How did you find your way to pathology?
Toward the end of my medical studies, my MD thesis had sparked a real interest in research, and I felt strongly drawn toward an academic path. Recognizing that I had some talent for visual analysis, I initially considered radiology, as it seemed to have a very immediate clinical impact.
But before fully committing to clinical practice, I decided to spend some time in pathology to build a stronger foundation in anatomy and anatomic pathology. That decision proved to be pivotal. I was fortunate to join an excellent pathology department at my university in Mainz. Within just three months, I knew I had found my field. I appreciated the versatility of pathology: its close connections with so many clinical disciplines and its unique position as a bridge between theoretical and clinical medicine.
Pathology also offered great opportunities for research, and I was lucky to secure a two-year fellowship at the Albert Einstein College of Medicine in New York. That experience was both affirming and successful, and when I returned to Germany I had exciting opportunities waiting. From then on, I was fully committed to pursuing an academic career in pathology – and I’ve never looked back or regretted my choice.
How would you describe your contribution to the field of molecular diagnostics?
When I returned to Germany after my fellowship in the United States, molecular pathology was just being introduced as a new subspecialty in pathology. Building on my translational research experience in the US, I became the first pathologist in Germany to receive certification in this emerging field. This early recognition allowed me to bridge clinical diagnostics with research, which was a major turning point in my career.
Looking back, I’m particularly proud of what we – specifically crediting our head of molecular pathology, Albrecht Stenzinger, and his team – have built up in Heidelberg in the field of molecular diagnostics. Together, we’ve established what I believe is one of Europe’s top molecular diagnostics centers – internationally competitive in scope, diagnostic quality, and research performance.
Another major achievement has been the implementation of the Centers for Personalized Medicine, both in Heidelberg and across Germany. This is the first consortium of its kind worldwide: a nationally coordinated, fully healthcare integrated and financed network offering high-end molecular diagnostics and tumor boards across all centers. With this structure, we can provide advanced diagnostics and treatment options even for patients outside the current clinical guidelines.
In my own specific area of expertise – liver and biliary cancers – we’ve developed and implemented specialized molecular assays that have further advanced understanding and treatment of these devastating cancers.
It’s important to emphasize that molecular diagnostics is not just about applying existing assays. You have to develop new tests, ensure quality assurance, and integrate these tools into clinical trials. Without connecting all these elements, you cannot complete a full innovation chain.
You’ve held leadership positions in many national and international pathology societies over the years. Why is it important to you to be able to speak for the pathology community?
In terms of numbers, pathology is a relatively small specialty compared with other medical disciplines like internal medicine, surgery, or radiology. But in terms of scope, we are extremely broad, interacting with nearly every branch of medicine. This broad interface makes our work both highly interdisciplinary and demanding.
However, pathology tends to remain in the background. We are not perceived in the same way as more visible, patient-facing specialties, where the value and relevance is immediately apparent to patients and stakeholders alike.
Despite this, pathology is one of the most innovative fields in medicine. We are uniquely positioned to move discoveries rapidly from research into clinical application. For example, the development of a new drug may take more than a decade before it reaches patients. In contrast, in pathology, if we develop and validate a new assay, we can begin using it in diagnostics within just a few weeks.
The range of expertise we must master is enormous, and the demand for interdisciplinary collaboration continues to grow. We are expected to contribute to clinical guidelines, to participate in clinical trials, to be active in political discussions and decisions that affect healthcare. But we do this with a very limited workforce and a heavy workload. As a result, only a few pathology institutions – and only a few pathologists – have the capacity, expertise, and resources to represent the field at the national and international levels.
I’m fortunate that in Heidelberg we have one of the largest and most visible pathology departments in Europe, with around 400 staff members. This provides resources, background, and expertise that many colleagues don’t have – but it also comes with a responsibility. If I – and the handful of others in similar positions – don’t speak up for pathology, no one else will.
It's not enough to stay in your office. You have to take responsibility, advocate for your field, and fight for its recognition and advancement – not just for your own institution, but for the entire pathology community.~
What have you learned about leadership through holding these offices?
Every leadership role is different – that’s what makes it so interesting. It’s one thing to lead a large, broad, multifaceted society like the European Society of Pathology (ESP), and quite another to lead a small, highly focused, expert group, such as a society dedicated to liver pathology. There’s no single blueprint for leadership across these contexts.
There are a few core principles that hold true regardless of the setting. First, you need a clear direction. You must have well-defined goals, and know how you want to achieve them. Just as importantly, you must communicate those goals clearly to the people you're working with, so they may share and support your vision.
