Forging Paths a Decade On

At The Pathologist, we take great pride in showcasing accomplished individuals and their discoveries. Over the past decade, we’ve taken various routes to showcase the evolution of the field and the pathologists that frequent our magazine. In celebration of our 10th anniversary, we’ve been looking back to 2014 in order to look ahead to the next 10 years and beyond!

In doing so, we connected with honorees of ASCP’s 40 Under Forty program of 2014 to see where they came from and what the future holds, both on an individual level and for the field as a whole.

What was the catalyst that brought you into the pathology field?
 

Christina Nickel: I graduated from community college in 1996 with an Associate of Arts in Biology and was working in a community hospital/nursing home/home health agency when a medical technologist told me about the field. Within a month of speaking with her, I was enrolled in a CLS program in Denver, Colorado and graduated with a Bachelor of Arts (yes, Arts) in Medical Technology from the University of Northern Colorado in 2000.

Sean Tucker: I had a great microbiology undergraduate professor who invited the MLS School program director to come in for a presentation. I changed my major the next week.

Marisa James: I took a microbiology course in high school, which I understand is quite rare. Not only did we make wine and cheese in high school, but we also had an assignment to research careers involving microbiology. Naturally, medical technology emerged as a potential path that intrigued me. My mother arranged shadowing opportunities in a small office laboratory and a hospital laboratory in Kearney, Nebraska, where I grew up. As a freshman, I was one of the few students who declared medical technology as their major and graduated with that degree, never changing my major.

I began working as a medical technologist and became the school’s program director three years later. I served in the educator role for over 17 years, taking great pride in guiding and mentoring students. In that span, our program provided Kansas City and the surrounding region with over 100 medical laboratory scientist graduates, some of whom have been recognized as ASCP 40 Under Forty recipients.

How has your path in pathology changed since being nominated for the ASCP’s 40 Under Forty program?
 

CN: The 40 Under Forty award was somewhat of a catalyst for my career advancement – I was recognized as an active professional and that resulted in connections with invaluable resources and new experiences. Volunteering and activism in specialty roles came from several experiences – including task force and council connections, and meeting with presidents of the Great Plains Chapter and CLMA. These opportunities also lead to awards I gratefully received at the chapter level and national level for CLMA and ASCP for volunteerism, management, and leadership.

Additionally, I’ve been invited to participate in work funded by a grant from the CDC for ASCP to support the OneLab initiative – helping create the ASCP Negotiation and Advocacy Toolbox. This work has allowed us to share our daily tools, present at major events like the Annual Meeting and KnowledgeLab, and hold "Office Hours" to help other lab leaders learn how to use these tools.

I also obtained my Certified Professional in Healthcare Quality (CPHQ) in 2016. Although it’s typically focused on Organizational Quality and Nursing, getting my CPHQ and encouraging our Lab Quality Manager to do the same has highlighted the quality focus of laboratory professionals to other groups.

ST: After the 40 Under Forty nomination, I was able to move into new leadership roles at my institution. This led me back into academic medicine and helped support my journey of becoming a laboratory director.

MJ: First, attending the ASCP annual meeting was an incredible experience. Receiving such an esteemed award in its inaugural year was truly special. It was my first ASCP annual meeting and I still keep in touch with the new friends I made in Tampa Bay.  

Winning the 40 Under Forty award was a turning point in my career. It jump-started my involvement in ASCP volunteering, which led to my nomination to the NAACLS Board of Directors as an ASCP representative. I volunteered with both ASCP and NAACLS for several years during a time in my career when I was eager to make a greater impact beyond the students in our MLS Program. This desire for broader influence led me to apply for the chief executive officer position at NAACLS – a role I have now held for the past two years.

Dana Altenburger: My day to day life hasn't changed much. I have the same job I did at the time and continue to work on blood and lab utilization. Currently, I remain an ASCP volunteer on multiple committees and joined the BOC BOG several years ago.

What do you believe is the most important development in pathology in the past decade?
 

