CAP Celebrates 75 Years

Julie McDowell (00:03):

Welcome to the CAP's CAPcast series celebrating our 75th anniversary. This episode's discussion will feature Dr. Paul Bachner who served as president from 1999 to 2001. And Dr. Bruce Williams, who served as president from 2017 to 2019. During Dr. Williams term, the board approved an update of the CAP's history for its 75th anniversary. As the last book was published in 1996 for the CAP's 50th anniversary, Dr. Williams asked Dr. Bachner to offer the book and he graciously agreed. I want to start off by talking about why writing this book was so important to the both of you, Dr. Williams, can we start with you?

Bruce Williams, MD, FCAP (00:49):

Well, sure. There's so many wonderful memories and activities that happen when you're a member of the College of American Pathologists and participate in all the committees and activities of the college. One of the ones that stood out in my mind over the years was in 1996, when I did receive a copy of a book called the pursuit of excellence, the college American Pathologist, 1946 to 1996, I was very excited to get it, the book received it and read it over weekend.

Bruce Williams, MD, FCAP (01:17):

It's not very long, but it's just jam-packed full of information that really opened some insights into me, into what the college had been through and the members had done. It was authored by Lloyd Wagner, who I knew, who's also a previous president and he did an excellent job. And I always thought the world of Lloyd, but after this, I even thought more of him.

Bruce Williams, MD, FCAP (01:38):

And there were many other authors in here too. Two of the one ones that stood out to me were John Duckworth and Bill Hamlin, who were both part of the accreditation program, which I grew up in the college and the accreditation program. To read the history after hearing from both of these people and others about what had happened over the years, really meant a lot to me. And as I became president, I realized the 75th anniversary wasn't too far away. And I was thinking, it's a shame we don't need to wait another 50 years for history.

Bruce Williams, MD, FCAP (02:08):

So much has gone on in the last 25. We really need to update that book. And I don't know that anybody else had the idea, but that really meant a lot to me. And I went to the board and talked to them about, they were very supportive of that. And I could think of no one other better than Paul to take over this task. And he's throwing himself into it and come up with a great book to update the 50th anniversary. So that's why I did it because the 50th minutes so much to me, I hope that 75th means as much to all of our members as the 50th did to me,

Julie McDowell (02:40):

Dr. Bachner, can we hear from you on why you think it's important to capture the content related to the 75th anniversary in the book that you author?

Paul Bachner, MD, FCAP (02:49):

Well, history is always important, not only in order to understand the present, but perhaps to, to prepare for the future. As Bruce says, the previous book edited by a written and edited by Wagner was a superb history. I reread it prior to starting my activities with the current version and learned a great deal. I had known Dr. Wagner, he had been one of my mentors and I had great respect for him. And although in planning the new book, we did a few things somewhat differently. He certainly set a model for the new book.

Paul Bachner, MD, FCAP (03:38):

And so I've attempted in putting the book together and I've written goodly part of it, but several other people have made major contributions to the book and to chapters in putting the book together. The challenge was to recapture some of the past, the earliest chapter in the book, the opening chapter is essentially a reprise, if you will, of the first book. Sort of a reprise of the first 50 years. And then the book is heavily oriented around the missions of the college. Laboratory quality, laboratory improvement, advocacy, education, and membership services. And those four pillars, if you will, were the skeletons around which the book was conceived and written.

Julie McDowell (04:38):

Dr. Bachner, what would you say you most enjoyed about writing this book?

Paul Bachner, MD, FCAP (04:44):

Well, it's hard because I enjoyed many things. I'll start with, I enjoyed finishing the project. The project took a lot of work a bit more than Dr. Williams told me in the beginning, but I must say it was truly a labor of love. And there were many things that I enjoyed. I'll start by saying the first staff leader for the book was Liz Kramer, who is no longer with us. And Liz played a major role in getting us started. And her on timely demise came as a shock, but other members of the staff stepped up to the plate. Then I must say one of the things I enjoyed the most was working with Mary Kay Krause, who took over from Liz, with Drew Davis. Who's the CIP Archivist and an outside writer and editor Jim Crowley, Nancy Johnson also was a great help in putting together the chapter on the CAP's response of the COVID epidemic.

Paul Bachner, MD, FCAP (05:53):

And Dr. Cartcher, who is now the president and elective, the college wrote the chapter on advocacy, but I think what I probably enjoyed the most was working with other members and other staff who provided material for me. And sometimes the material was merely a conversation about some aspect of, as that I interested in portraying or sometimes in giving, in providing excerpts and segments of the book. So it was a multifaceted process for me, and it took almost three years really to have this happen. And it was a daily adventure for me, but now that I'm essentially retired. Kept me off the streets and thoroughly enjoyed every minute of. I hope that the final product, which I think is impressed right now, I know that an electronic version is available to our members, but I do hope that the final product will live up and fulfill all the time and effort that went into it.

Julie McDowell (07:01):

In looking back over the past 75 years of the CAP. What do you think we've learned that can inform where we go from here? Dr. Williams, can you share your perspective on this?

Bruce Williams, MD, FCAP (07:14):

Well, I think one of the things that you have to do, a couple things is you've got to be true to your mission. I think we are strongest in the areas that we have the most expertise. Whether it be accreditation, laboratory improvement, education advocacy. And I think if you keep within your expertise, then the products that will come out will reflect that and that you come out with excellent products. And the college has been blessed by numerous staff of volunteers over the years. Who've worked jointly to produce products that have been really outstanding for Pathologists and for the field of laboratory medicine. And I think if we do that, you can see from the history of how that evolves and how that comes about.

Bruce Williams, MD, FCAP (07:58):

I think that's a great template for those moving forward in the future is to work collaborative staff and members. I think that's a really biggest strength of the college too. So we're blessed by so many great staff in Northfield and Washington. And we have so many volunteers from across the United States, really around the world that are experts in their fields. And that can produce products that are so beneficial to a Pathologist and to medicine in general, and ultimately to benefit the patient. And I think if we keep that as a template, which we can learn from our history is something that would be very useful going forward.

Julie McDowell (08:37):

Dr. Bachner, what are your thoughts on this?

Paul Bachner, MD, FCAP (08:39):

Well, Dr. Williams hit the nail on the head when he commented that the important thing to remember always is to stay true to our mission. You've asked me for comments about 75 years. Well, despite the gray hairs that I have, I can only speak to 50 years, not 75. I miss those, but again, the college is a unique organization. It is a professional organization in the sense that it serves the needs of our members in terms of advocacy and education. But it also has this huge laboratory improvement on with laboratory accreditation and proficiency testing, which is essentially the organizational and financial engine that supports so many of the colleges activities and keeping these two alarms, if you will, working in a productive and synergistic manner sometimes is a challenge, which I think the college always seems to meet. The unique feature of the college is the intense engagement by a huge [cadre 00:09:55] of highly intelligent, knowledgeable practicing members supported by the terrific staff.

Julie McDowell (10:04):

So 75 years from now, when someone reflects on your era. What will you say was your unique contribution to the CAP and to pathology. Dr. Williams, what are your thoughts on this?

Bruce Williams, MD, FCAP (10:17):

Well, I think 75 years from now, not very many people be thinking of me and Paul, unfortunately. But I think really the contribution that we give is the contribution that all members give throughout the time. You have to meet the challenges of the time as you see them and address them and try to solve them to the best of your ability, to the benefit of a Pathologist and to medicine and to other physicians and to the patients. And I think, again, with keeping that in mind, what they'll think back is that we were a strong organization over the past 150 years, that we've had numerous members.

Bruce Williams, MD, FCAP (10:55):

Some remembered, some most not, but at the time they produced the product, the work that actually moves pathology forward, that moved medicine forward. And that we continuously kept up to date and continuously kept improving the practice of pathology. I think that's the greatest legacy for the college in the future is that during that 150 years, we never stopped improving. We never stopped trying. We never stopped advancing the practice of pathology.

Julie McDowell (11:27):

Dr. Bachner, what do you have to say to this?

Paul Bachner, MD, FCAP (11:30):

Well, again, to the extent that anyone will remember, specifically in my time as president, of Dr. Williams as time as president. I think I can take some pride in being able to say that nothing terrible happened as a result of anything that I did. And I can say the same to Dr. Williams from a personal standpoint. When I look back on my two years as president, what I look back on with the most pride, if you will, is starting the process of making education, a freestanding independent arm, if you will, of the college, rather than just a support mechanism for laboratory improvement programs.

Paul Bachner, MD, FCAP (12:15):

On a personal level, the QIPCAP was something that Peter Howanitz and I developed many, many years before my presidency and was I think a very major part of pathology for many, many years, and still is. It was a program and designed to help Pathologists in the beginning to meet certain joint commission accreditation requirements, but turned out to be a management tool of great usefulness during my years as a Lab Director. I found key [points 00:12:49] very helpful and managing a large [inaudible 00:12:53]

Julie McDowell (12:55):

So finally, to close out, I'd like to hear from both of you about what advice you have for up and coming leaders. Dr. Bachner can we start with you?

Paul Bachner, MD, FCAP (13:04):

Well, I'm taking the word leader in a very broad sense. I, I think you're talking not just about being president, but about being an office or member of the board, or more importantly, the engine of the college, the committees and the councils. So my sense of leadership is a very broad one. And I think, and again, this has been a sound sort of basic and nothing really new. But obviously you have to set an example. Example in terms of behavior and your own personal behavior and your own dedication to the tests that you're dealing with.

Paul Bachner, MD, FCAP (13:47):

The college is blessed with an incredible knowledge resource base in our committees and council. And I think any reader has to recognize the importance of listening more and talking less and taking advantage of the knowledge base and the experience base that's happening. And then the other piece of advice is always to work closely with staff. The members come and go, presidents come and go, leaders come and go, but the staff is always there. And for us to achieve as leaders, our goals, if you will or aspirations. The day to day heavy lifting is done by our staff. And it's important for all leaders to work carefully with them.

Julie McDowell (14:48):

Dr. Williams, what's your advice for up and coming leaders?

Bruce Williams, MD, FCAP (14:48):

It's very similar to Dr. Bachner as usual. I think he's also hit the nail on the head. But there are two sets of leaders as Paul mentioned. There's staff leaders and the member leaders. Staff leaders in my tenure, I only had two Charles Russell and Steven Myers, and they both did a great job. And I think one of the strengths that they both have was willingness to work with members. The college is different than a usual business in that there's really two sets of folks helping run one organization. And they're very distinct and very different. As Paul said, the staff works daily to improve the college. Members work sometimes daily, but mainly periodically, have their committee meetings or telephone calls in between, in order to help guide and produce the material that makes the college very excellent. So from the professional side, from the leadership side, my advice is a couple things.

Bruce Williams, MD, FCAP (15:46):

One is to work closely with staff because without the staff, you can't produce anything. That's not a our day job. The staff is very excellent and very technically oriented and good at what they do. So that's one bit of advice is we're closely with staff. Another one is don't be satisfied. It would be easy to come in and keep on keeping on maintain. What's happened up till then. That we're going to improve, you have to think outside the box, you have to think strategically, and think forwardly as to what is the current needs that are not being met. What could be some potential future needs that we need to start getting ready for. And that happens all the way down to the committee members. A lot of things that come out of the college that are very good start at a committee meeting, and it's not the leadership per se.

Bruce Williams, MD, FCAP (16:34):

It's the members who have heard something new or learned something new and, and thinks the college ought to be involved with it. And it takes a while to work its way through the committee and up to the council. And then finally to the board. Work can be voted on and done. But as Paul said, the committee leaders then, and the council leaders and the board and the president have to listen to other members, have to listen to their expertise in the fields and listen to what advice they're being given. And so not only do they have to think for it, but they have to be active. You can have all sorts of good ideas, but you have to actually produce something. And that sometimes is the hardest thing to do. I may have snickered Paul into doing this by saying it being an easy ride, but it took three years, but it does take time to do something good.

Bruce Williams, MD, FCAP (17:23):

It takes a long time to come up with something worthwhile, takes a lot of hours and days and years to work through something, to come up with something quality that not always recognized in our, our field in America, but around the world, has been an excellent product in the field of pathology. So you have to be able to work. You're not going to have to be able plans. You have to be able to produce what you're thinking of. And so my advice to leaders is to enjoy your time in the college. It's a wonderful place to volunteer. It's got a great purpose. It's got great folks. You get to know, and our friends, your entire life like Paul and I. But you also have to then be dedicated to doing hard work and to actually producing a great product. And that's the way you get to be remembered. Maybe not you individually, but the college of the next total of 150 years.

