International Impact: an Interview with Larry Wang

What led you to a career in pathology?
When I graduated from medical school, my dream was to become an internist – but the school assigned me to pathology. I was not happy at all. On my first day of work, the chair of pathology told me about being “the doctors’ doctor” and recommended I read Arthur Hailey’s The Final Diagnosis. I quickly realized that pathology included broad medical knowledge and incorporated a wide range of bioscience research fields and medical practices – and I came to love it.

What intrigued you about pediatric pathology?
When I was in graduate school, I participated in a research project on neurodevelopmental diseases. I discovered that childhood development was full of unanswered questions – and I love a challenge. After finished my residency, I chose a pediatric pathology fellowship and really fell in love with the field.

My current research involves pediatric tumors and pulmonary developmental disorders. Working with the Children’s Oncology Group as a member of the International Neuroblastoma Pathology Committee, my colleagues and I were the first to propose the concept of highly aggressive MYC-driven neuroblastoma. Recently, we investigated a rare and fatal lung disease, alveolar capillary dysplasia with misalignment of pulmonary veins, and found aberrant growth of extrapulmonary veins in the bronchovascular bundle (whereas septal pulmonary veins still exist without misalignment). The new findings challenge the current concept of “misalignment of veins” in this disease.

You have practiced in both China and the United States. What are the similarities – and differences?
Similarities between the two countries include the style of medicine practiced, the subspecialties, and the medical education system. But there are also clear differences. For example, like Europe, China’s pathology structure includes only anatomic – not clinical – pathology. Additionally, when I was younger, China did not have nationally unified residency training programs. Young doctors were trained while working, leading to obvious variations in quality.

In recent years, China has learned from the experience of the United States and has started nationwide, unified residency training. So far, there are no official fellowship training programs in China, but I think those will follow in the near future.

Finally, due to differences in the medical systems, Chinese patients – especially those with difficult and serious diseases – tend to go to larger teaching hospitals for treatment. This has caused an imbalance in medical resources and negatively impacted pathology training for residents at smaller institutions.

What’s your advice to pathologists moving into a new region or culture?
When facing new challenges or a new environment, keep your spirits up; always have an enterprising heart; and strive to melt into your new life.

Everyone should know how to be grateful. As new immigrants, although we should work to integrate into our new environments, we should also know how to appreciate our homelands and our alma maters. Healthcare has no borders – think about how you can use what you learn in your new home to help the one you left behind. In this respect, many of my predecessors have served as excellent examples; their work has inspired me to participate in international projects.

Since 2008, I have worked with Chinese pathologists to train the next generation of pathologists. We have gradually improved the level of clinical diagnosis and laboratory management in China by holding workshops and inviting pathologists to American hospitals for short-term training. This has worked so well that I was invited to co-organize, co-edit, and co-write the pediatric pathology volume in the country’s first pathology textbook series, which I hope will promote the discipline’s development in China. I also went to India to attend CME courses for pediatric pathologists there. In the past decade, I have given more than 100 international lectures in pediatric pathology and trained 26 pediatric pathologists from seven countries. Next, my colleagues and I plan to conduct a one-year training program for international pediatric pathologists in accordance with general guidelines from the Fellowship Committee of the Society for Pediatric Pathology. In addition, I am helping Chinese children’s hospitals train senior pediatricians, head nurses, and administrative personnel by organizing short-term training courses in the United States. The effects are impressive – and I hope they will benefit children around the world.

You’re active in many professional societies – what are the benefits?
Pathology is a specialized subject that requires a wide range of knowledge. Especially in the current era of rapid technological development, we must maintain our curiosity and stay up-to-date on relevant professional knowledge if we want to be good pathologists. In particular, molecular genetics presents a significant challenge, because it changes many traditional concepts of pathology. With advances like this on the horizon, there is no way we can survive without continually updating our understanding.

How can pathology figure more prominently in medical education?
Pathology is not exactly overlooked; rather, it is seen as an auxiliary discipline. New imaging and molecular genetic technologies have replaced many traditional diagnostic methods, changed many traditional concepts, and gained a deep understanding of diseases – all very good things, but ones that present a major challenge to traditional pathologists. Molecular pathology is growing as a subspecialty – so it’s more important than ever to master new technologies and incorporate them into routine diagnostic work so that we can remain “the doctors’ doctor.”

If you could give yourself one piece of advice at the start of your career, what would you say?
Follow your interests and instincts. Decide on a career path as early as possible. Choose a few things in your life that you love and focus on succeeding at them.