licensure
    
    All remaining baccalaureate degree programs are converted to master’s degree programs. All future certification exam candidates are now required to graduate from a master’s level NAACLS-accredited pathologists’ assistants training program, and as previously required, must successfully pass the exam within five years of graduation.
    
    New York State enacts a licensure program for all laboratory personnel. This causes significant confusion for many lab professionals as there are only three (3) categories. The AAPA, ASCP, other lab professional organizations, and even hospital administration organizations get involved to direct the state on how to better classify lab professionals while advocating for licensure.
  - 2017: Strategic Plan Goal Accomplished: Grossing Guidelines
    
    The AAPA Macroscopic Examination Guidelines: Utilization of the CAP Cancer Protocols at the Surgical Gross Bench (Grossing Guidelines), 1st edition is released.
    
    During the period of 2009-2011, the AAPA Board of Trustees began a reorganization process of its basic governance and core distinctives. The evolution introduced a reordering of priorities for the association.
    
    Specifically, we would expand or extend existing support where possible and the most powerful driver of any new support or endeavor would be patient care (this became the first and highest core value of the AAPA). On paper, the change was subtle from who we claimed to be “before”. But, to me, it was a huge shift – and as the AAPA Board Chair, it opened the door for me to lead some Board-level conversations that engaged some very important ways of thinking. To be very frank and personal, throughout my leadership tenure we had chased after acknowledgment from major healthcare stakeholders. And, I was growing tired of expending association energy and resources seeking recognition. I believed it was time for our association to look past others to validate who we were as practitioners (what we commonly referred to as “national recognition”) and simply to be who we are and allow our identity as important providers on the health care team step forward. I believed we would accomplish that by purposefully extending ourselves towards our patients and “owning” our small part of the healthcare pie.
    
    As the AAPA Board of Trustees sought to bring these new layers of “patient-centered” support to pathologists’ assistants, one need reached the forefront. At the time, the CAP Cancer Protocols and AJCC staging manuals (representing the work of hundreds of world experts in the field of cancer) comprised the main body of literature addressing the information extracted from cancer resections. While the information is extracted and applied in a fairly systematic approach, collectively, the documents are thousands of pages with details pertinent to the work of pathologists’ assistants embedded throughout. The AAPA endeavored to bring those features that pertained to the work of pathologists’ assistants into a consolidated guideline (the “Grossing Guideline”).
    
    The Grossing Guideline began as an ad hoc committee of the AAPA Board of Trustees in 2011. Initially Mike Sovocool, PA(ASCP)CM, took the lead and skillfully navigated the earliest steps. Not long into the project I took on the role of Editor in Chief. Vision for the committee commenced with a prototype protocol drafted by Dennis Strenk, PA(ASCP)CM, and me. Illustrations were crafted by Jesse McCoy, PA(ASCP)CM. The protocol was given to the AAPA Board of Trustees for review and met with positive response. Since the protocol was built on the CAP Cancer Protocols and AJCC Staging Manual, it was shared with those groups as well. This led to a teleconference with the leadership of the CAP Cancer Committee (the Cancer Committee is the arm of the CAP responsible for drafting the CAP Cancer Protocols). It was met with positive results and encouragement to continue. Following this it was shared with the AJCC. The reception was equally warm (not long after, the AJCC asked the AAPA to become a Member Association of the AJCC). At this point I discovered a bit of an irony. The desire to steer AAPA resources towards patient care may have produced a bit of unexpected national recognition. In my opinion, this is an important lesson for the AAPA.
    
    In 2012, as Editor in Chief of the Grossing Guideline ad hoc Committee I made a call for volunteers from within the AAPA membership. Specifically, we needed expert authors and editing staff (all volunteer). To this day, I am still amazed at the response. It was huge! In fact, the Committee, by itself, was larger than the entire remainder of the AAPA leadership (Board, Officers, Committees, Subcommittees; combined). It was a moment of great excitement and encouragement for me. I believed the patient care “path” we had begun was the right one for the association; but this was individual membership response – the highest validation I could ask for.
    
    But, with excitement came challenges. Volunteer coordination, illustration burden, workflow tracking, and a host of other obstacles had to be addressed. Ultimately, the AAPA contracted support for illustrations (thanks to Jesse McCoy, PA(ASCP)CM, for staying in the lead and helping us find Tolpa studios) and for the second time in the history of the AAPA, a pathologists’ assistant was employed to see a task to completion (Connie Thorpe, PA(ASCP)CM). Ultimately, these adjustments proved invaluable. The “internal” obstacles to creating a publication of this scope were overcome, and the massive quantity of “external” work performed by pathologists’ assistant volunteers and CAP reviewers was coordinated and brought to completion.
    