Julie McDowell (18:16):

Thank you, Dr. Bachner and Dr. Williams for this great discussion. CAP members can download the 75th anniversary history book, authored bypass president Dr. Paul Bachner on cap.org. Please visit cap.org and type in 75th anniversary into the search function at the top of the site, to find the link to the book, download page on the CAP E-store. Thank you for listening to this CAPcast. To listen to our other episodes, find us on the MyCapApp available for CAP members, as well as SoundCloud, Apple podcasts, Stitcher, Google podcasts, Spotify, and Amazon music. Just search for CAP cast from the college of American pathologists on these apps. Once you find our podcast, be sure to click the subscribe button. So you don't miss New CAPcast episodes.

Julie McDowell (00:03):

Welcome to the latest episode of this special CAPcast series celebrating the CAP's 75th anniversary. This discussion features past presidents Dr. Stephen Bauer and Stanley Robboy. Serving back to back terms, Dr. Bauer was president from 2009 to 2011 and Dr. Rob boy was president from 2011 to 2013. Both led the CAP during a transformational time in pathology. Dr. Bauer and Robboy, you all have talked about the four year block of a presidency. As back to back presidents, can you say a little bit more about that and the time commitment it takes? Dr. Robboy, can we start with you?

Stanley Robboy, MD, PhD, FCAP (00:45):

Actually, it's more than a four year block. Up until our times, very often the presidencies would be two years and often themes would shift from two years to two years. We thought there was too much at risk. And we thought, along with the board, it was much more important to have a unified theme that would carry on for multiple terms. And so it was not just for four years, but it was really for longer. And it was to be a theme that was not particularly of the presidents, but it was a theme that was pertinent for the organization and for the board to determine.

Julie McDowell (01:20):

Dr. Bauer, what are your thoughts on that?

Stephen Bauer (01:22):

A lot of this was tied into the way that the board managed long range planning. And historically, each incoming president had their own long range planning committee that they organized and ran, and they set the agenda for it. And depending on the outcome of the deliberations of group, the direction of the college could shift every two years with each new president.

Stephen Bauer (01:48):

And I think that we recognized fairly early on that with the degree of threat and opportunity that we faced, that we couldn't have the college shifting gears constantly, that we had to maintain a steadier course. And so beginning with my presidency, we eliminated that president directed or president-elect directed long range planning process. And that enabled us to shift into this mode of trying to keep the college working on some consistent themes.

Julie McDowell (02:23):

So just speaking of threats and opportunities, one thing that you both grappled with or confronted during your tenures was next generation sequencing, and you had to think long and hard about what it would take for this technology to be widely available, as well as the cost and any payment issues. Can you explain some of the multidimensional issues that were addressed and how you address them? Dr. Robboy, can we start with you?

Stanley Robboy, MD, PhD, FCAP (02:51):

Let's go back to the period of about 2006, 2008. It was clear at that time that American medicine, not just pathology, but American medicine as a whole, was a great, great difficulty, and it was broken, and it had to change. And if anyone has read Winston Churchill's book The Gathering Storm, the title really explained where American medicine was.

Stanley Robboy, MD, PhD, FCAP (03:14):

And the issue that we often talk about is you can be at table. If you're not at the table, you'll become the menu for the table. And from our board, we wanted to really be there in front, we wanted to help set the table. So we wanted to be at the forefront of whatever change was going to come, helping to set the menu and to really plan for the future of medicine. In this, it meant we had 28,000 member. And if pathology would collapse, if medicine would change so drastically, it could be a great detriment to our specialty.

Stanley Robboy, MD, PhD, FCAP (03:46):

And so in our planning, and this is where Steve, I think he'll talk about it probably more during this time, headed up the transformation committee. It was to look globally at where we were, where was pathology, what were really the threat, what were the potential opportunities? And after an entire year, we spent talking about what were the major issues, the workforce, payment for pathology, the value that we bring, and the new technologies and the future of medicine. And I think that became the transformation. Maybe Steve, you might want to amplify in this.

Stephen Bauer (04:23):

Well, I think that we really started with looking at the practice of pathology, and then trying to make a list essentially of all of the technologies that we saw evolving at a very rapid pace and to try and estimate the effect that these potentially had on the practice of pathology, and then to look at all of the complexities that flowed out of that. But fundamentally, what we really were talking about were major shifts in the way that we practiced.

Stephen Bauer (04:53):

And we had gotten ourselves into a position where we were heavily dependent, economically for many pathologists, on just routine surgical pathology, and only things described by a few CPT codes. And we knew that that was a major risk for us to be so dependent on that one source of income. So we were concerned about both the economic future of the society and its members, and also really pathologists as they practice medicine, and how we fit into the broader practice of medicine. And so that's a terribly complex undertaking, to look at your practice and how it's going to be affected by all of these technologies.

Julie McDowell (05:34):

Is there anything else about the transformation in your work during this time, particularly focused on the transformation, that you would like to highlight Dr. Bauer?

Stephen Bauer (05:42):

Well, I think probably the biggest thing for me was how slow it seemed to progress. We were facing these really major challenges. And the college has a very deliberate way about going about decision making and planning. And in some ways, it's very, very good, but it makes it difficult for us to be nimble. And so for me, I think one of the things that was most difficult to deal with was just this sense of frustration that we weren't going quickly enough. I think our sense of pressure to do something rapidly probably was good in the sense that it drove us a little bit harder. It was probably a little bit off though in terms of how quickly changes really were occurring.

Julie McDowell (06:27):

Dr. Robboy, anything you wish to share about your experience working on these transformation issues?

Stanley Robboy, MD, PhD, FCAP (06:33):

Well, as Steve said, it was something that was new to both of us. It was far larger than anything we ever imagined. We were very fortunate because we brought in as a new CEO one of the former managing partner of Accenture. And he had taken a number of the Fortune 500 companies through transformation. And so he really helped galvanize all of the intellectual power we have at the college.

Stanley Robboy, MD, PhD, FCAP (06:57):

We started off with the smaller committee, and eventually we ended up with four committees, each of 20 people, working nonstop for a period of time. And the first was to lay out what were the major areas that we needed to deal on. And then the second was actually within each area, we talk of the new technologies, what we were going to focus on and how were we going to take all of our members and bring them up to speed.

Stanley Robboy, MD, PhD, FCAP (07:20):

And for example, with the DNA, we realized we can't take 20000 members and make them all experts, research experts. But we could make all of them comfortable so that when any clinician, who would sometimes be like a deer in headlights, had to deal with this, they would come to the pathologist and want to know what is the right test to do.

Stanley Robboy, MD, PhD, FCAP (07:40):

And we worked with all the pathologists. This was part of our feeling our way along. We started setting up courses. We started setting up webinars. And each little success led to something bigger. And by the end of the year, we were giving multiple seminars and having a whole division on the technology so that our pathologist really felt comfortable.

Stanley Robboy, MD, PhD, FCAP (08:00):

At the same time, we were working with the government because the government was mildly concerned. If people were ordering the wrong test, and at the beginning they were, each test could be very expensive. And so that's a cost the government didn't want. Plus if the test was used badly, then patients would be treated for disease they might not have. So that would complicate it.

Stanley Robboy, MD, PhD, FCAP (08:22):

So we set up this very long range goal to help all of our pathologists become the go-to person, and more from our scientific side to set up so that the tests were done correctly, and from the accreditation side, so that when the tests were done, people could rely on them, whether you went to, locally, to my hospital, UNC, or to Duke University, or if you were in Beijing, or you were in London, or in Chicago. If you had the test done, it would be the same result.

Stanley Robboy, MD, PhD, FCAP (08:50):

So we tried to look at all of these and make sure that the college came out of it better, the individual pathologists came out of it better. The patients certainly had to come out of it much better. And that was always the major focus. And the government had to have good tests done at a reasonable cost. So we made sure through this transformation that all of these bases were covered.

Stephen Bauer (09:11):

We did recognize very early on that we weren't going to be able to change the technology and how it was going to develop. Those were forces that were going to move independently of us. And that what we could do was to help pathologists be ready so that as they did develop that they were able to integrate into their practice. And I think that a lot of the things that were put in place by the college, for example, in improvements in our ability to teleconference or to do things with the internet paid off in the pandemic, because if we hadn't made those initiatives to improve our systems to be able to handle that kind of activity, we would've been in real trouble with the way that the country shut down, and with the loss of our face to of face meetings.

Julie McDowell (09:57):

Another major issue was whether the CAP was going to have more of a global presence. Did both of you think that it was critical that the CAP go global? Dr. Bauer, can we continue with you?

Stephen Bauer (10:10):

Yes, we did. I certainly did. The college has always had a global presence or has had an international presence. We weren't global, but we were very international. At the time when I became president, we already had programs running in 80 different countries through accreditation and through proficiency testing.

Stephen Bauer (10:29):

So we had a fair amount of success internationally without ever having had any formal plan for developing it. It really occurred just opportunistically as people in other countries would actually approach us and ask us to, could we provide services for them? And we recognized that we were vulnerable to changes in the United States, and that by broadening our programs internationally, we could reduce our overall risk to the organization.

Julie McDowell (10:59):

Dr. Robboy, what's your thoughts on this?

Stanley Robboy, MD, PhD, FCAP (11:02):

Well, I agree with that. But let me take it a step further, because certainly during both our presidencies, there was a great deal of discussion from various sides whether we should continue with our global presence or curtail it, where should it go. And something that Steve mentioned, you live by regulatory rules.

Stanley Robboy, MD, PhD, FCAP (11:20):

And one potential rule would allow foreign competitors to come in as long as they had a US presence and start the same programs that we had. And if you had someone coming in at half the cost and not worrying about the quality, that could end up being very detrimental to the college. We also had so many residents coming to the United States who then went back to their countries and they wanted to take the American medicine with them, they wanted to raise the quality.

Stanley Robboy, MD, PhD, FCAP (11:46):

So it became natural, both as an opportunity and to eliminate a threat, to bring the college really strongly overseas for an accreditation program. And that's been marvelous because we now have the residents who are now there and they're leaders in their country. We certainly have the economics from it that provides the money for the college to do so many of the outreach programs they do that financially would be a loss. So it's really been a major win for everybody, and it's brought the quality that we've known here in this country to other countries.

Stanley Robboy, MD, PhD, FCAP (12:17):

It was fascinating. As we went and we traveled in some of these countries, in Dubai for example, the Sheik, I think it was in 2013, actually made a proclamation that by 2015, any laboratory that was not certified by the CAP could no longer exist in the country. In China and in India, when we went there, the pathologists sometimes would plead with us, "Please, whatever we do, do not take a bribe." We're not allowed to take bribe, but they would say, "Please don't take a bride." because they wanted the quality that we had, and they wanted that quality in their countries. And the only way that they could achieve it was by having our accreditation program as rigorous there as it is in the US. Those were the threats and the opportunities. And it was an incredible time doing this arm and arm with Steve as we went through this period.

Julie McDowell (13:03):

Dr. Bauer, I know that you got involved in organized pathology and federal legislation early in your career, and that really laid the foundation for your role in leadership at the CAP. Can you tell us a little bit about your experience and what advice you might have for other pathologists who might be newer in their careers?

Stephen Bauer (13:22):

Well, I really got involved by complaining to one of my senior partners about some federal legislative activity and he never really replied. I asked him, "How can they do this to us?" And he never really replied to my question, but he just looked at me and he said, "They can do it. And you can either decide to complain about it or you can decide to do something about it, which would you prefer?" And so I said, "Well, I'd prefer to try and do something about it."

Stephen Bauer (13:46):

And it turns out that he had been very active in the California Society of Pathologists. And so fairly soon I go got an invitation to represent pathologists on a panel that was going to be advising the state of California on contracting for clinical laboratory services for the Medicaid program in the state. And in the process of doing that, I was representing the California Medical Association.

Stephen Bauer (14:14):

And during the process, I met other pathologists from the California Society of Pathology. And just through the interactions we had there and having lunch together before or after meetings, I didn't realize it, but I guess some of those lunches were essentially interviews. And I got an invitation to be on the board for the state path society. And from there, I met individuals who'd been active in the college and was able to join a college committee.

Stephen Bauer (14:44):

So that really was how I got involved. And I think the message I like to give to younger pathologists is that there's a tremendous need out there for them to become active, and there are tremendous opportunities for them, and there are a number of ways that they can go about becoming involved. They can become involved at the state or local level in their societies there, or they can become involved directly in the college.

