Several types of professionals must have specialized training in pathology, ranging from medical doctors and veterinarians to dental specialists, lab scientists, and pathologists’ assistants. Each role has its own education track, but all require formal, accredited training and board certification before independently practicing in the field.
Medical Pathologists
Physicians who specialize in pathology must first earn either an MD or DO degree, then complete a residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME). The American Board of Pathology recognizes five residency tracks: anatomic pathology (AP), clinical pathology (CP), combined AP/CP, AP with neuropathology, and a physician-scientist research pathway. Most residents train in the combined AP/CP track, which takes four years. The standalone AP or CP tracks each require three years.
Interestingly, pathology residency draws from a broad pool. In the 2021 match, only about 34% of filled pathology positions went to senior students at US allopathic medical schools, meaning many spots are filled by osteopathic physicians, international medical graduates, and others. Osteopathic physicians can pursue board certification through the American Osteopathic Board of Pathology as an alternative to the standard ABPath route.
After residency, pathologists must maintain their credentials through a continuing certification process overseen by the American Board of Pathology. This includes submitting a reporting form every two years covering their medical license, continuing medical education, and quality assurance activities.
Subspecialty Fellows
Pathologists who want to focus on a narrow area of the field need additional fellowship training on top of their residency. These subspecialties each carry their own board examination.
Neuropathology fellowships require a two-year commitment. The first year typically focuses on clinical service, including neurosurgical cases and autopsies, while the second year shifts toward neurodegenerative disease, neuromuscular pathology, and scholarly work. Forensic pathology is another subspecialty with its own demanding certification exam, which combines written questions, practical sections, and virtual microscopy review over a full day of testing.
Most pathology fellowships (with the exception of dermatopathology) can actually be completed before finishing residency, per ACGME rules, which gives trainees some flexibility in how they structure their education.
Veterinary Pathologists
Veterinarians who specialize in pathology follow a parallel but distinct training path. Certification through the American College of Veterinary Pathologists (ACVP) requires passing a two-phase examination process, and the training requirements are substantial.
To sit for the Phase I exam, candidates need at least 12 full-time months of in-person veterinary pathology training under a qualified sponsor. After passing Phase I, candidates pursuing the standard route must complete at least 36 months of full-time, directly supervised training in their primary field (anatomic or clinical pathology). An alternate route exists for those training outside traditional programs, but it requires 48 months of experience, with at least 12 of those months spent in person under an ACVP Diplomate. Veterinary pathologists seeking certification in both anatomic and clinical pathology need a minimum of 12 additional months of training in the second discipline, which can be spread over one to five years.
Oral and Maxillofacial Pathologists
Dentists can specialize in diagnosing diseases of the mouth, jaws, and surrounding structures through oral and maxillofacial pathology (OMFP) residency programs. These programs require a minimum of 36 months of training, with at least six months spent in ACGME-accredited pathology rotations. Graduates earn a certificate in the specialty and become eligible to sit for the board examination.
The training is hands-on and broad. Residents must gross, diagnose, and order additional studies on biopsy cases under faculty supervision. They also interact directly with clinical patients and consultations, participate in teaching, and complete scholarly work such as case reports or research projects. Rotations cover head and neck anatomic pathology, dermatopathology, hematopathology, pediatric pathology, bone and soft tissue pathology, molecular and genomic pathology, and even autopsy experience.
Pathologists’ Assistants
Pathologists’ assistants perform gross examinations of surgical specimens and assist with autopsies under a pathologist’s supervision. To earn the PA(ASCP) credential from the American Society for Clinical Pathology, candidates need at minimum a bachelor’s degree plus successful completion of a program accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). The education from a NAACLS-accredited program is accepted for certification purposes for five years from the date of completion, so graduates need to sit for the exam within that window.
Cytologists
Cytologists (previously called cytotechnologists) specialize in examining cells under a microscope to detect cancer and other abnormalities, most famously in Pap smears. Under the Clinical Laboratory Improvement Act of 1988, every individual practicing cytology in the United States must have completed a cytology program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). There is no way around this requirement.
These programs are currently transitioning from bachelor’s to master’s level, though graduates of either type remain eligible for the CT(ASCP) certification exam for up to five years after completing their program. Graduates of the newer master’s degree programs can also choose to pursue the SCT(ASCP) credential, a specialist-level certification.
How These Roles Work Together
Each of these professionals fills a different niche within pathology. Medical pathologists and their subspecialty fellows make diagnoses and oversee laboratories. Veterinary pathologists do the same for animal disease. Oral and maxillofacial pathologists bridge dentistry and pathology for diseases affecting the head and neck. Pathologists’ assistants handle the critical initial processing of tissue specimens, and cytologists screen cellular samples that catch cancers early. All of them share one thing in common: they cannot practice without completing a specific, accredited training pathway and passing a certification exam tied to their role.