    Ultimately, during 2017, the first edition of the AAPA Grossing Guideline was released (in electronic form). The second edition followed shortly after in 2018, corresponding to the release of the 8th edition AJCC Staging manual and CAP Cancer Protocols.
    
    Since the release, the protocols have been viewed and utilized thousands of times. Of course, the amount of gratitude owed to an excellent core of experts, editors, and staff cannot be overstated.
    
    Jon Wagner, Editor-in-Chief
  - 2018: More Strategic Plan Goals Accomplished
    
    The AAPA made significant strides in 2018. First, the AAPA become a member organization of the Commission on Cancer (CoC), a program of the American College of Surgeons (ACS). This is a significant accomplishment because the AAPA has gained recognition from non-laboratory organizations and now sits at the table with not only the CAP, but organizations like the AJCC and the ACS! Our pond has gotten bigger!
    
    Second, the revised “Scope of Practice” was released and sent to our partner organizations like CAP and ASCP. Along with this, the AAPA released its “Inspection Rediness Kit”. This was developed as a joint effort by pathologists’ assistants and pathologists to provide laboratory administrators, pathologists, and PAs with all the needed documentation and assessments needed for accredidation inspection. While it focuses on CAP accredidation, it can serve as a tool for all laboratory inspections, even CLIA .
    Inspection Readiness Kit Scope of Practice
    Third, the AAPA Macroscopic Examination Guidelines: Utilization of the CAP Cancer Protocols at the Surgical Gross Bench (Grossing Guidelines), 2nd edition is released. This was a significant update to this document. It added focus to how to approch difficult specimens, more staging, and much more. It also updated several protocols with the newest release of the AJCC staging manual.
    Grossing Guidelines
    Also in 2018, the AAPA BOT started its “Town Hall Meetings” to allow members to discuss specific topics with the BOT directly via video conferencing.
    
    And finally, 2018 marked the 5-year milstone of the celebration of PA Day!
  - 2019: New benefits for members!
    
    With the increase to 60 required CE credit hours, the AAPA now offers 20 free CE credits annually to its members. Just by being a member, you get all the free credits you need to maintain your certification!
- 2020 to Present
  Background: Pivoting through the pandemic and coming back together to celebrate.
  
  A new decade arrived, bringing both challenges and successes. As the world shut down due to the COVID-19 pandemic in early 2020, pathologists’ assistants had to adapt to new ways of doing their jobs, while PA students adjusted to virtual learning. Meanwhile, the AAPA pivoted from offering in-person events to virtual and created resources to assist with those whose workflows and studies had been impacted by lockdowns and new protocols. Once we began to emerge from the pandemic, members were able to come together just in time to celebrate the AAPA’s milestone 50th Anniversary in 2022 and reflect on how far our profession and organization have come.
  - 2020: The year the world stopped!
    
    The COVID-19 pandemic hits everyone hard. Our hearts break with the rest of the world as the virus spreads and touches everyone in some way. The AAPA grieves for the many losses but also celebrates the awesome healthcare heroes we call AAPA members! Without you and your commitment to patient care and the willingness to serve, the healthcare of so many would have suffered even more. Throughout the early days of the pandemic, the AAPA highlights members whose stories reflect the collective experience of working PAs and students across the country.
    COVID-19 Resources
  - 2020: Virtual meetings & additional CE offerings
    
    Due to COVID-19 pandemic lockdowns, along with travel and meeting restrictions, the AAPA must rethink its meeting offerings. In fall, the AAPA offers “Fall for Pathology: 2020 Virtual Lecture Series”, a collection of pre-recorded lectures along with recorded poster presentations (in place of the onsite poster sessions) from the Student Delegates. In Spring 2021, the AAPA holds its first fully virtual meeting, followed by the “Virtual Symposium of Pancreatic Disease for Pathologists’ Assistants” that summer. Beyond the Bench, Volume IV, is released at the end of 2020.
  - 2020: Rebrand and “It Pays to Know” Campaign
    
    The AAPA introduces a new logo and the “It Pays to Know” marketing campaign. The goal of our updated brand is more than a fresh look – it’s a campaign to draw in various target audiences from prospective PA students to pathologists and administrators to other medical specialties and organizations through our social media sites, exhibitor booth, promotional materials, and occasional print advertisements.
    Logo FAQ
  - 2021: New AAPA Career Center Launch
    