Stephen Bauer (15:09):

And the grassroots way of becoming involved in the college, before you go on a committee even, is oftentimes through the house of delegates. And you'll meet people through the house of delegates, you'll familiarize yourself with a lot of the issues through being on the house of delegates. If you can look for somebody like I had, who was a mentor to me and opened the doors for me, attend meeting, talk to people, get to know them and look for people who can help you open doors. If you really want to become involved, you'll find that you're warmly welcomed.

Julie McDowell (15:41):

And Dr. Robboy, you joined the CAP early in your career. What prompted you to join and even become a lifetime member so early in your career?

Stanley Robboy, MD, PhD, FCAP (15:50):

When I was graduating from my residency, first thing I did was look out at what are all the pathology organizations and what did I want to do later in my life, which area of pathology was I going to be in. And part was also who was going to represent me, who was going to be able to talk for me in a way that I couldn't. I was an individual. What organization could stand up to the government, to other forces and say, "This is what we want for medicine." Certainly, I was going to join the AMA. But what were the pathology specific organizations. And the single organization that seemed to have the skill and presence in Washington that I wanted to see was the CAP. So I decided I was going to join the CAP.

Stanley Robboy, MD, PhD, FCAP (16:34):

Well, I looked at the dues and the dues were expensive, especially when you're finishing your residency, you have no money. And I also saw that the life membership then was only 12 years worth of dues. And I thought, "Well, I have probably 40 or 50 years that I'm going to be in pathology. So it certainly sounds like a much better deal to become a life member early on than to pay dues every single year."

Stanley Robboy, MD, PhD, FCAP (16:57):

Another piece, a quiet piece, is once you join an organization, then you tend to get very much involved. And I knew this would happen in my life because I could stay in and not have to pay dues every year. So that was the decision to become a life member.

Stanley Robboy, MD, PhD, FCAP (17:12):

Then as it happened, in 1974, just two years after I came back from the army, I embarked on a project way beyond anything I ever thought I was going to do. I ended up trying to computerize the whole department of pathology at Mass General Hospital. You have to remember, this was at a time that the technology was pretty primitive. PCs hadn't been invented yet. Smartphones, a long way away. The computer terminals we had were dumb terminals.

Stanley Robboy, MD, PhD, FCAP (17:37):

And when I envisioned this project and was asked to do it, having help from our hospital, storage was very limited. We had 27000 patients a year. And the thought of taking all those reports, 27000 reports, keeping the information for the next 10 years, having to introduce new patients, was way beyond anything that natural language could do. And so I looked at the college, I said, "I need a coding system where I can reduce the whole report into several codes." And that was SNOMED, because I asked to join the SNOMED committee. So this is two years out of residency.

Stanley Robboy, MD, PhD, FCAP (18:10):

What struck me when I went on to the committee that I was young and I thought people would say, "Okay, you're kid. You keep quiet. You're in the back of the room." But instead, what I found was a leadership that so embraced all of us who were young and said, "We'll put you to work. Give us your energy, help us devise something, work with us, so you'll have oversight and develop something that would really be useful."

Stanley Robboy, MD, PhD, FCAP (18:31):

So in the SNOMED, I know, personally, I added several thousand terms with my medical resident who's now very senior in the college, Ray Aller. We built a whole system of syntax. And through this, we had a really functioning system at our hospital thanks to the college. Well, 47 years later, and still every year I've been on a CAP committee and I've loved every moment of it. And you are as young as you feel, and you're as old as you feel. I tell you, I feel like a young kid every day waking up looking at what are we going to do next? It's been a great treat to be with the CAP, and it's always been phenomenal.

Julie McDowell (19:06):

Thank you both for this great discussion. CAP members can download the 75th anniversary history book, authored by past president Dr. Paul Bachner on cap.org. Please visit the CAP website and type in 75th anniversary into the search function at the top of the site to find the link to the book download page featured on the CAP's e-store.

Julie McDowell (19:28):

Thank you for listening to this CAPcast. to listen to are other episodes, find us on the MyCAP app available for CAP members, as well as SoundCloud, Apple Podcasts, Stitcher, Google Podcasts, Spotify and Amazon Music. Just search for CAPcast from the College of American pathologists on these apps. Once you find our podcast, be sure to click the subscribe button so you don't miss new CAPcast episodes.

Julie McDowell: Welcome to the CAPcast series celebrating our 75th anniversary. And this episode, we talked about past Presidents doctors Sodeman and Williams, Dr. Sodeman was president from 2005 to 2007 and Dr Williams was president from 2017 2019 Dr. Sodeman appointed Dr Williams to one of his first leadership roles in this gap.

Julie McDowell: Dr. Sodeman can we hear from you, to begin with.

Sodeman: Yes, I guess, your question is one of leadership. President is not responsible for the daily operation that's left to the CEO. President, however, as an advocate, not only for pathologist but for the success of the CFP. The CEO is really responsible to the board for the operation of the financial status of CAP. At the College, the President, as the chairman of the board, this is not always the case and organizations. But since the President holds both the president's position and the board Chairman position in the College, the CEO position does end up reporting to the President and so both the CEO and the President become held responsible for CAP. As the President three assume responsibility for the membership involvement and advancing pathology and the role of the CAP, the leadership during my presence, he didn't change. The responsibilities that I assumed that the beginning, where the same as at the end. As the chairman of the board, the President assumes the responsibility for carrying out or policy to provide a leadership role. Any people forget that one of the primary roles of the President, really is as chairman of the board. President does not work, independent from the board. But the President needs to review the effectiveness of the Board and assure that the board actions or carry out. As the President you publicly represent the College, but within the College you represent the board. The Board structure, when I came on had been stable for many years, I felt as did the strategic planning committee that restructuring and strengthening membership involvement with sure more successful college. As an example, over the time CHP had grown to become a major player in pathologists education and a growing activity and both anatomic AMA record activities. The Board needed to restructure the better reflect those activities to accomplish this the council's and the committee's had to be expanded. New Councils had to be an added to support education membership existing structure had to be adjusted so they could be more focused on their missions and new technology was becoming recognized in informatics that needed to be addressed within the College. So those were the main things that I felt the leadership had to provide College as I came on board.

Julie McDowell: Dr Williams, can we hear from you what changes, did you see during your time on the board and as President.

Williams: Sure, I think I can address this that there were three areas of have some change during the time I was President and on the board. One was the involvement of the board in board activities, a lot of times board members…tended to be able to sit and not participate very much if they didn't want to one of the ways that I try to lead meetings in general is, I want to make sure everybody's involved. And I think you can see it in meetings, all the important issues that we have before us, I made sure that every single board member had a say. And that they had an opportunity to contribute to the decision that the board finally made and even at times when it seemed like there was a fairly straightforward…opinion and several people had spoken in favor of it Nobody seemed to be outwardly against it much I would encourage other people to speak up who had a different opinion, I remember several times, I had to call on some people. And they brought up kind of timidly that everything looks you know pretty good to them, except. What about this, or this or this and all of a sudden, you know light bulb went on around the table everybody said oh yeah we didn't think about that we need to change how we're going to do this in order to make sure that that doesn't happen. So I think one of the things is that I tried to strive a stroke, to get the entire board engaged with every discussion that came before the board. And I tried to structure the meeting, such that we had important things on the topics, there was obviously some routine work that we had to take care of. But the Board and the President should be leading the strategy of the College and not really concentrating on the operational part. And one of my goals as president was to make sure that the board really did participate in the strategy and try to forward the strategy of the College as a group. When they have a did change during my pregnancy last part of the board when I was President and President was we hired a new CEO.

We had a search committee that was extensive and evolved all the board to start with, we went through several rounds of reviewing applications and we narrowed the the field down to a few people, and then there was an interview committee. And we went through that ended up choosing Stephen Meyers who's had been the CFO and CEO of the College. And that really changed a lot of things for me if we brought someone in from outside of the College, my first year or two or the whole two years…may have been in orienting the new CEO to the College and to try to induce them to college activities and the culture of the College, but with Stephen coming on I didn't have to do that, and I think we actually hit the ground running between Stephen and I in a very collaborative way. That was enabled the College to actually use the two years of my presidency is as a means to forward our agenda and not. Just marking time and getting the new CEO acquainted with what the College did and was. I have to say that Stevens has been and continues to be a great see go, I think one of the strengths of the College is the collaborative efforts between the staff and the Members. The Members have a lot of the knowledge and vision of what happens in pathology both clinical pathology and then atomic pathology. And they have expertise that is beyond belief and a lot of fields, and they also have visions on where college is going where pathology is going to go and where the College how the College could help folks get there. But, but we have a day job you know we have to come back after our meetings… and go to work and we don't have time to develop these visions that we have about how pathology could be improved and how the College could help. And we live rely upon the staff to do that is only the very close collaborative effort between the staff and the Members that we can do all the great things that we do in the college and Stephen really is a great example of how staff can collaborate with. Members, especially his interaction with the board and with officers, the President elect Secretary treasurer and President…he's a very knowledgeable he's easy to work with he has great insight and he's got great instincts and what can and cannot be done, and he shares his beliefs in a very gentle by not overpowering but very convincing and it was very unfortunate, I think that we chose Stephen and that that change leadership has had a very positive impact on the College. I think the third area that the leadership has changed is at the committee chair of the committee chairman level, and then the committee's in general, of course, the council's are run by the Board members, the Chair vice, Chair of our board members, and I was fortunate to have great chairman, the vice Chairman of all five Councils, while I was the President, they all did an excellent job, but I think some of the real differences came at the chairmanship of the committee's level. One of the things I tried to do was empower the chairman and the committee's to do more on their own to think outside the box and present new ideas and ways that the College could improve…and pass it on up to the Council, I also made sure that there was new people on the committee that had not been on any committee in the college before and that. The same was true with some of the chairman that came available for me to a point I was trying to make sure that we got new blood in. Some younger folks are folks that have been experienced in this area, but hadn't really serving the College. And I think other committees during the time that I was President really stepped forward, we have some new committees that I appointed. And between all that, I think that the committee structure was really strengthen and produced a lot of great things, so I think there's three areas of did have some impact on the way college did that changed during the time I was President.

Julie McDowell: Now, Dr. Sodeman your background is one of being a strong manager in terms of your professional background overseeing the consolidation and mergers of hospitals and laboratories, how do you think this background impacted the way you view the structure and operations, the CP and its members.

Sodeman: A question is, how does your experience affect your leadership, and I think that's true for all the leaders of the College and that's one of the important things about college is the diversity of leadership brings in a diversity of ideas. I had been involved in two major health systems with the responsibility, as you say, from merging laboratory operations sort of better take advantage of the economics of personal savings personal savings…was aware of the importance of structuring operation from that activity Captain been stable and its organization on the pathologist side for a long time. The question posed to the strategic planning committee during my two years as President elect was was the structure supportive of the operation. Could we improve the structure to better support pathologists and the activities of the College, could we improve the structure and the leadership that the College had. That was the same question that I approached all the consolidation, to the laboratories of the Walter health systems that I was in.

And the case of the College could accreditation be separated from scientific affairs to focus the scientific, the Council and scientific affairs on its mission of assuring a high performance level and laboratory operations. Was it not better to have a Council on accreditation to focus its efforts on laboratory operations and compliance with the standards. Would that also avoid any potential conflicts between surveys and accreditation That was really the question that the strategic planning Committee was facing as we began to develop. The changes that we look for in the college's I came on as President. As the premier organization for colleges and as a very important educator pathologist we needed more leadership in that role, so a new Council on education, with appropriate committees, where it's needed to support the operation of education. When I came on as President elect and the education, efforts were under the board itself was a direct committee but they needed some independence to be able to operate have a really growing program of education. Membership we know as the backbone of the College so who looks after the membership needs a new Council seemed obvious with committees to focus on pathologists that are just entering practice and supporting those through practice management, where did you go to learn about practice management, especially if you were the new leader in your group college really didn't have a place for that activity. The last really growing area. At my time was informatics technology. One of the roles that I assumed in my working life. Was laboratory information and computers. Computers nothing about computers I played around an apple at home and that's it, but all of a sudden Chairman at the University of Michigan go me I the responsibility of computerized in the laboratories. I was focused on Microbiology because I was the director of the Microbiology laboratory computers never really entered my mind. So I had to learn and understand about computers, there was no way to turn the College that needed to be corrected so it felt important to me and the strategic planning committee to an informatics technology leadership committee had to be established. So I think our roles in our own community and our own practices, give us experiences that we can carry to and bring to the College.

Julie McDowell: So, keeping with you, Dr Sodeman, as I noted in our introduction you appointed Dr Williams one of his first leadership roles in the CAP can you talk a little bit about what you saw and Dr Williams that made you think he had the potential to be a great leader at the CAP.