Second, you need a strong team. No leader can, or should, do everything alone. Having the right people around you – people you trust and who support the mission – is absolutely essential. Without that, you're likely to fail.
And third, you need to be personally committed and emotionally invested in the work. If you don’t care deeply or lack the necessary insight, you’re in the wrong position.
What are the other key learnings from your career?
One of the most rewarding things about a career in pathology is that you never stop learning. If you look behind me, you’ll see a huge bookshelf. It’s not there for decoration – it’s there because we constantly need to learn and search for new answers. Diagnostic work requires creativity and persistence. You’re always solving problems, navigating complexity, and refining your approach. That’s part of what keeps the work so stimulating.
What I especially value is that pathology is not dependent on any single success. Instead, you work across many areas – diagnostics, research, teaching, leadership, grant writing – and it is this variety that brings both good and difficult days. But it also brings resilience and perspective; when one part of your work is challenging, another may be thriving.
Over time, you gain deep insights – not just into science and medicine, but into people as well. You learn from colleagues, from patients’ stories, from setbacks, and from successes. It’s not about one defining lesson – it’s an ongoing journey of discovery.
What are the biggest challenges currently facing pathology, in your opinion?
Pathology now spans a vast range of domains, from traditional histology to high-end molecular diagnostics, digital and computational pathology, and high-resolution tissue-based imaging technologies. The breadth of expertise required to cover all these areas is greater than in most other medical specialties.
More than 20 years ago, we began integrating professionals from other disciplines into our pathology departments to address these emerging challenges – molecular diagnosticians, bioinformaticians, biobankers, and other specialized professionals. We have to develop ways not only to formally integrate them into the pathology framework, but to ensure they feel valued within our field, and provide them with high-level education and career perspectives in pathology.
A second major issue is the shrinking workforce. In many countries, the number of trained pathology diagnosticians and technicians is declining, while the demands placed on the discipline continue to grow. Meeting this rising need with fewer skilled professionals is extremely difficult. We strongly believe pathology is an attractive field – but we need to show that to the next generation and attract the most talented. Without this outreach, we won’t have the personnel – or the quality of personnel – we need to move forward.
The third challenge is structural: academic pathology is losing ground. Coupled with funding cuts and headcount reductions, some of our younger professionals are increasingly focused on the so-called work-life balance – a terrible misnomer – preferring predictable hours and routine diagnostic work. But academic pathology requires dedication, perseverance, curiosity, and stamina. Attracting and supporting people with that mindset is a growing challenge – and one we cannot ignore.
Finally, there’s the issue of visibility and representation. Pathologists lack visibility not only in public and political arenas, and sometimes among our clinical colleagues, but also within funding bodies. Yet visibility translates into influence – and into funding. If we remain unseen, we risk being underfunded and underrepresented at critical decision-making tables.
What advice would you give to an early-career pathologist who wants to pursue an academic career?
First, you need a clear sense of purpose. That motivation is essential in order to help build a tolerance for frustration. Not every grant will be funded, not every project will succeed. In fact, in many areas of science, failure is the norm. As Samuel Beckett once said: “Try again. Fail again. Fail better.” That persistence only comes with real interest and internal drive.
Second, surround yourself with people you can learn from. Choose mentors and peers carefully – those who are strong in research, diagnostics, leadership, or administration. Watch them closely. You don’t have to idolize them, but you can learn a great deal from their strengths – and from their shortcomings. Identify what works well, and also what you’d do differently. From that, you’ll begin to develop your own leadership style and academic path.
Third, you need the right environment. Your success will be limited if your institution cannot offer the necessary resources or opportunities. To pursue an academic career – especially one that includes leadership – you need to be in a place that supports your ambitions. Some institutions can still support the full breadth of pathology – from advanced diagnostics to translational research to emerging technologies – but they are rare, perhaps only 10% of academic centers worldwide
This doesn’t mean you must only aim for the largest or most prestigious institutions. A good leader can elevate a smaller or under-resourced institution. If you’re at a smaller institution, the key is focus. You may not be able to cover the entire spectrum, but you can still do internationally competitive work if you concentrate on a specific disease area or technology. Choose your environment based on where you can learn the most – whether that’s a center of excellence in liver pathology, or a department leading in digital pathology, or an institution pioneering new molecular techniques.
Ultimately, if your goal is to become a top academic pathologist, you’ll need a strong foundation: some talent, internal motivation, excellent mentors, and the right institutional support. With those in place, there are many different paths to success.
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