R. Bruce Williams, MD
June 2019—I wasn’t one of those kids who always knew they wanted to be a doctor. Science was a powerful draw, which might have suggested medical school if my sister hadn’t gotten there first. But she did, so I majored in chemistry at Vanderbilt.
As an undergraduate with little money, I hoped to fast-track, so I found a summer job anesthetizing laboratory rats in the middle of the night and removing their kidneys. The work supported a group studying the renin-angiotensin system. They thought I had a knack for surgery, which prompted a reassessment of my chemistry major and eventually led to an application to medical school. Life makes choices for us sometimes, and I was lucky that way.
I needed biology courses for my medical school application so I switched to a molecular biology major, which is where I encountered Gisela Mosig, a brilliant scientist who was doing pioneering work with bacteriophage T4. Dr. Mosig was intense, generous, and curious—a born mentor. Once a week she would host a wine and cheese party where we talked about tantalizing possibilities in genetics and molecular biology, a field that was just beginning to take shape. You walked home the long way, thinking about it.
I wanted a summer job in medicine between the second and third years of medical school, but for that I needed clinical experience, and clinical rotations back then didn’t begin until the start of third year. Then someone suggested the pathology department, and I got lucky again. There were real giants in that department—William H. Hartmann, MD, David L. Page, MD, Robert D. Collins, MD, Robert G. Horn, MD. Dr. Hartmann would later edit the AFIP Fascicles and chair the American Board of Pathology; his faculty would do world-renowned work in breast pathology (Dr. Page), hematopathology (Dr. Collins), and renal pathology (Dr. Horn).
When I walked in on the first day, Dr. Page presented me a parotid lesion and told me to let him know when I figured out what it was. After researching the case extensively (this was my first try at a diagnosis), I discovered it was a Warthin tumor. He seemed genuinely pleased that I was right. I was pleased to see that everyone in the department seemed to like what they were doing, and while I was reluctant to interrupt, they always found time to talk to me about it. I was peripheral, of course, but the diagnostic challenges people were working on would keep me up half the night. It was a great summer.
When we began clinical rotations that fall, I found that I really liked taking care of patients. So when we began to apply for residencies, I was torn. Everyone said I was a born internist, which only made it worse. Then a friend said to think about which rotation had made me happiest. That was when I realized that the most fun I’d had was in that summer job in the laboratory.
We don’t always know what we want or what will satisfy us longest, which is why we need a full-court press to educate medical students and science-minded undergraduates about opportunities in pathology. Within the CAP, we talk a lot about how best to support pathologists in training and new to practice. All of us can help undergraduates and younger students understand what we do. We might volunteer to speak at local career fairs (where we can share a link to the CAP medical student forum home page, www.bit.ly/CAP-student forum). We can make ourselves available to the hospital communications team, which gets requests from newspaper and radio reporters. None of this needs to be time-consuming and all of it can be fun.
Members of the Residents Forum executive committee have hosted laboratory tours for medical students at their institutions. Members of the New in Practice Committee have posted 24 first-person articles (www.bit.ly/CAP-NIPCadvice) about what the newly minted pathologist needs to know. Their stories cover everything from interviewing skills and salary negotiation to recovering from mistakes and adjusting to practice life. CAP fellows who have been in practice share insights at Pathologist to Pathologist (www.bit.ly/CAP-memberarticles).
Paying for medical school is a bigger worry today than ever before, but we’ve all been there. Our new-in-practice and resident physicians have created excellent programs and publications on financial management (www.bit.ly/CAP-financialhealth) to provide the perspectives of colleagues with recent experience. Because we know that education debt can be overwhelming, residents and first-year fellows pay no CAP dues and a graduated dues discount applies during the first three years after board certification.
Choosing a specialty, and then a practice setting, is complicated; we have to be intentional about explaining it. Our president-elect, Patrick Godbey, MD, has been known to say that when you’ve seen one private practice, you’ve seen one private practice. I couldn’t agree more. Research is good and metrics are useful, but you have to give it time and talk to people. Those of us in practice can encourage students in our communities to explore widely and keep an open mind.
People say that pathology is medicine’s best-kept secret, but not many people understand exactly what it is we do. The good news is the bad news: Medical education can only skim the surface of what pathology takes in. We cannot expect to build a future for our specialty on the chance that enough young people who are drawn to both science and medicine will wander in looking for a summer job. Those who do may well discover their most satisfying career at the intersection of the two. But first we have to get them in the door.
P.S.: I’d like to share an idea that I hope will generate 100 percent participation. The CAP is collecting stories for our 75th anniversary history book, an effort that former CAP president Paul Bachner, MD, is leading. We want to hear from you. Tell us about the inspiring work you do inside and outside the laboratory, including unique talents, hobbies, and public service. We’ll select a few stories to include in the book. We are particularly interested in hearing about families with more than one pathologist. Please send your stories now to Liz Cramer (lcramer@cap.org). Work has already begun on the book.
Dr. Williams welcomes communication from CAP members. Write to him at president@cap.org.