Sodeman: Sure, finding leaders for the future and I just are really a heavy responsibility for the President elect because the President elect will ultimately appoint leadership within the College and in the committee's so you really have to be involved in the membership, and you have to be have ways to identify new leaders. Again, new ideas come from new leaders static leadership stalls of growth and the development of an organization. I changed jobs actually every 10 years because I needed the challenges of a new environment.I needed to learn and lead with new ideas and those organizations that I joined, so the College has to turn over its leadership for a new direction and ideas to it can't stay static. Well, while I was President elect and later as President I visited every committee and the College. I concentrated more my activities and attending committee than Councils, because I knew the council's run your good leadership, they were under the leadership with board members. And I was going to hear what happened with the Council, with the board meeting anyway, but I needed to get out there and meet members and as President elect. It was my responsibility than later to appoint these leaders and members, Dr Williams do it out stood out during that process of going to these committee meetings, as did many other individuals. But clearly Bruce had the leadership skills and knowledge, he had a love for the College and he involved himself ncaa P activities, not all Members. On committees actively involve themselves in the College. They involve themselves in the idea that the committee's dealing with, but not in the college itself, so I chose right, I think, because Bruce crude come president of the CP.

Julie McDowell: So speaking a little bit more about leadership. Part of the responsibility as you've stated, Dr soda men as president was in appointing Member leaders to Councils and committees. To give them the opportunity to expand their knowledge and of course grow leadership I’d like to hear from both of you a little bit more about what was your strategy about going about. identifying some of these Members who would lead the council's and committees and again Dr. Sodeman if we can hear from you first and then Dr Williams.

Sodeman: Certainly.You have to understand that CAP meetings committee meetings and Council in board serious business. Yes, it's a professional organization, but the organization itself conducts a very significant operation that impacts pathology. But it doesn't mean you don't have fun, you always look for the opportunity have fun. The opportunity to meet with your peers, both in the formal meetings and after our dinners make us. So it grows and so you grow as a pathologist and you identify new leaders, while I was involved in the college for a long time long time.

I served on 46 different committees. I got to know a lot of people serving on those committees, and I think that's one of the important things for leadership. They need to, especially the leadership on the Board and the leadership for the President, they need to have had involvement with a college it with committees enough so that they can identify. Those leaders each individual brings to the committee their own their own interest, and you have to understand what those interests are and what that individual is going to bring. And that's that's the thing you have to do when you consider all these appointments finding the right match between interest and an individual. Certainly not everybody's interested in management leadership, but some are but you don't need all leaders managers, you need people who are involved on the committee and are interested in the ideas of what that committee is doing to so it's a mixture of individuals as President elect that's really a responsibility that you're going to end up with trying to appoint both the leaders, as well as members to the committee, so you happen to know people. You have to get to know the Members, you have to be in by identifying those leaders. You have to recognize some of yourself, others are brought to your attention either in committees or people will come forward to you as President elect and they'll bring up individuals that they know of that are are showing those leadership capacities. So many times it's information that you received from others that helped make these decisions. The role like Ghana that President elect us to review the direction of the College and to recognize potential members and leaders of the College and you don't do that without the help of many, many active people that are involved in the committee's.

Julie McDowell: Dr Williams, can we hear from you on this?

Williams: Sure. I like to thank Tom for his kind words about how I got involved in leadership roles in the College, I would like to thank him personally for doing that, without his pointing me to chair of the Commission lab for accreditation I would never have progressed up through the leadership chain, I really do appreciate it. I must say I got to know, several the president's over the years before Tom woods, was the first time I met, we were coming back from a meeting, and we were both going to go to Atlanta and then he was going to go on to Florida, I was coming over to Louisiana and so we're sitting in the. Airport way you know the flight and he just spoke up and said I recognize you from the meeting Tom was a great pathologists he was a great individual, and I think he's the template for the president's coming after him, he was a wonderful individual. But Tom was the first president I’ve really had worked closely with, I must say that his leadership gave me inspiration a template for how to become a leader in the college and how great leader should be I really appreciate his taking time to mentor me in the role that he appointed to me and Tom is exactly right the appointment of committee members is probably we can be members and chairs the committee's is probably the most important activity that you do like Tom I went to several different committees, I did go to some Council meetings, also during my present time and on the board time but I tried to make some committee meetings, also and is very energizing to see the new Members that have recently be come members of committees, and it was exciting to see more experienced people that have been on the committee's or different committees for a while and brought a depth of knowledge. The committee's are really the core working groups of the College counselors are important in getting this information and activities to a point where they can be instituted or presented to the board for activities but it's the committee where all this really starts, and I think that became very aware to me during my time before it became President, so I was very involved and interested in getting the right people the right place, when I was that. But my philosophy was you ought to appoint people with a deep knowledge in the field that they're in. So there's someone that had a lot of accreditation experienced and I think they should have as a board member be over the accreditation committee or if they were education or new law about membership or advocacy then they should be in those fields in order to bring the best expertise, the most knowledge to the College. And I found that to be very, very helpful having the highest committees, being the council's and the board. Being stocked with folks that are well versed in the whole operation of the College, but specifically versed in the areas that they were involved with the Council level, I think, lead to. Greater activity and greater success because have a spoken word from a years of experience in the background, and I like to thank everybody who was a board member, when I was President elected president and he served on Councils and committees, I think everyone did a great job.

Sodeman: Sot let me respond real quick to what Bruce just said, I think he's correct, you need to have information about an experience when you're going to move into a position of leadership, not every President felt that way, though. When I came on to the board I got appointed as Chairman of the Council on government affairs, I had never been involved in any activity related to the Washington office, so I guess it brought some new ideas for me. But it was interesting.

Julie McDowell: You both have noted how important having the support of your spouse and family was during your presidency and I’d like to hear a little bit more on that from each of you, Dr Sodeman can we start with you.

Sodeman: Oh sure. Long hours it's been long hours, when you get active in the college and committees and counsel or the travel the time away from home. And the need for support on the personal level is critical and while you can turn in many people for help, no one is really closer or better than that than your spouse my wife Sandra recognize that early and, in fact, she retired from her job delta airlines to support me during the presidency. She was my travel companion. My helper you get ready. She worked for the airlines so she understood the way to get around the system and get around flights, which was very central considering the number of flights that we're taking. I can remember well at Mary cass's husband Dennis did the same thing for Mary he arranged all the travel for married when she was the President. Many of the Members bring spouses with them to the meetings and they look to the leaders spouses to find activities during the day, so if you're the chairman of the committee and your wife, is there a lot of the wives will look to his wife or her life to say what are we going to do today, while the guys are meeting. As President our spouses did the same thing Sandra while I was President started a book club that met during the board meeting in the afternoon, most of the wives joined it. The next day they usually would go out on sightsee dinner, they were really a central to listening to what the spouses had to say, is no better information on how you're doing and what's going on and what you hear from the spouses. You can get a sense, for if everything is right, because it's not spouses right and everything's going right spouses become really a major source of success for President. They support their partner in their activities they support college. The other thing is you can't forget members of your group your practice group. Like College pulls you away from practice a lot, and someone has to cover for you so it's not only your spouse's but your partners in practice that are essential to your success success as President.

Julie McDowell: Dr Williams, can you share your thoughts on this topic.

Williams: I think I think Tom did a great job he covered all the points i'll try to recover them as it applies to me when I was younger and start out in. The Commission laboratory accreditation I had school aged children at home and my wife was a rheumatologist it was not possible for her to travel with me because she had to stay home and pay work and be take care of the kids, and so I was gone to a fair amount of time without her along. And then, as we joined the board she did start joining me to board meetings and like Tom said there's a camaraderie among the spouses of the board, because they have a lot of time to be together, I want the Boards meeting, but one of the things that happens is the is evolved. Over the period of years that the president's wife actually does do exactly what Tom said they organize meetings and activities and Susan was very involved with that during her time as when I was President and the spouses are a great source of support for all the board members and for the officers and for committee members and Council members, you really couldn't do it without their. A green for them to sacrifice that it doesn't seem like it, but there really is why sacrifices that the leadership or Council or our committees or the or the board does, because the time gone does take away from family and from work and you do have to have support of your partners at work, and you have to have the support of your partner at home, you have to have the support of the spouse, to be able to do what you do and I really think. My wife and the children who put up with my being gone and then did travel with me during the time to enable me to do this.

Julie McDowell: Well, thank you both very much for this great discussion.

Julie McDowell: Welcome to our latest episode of the CAP cast 75th anniversary series where we asked past presidents. To provide a glimpse behind the curtain of leadership and share their insights on leading the profession and a major organization like the gap. This episode's discussion features doctors Richard Dr. Friedberg and Bruce Williams serving back-to-back terms, Dr. Friedberg was president from 2015 to 2017 and Dr Williams was president from 2017 2019. So, the two of you joined the board around the time of the market collapse in 2008 Dr. Friedberg you joined in 2007 and Dr Williams you joined in 2009. Given the backdrop of the market collapse What was your focus at the time, and what changes, did you notice in the Boards thinking Dr. Friedberg can we start with you?

Richard Friedberg: Sure sure, so one thing we noticed early on was the increased concern about the budget and the reserves. And so early I since I joined in 2007 we had its CEO transition early on in my tenure there and by time to the 2008 crash came along, we were very concerned about the reserves, So, the biggest issue the market collapse, was what is it going to mean, are we going to recover from this quickly is there going to be a transition, how are the customers physicians the hospitals, how are they all going to be affected moving forward so there's a lot of uncertainty.

Julie McDowell: Dr. Williams, how about you what's your perspective on this?

Bruce Williams: Sure, I came in on the board after the market collapse, and the one thing that I need to say is that the College is in the fortunate position of being a large enough organization that we can have first class consultants. Aid us in our needs, as we see them coming up at the time, and still to this day, Bob shear was our financial consultant, and he was extremely beneficial in going over our portfolios in making sure that we were invested in the right things that would last through this downturn and turn positive, I must say that because of his guidance over the years we've we came out of that very well the Board was very concerned about it. Bob was very reassuring and actually led us through several meetings where we thought about our investments, how we could rearrange them and keep them in a good position, and he did that and that we came out of that very well. I do think that that did have a longer-term impact on the College and pathology in general, the other time there were several there was a group of physicians getting ready to retire that because of their retirement funds decreased and value decided to stay around longer to work while their earnings came back their investments came back and they could continue earning some money and because of that. The job market in the United States for pathologist shrunk because the people that were leaving should been leaving we're not leaving. This actually became a mini crisis in pathology in that the residence found that there was no jobs available. And the word kind of got back to medical students who then did not go into pathology and I think that's led to our current status of having a decreased number of pathology candidates, because of that market collapse. It was a big point of interest of the College about this. It was a keen interest to the board to investigate this lack of retirement and what was doing to the pipeline and actually a prior President, Dr Stan rob boy I had a years long look at the pipeline issue for pathologist and publish several articles about this and I must say that. In long term the outcomes of the predictions of those of his committee and those publications have come true that we're now that there was be a retirement cliff sometime in the future and it's happening now, and by the because of the concerned about pathology resins not be able to get jobs easily back in the early part of the teens. That, then, this has led to decrease the pathology pool residency pool who are graduating has led to some of authority, this is something that's gone on over the years, though I think Richard you've probably seen i've seen it aware. You know there's not enough pathologist out there, where it goes from the residents to the medical students before I get a job anywhere, a lot of medical students go into pathology residency. And after a while there's so many there that they're saying I can't get a and they feedback to the medical students say whatever you do don't go in theology because there's no. Jobs out there and therefore there's nobody goes into it, and then the cycle starts all over again if he knows it, Richard.

Richard Friedberg: Yeah, that's absolutely true, and one point just to sort of preface Bruce’s entirely correct comments about the College is not retiring. In 2005 2006 right before I joined the board, there was a double year of residents coming out because the American board to change it from a four- or five-year residency to a four year residency. So, we had double the number of residents coming out in 2005 or 2006 and so, by the time 2007 was out do they were still being brought into the system so there's more people looking and then, when pathologists stop retiring and what's not working longer you end up with what's in essence and over what seems to be an oversupply of pathologists but all you're really doing is you're you're hitting the high part of the curve and there's a sort of an ECHO later on with them to get the…just an insufficient number pathologist, which is where were you know many of us believe we are now. And one other thing happened that led to a lot of residence, getting to fellowships before then most pathologists could go directly from residency into a practice about that time it was becoming more popular become to get a single fellowship to have a subspecialty training.