ST: I do believe the most important development was how quickly investment in molecular testing changed with the pandemic. The funding that became available for R&D and capital equipment purchases helped accelerate molecular testing applications for large and small departments.

CN: Similar to Sean’s point, automation and molecular testing is rapidly evolving. I anticipate seeing more of this and a push for better reimbursement for molecular testing.

DA: Though not really an important development, I’ve transitioned to dictation software and it's both my friend and enemy.

MJ: In laboratory science education, one significant advancement is the development of simulation labs – alleviating the burden on clinical facilities to provide training locations for their students. Given the massive laboratory workforce shortage, our programs must innovate to increase the number of students who can complete them.

What challenges have appeared in pathology over the past decade, and what might the solutions be?
 

MJ: The laboratory workforce shortage is a critical challenge, requiring concerted efforts from laboratory leaders to strategize and address the issues. I am proud of the collaborative efforts among executives from various laboratory professional organizations, which create a unified approach to tackling the workforce shortage. Meeting with other executives has been a highlight of my first two years as CEO, and I plan to continue fostering these strong partnerships for years to come.

ST: Following on from Marisa’s point, I believe staffing will continue to be the biggest challenge in the next 10 years. It will take us as professionals to go out and help recruit young people into the field. I’d urge readers to consider becoming an ASCP Ambassador to push this initiative.

DA: Yes, I think most professionals in our field would agree that the workforce is a major issue. I know there is an ASCP task force working on this and I will leave it to them.

CN: Reimbursement for necessary (and better) testing for patients.

Looking ahead: what do you predict or hope will happen in the next 10 – 20 years in the field?
 

MJ: I hope we’ll see greater involvement of laboratory professionals with other healthcare experts. Specifically, I envision laboratorians and pathologists as integral members of interdisciplinary teams within hospital environments.

Additionally, I would like to see laboratory professionals interact with patients and nurses more frequently in person, moving beyond faceless voices on the phone. There is immense value in developing interprofessional relationships with other departments to truly showcase the brilliant minds working behind the scenes in the laboratory. Laboratory professionals possess a wealth of knowledge crucial for patient care, and we need to promote our expertise more effectively. Everyone on the healthcare team should understand our importance and how our involvement can enhance the patient experience. To achieve this, we must confidently step out of the lab and engage directly with our healthcare colleagues and patients.

DA: Similarly to Marisa (and though it can be scary to think about!), I like the idea of pathologist consultations with patients and hope this would become a national initiative. I’d be happy to participate myself at my local cancer center.

CN: We’ll certainly see more automation and AI in the lab. Clinical pathology lab reports need to be easier to understand as patients become consumers of our product. Not only is it unrealistic to expect clinicians to keep up to date on all lab tests, but it is also unrealistic for the layperson to fully understand what they mean. Reports must become user friendly and provide detailed information, including recommendations for additional follow up or reflex testing. I also expect to see more bloodless test monitors like those used for diabetes today – both wearable and cell phone testing. It is likely that we will not need tests in the traditional sense. Instead, we'll have devices in our homes that give us this information and automatically set up treatments and appointments when needed.       

ST: I agree with Christina – continued growth in automation will be crucial in managing staffing challenges. AI will hopefully help us better understand changes in patient diagnostics to improve service outcomes. The continued efforts in microfluidics testing at the bedside to monitor ICU patients should help decrease mortality. 

What does the next decade look like for you?
 

CN: Expansion of reference laboratory services and expanding Direct Access Testing services in Nebraska. We work with our providers to create our list of appropriate tests which has created a better route for patients with no insurance, or insurance with high deductibles, to obtain the testing they need.

MJ: In the coming decade, my goal is to ensure all laboratory science educational programs achieve NAACLS accreditation. This accreditation assures the public that laboratory professionals are well-educated and qualified. I recognize that achieving accreditation can be challenging, but our team is committed to partnering with programs to offer personalized support. This approach helps programs meet their accreditation goals, deliver high-quality education, and earn the NAACLS seal of approval.

ST: My focus will be on expanding outpatient laboratory testing to improve financial performance for laboratories. We need to make sure that laboratories are profitable and deserve investment.