    In place of the former Job Hotline, the AAPA launches a new members-only benefit, the AAPA Career Center, powered by a partnership with YM Careers, an industry-leading career platform. This partnership allows us to offer members a modern, up-to-date career website that serves as a one-stop shop for all members who are looking to job seek, update their resume, or simply advance their career. Members also have access to the Resource Center, with helpful advice articles and the opportunity to meet one-on-one with a career coach or have their resume reviewed by an expert.
    Career Center
  - 2022: New CMP Requirements
    
    The ASCP BOC’s new certification requirements for PA(ASCP)CM go into effect, increasing the required credits to 60 per three-year cycle beginning in January of 2022. Since 2019, the AAPA has offered members 20 free CE credits annually (including advanced AP, laboratory safety, and medical ethics credits) to fulfill these requirements.
    CMP Requirements
  - 2022: Grossing Guidelines, 3rd Edition
    
    The AAPA begins release of the 3rd Edition AAPA Macroscopic Examination Guidelines: Utilization of the CAP Cancer Protocols at the Surgical Bench (Grossing Guidelines) in May 2022. The 3rd Edition of the Grossing Guidelines has a new and streamlined format that is designed for ease of use at the gross bench and is a valuable reference for the new graduate pathologists’ assistant as well as the experienced pathologists’ assistant, pathology resident, or pathologist.
    Access Grossing Guidelines
  - 2022: Inaugural Summer Meeting
    
    The AAPA holds its Inaugural Summer Meeting in Baltimore, Maryland. As with the Spring Meeting, the focus of the Summer Meeting is solely dedicated to continuing education, offering attendees the opportunity to earn up to 15 CE credits in a condensed 2 ½ day format. The timing of the meeting during the summer is also meant to encourage attendees to make the trip into a family vacation.
    Upcoming Conferences
  - 2022: 50th Anniversary Celebration: Looking Back, Looking Forward
    
    Throughout the year, the AAPA looks for ways to celebrate this milestone anniversary, culminating in the Annual Conference: Looking Back, Looking Forward held in Minneapolis. The keynote speaker, James Wright, MD, PhD, presents on the History of the Pathologists’ Assistant Profession, offering an extensive and gracious look at the beginnings of our profession. Spring Meeting Chair Becky Stankowski, PA(ASCP)^CM, leads the “50th Anniversary Exhibit” project, which is proudly on display throughout the conference.
    Read More Visit the Virtual Exhibit View Event Photos

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A Brief History of Pathologists’ Assistants, Their Profession, and an American Association of Pathologists’ Assistants Timeline

Gratitude

About the Author

Introduction

Background: A Brief History of non-physicians providing healthcare services

Referencesexpand_more

1898: U.S. Navy Hospital Corps

1910: Flexner Report

1911: Henrietta Phelps Lawson Jeffries

1925: Frontier Nursing Service

In 1925, Mary Breckinridge established the Frontier Nursing Service in the Kentucky mountains. Wendover, now a national historic landmark, is the first effort to professionalize midwifery in the U.S.

1930: Vivien Theodore Thomas, LL.D

1940: Henry “Buddy” Treadwell

1942: PA Beginnings

1943: Battalion Surgeon’s Assistant

1961: AMA publishes “Expansion of Medical Professional Services with Nonprofessional Personnel”

1965: Social Security Amendments of 1965: Medicare & Medicaid

1965: Duke University creates first Physician Assistant training program

Eugene A. Stead Jr., MD, at Duke University (Durham, NC) creates the first formal training program for physician assistants. The first class consists of four former US Navy Hospital Corpsmen.

1967: “Surgeon Assistant” at University of Alabama

The University of Alabama (Birmingham, AL) establishes the first “Surgeon Assistant” program.

1968: American Association of Physician Assistants

The American Association of Physician Assistants (AAPA) was established by Duke University students and alumni.

1969: MEDEX

The University of Washington (Seattle, WA) establishes the MEDEX programs, designed to provide healthcare to rural areas in the northwest.

1971: AMA formally endorses the physicians’ assistant concept

The American Medical Association House of Delegates adopt “Essentials for an Educational Program for the Assistant to the Primary Care Physician”.

1969: Pathologists’ Assistants

1970: And then there were two. The second Pathologists’ Assistant program.