Bruce Williams: But because they could not get a job, a lot of residents went to a second fellowship and so for years, there has been a tendency to have a lot of graduates going into practice that they would have to fellowships, I think, because the shortage, this is now going back to one and maybe even some people going directly from residency and into practice so that that also is another effect from it.

Julie McDowell: So also, during your time on the board, transparency and participatory leadership we're a focus and I’d like to hear from both of you I’m sorry I’d like to hear from each of you about how the entire Board was really engaged in this process, Dr Williams, can we start with you.

Bruce Williams: Well sure I think it had already started when I was on there because, from the very beginning, the board really wanted to make sure that the entire membership of the College understood their reasoning behind that actions they were taking they had communications to the membership and they wanted to increase participation of members into the different committees and Councils of the College. One way to do that and that really occurred, all the way through both Richard my time on the board and then really accelerated. When Richard was President and I followed in his footsteps is that may time there were some people that were very active to join the College and they get one committee and then somebody else said they really good they get on another committee, and they'd be on three or four committees and effectively that kept fewer people from being able to participate in college committees and Councils, because one person was feeling a lot of spots. I know when Richard was President he made a specific effort to look at the number of committees and Councils, people were on and to try to keep them on one in order that participation could increase. He did tremendously during his Presidency and during mine, I followed in the same footsteps and even cut back more on the number of duplicate members in different committees, so that we could expand that one of the things about what's happening with code is that there more participation in committees and Councils via electronic means and there's some talk now that there's even a still a tremendous demand we could never get all the people who want to be on a committee on a committee. And the other thing we did was if somebody apply for two three years in a row, we make sure those are the people that got on the committee because they showed a history of being persistent about trying to get on the committee's and both Richard, and I did that. But even now there is more people trying to get on committees, and there are in because of a lot of meetings are electronic and are able to be joined that we can have more people on the committee's without paying for airfare and travel and hotel and food. And it costs, very little to have more people participate, so I think the entire time i've been on the board there's been an effort to increase transparency and participation.

Julie McDowell: Dr. Friedberg, what's your perspective?

Richard Friedberg: I think he hit the nail on the head. One of the pre presidency preceded me there are so few open spots, for them to a point and there is so many people who wanted to join. And so, we made a concerted effort to try to make sure that people. Had specific six-year terms on boards and that they would be when it came time to rotate off, they would rotate off and let some fresh blood in, and I think it did. A world of good to get more and more people involved because it's a lovely problem to have when people are complaining about not being able to be in as many committees as they want to be.

Julie McDowell: Now, also during this time, the CAP strategic planning process really shifted to more of a longer-term process, can you tell us a little bit about the changes and this strategic planning process, Dr. Friedberg, can we continue with you?

Richard Friedberg: Yeah, so when I joined the board the strategic planning Committee had always been appointed by the president elect. The strategic planning committee was in essence that Presidents group of people to help him plan out him or her know anticipate and plan out their time as President, and so I was actually on the strategic planning committee for Jared shorts when he was President of the CAP. When I came on the board and shortly thereafter with that, when we got a new CEO with Charles on board, we transition, the strategic planning committee to really be a longer-term operations, we weren't having two year cycles of this set of policies and that says policy we're really taking a longer term look as just really strategic planning and there's a more it's much more official process around planning for the future, anticipating the problems, having a risk management committee that really looked at where the risks and rewards and the benefits and the hassles and the issues would be for us moving forward, and so we took a much longer term look at strategy strategic planning and growth, instead of allowing a change every two years of focus.

Julie McDowell: Dr. Williams, you want to share your thoughts with us?

Bruce Williams: Sure, I think Richard’s exactly right, I was on a strategic planning committee that involved a president elect and it was a good process, but it did result in emphasis changing of the CP every two years, and that that was not really to the best benefit of the Members. And Charles did a lot of good things, I think, for the College and one of the one of the things he did was to say that we needed to change the way the board worked and to look at it more as a strategic implement of the College and that happened. After we started thinking about how we should go forward in strategic manner, I had some of the older more senior board members say that it really did change because back before then sometimes they sit around more means and look at the expenses of individual pathologists on their travel expenses going to meetings and things and which is obviously a waste of time for the board to do, but under the news circumstance We really did change to strategic effort on the part of the board in lot of different areas, and I think we were looking forward to the future of pathology and because of that we were able to create new committees and even some new Councils. And Richard I talked about this, I must say first of all, it was an honor to serve as President elect into Richard, I think he was the best President possible for me, because he enabled me to do things and gave me jobs to do that got me ready to be President, even after six years on the board you're not always ready, I think, to take over and there's still more to learn, and the two years I spend as President elect under Richard were very beneficial to me to be able to do what I was able to do when I was President but during that time we both talked about how to make the Board more strategic and he set goals and agendas that really reflected the strategic goal of the of the board, and I was able to try to recapitulate that when I was President, I just followed his lead. In making sure that the agendas, which really drive the board discussion had a lot of strategic items in it, as well as some operational items and some housekeeping items that you had to have in there, but I really credit Richard with the really leading on that strategic goal setting.

Richard Friedberg: It's a very kind words from verse joy and I appreciate them I think it's important to recognize that. As the CAP grew and became a more complex organization and the more professionally run and managed organization, the board needed to be part of the strategy and not part of the in the weeds paying too much attention to the minutia and missing the overall picture, and so we would have a healthy discussion at the board about the bigger picture kind of questions. Not my than the smaller issues is the weather one committee was spending too much money by going to this spot about spot those there were ways to those things we handled we didn't even have the board handling that the Board needed to be a much more involved in the strategy and operational side of the strategy and not in the real day to day business parts of money in the organization.

Julie McDowell: So, keeping along the same theme of strategy along this topic, both of you were involved in the creation of the CA piece first brand strategy, which was all encompassing involving clarifying the CP target audience and messaging as well as creating brand standards and a new expression system. As well as a new logo, which is a major thing for any entity any business any organization and obviously signified the modernization and the evolving of the of the CAP. I'd like to hear both of you talk about why it was so important for the board to be involved in this and really driving this and why it was important to even do this and modernize the CP and distinguish the association from other organizations. Dr. Williams, you want to start us off on this discussion?

Bruce Williams: Sure. I mentioned before that the State Path was getting large enough to get good consultants. And Richard already mentioned the professionalization of our staff, and I think one of the highlights of that was hiring Elizabeth usher to take over the marketing area of the College in that she had had extensive brand. Research and expansion in another medical field in a commercial side but was well established in the ways to do this and the needs to do this. The reason for the update I think was several one as far as the logo went, it was an early style, and I was stylized or alumni or flask which lot of people thought look like a bit coat hanger and

Those of us like Richard and I knew very well what … was but it had been years since those has really been using a clinical lab to any great extent. And it was felt that, because the logo was not up to date, a lot of people might feel the College was not up to date. I think the other emphasis, though, was even a little bit different than that the board had made a strategic decision at one point in time to take out of the Vision mission statement that CP would be the leader of pathology worldwide, and they took out worldwide strategically because of the they thought that we ought to be emphasizing the practice of pathology in the United States. This the board that was under that Richard and I were on voted to put that back in the mission statement because we really felt that we had a lot of knowledge and expertise that could affect patient care worldwide, and then, if we could promote quality in a worldwide manner. That we would have a beneficial effect on the practice of medicine through throughout the world. And I think that's true, I think we made the right decision, I think, with the improvements that we make through pips and PAPs and pts and inspections and education. That we have made a positive worldwide impact on the price pathology does raise the practice of medicine throughout the world and the aroma flask did not reflect an up to date worldwide…And I think it actually did make a change, I think people look at the College too many Members looked at the College differently, I think the board, like the College differently.

Bruce Williams: And I think people around the world did a Richard I both in a position, fortunately, to travel around the world to represent the College of various international meetings. And I must say the reception that you get from pathologist and laboratories worldwide to what the College meant what the College did and how the College promoted the price of pathology was overwhelming I had some of the most amazing talks with international pathologists that were at a meeting outside the United States and many of them said, I cannot describe to you what the College means to me as a pathologist or means to the practice or the means to the patients in my country of what you've been able to do to increase the quality and I think the the new brand really reflected our worldwide effect, and I think it was the right thing to do.

Julie McDowell: Dr. Friedberg can we hear from you?

Richard Friedberg: yeah I think that resonates and are very important points there, the one of the pleasures that I had as President elected president was to do a lot of talking around the US and internationally, I probably I think I spoke it somewhere, maybe a half or a third of all the medical school and residency programs in the country during my time on the board. And it was interesting to talk to the residents and fellows about what the CAP logo was and you get the hint you have them here them argue about whether it was a coat hanger. When I you know they couldn't they didn't know what else it might be maybe was a triangle, maybe we're. Trying to talk about stability, because it's an unstable triangle, it was but i'd say it's an urban Meyer flask I got this quizzical look which they had tried they knew they'd heard about it, but they weren't really sure whether that was the one that had the thing can we automate neck or just the open Hall, on the top, it was a non sequitur it wasn't it wasn't it was an anomaly, for the time. And we talked about the new logo the residents and fellows universally accepted it right away. They were all talking, they were getting to interesting discussions about what the weather the pattern of the colors and the sizes of the dots meant anything and whether this was. You know the ones in he was saying was clearly a blood smear and. And the more traditional ap guys are saying that's clearly one of these, and I was an interesting chuckled to get to because they were they saw this as something relevant to what they're doing they saw this as an image of little bits of data coming in from multiple different parts are all being synthesize together to make the diagnosis and not just some irrelevant piece of glass where that didn't have a real foundation to what they had so we had a new logo, we had a standardized coloring color scheme standardized. The fonts just to sort of keep things consistent and you know, we had some very interesting arguments about whether you know what should be capitalized and what should be capitalized and whether the word American was good or bad. Because you know, is it Canada American is Mexico American as it's just international we don't have the discussions about the international aspects as we realize how at that time, especially how big the international but was aspects which was for growth.

Obviously, with kovats some of these things have been reassessed just because of the logistics that are tied into that. But you know we expanded very significantly worldwide, and I think it was right to have an up to date image that sort of reflected us as some part of the new digital approach to how medicine was being aggregated and delivered and not just a arcane piece of glass where that belongs on jeopardy question.

Bruce Williams: And I think Richard so right about the dots. The Board actually got the final decision about which logo, it would be, and I think one of the things that attracted me, and so the other people to it also was that you could make the dots into whatever you wanted to pay. It was round, and I did think of a global image on that, but digital bits and Bytes would be possible me his global stains blood smears you could make it into whatever you wanted to, and in the long run, I must admire Elizabeth for guidance through it and giving us the choice, and I think the board make the right choice of the options given them as far as what the future logo would be.

Julie McDowell: Finally, both of you have been vocal about the important work that the board's proceeding you had on moving the profession forward. For instance, the formation of the Council and accreditation, as well as the transformation program office Steering Committee, how did these decisions impact your leadership involvement in this EP Dr. Friedberg can we start with you?

Richard Friedberg: Sure, so um as we all know very well the accounts on recordation was really part of the response to the Maryland general set of issues that popped up that Maryland general preseason preceded my time on the board, but we were definitely living with the consequences of that set of challenges and so bring the Council on accreditation, as you know, the bringing the accreditation aspects of the College. Up to the highest levels of the College and putting them on the board made sure that everybody really understood that accreditation was a fundamental part of who we were, and now we are perceived. We have lots of people are very familiar with the Council of the CSA this councilman scientific affairs and all the PT and they put that when they oversee and all the good work they put out accreditations started before me, as the Council on education had been formed a couple of right when I joined on to the board came on there, and that was another part of raising that to the level of the board. And I'd spent a lot of time on the Council on government professional affairs and so by having the five Councils all represented very prominently on the board made sure that we were operating our organization from a strategic perspective as a unit, so that the CSA and the CEO and the CEO a, for example, we're working together to move the College forward, because we are much more than the individual parts, where this is where we are with the board isn't it shouldn't be over say a strategic aspects of the entire college operations, instead of having a one console doing what they want to do for a two year period of time I got changed, two years later.

