CAP at 75 - Leading Medicine During a Pandemic

• CAP Historical Timeline

Julie McDowell:

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?

Dr. Patrick Godbey:

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 pathologist and the medical laboratory scientists that we work with to unnecessary COVID-19 danger. We secured the ability to submit BIPS 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 register. 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. 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.

Julie McDowell:

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

Dr. Emily Volk:

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 the 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 that therapies are based. So to be the incoming president of this society is a tremendous honor, and it is a huge responsibility, which I do not take lightly. I will say that being a partner of Dr. Godbey as president-elect while he has been president, has been absolutely a 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.

Julie McDowell:

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

Dr. Emily Volk:

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. 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 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. 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.

Julie McDowell:

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?

Dr. Patrick Godbey:

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.

Julie McDowell:

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?

Dr. Patrick Godbey:

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 pathology and any other president has been able to do to date. COVID-19 gave us this opportunity and we took advantage of it.

Over the past two years, I've done many, many, as has Dr. Volk, as has several other of our members, interviews with the press, appeared on MSNBC, that 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 recognized that. A few years ago, I was on an airplane and the call came out as, 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. 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 in 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, 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've had the chance to give direct input into both administrations and to 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 in 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. 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.

Julie McDowell:

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?

Dr. Emily Volk:

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 and 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. 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. 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.

Julie McDowell:

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

Dr. Patrick Godbey:

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, what 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.

Julie McDowell:

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?

Dr. Patrick Godbey:

Sure. I'd like to share a couple. There are many, I know many, many examples, but I would like to share two. 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 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. 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 sat 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.

He left, and I thought, I've done my part. I've gone to my elected representative, informed them, but three days later, I got a call from Senator Isakson's chief of staff, and he said, if you'll 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.

So with all the talent, 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've been able to do that, and I think that's a good example of what members can do with the CAP.

Julie McDowell:

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

Dr. Emily Volk:

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. Jean Herbeck at one of the very early See, Test & Treat events at the Rosebud Indian Reservation in South Dakota. And that three-day experience that I spent with Dr. Herbeck and others, working with the residents of that reservation offering breast and cervical cancer screening, and an immediate turnaround of the results of the PET 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. 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 of 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 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.

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.

Julie McDowell:

Any final thoughts you want to share before we close?

Dr. Patrick Godbey:

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

Dr. Emily Volk:

Oh, well, thank you.

Julie McDowell:

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 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.

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