Start with the safety function
Competent clinical oversight, effective escalation and clear accountability are central to the discussion. These requirements are distinct from the question of which professional group should hold every role.
Scientific authority and medical accountability need to be distinguished. Neither a job title nor a qualification alone describes a person's competence, experience or scope of practice.
Make responsibilities explicit
- Define the service's scope and the clinical and scientific risks of its work.
- Identify the qualifications, competence and experience needed for each responsibility.
- Make accountability for interpretation, advice and escalation clear.
- Provide access to specialist advice when work extends beyond a person's scope.
- Use monitoring and evidence of effectiveness to demonstrate that arrangements work.
Cooperation without assumptions
No resident pathologist, no pathologist employed by a laboratory, and no medical involvement in its wider arrangements are different situations. Comparisons between services need to consider their scope, risks and access to advice, not simply staffing titles.
This discussion does not prescribe one staffing model for every laboratory. It focuses on making clinical and scientific responsibilities explicit and evaluating how those arrangements work in practice.