Bruce Williams: As Richard mentioned, I also was very familiar with formation and the Council accreditation coming print the Maryland general issues, because my background in the college was in accreditation, I had been part of the accreditation effort and I had been before then, as a state, Commissioner, of back in the 1980s. But we went through the format, the activities of the accreditation through the Commission on accreditation, which was part of the recognition that one of the most important things to college did was the accreditation of hospital laboratories independent laboratories commercial laboratories throughout the United States and really throughout the world. And, to the benefit and to the credit of the Board before me they decide that it really needs to be elevated to a Council position as opposed to just being basically a committee under the CSA However I had…and then rotated office chair and I came on as chair of the Commission, a laboratory accreditation and it was during my time that they decided to form the Council on accreditation and again to their credit, they engaged me highly to help develop that Steve Bauer was President during this time, and he approached me and asked me my opinion a lot of things and actually invited me to some board meetings where the formation was discussed and, in fact, was voted on one board meeting when I was there as chair the Commission. And I think this is a great for side on there, I think the creation of the counseling education to emphasize that the College is always interested in continually educating pathologist and elevating the price of pathology through education and then also to elevate the College, not only through proficiency testing with CSA did, but through accreditation, which is what net the new Council on accreditation the CRA would do. And the impact that both all three of those arms of the College education, science and accreditation would have on the impact of the practice of pathology worldwide, and because of this we've been able to generate new subspecialties of accreditation to look at a different area that weren't accredited before. And I think the emphasis on accreditation has enabled the College to maintain his leadership and accreditation of clinical laboratories around the world. More than any other organization in the world and I’m very proud of what the College did concerning the accreditation area in making a Council.

Richard Friedberg: I think it's important, if I can add one on to what Bruce just said so, when you look at the structure the board the Board has on it 12 governors, each of whom was elected to a three year term, and they can have two terms, there are three officers, the President, the President elect and the Secretary treasurer, there is the President of the Foundation there's the president of the resident head of the residents forum. There is the speaker and vice Speaker of the House. And then every other year, there is the past President who's on the board so in all those that those are the people who make up the board, but the solid part of the board at 12 governors that are elected. And then you've got the other six, seven or eight people who are officers or Heads of major other portions of the College, that are not conscious. And I think it's worthwhile pointing out that was my first board meeting is the first was the initial creation of the Council on accreditation, so I said the councilman education and two and I think two years before that it was when they started the Council on accreditation. So all of these things, these changes were really coming into play, not a part of the first decade of the century and that's right one weekend on board, we standardize a lot of the processes around the various Councils to make sure that all aspects of the consoles were heard and a prominent part of the of the strategic operations, the board.

Julie McDowell: Well, thank you both for this great discussion CAP Members can download the 75th anniversary history book authored by past President, Dr Paul Bachner on the CAP website, please visit CAP.org and type in 75th anniversary into the search function at the top of the site to find the link to the book download page on the CAP e store. All right, thank you all very much that was awesome.

Interviewer (00:04):

Welcome to the CAP's CAPcast series celebrating our 75th anniversary. We're here to learn from Doctors Godbey and Volk about what it's been like to lead the profession in a major medical organization like the CAP, particularly during this historic time, during the COVID-19 pandemic. Your terms as president and president-elect have occurred during these unprecedented times we are in today, a worldwide pandemic and a global reckoning of diversity, equity and inclusion. Let's talk about these factors starting first with the CAP's COVID-19 response. Dr. Godbey, can we start with you?

Patrick J. Godbey, MD, FCAP (00:40):

Surely. The first thing that comes to mind when we talk about the CAP's response is speed. We all had to adapt quickly, and we did. From the advocacy standpoint, money became available to support small businesses, and we made sure that that money could also be made available to pathologists and pathology practices. Not only did we do that, but we taught our members how to access those funds. We also made it possible to sign out remotely, so that we could better address the challenges presented to us by COVID. We got a suspension of laboratory inspections so that we could continue to provide good lab work, but not expose our pathologists and the medical laboratory scientists that we work with to unnecessary COVID-19 danger.

Patrick J. Godbey, MD, FCAP (01:40):

We secured the ability to submit NIPS data a little bit later, and we immediately sought ways to engage with the federal government, both the legislative and the administrative branches. They were very responsive and have continued to allow us, in fact prompt us, to be engaged. This is true at both the federal and the state level. We knew that education would be hampered, so we began to offer free online learning opportunities. These courses were given by CAP members, and they were well-attended with one having more than 5,000 physicians registered.

Patrick J. Godbey, MD, FCAP (02:26):

For the first time ever, we had a virtual meeting, and it was a very good one. We brought it together in record time and served up a very good product. We also assisted state pathology associations in many ways to not only continue but to grow. One of the methods that we used was to make available a virtual platform, so that states could continue to have their meetings virtually. We made this available to our state societies with no cost.

Patrick J. Godbey, MD, FCAP (03:00):

Also, we quickly came up with a proficiency testing product for COVID-19. This was necessary to ensure continued accurate testing, and we brought it out in record time. We engaged the press and patients like never before, but I intend to talk about that more in just a minute. Our actions were quick. They were good. Pathologists and our patients were the beneficiaries.

Interviewer (03:29):

Dr. Volk, what are your thoughts on taking over leadership of the CAP as COVID-19 continues to impact the entire world?

Emily E. Volk, MD, FCAP (03:37):

Well, above all, it's a tremendous honor to represent this organization that embraces science and truth at its very foundation and represents amazing physicians who have dedicated their lives to making sure that patients are taken care of in a scientifically rigorous way, that physicians have the data that they need to make good medical decisions, and that they have accurate diagnoses on which all the therapies are based. So to me, the incoming president of this society is a tremendous honor, and it is a huge responsibility, which I do not take lightly.

Emily E. Volk, MD, FCAP (04:22):

I will say that being a partner of Dr. Godbey as president-elect while he has been president has been an absolutely terrific experience for me. I've gotten to work closely with Dr. Godbey, I've gotten to learn from his leadership style, and I have also developed a friendship that I think will be a lifelong friendship with both Dr. Godbey and Mrs. Godbey. I'm very grateful for that.

Interviewer (04:53):

Dr. Volk, can you say a bit more about the CAP's diversity, equity and inclusion initiatives during your tenure as the president-elect?

Emily E. Volk, MD, FCAP (05:04):

Well, in the last several years, across the country we've really seen a reawakening of interest in making sure that leadership in all different industries represents the diverse workforce that is out there. Certainly in healthcare, we know that the vast majority of folks who work in healthcare are women, and yet there's a minority of healthcare leaders that are female. As an incoming leader of a large healthcare organization, I am really hoping that my presence will inspire those who come from different backgrounds to step up and get the courage to take a leadership position, even if it's a leadership position in a smaller way that would lead to other participation down the road.

Emily E. Volk, MD, FCAP (05:54):

The leaders at the CAP recognized, in the last several years, the importance of representation at the highest levels of the organization. So we undertook a very intentional process to improve diversity, equity and inclusion at the CAP. I think one of the most important things folks need to remember is that this is not an overnight quick fix. This is a problem that has been in the makings for many, many decades, and the roots of inequity go back centuries. So we have to be very careful and thorough in our efforts.

Emily E. Volk, MD, FCAP (06:40):

So we are doing a lot of listening, and we are doing a lot of careful consideration about what we need to do next to make this improvement a sustainable and meaningful one. We are not interested in a bandaid. We are interested really in a appropriate evolution. That being said, one of the things that we have done in the last year has been to create a committee of diversity, equity and inclusion that reports directly to the board of governors. And the reason it reports directly to the board of governors is because this is so important that this work needs to get off to a good start with the support of the leadership of the organization.

Interviewer (07:28):

Dr. Godbey, what are your thoughts on the CAP's efforts in the area of diversity, equity and inclusion during your time as president and on the board?

Patrick J. Godbey, MD, FCAP (07:38):

Well, I'm proud of our efforts, and I couldn't agree more with Dr. Volk. This is not a problem that can be quickly fixed, but it's a problem that I believe that we will do the best we can and do the right thing. This is going to take a while. We've recognized that it is a problem, but we are definitely heading in the right direction. I'm proud that over the past two years, we've not only recognized it, but set up a path to really make progress in this area. And I have full faith and confidence that Dr. Volk will continue this effort and make it a success.

Interviewer (08:25):

Dr. Godbey, in keeping with you, you've mentioned previously that the things that exhilarated you during your tenure were at times the same things that exhausted you. Can you please give us some examples and share some insight on this?

Patrick J. Godbey, MD, FCAP (08:41):

Surely. I'll give you several examples. First of all, it has been my honor and my privilege to lead this organization and speak for this organization during the past two years. We've had a tremendous opportunity. And as I say, it's been my privilege to be able to champion pathologists and the laboratories that we direct more than any other pathologist and any other president has been able to do to date. COVID-19 gave us this opportunity, and we took advantage of it.

Patrick J. Godbey, MD, FCAP (09:24):

Over the past two years, I've done many, many, as has Dr. Volk, as have several other of our members, interviews with the press, appeared on MSNBC, but had a real chance to bring forward pathologists and the importance of what we do. I stopped counting my interviews a few months ago, and that was at 76. But I'm proud that now the Wall Street Journal, the New York Times, the Washington Post, USA Today, US News and World Report, MSNBC, NBC outlets, ABC outlets, Popular Science, and many, many other outlets now look at us as the source of truth when it comes to testing. They now come to us when they want to know things. They regard us as the source of truth, and they should. I'm just very glad they recognize that.

Patrick J. Godbey, MD, FCAP (10:29):

A few years ago, I was on an airplane, and the call came out, "Is there a physician on the plane?" So I got up and left and went to the back. And the lady sitting next to my wife said, "Is your husband a doctor?" "Yes, he is." "What kind of a doctor is he?" "He's a pathologist." And her response was, "What's that?" I hope that today, after all the recognition that we've received, and rightfully so that we've received, she wouldn't ask the same question.

Patrick J. Godbey, MD, FCAP (11:03):

Now, having said that, each interview lasts between 20 minutes and an hour. On many occasions, crews have come to my house and turned a room in my house into a studio. In each interview, each touch with the press, I wanted to make sure that we were fairly represented, rightly represented, and that we gave information based in science. I did not want to misspeak because I knew I was representing pathologists and laboratories. I did not want to be drawn into political controversies because everything we do is based in science. So at times, that's a little bit of a strain, but the effort was and is well worth it.

Patrick J. Godbey, MD, FCAP (11:59):

And I'll give you another example that's both exhilarating but tiring, and that's dealing with administration and congressional offices. Many times I have had the chance to give direct input into both administrations, into multiple congressional staffs, members of Congress themselves and US senators. And just like with the press, I wanted to make sure that what I said highlighted the importance of pathologists and the labs that we direct. We've never had nearly as much exposure as we've had, and I wanted to make sure that exposure was the best that it could be.

Patrick J. Godbey, MD, FCAP (12:49):

Having said that, that is tiring. But as my daughter used to say, "That's a good tired, because you had the opportunity to do good things."

Interviewer (13:04):

So the CAP as an organization is really quite complicated and comprised of many talented members and staff, all working in partnership to move the profession and organization forward. Given this, how does the complexity and culture of the CAP shape the advice you give to up-and-coming leaders? Dr. Volk, can we start with you for your thoughts on this?

Emily E. Volk, MD, FCAP (13:29):

Sure thing. The thing I would say to up-and-coming leaders about the CAP and a recommended approach to it is to be studious in understanding the complexity of the CAP and remain curious. And understand too that there are many ways to be a leader at the CAP far beyond just being on the board or being an officer of the college. I think the CAP is many things to many people. Depending on our roles and our daily work, we may be more interested in the CAP's advocacy arm and the CAP's efforts to make sure we are paid appropriately for the important work that we do. There may be others who are more focused on the important work that the accreditation mission of the college does and how that work to ensure that laboratory values are reliable and that labs are run with quality systems in place. That may be more important to a CAP member.

Emily E. Volk, MD, FCAP (14:34):

Pathologists may also be interested in the proficiency test work that we do in the Council on Scientific Affairs. Then there's the membership aspect of the college. In addition to the advocacy arm of the college, there is a whole Council on Membership and Professional Development, and it may be there that a pathologist may want to engage with the college. All of these different things serve different aspects of being a physician and being a pathologist. So before an up-and-coming leader decides how they want to engage with the college, I think understanding the depth and breadth of the college is a good first start.

Emily E. Volk, MD, FCAP (15:12):

The other place that folks can lead is in the House of Delegates, and this is an excellent place for folks to engage who are interested in leadership. Being a member of the state delegation is a leadership role. You don't have to be the leader of the delegation to be a leader in your state. The other thing is we can be critical of things that we don't understand. So before folks decide that they need to fix something at the college, I would ask that they try to learn a little bit more about why something is the way it is. Usually what I find is that if I can be a little bit more curious and a little bit more open to understanding, either a perceived problem will melt away, or I'll be able to contribute to a better solution to whatever it is that I'm thinking isn't working as well as it should.

Interviewer (16:04):

Dr. Godbey, how about you? What is your advice for future leaders of the CAP?

