Right now, the pathologists' assistant workforce is well-adjusted to the current needs of Portugal's healthcare system, both in public hospitals and private sector. However, this hasn’t always been the case.
Here is the story of what happened when pathologists' assistant training in Portugal ceased, and how the pathology community came together to put it back on the syllabus. United, we secured the future of our invaluable profession across the whole country.
A holistic view of anatomic pathology
In Portugal, our equivalent to a pathologists' assistant is a pathology technician specialized in macroscopy. We take full responsibility for the gross examination of all types of human biological specimens – ranging from simple biopsies to highly complex oncological surgical resections. In this role, we handle the preparation, fixation, gross description, and targeted sampling, or "grossing," for histological diagnosis. We also actively participate in intraoperative consultations and often take on clinical research and teaching responsibilities.
Authority varies slightly depending on the institution and the medical team's dynamics, but the vast majority of us operate with full autonomy at the grossing bench. One interesting difference compared to the US or UK models is our versatility. Because our core training is broader, we aren't restricted solely to macroscopy; we are also fully qualified lab techs in histology and cytology preparation. This gives us a valuable, holistic view of the entire specimen workflow.
Highly trained, but under-recognized, professionals
The training path in Portugal requires solid postgraduate specialization. The baseline is a mandatory four-year bachelor’s degree in anatomy, cytology, and thanatology – known in many universities as Biomedical Laboratory Sciences. That is followed by a one-year postgraduate course, Macroscopy in Anatomic Pathology, combining intensive theoretical and practical classes with hands-on internship training in a real hospital setting. Once qualified, you are theoretically ready to step into a department and manage the grossing bench.
However, there is a massive gap between the skills acquired and what Portuguese law actually recognizes. Legally, macroscopy is still considered a delegated medical act. There is no specific regulation defining our role, which leaves us in a legal gray area.
This lack of formal legal recognition impacts our careers directly. There is no distinct salary scale or professional category to match the level of responsibility we carry. In the National Health Service, we are grouped under the general "Diagnostic and Therapeutic Technician" career ladder alongside general techs, and the private sector just follows standard baseline salary grids. That said, the trend moving forward is clearly pointing towards closing this gap, which will hopefully bring full autonomy, legal accountability, and fair salary differentiation.
Non-sustainable training
It's worth noting that the Macroscopy in Anatomic Pathology course is offered by a single institution: the Faculty of Medicine of the University of Lisbon. Since its launch in 2008, the course ran every two years, but its continuity relied almost entirely on a complex partnership between the University of Lisbon and the Lisbon School of Health Technology – the school that trains the techs at a baseline level – alongside the voluntary efforts of a tiny, dedicated group of pathologists and professionals running the coordination.
Professionals emerging from the first five editions of the course were instantly snapped up by hospitals desperate for specialized staff. Labs were facing reductions in the number of pathologists while the demand for pathology services was skyrocketing.
However, planning and executing such a niche and demanding postgraduate program is a lot of work. Because institutional support was scarce, and the whole operation depended heavily on the goodwill and energy of a small, passionate group, it naturally ran out of steam. It was essentially structural burnout due to a lack of a formal framework to sustain the project long-term. After those initial rounds, the course went into a long hiatus.
While the need for this specific profile kept growing, there were no new graduates entering the market. This created a massive gap and a high-demand, low-supply bottleneck.
A desperate situation
The impact was felt immediately and across the board. With no new course editions, there was no fresh wave of professionals to ensure continuity, allow for team rotation, or replace those who changed careers or retired.
Faced with this shortage, many hospitals had to resort to in-house training without any formal academic certification. While it worked as a quick fix, employers don't view internal training favorably. The market clearly prefers professionals with university-validated skills and credentials, which created a lot of pressure and an uneven landscape regarding technical recognition and quality across the country.
The community takes action
The reopening of the course was driven by organic institutional pressure from the hospital pathology departments themselves, who were desperate for qualified staff.
The process brought together several key figures in our field, notably Paula Borralho as the course coordinator, along with Mário Matos and Amadeu Ferro. Alongside this leadership, a group of highly experienced specialist techs – including myself – and pathologists joined forces.
This marked a massive shift in the course paradigm: while the faculty used to be exclusively made up of pathologists, we now have specialized macroscopy techs leading the teaching. Together, we built a robust, multidisciplinary faculty capable of training a new generation of high-quality certified professionals.
Happily, today's digitally connected world renders course logistics much easier than in my training days. We can easily set up online lectures, leverage AI as a supportive resource, and access an immense volume of digital scientific literature.
This online democratization of information and the flexibility of modern tools allowed our current students to develop a highly efficient, free-thinking critical mindset. In place of one-way lectures, we can foster real, open clinical debates, which has massively elevated the quality of the course.
The training reboots
The first course is set to wrap up with final evaluations later in 2026. The outlook is already incredibly positive, with the next course most likely to start in 2028. I think I speak for everyone involved in the faculty and organization when I say that this comeback has been a huge success.
Naturally, as with any major training program – especially when reviving a project of this scale – there were minor teething issues and adjustments to make along the way. However, the feedback I've been getting directly from the students, including my own interns who work beside me daily at the grossing bench, shows that the balance is overwhelmingly positive. We are successfully delivering a highly prepared new generation of professionals to the field.
Actively shaping the future
For me, this moment feels like a real rite of passage. I went from being "just" the lab professional focused on the bench, daily throughput, and analyzing samples, to stepping into a teaching role where I can pass on knowledge – much of it highly practical and born out of firsthand experience.
On a personal level, it has been incredibly rewarding. It showed me that I have the skills, the confidence, and above all, the passion for it. It's likely that I will dedicate even more time to teaching in the future. I truly believe this is the best way to elevate our profession: by ensuring we provide top-tier training here in Portugal and actively shaping the future of our field.
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