August 2017—Nearly two years ago, I mentioned that I wanted to start a conversation about how we as pathologists and the CAP as our professional society must evolve in order to meet our emerging needs as individuals and as a specialty. Now, as my time in the perch is coming to a close, I’d like to explore what we have come to realize—and sometimes reinforced—about building and maintaining a complex infrastructure that reflects and serves our core purposes.
Dr. Richard Friedberg
Looking back, I seem to have approached serving as CAP president in much the same way I looked upon starting a family. I’d had nine months’ notice for one and two years for the other. Although I was enthusiastic about both, I did find myself staring into the distance, thinking about possibilities and potentialities, points of likely influence and control, and how I would or could steer or influence the outcome.
At least from my point of view, our children were relatively low maintenance; my wife, Di, may differ on that. Then again, I think I’m low maintenance and we might differ on that, too. But after induction as CAP president, I soon learned that this role is less like parenting and more like running a laboratory or department. And as we all know, things that are left alone too much succumb to entropy and those not left alone enough simply suffocate.
Laboratory management is largely about keeping things from blowing up while allowing well-thought-out processes to hum along—and making it look easy. And in a similar way, the CAP presidency comes down to anticipating curves in the road, navigating gently, and negotiating fairly while expecting a few surprises, most of which will be good and all of which will work out in time because what we do is important and patients depend on us to do what’s right.
Our recent history is captured well in the CAP Annual Report, but I’d like to mention just two pleasant surprises that came our way after it was written. Both came about courtesy of the American Society of Association Executives. The CAP Foundation See, Test & Treat program, which in 2016 alone provided free cervical and breast cancer screening to 700 underserved women, was among a select few to receive the ASAE’s highest honor, the Summit Award. And the CAP Center, which has collaborated with 16 specialty organizations over the past seven years to write evidence-based guidelines for pathology and laboratory medicine, earned an ASAE Gold Award. Although their considerable efforts are so integral to our core identity as to be sometimes overlooked, the Foundation and the Center represent much of what makes us unique and fundamental.
We are an organization of impressive complexity. Although I have been a CAP volunteer for many years, I had to step into this job to appreciate how much is going on all the time and how it all fits together. Stepping up to volunteer is almost always a good idea, because it will make you a better and more open-minded physician. Plus, as CAP volunteers, we often discover talents we didn’t know we had.
Through the CAP, we do everything a top professional medical organization does (education, advocacy, fellowship) and we also manage a $200 million laboratory improvement arm. Surveys and laboratory accreditation are keys to quality patient care, our core commitment. The excellence of these programs reflects the mental energy and level of scrutiny that our members devote to them. And the revenues they generate enable robust pursuit of other opportunities—conceived, vetted, and supported by CAP members and staff—that advance pathology by protecting our professional and socioeconomic interests as physicians caring for patients.
Because we are so intensely engaged and diverse, experience on the CAP Board of Governors fosters an ability to accommodate unknowns and navigate ambiguity. We’ve found that passionate disagreement can allow creative solutions to emerge, provided that all concerns are freely shared and explored. Lesson No. 1: Welcome respectful disagreement and give alternative viewpoints a fair hearing.
While CAP leadership, philosophy, and policy are member driven, the scope and depth of our laboratory improvement programs require the support of a professional staff. Another important task completed during my term was selection of a new chief executive officer. We made a commitment to find the person who fit our needs rather than sculpting a job description that pointed to a certain personality, and we hired a professional search team to keep it professional. It was a long process, but eventually we found that we had both the right person and the right skills in our own Stephen Myers, who became our CEO on June 15. Lesson No. 2: If the choice is critical, define the ideal, describe the gaps, and devise a solution to bridge the two.
Stephen came on board as vice president of finance in 2003. A talented manager, he has earned our respect by doing the right things right while staying open and flexible. We already knew that with Stephen in charge there would be good feeling all around. He was deeply involved in identifying thoughtful steps to ensure the financial stability we now enjoy.
Lesson No. 3: Stay close to your knitting. Our financial well-being reflects work we’ve done over time to stabilize operations by strengthening structural supports and integrating everything around our core purposes. The CAP Board of Governors routinely evaluates a 10-year budget plan in the context of mutually reinforcing and overlapping three-year strategies. The budgeting process creates comfortable predictive windows that translate to more readily managed costs, reserves, and revenues. Finally, a 12- to 18-month Board calendar makes any course corrections minimally disruptive. Taken together, these steps keep us focused on our collective goals and reveal relevant opportunities early on, when they can be properly studied.
The Greek mathematician Archimedes famously said something along the lines of, “Give me a lever and I will move the world.” Our version might be, “Give pathologists the science of medicine and the CAP to leverage our efforts, and we can move our world.”
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Dr. Friedberg welcomes communication from CAP members. Write to him at president@cap.org.