Patrick J. Godbey, MD, FCAP (16:10):

I agree with Dr. Volk. I think you should learn as much as you can and look at all the opportunities available to you, and there are many opportunities. The CAP is the number one pathology organization in the United States. It's the gold standard in accreditation. It's the best advocacy arm. It's also a very good education organization and presents education opportunities that can't be found many other places. The CAP, once you learn about it, will teach you to be a good spokesperson. They'll teach you to be a good lobbyist. They'll teach you to be a good breast pathologist. They'll teach you to be a good blood banker. So the opportunities here are tremendous. And when you are a leader, then you sharpen, better those opportunities and recognize new ones that will benefit all the members in the CAP. Tremendous opportunity.

Interviewer (17:14):

Finally, both of you are known for talking about how the CAP gives members the mechanism to really make a difference. Can you share some personal stories of your own? Dr. Godbey, if we can start with you on this.

Patrick J. Godbey, MD, FCAP (17:26):

Sure. I'd like to share a couple. There are many. I know many, many examples, but I would like to share too. First of all, the CAP gives you an opportunity to meet with people all across the country that you probably would not have an opportunity to meet and to learn from and to befriend. A good example, from my family's standpoint, is Dr. Volk. If not for the CAP, we would never have had the opportunity to meet Dr. Volk and her family, and that would have been a real loss on our part. Dr. Volk is a respected and trusted confidant of mine and I have appreciated her advice for many years. But that would not have been the case if not for the CAP.

Patrick J. Godbey, MD, FCAP (18:22):

Now I'm going to give you another example. 10 years ago, CMS came out with a draconian fee schedule. It cut some of our fees in our most common codes between 30 and 50% at one time in one year. Over 10,000 letters were sent to CMS in protest, but CMS did not relent. They didn't want to and indicated they were not going to change. So I called Senator Johnny Isakson's office and asked if their field office could send someone to our lab. A few days later, they did. I gave them a lab tour and then set them down and showed them, in our lab, what these cuts would do. And what it meant was we would have to close our lab. More than 200 people would lose their jobs, and the patients that we served, I had given him the number of the patients that we served in the previous year. The patients that we served would not have access to our vital services.

Patrick J. Godbey, MD, FCAP (19:39):

He left, and I thought, "I've done my part. I've gone to my elected representative, informed him." But three days later, I got a call from Senator Isakson's chief of staff. And he said, "If you will write a letter, we will take that letter, circulate it in the US Senate and get support to ask CMS to stop the cuts, but we have to have it within 24 hours." So I picked up the phone, called John Scott in the Washington office and said, "I've got this great opportunity, but I need help. I need your letter writing skills because this is going to go to the floor of the US Senate. Help me."

Patrick J. Godbey, MD, FCAP (20:27):

So with all the talent of the Washington office of the CAP, we put together a letter, had it in Senator Isakson's office in less than 24 hours. It was circulated, even though the Senate was in recess, and Senator Isakson secured 63 signatures from senators on both sides of the aisle. He then submitted that letter to CMS, and only after that letter was submitted did CMS take away those cuts. That's an example of what an individual member using the means and power of the CAP can do, and every pathologist in the country can still count those dollars. But without the CAP, I don't think anyone would have been able to do that. And I think that's a good example of what members can do with the CAP.

Interviewer (21:24):

Indeed. Thank you for sharing that. Dr. Volk, can we hear story or two from you?

Emily E. Volk, MD, FCAP (21:29):

Well, I'll take a little bit different approach than Dr. Godbey, just to keep it interesting, I guess, and just say that the CAP has offered me a number of opportunities to make a difference in ways that touch patients directly and in ways that helped physicians be appropriately paid for the work that they do. And the first one is the opportunities through the See, Test & Treat program. I was so blessed to be able to join Dr. Gene Herbek at one of the very early See, Test & Treat events at the Rosebud Indian Reservation in South Dakota.

Emily E. Volk, MD, FCAP (22:07):

And that three-day experience that I spent with Dr. Herbek and others working with the residents of that reservation, offering breast and cervical cancer screening, and an immediate turnaround of the results of the PAP tests and the mammography that we were able to do in partnership with radiologists, and being able to touch the lives of these mothers and sisters and grandmothers on this reservation was absolutely one of the most impactful experiences of my adult life. And I'll never forget it. That opportunity to participate in that kind of public service is just one of the many ways CAP has enriched my life.

Emily E. Volk, MD, FCAP (22:56):

The other thing I would say is, because of, again, the help of the Washington office and the really brilliant folks that understand policy, understand how we get paid, understand how to influence this behemoth federal government that we have, I've been able to lead efforts in the college to build a registry, a registry that helps pathologists get paid in the value-based programs that are a part of CMS. And to be able to work side-by-side with professionals in payment and policy and other member pathologists to create something that helps pathologists across the country get reimbursed appropriately for the hard work that they do was an incredibly rewarding experience.

Emily E. Volk, MD, FCAP (23:49):

Not only did I learn a lot, but it also enriched my day job, if you will. The expertise that I was able to gain through working on this project and understanding how you measure physician performance really opened the doors for me in my career to become a chief medical officer, and that's been a wonderful opportunity for me to bring the viewpoint of a pathologist into the C-suite of a health system. I couldn't have done any of that without the CAP.

Interviewer (24:23):

Any final thoughts you want to share before we close?

Patrick J. Godbey, MD, FCAP (24:25):

Thank you, Dr. Volk. I know you'll be a great president. Thank you.

Emily E. Volk, MD, FCAP (24:29):

Oh, well, thank you.

Interviewer (24:32):

Thank you, Dr. Volk and Dr. Godbey, for this great discussion. CAP members can download the 75th anniversary history book authored by past president Dr. Paul Bachner from the CAP website. Please visit cap.org, type in 75th anniversary into the search function at the top of the site to find the link to the book download page on the CAP's e-store. Thank you for listening to this CAPcast. To listen to our other episodes, find us on the My CAP app available for CAP members as well as SoundCloud, Apple Podcasts, Stitcher, Google Podcasts, Spotify, and Amazon Music. Just search for CAPcast from the College of American Pathologists on these apps. Once you find our podcast, be sure to click the subscribe button so you don't miss new CAPcast episodes.

Julie McDowell (00:03):

Welcome to the CAP CAPCAST series, celebrating our 75th anniversary. We're here with Dr. Paul Bachner and Paul Raslavicus serving back-to-back terms, Dr. Bachner was president from 1999 to 2001 and Dr. Raslavicus was president from 2001 to 2003. In this CAPCAST episode, Drs. Bachner and Raslavicus discuss seminal aspects of their presidencies, including navigating their leadership transition during 911 and the focus on bioterrorism following the terrorism attacks. Dr. Bachner will also discuss how the CAP's educational focus shifted under his leadership. And Dr. Raslavicus will discuss why he's so passionate about advocacy. And both will offer advice to not only incoming and future CAP leaders, but also pathologists who are early in their careers.

Julie McDowell (00:55):

So to begin with, there was a lot going on during both of your presidencies, Dr. Bachner SNOMED the most comprehensive clinical terminology was created by the CAP and is now used throughout the world, but it has undergone many transformations since your presidency. Can you tell us a little bit about these changes?

Paul Bachner, MD, FCAP (01:16):

Yes, I certainly can. SNOMED is really one of the crowning achievements of the CAP and it was created many, many years before my presidency. And actually the first version of it was actually called SNOP S-N-0-P the Systematized Nomenclature of Pathology. And it was only later that other arms, if you will, of the vocabulary were added and it became SNOMED, the Systematized Nomenclature of Medicine. For many years, SNOMED med was maintained exclusively by the CAP and developed and grew. And very early on in the course of my presidency, as a matter of fact, I think it was within a week, I traveled to London to meet with representatives of the National Health Service who had a somewhat similar program called the Reid Codes, a name for Dr. Reid, R-E-I-D.

Paul Bachner, MD, FCAP (02:16):

They were basically for private practice, primary care physicians. As a result of the at meeting, the two codes were merged and the SNOMED then became SNOMED CT or SNOMED clinical terms. And that was sort of a very major achievement. And then subsequently there were negotiations with the National Library of Medicine, which I was a member of the committee, but I think by that time, Dr. Raslavicus was president then. He oversaw that merger process so I'll let him talk about that.

Paul Raslavicus, MD, FCAP (02:59):

Well, yes. I sort of came in at the end of the creation of SNOMED CT and actually signed for the college to provide at the National Library of Medicine, the right to distribute the nomenclature at no cost to any user in the United States. It was really so a finale in the growth from SNOP, Nomenclature of Pathology to a full terminology for clinical medicine. The addition of the Brits into the formula in which Dr. Bachner was very important really since then has moved it into a totally international or a worldwide accepted nomenclature run by an organization that has a slightly complex name, I think say International Health Terminologies Standards Organization, or something similar, but they've gone back to using SNOMED for marketing purposes, SNOMED CP. It's developed throughout the English-speaking world as well as many other countries.

Julie McDowell (04:08):

So Dr. Bachner another change that started during your presidency was the transformation of education from an ancillary program to a freestanding one. Can you talk a little bit about how that happened?

Paul Bachner, MD, FCAP (04:22):

Yes. It was a slow evolutionary process, but with some pride. I can say that it started during my presidency and then was continued by Dr. Raslavicus and even subsequent presidents. The college has always had a mission education in addition to laboratory excellence and advocacy for the members. But for many years our education was really sort of a handmade to the surveys and accreditation programs, the national meetings, which were joined with the ASCP the educational content was driven more by the ASCP than by the CAP.

Paul Bachner, MD, FCAP (05:09):

During my presidency and during Dr. Raslavicus' presidency, the two organizations decided to go their separate ways in terms of the national meeting. And the ASCP has a very successful national meeting now, as does the CAP. But parallel to that process, the CAP devoted major, the board agreed to put major resources into education and made education into a freestanding program that was designed to meet the needs of the members in an environment where the science of laboratory medicine was rapidly expanding and becoming more complex with the advent of molecular and genetic pathology.

Paul Bachner, MD, FCAP (05:57):

So it was a sea change for the CAP. Ultimately a council, a freestanding council on education was created, a staff with very specific and high level training in program development and education was developed. And now the CAP has, I think it's fair to say, in addition to laboratory excellence and advocacy, education of our members has become a major program. During the COVID epidemic, a whole group of online programs were developed to help pathologists and other laboratory professionals deal with the very complex issues of testing for COVID. So when I look back on my presidency, if there's anything, I sort of take pride in it, it's the start of the process of education as a primary, which then was followed up by Paul and by other presidents.

Julie McDowell (07:00):

Dr. Raslavicus, can you talk a little bit about what changes occurred during your presidency related to education offerings from the CAP?

Paul Raslavicus, MD, FCAP (07:07):

Well, certainly the national meeting, the joint national meeting had seen a decrease in attendance that last a number of years, where in a short period time, there was almost lost 50% of the attendance at that meeting. And there was a joint group between the CAP and ASCP. I think during Paul Bachner's time that met to discuss the issue of the national meeting, as it evolved the two organization meant quote, "Truly joint meetings for a couple of years." And they were not satisfactory, I believe to either group. And so they went their different ways. One of the consultants at that time spoke about the two organizations, one being more introverted, and the other one being more extroverted, and that was presenting some conflict in how the programming was being made. So the college went off to develop a very broad individual involvement in their programming.

Paul Raslavicus, MD, FCAP (08:10):

They evolved into larger and specific topic oriented presentations for a period of time at least, I don't know if it's continues. It actually would present some of these programs and with other apology organizations such as USCAP and they were well attended. The other thing that happened as a consequence of the change in education was really the redevelopment and reactivation of the colleges residents forum into an active organization, which had its own fairly long meetings. It had its own powers. And in fact, developed voting powers within the board because the board was very interested in allowing the people that were receiving the education have a word to say in what kind of education and was made and how it was presented. So I think you see at this point in time, a couple decades of evolution of education within the CAP and it is dramatically different than it was at that period in time. It also opened up much better attendance in the exhibit halls. And I believe really invigorating the membership because they're really part of what's going on to a very great extent.

Julie McDowell (09:35):

I want to shift from education right now to talk a little bit about a historic event that occurred during your presidency, Dr. Raslavicus, you began your presidency during the 911 bioterrorism attacks. Can you talk a little bit about what that was like and how you navigated and led the CAP during this time?

Paul Raslavicus, MD, FCAP (09:57):

Well, actually, the person was there in the driver's seat during the attack in September 11th was my predecessor, the other Paul. And maybe he could tell first what happened, if anything special in the first 30 days or so.