A Veterans Administration grant enables the establishment of a second pilot pathologists’ assistant program, involving the University of Alabama (UAB) in partnership with the Veterans Administration Medical Center (VAMC) in Birmingham, Alabama.

1971: And then there were three. The third pathologists’ assistant program.

A Veterans Administration grant enables the establishment of a third pilot pathologists’ assistant program, involving the West Haven Veterans Administration Medical Center (VAMC) in partnership with Yale University and Quinnipiac College.

1971: American Association of Pathologists’ Assistants: The Beginning

1972: American Association of Pathologists’ Assistants: The Founding

1972: “The Pathologist Assistant: First Year Job Experience of a New Paramedical Career”

1974: A fourth program established

A fourth training program, and the first not to be affiliated with the Veterans Administration grant program, is established at the University of Maryland in 1974. The program is notably the first to eventually offer a Masters’ degree.

1974: First Professional Contact

1975: The First Annual Meeting of the AAPA

1976 to 1993: The AAPA Forges new Relationships

1976: AAPA Officially recognized by Professional Pathology organizations

The AAPA is officially recognized by the Intersociety Pathology Council (IPC) and establishes a relationship with the Association of Pathology Chairs (APC).

The Intersociety Pathology Council (IPC)

The Association of Pathology Chairs (APC)

1976: The First Fellowship Exam

1977: Another attempt at partnership with fellow PAs

The AAPA, by vote of Fellow members present at the 1977 AAPA annual meeting, decides to look once more into possible affiliation with the American Academy of Physician Assistants as an umbrella organization in order to gain strength in numbers.

1978: American Academy of Physician Assistants again rejects membership.

At this time, the AAPA makes a formal request to the ASCP, asking them to consider establishing a “Pathologists’ Assistant Registry”.

1979: Issues with the VA system

The AAPA (ca 1979) meets with representatives of the Veterans Administration (VA) in Washington, D.C. to express concerns that while the VA was involved in training PAs, they had no job description for them in their system or job opportunities for them.

Background: Establishing the Pathologists’ Assistant as a member of the medical team.

1980: AAPA submits application to the AMA

1982: The AAPA Exhibit Booth has a positive impact at organized pathology meetings

1983: Association of Pathologists’ Assistant Training Programs (APATP)

1983: The first Scope of Practice

1987: AAPA applies again to the AMA

1988: Building new relationships

The AAPA joins the American Society of Allied Health Professions (ASAHP) as a professional association member.

International Academy of Pathology (IAP)

1988: The AAPA formally requests support from the CAP

Overview: Setting the Strategic Plan: National Recognition

1990: The AAPA asks for support again

The AAPA presents a new resolution to the CAP House of Delegates in the fall of 1990 asking again for support for their application to the AMA for national recognition as a new emerging health profession. The CAP House of Delegates maintains their decision to deny such support.

1991: Resolutions on National recognition and AAPA-Approved Training

The AAPA BOT creates the “Guidelines for Establishment of an AAPA-Approved Training Program” document.

The AAPA forms an Ad Hoc committee on national recognition.

1991: The first Central Office

Central Office

1992: Clinical Laboratories Improvement Amendments (CLIA)

Brief overview: The Clinical Laboratories Improvement Amendments (CLIA) was originally enacted in 1967 when error rates of laboratory testing, particularly in the area of cytology, became very high and personel were overworked. The act originally covered independent and hospital laboratories.

1992: CLIA and the AAPA

CLIA ’88 supplants CLIA ’67. The AAPA creates an Ad Hoc committee on CLIA ’88. CAP and ASCP advise AAPA not to pursue a political campaign to change the CLIA ’88 regulations as written.

1992: Association of Pathology Chairs contacts the AAPA

The Association of Pathology Chairs (APC) contacts the AAPA to obtain information on the pathologists’ assistant profession. They express concern about projected pathology manpower shortages and are interested in the role pathologists’ assistants play in pathology laboratories.

1993: New AAPA structure and Strategic Plan

In 1993, the AAPA Code of Regulations is revised to create governance and fiscal efficiencies. Along with this, the AAPA BOT creates a “Strategic Plan” outlining short-term, mid-term, and long-term goals.

1993: CLIA ’88 goes into effect and Licensure in the State of Nevada

The state of Nevada contacts the AAPA regarding state licensure for pathologists’ assistants. Information provided by the AAPA is utilized by the Nevada State legislature to create such licensure for pathologists’ assistants.

1993: National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) & the AAPA

References