We, the Pathologists of Texas, are also stronger together. Our united strength can be identified in several venues: pathologist and pathologist, academic and private practice; mentor and student; state society and state society; and state society and national society.
Pathologists face unprecedented threats to payment for our services, including for increasingly valuable clinical laboratory and molecular laboratory interpretative and consultative services that provide immediate and significant value to our patients. These payment threats limit pathologists’ ability to solve problems; however, pathologists persevere in helping our patients, for example, with the increasingly significant molecular diagnostic interpretation and consultation that drives, or appropriately excludes, extremely expensive molecular therapies.
There is an increasing awareness that the clinical pathologist, as part of the diagnostic management team, provides immediate consultative diagnosis for the provision of personalized therapy while at the same time providing value to the institution by reducing costs enormously through appropriate testing, guiding appropriate treatment. This is a vital endeavor in this time of limited resources and cost containment; and an endeavor for which clinical pathologists should be paid.
Of course molecular therapies depend upon accurate anatomic pathologic diagnosis, which has become increasingly detailed, with increased need for immunostains and molecular testing of tumors to assess their molecular profiles and suitability for targeted molecular therapy. Yet even as anatomic pathologists gladly accept this challenge, payment for our anatomic pathology services are being slashed; and slashed in large part because patients and families, physician colleagues, policymakers, and payers have little understanding of who pathologists are, and the enormous and necessary value we provide to our patients.
It is always important to remember from whence one comes, no less so as the TSP approaches its centennial. The TSP was born in 1921. In 1921, from Maynard EP. The Practice of Medicine in 1921. Bull NY Acad Med 1972;48(6):807-817:
“Nitroglycerin is very effective for relieving the pain of angina pectoris. In I92I it had been in use for at least 100 years. Even now it is the best medication we have to relieve this type of pain… we had no really effective medication to increase the flow of urine and thus get rid of the water. Therefore in patients whose legs were badly swollen we inserted hollow silver needles under the skin and allowed the edema fluid to drip into buckets placed on the floor… For typhoid fever we had no treatment and were still guided by the old dictum, "Feed a cold but starve a fever." Our chief of medicine, Dr. Joshua Van Cott, had had severe typhoid as a young man. He attributed his recovery to the fact that an old family servant, instead of starving him, fed him well-without his doctor's knowledge….Tuberculosis was a serious public problem. At that time we had no specific treatment and believed that fresh air and bed rest in prolonged doses were required….When the bread-winner of the family contracted tuberculosis it was a disaster; he was usually sent away to a sanitarium for months or years. The family income suffered and the mortality in such cases was high.”1
Since that time much has changed, and the TSP has been a participant throughout. The TSP has been tested over the years with a variety of challenges, and continues to prove itself to be a leader in patient advocacy and protection of the profession. Undoubtedly advocacy will play a major role in the TSP’s activities this next year. The Texas Legislature now in session.
The issues currently facing pathologists in Texas, and across the country—dramatically reduced payment, loss of professional autonomy, enormous and still growing regulatory burden—risk destroying the profession. This is not hyperbole.
Yet the TSP cannot be, and indeed is not, only an organization of advocacy.
Education and networking are just two other areas for which the TSP serves it members, and serves them well. Dr. Phil Cagle’s Education Council continues to provide, as it has for several years, international quality educational meetings which continue to attract Annual Meeting attendees. And one would be remiss not to recognize our CAP colleagues who join us and enrich us at each Annual Meeting; and support us both in thought and in deed. So despite this unprecedented time of advocacy need at the TSP, it is important to keep the TSP growing in all its fullness. As such, I am establishing three subcommittees.
Having recently visited our colleagues at the California Society of Pathologists, and seen them working successfully to build a state-wide electronic tumor registry, and the benefits of its collaboration with others in the state, I am establishing the TSP Ad hoc Committee on Tumor Registry Coordination, chaired by Dr. Mary Elizabeth Edgerton, reporting directly to the Board, with the one year charge of exploring, without prejudice, the possibility of coordinating, with other Texas stakeholders, an electronic tumor registry to better serve the TSP members and citizenry of Texas.
As pathologists increasingly understand the value of social media as a force multiplier to share with patients and their families, payers, and policymakers who pathologists are, and why pathologists matter, I am establishing two subcommittees of the Communications Committee, which Dr. Leilani Valdes has generously agreed to chair, with the very capable assistance of former TSP President Dr. Ed Uthman as a committee member. One subcommittee is the TSP Subcommittee on Digital Content. The Subcommittee on Digital Content is charged with developing TSP social media and other digital content for the furtherance of the Profession of Pathology, and for the benefit of TSP members and our patients. Dr. Adam Booth has agreed to chair the Subcommittee, and will work with Communications Committee and to appoint Institutional Coordinators at each of the pathology residencies in Texas. The Subcommittee’s first charge is to establish a robust, educational, and an exceptionally professional TSP twitter presence. In fact Dr. Booth and many TSP residents have already been hard at work on this, and I expect it will begin immediately.
The other subcommittee of the Communications Committee is the TSP Subcommittee on Advocacy Communication, chaired by TSP Immediate Past President Kevin Homer, whose excellent communications to the TSP membership during this very active past year contributed significantly to our improved and clear understanding of the complex and dynamic advocacy issues with which Texas pathologists are grappling. Dr. Homer will work directly with the TSP teams, including the Legislative Council, Economic Affairs Committee, TSP lobbyist, and me, to craft superiorly-worded communications to TSP members. These communications will be of particular importance as we continue through Texas’ 85th legislative session.
Being chosen by one’s peers to serve them is profoundly humbling. It is with the TSP Legislative Council that I have spent most of my time serving Texas pathologists. I cannot overstate the value that I have seen the Legislative Council provide its members and our patients through these years. I recall watching it perform seeming miracles in successfully dealing with knotty legislative threats to TSP members and our patients. These threats are seemingly never-ending, and indeed continue to mount in number and gravity. This TSP legislative braintrust of experienced, profoundly dedicated members is, in my opinion, unmatched. Serving as its Chair has been an enormously rewarding experience, in large part due to those great members. I look forward to its continuing good works as I serve as TSP President, and for many, many years to come.
In 2017, through our unity, the Texas Society of Pathologists shall undoubtedly have the strength to tackle our challenges, grow our Society, and advance our Profession for the betterment of our patients, in Texas and beyond.