Paul Bachner, MD, FCAP (10:15):

Yeah. 911 took place during the last month of my presidency and obviously it's many, many years back now. But if you start to remember, there was great deal of confusion when it happened. No one knew whether there would be other attacks. There was a great deal of concern about air travel and safety of air travel. So one of the things that happened during my presidency with the support of the board was we put a halt to all air travel by members and held no meetings. This was of course presumed. So there was really no way to hold meetings other than by telephone conference call but the college essentially stopped meeting for a month because we just felt that it was necessary for the safety and the sort of confidence level for our members.

Paul Bachner, MD, FCAP (11:08):

There were a number of other things that the college did to support our members, but that really was just one. The last month of my presidency and what happened after that Dr. Raslavicus can talk about.

Paul Raslavicus, MD, FCAP (11:22):

Well, as it happened, my inauguration was not that far from New York City, in fact, it was in Philadelphia. And my inauguration speech was extremely focused on what happened in New York and really had a lot of patriotic thoughts were brought into it such as, "From many separate states we're now a United States and we will not tolerate this kind of aggression, et cetera." And it starts with these thoughts and it actually finishes with God bless America kind of thought reciting one of the famous American patriotic poems. And the meeting was well attended. I think it was the first meeting after a month long break. But after that, and very shortly thereafter bioterrorism became the name of the game because of the anthrax attacks, which occurred, I think in October and perhaps early November.

Paul Raslavicus, MD, FCAP (12:20):

Those led to a number of meetings of the college with the secretary of health and human services, Tommy Thompson, previous governor of Wisconsin, to discuss this. This further led into a number of publications and messages from the CDC to the National Clinical Laboratories about how to be prepared for a bioterrorist attack and how to identify organisms such as anthrax in a clinical lab. So there was a focus for significant time, perhaps a year or two before. So the pressure went off of that and we went on to talk about other things.

Julie McDowell (13:01):

Dr. Bachner, you've got two specific pieces of advice for incoming CAP presidents. What is that?

Paul Bachner, MD, FCAP (13:09):

Actually, I have three. The first is to listen far more than you talk. That's not a novel concept in the management theory, but I can tell you that during my presidency, I tried and I learned to listen carefully because the knowledge base that exists in the college from its members and the committees and the councils is mind boggling and is unmatched anywhere, I think in the world of medicine or science. So my first piece of advice is keep your ears open and your mouth shut as much as possible. My second piece of advice is that college is a very, the very complex organization and is blessed with having a very capable staff. And so, my second piece of advice is work closely with staff. And my final piece of advice is the skip dessert, because it makes the process of all the meetings that you attend easier. One, it means you get to go to bed an hour earlier, and you don't gain any more weight than you need.

Julie McDowell (14:26):

How about you Dr. Raslavicus, what advice do you have for incoming CAP presidents?

Paul Raslavicus, MD, FCAP (14:32):

Well, I sort of second what Dr Bachner has said. And I think that I certainly knew that I was not an executive person, but I was the leader of the board and it was the board that was making the decisions and I represented their opinion as well as mine, so that it is by far and not just a particular presidency, but it is not an executive position such as the US president has. The board is filled with very competent and confident people with strong opinions. And sometimes it is not possible to determine which way things are going to go at the end of the day for one individual. So you moderate the system, but you do not really control it.

Paul Raslavicus, MD, FCAP (15:21):

For example, my experience was that every incoming president presents a strategic plan for the future. And when it comes in one way, it might come out quite different when it is vetted by the individuals that comment on it and promote it. One of the issues at that time was how much international involvement should the college have? Or should it just focus its work on the US pathologists, which we represent. It is true that we had a number of things that we were doing international. We were actually inspecting over a hundred laboratories around the world, under our inspection program at that time. We had major role in an organization that in fact, the college helped establish at the end of World War II called the World Associetion of Societies of Pathology and Laboratory Medicine.

Paul Raslavicus, MD, FCAP (16:15):

And we were their laboratory quality bureau. And there were some people who wanted to have more involvement internationally. And in fact, at one point we voted to add presenting pathologists in the US end of the world however, our title goes. Thereafter, it got removed for a few years and I think it's well back again that we are involved in world pathology. So that's a little, very brief summary of what was going on during mine.

Julie McDowell (16:44):

Dr. Bachner talked a little bit about how his advice would be to listen more than talk, but I know both of you maintain a mindset that change is inevitable. Can you talk a little bit about how this approach has served you in your life in leadership? Dr. Beckner, can we start with you?

Paul Bachner, MD, FCAP (17:03):

Well, yes, the change that has taken place in pathology and medicine in my period of practice is now essentially retired. Although I still do some teaching, but it's almost 50 years. The change is incredible. When I teach my residents laboratory medicine, I sort of share with them how thyroid disease was diagnosed 50 years ago. And they don't even know what I'm talking about. It's a language that's totally unknown to them. And then when I tell my residents that when I finished my training, there were three lymphomas. They stare at me as if I'm from the dark ages, because now the last time I looked there was something like 22 lymphomas. So change has been enormous and continues. And the change not only is in the science, but in the practice of pathology. I've seen changes in the last 10 years in how pathologists practice, the size of the groups, the nature of the groups, the relationship of the groups, the shift of pathology practice in part from a private basis to a hospital-owned practice.

Paul Bachner, MD, FCAP (18:23):

So the great deal has happened. And one of the things I learned during my presidency was that it was all well and good to make plans and have the strategic plans, but things happen. It's like the famous saying of some crush in general, that it's all very well to have a plan of battle, but it goes away as soon as the first bullet is planned. And I found during my presidency, that things just changed and things would come up and one would just have to sort of deal with it as best one could and gather as much advice as you could and deal with it. But change was with us then, is with us now and will be with us in the future.

Julie McDowell (19:10):

Dr. Raslavicus, what's your thoughts on this in terms of change being inevitable?

Paul Raslavicus, MD, FCAP (19:16):

It is really true when you look at Dr. Bachner talks about how things were through the 40 years ago. A hundred years ago, we were barely looking through the microscope and there was absolutely nothing more to look at than red blue colored artifacts. And it was during our active involvement that molecular pathology came into being, nuclear medicine now known as computed tomography came in and some of us in pathology because the radiologists did only x-rays. So some of us in pathology actually were certified in nuclear medicine and did things such as lung scans and brain scans. Some of us were able to maintain our interests. Otherwise some people just faded out of that particular zone. Now we're trying to come back into finding our aspiration.

Paul Raslavicus, MD, FCAP (20:09):

I remember on my first job in pathology, I was walking around and doing bone marrow biopsies on patients in beds until the surgeon said, "Wait a minute, you don't have any surgical privileges." So you have to ride with a change. And the college and its membership are the ones that are going to determine the future of our specialty and which areas we are proficient and interested and learn. And in which areas we give up. So change is inevitable but the purpose of, I think our organization is, and has been to reconfigure the future to the best interests of the people that we represent and who are the legacy for the future.

Julie McDowell (20:54):

So finally, I'd like to hear from both of you about how the CAP helped you to grow and develop as both a pathologist and a leader. And if you can tell us a little bit about some of the experiences that made you a, a better pathologist. Dr. Raslavicus, can we start with you?

Paul Raslavicus, MD, FCAP (21:10):

When I arrived on the scene, I was an officer junior medical officer in the Navy. We met downtown on the state street in Chicago at that time was a famous hotel and people were concerned even then about well known pathologists at that time, he had something called a [Scionero 00:21:29] hypothesis, and that is if we don't change and we don't broaden our aspects, we are noners. So that struck a sort of an interesting thought in my mind, because other people like a pathologist physician by the name of Wei-Shen Chen, were very interested in promoting advocacy. And I wound up heading in that direction more than I did rather than in the direction of teaching pathologists. And therefore I became very active in the affairs of the Washington office. And as well as with the AMA representing the college in the AMA and from there was the time where Medicare was changing, the way they were paying all physicians, not just pathologists.

Paul Raslavicus, MD, FCAP (22:18):

And the first attempt by the government was to declare all of pathology as a non-professional field. So first we had to defend anatomic pathology. And then second, we had to depend as much as we could off clinical pathologists doing physician services. That sort of led me into become the representative for organized pathology in the creation of the scale reimbursement for services. And we had a specific fight about what's a pathologist service? Is that everything that the surgeon does at that time? Or is that a service for the entire hospitalization of a patient and through my efforts and the leadership of one or two presidents that existed at that time, we wound up being able to define a service in pathology as being the specimen. So if there was four or five specimens and one procedure, in fact, there were four items of service.

Paul Raslavicus, MD, FCAP (23:18):

The levels of service were integrated throughout all of medicine to one bucket so that I don't want to call it. It was a privilege it, a bit of a problem to present the entire specialty as a solo person and defend the proposed relative value given to our procedure a, to somebody's post-op of examination of a patient that got surgery two months ago. And I got quite involved in that. I think Paul can verify that. And through that, I became more and more involved in administrative affairs. In fact, in practice, I advocated for pathologists, be more involved with their laboratories. Here in the Boston area, we created one or two pathologists summoned free standing, labs lasted almost up to this time as a division of Mayo Clinic.

Paul Raslavicus, MD, FCAP (24:16):

And from that, I wound up getting a master in health administration degree in mid-career. I'm glad to see that the incoming and president Emily also has an MBA degree, because that way I could defend our position better with all those people who are administrators, who many of us think are the issue that we have to very closely monitor.

Julie McDowell (24:41):

Well, thank you. And Dr. Bachner, can you talk a little bit about how the CAP impacted your development as a pathologist?

Paul Bachner, MD, FCAP (24:51):

Yes, I certainly can. Before I do so I just really want to emphasize the seminal role that Dr. Raslavicus has played in the development of the RBS system. Every pathologist today that practice owes him a huge vote of things. So, in terms of your question, I think most people know that I've been at the University of Kentucky for the last 20 years, but prior to that, I was a New Yorker gone to medical school, or my residency in New York, and practiced for many years in the New York area. And like most New Yorkers, I had a very New York-centric view of the world. And what the college did was tremendously broadened my outlook on life and on pathology.

Paul Bachner, MD, FCAP (25:38):

I quickly learned that people who didn't have a New York accent could be very smart and very clever. And I know, and as you know, I've just had the honor of editing the 75th anniversary history of the CAP, which gave me an opportunity to look back on some of the giants that I had the privilege of contacting, and without trying to be exhaustive, couple of names come to mind, Howard Ronsley, Sinha, who just had a seminal role in getting me to think in different ways and recognizing different approaches to problems.

Paul Bachner, MD, FCAP (26:22):

I've had the privilege of serving as lab director in many places and being chairman an academic department, and all of the things that I learned in the college from committee members and colleagues and people that I had contact with and staff as well, really broadened my horizons from a very parochial worker to one who I think has a more broad view of the CAP.

Julie McDowell (26:54):

Well, thank you both very much for speaking today. Is there any final thoughts that you want to share before we close out? Dr. Bachner anything you want to share?

Paul Bachner, MD, FCAP (27:04):

Well, I would share something with the younger pathologists and the residents perhaps, who are listening to this podcast. And that is for 50 years, I have been hearing comments about the demise of pathology, and guess what it has never come true. Pathology continues to be a vibrant and exciting practice, and they should not be deterred by the naysayers that they hear.

Julie McDowell (27:35):

How about you, Dr. Raslavicus any advice for younger pathologists?

Paul Raslavicus, MD, FCAP (27:40):

Yes. I think I would definitely say to all of you, who might be listening, that it is critical that you join into the organization, become an active member if you're not already are, give your talents to those who come after you, because just like you are our legacy to the present. Those who are coming behind you will be your legacy. And when you finally close your practice, like I think we have both by now. You don't want to just wind up saying, well, I was there, but I didn't do anything. You are the future of our specialty to a great extent the health of the people that need medical attention. It's very important that you participate and don't just to say, "Well, I was there, but I was too busy.

Julie McDowell (28:30):

Thank you, Dr. Bachner and Dr. Raslavicus for this great discussion. CAP members can download the 75th Anniversary history book, authored bypass President Dr. Paul Bachner on the CAP's website. Please visit cap.org and type in 75th anniversary into the search function at the top of the site to find the link to the book download page, which is featured on the CAP's e-store. Thank you for listening to this CAPcasts. To listen to our other episodes, find us under my CAPAPP available for CAP members as well as SoundCloud, Apple Podcasts, Stitcher, Google Podcasts, Spotify, and Amazon Music. Just search for CAPcasts from the College of American Pathologists on these apps. Once you find our podcast, be sure to click the subscribe button so you don't miss CAPcasts episodes.