As we face the daunting challenges and complexities in medical practice today, perspective is helpful. Nearly one hundred years ago, the practice of pathology was maturing into a recognized and valued medical specialty. In that context, the State Pathological Society of Texas, the foundation for the Texas Society of Pathologists, was formed in 1921 by sixteen pathologists who gathered from across the state, from academics and private practice, with the ambition to share developments in medical science, to advance quality in the clinical practice of pathology, and to address shared socioeconomic challenges.
The decades before had seen astonishing progress in medicine. The individuals who gathered to form the new society came of age in an era of discovery and development, and were witnesses to a new medical paradigm: the successful prevention and treatment of diseases based on emerging understandings of their pathophysiology.
A crowning achievement in this new paradigm was the development of testing and treatment for the scourge of syphilis. August Paul von Wassermann’s groundbreaking serologic diagnostic test, developed in 1906, was followed by the introduction of the first ever targeted, synthesized antibiotic compound, Paul Ehrlich’s arsenic-based drug, salvarsan. Until then, the proffered treatments for syphilis were ineffective at best, and not uncommonly killed the patient faster than the disease. Now, finally, there was a test… and a cure. No wonder Texas pathologist Beecher F. Stout called the “rapid sequence of events leading to the diagnosis and treatment of syphilis… one of the most dramatic episodes in medical history”. Dr Stout traveled to Berlin in 1910 to see for himself the combination in use. The following year, Dr. Stout performed the first Wasserman test and administered the first dose of salvarsan in Texas. Texas pathologists in the lead, off to a good start!
Along with scientific and medical developments there were, then as now, shifts in the socioeconomic and regulatory structures of medicine. Laboratory testing had come into its own in the early decades of the 1900s. Analysis of blood leukocyte count, differential, hemoglobin, urine and other body fluids was revolutionizing diagnosis at Texas’ medical schools and through emerging private clinical pathology laboratories in the major cities in Texas, the first opened in 1904. In the midst of this evolution, pathologists recognized that by standing together, they would be more effective in promoting standards of practice that would serve the profession and the people of Texas. In the intervening decades, our profession has faced many challenges.
Fast forward to our time. The pace of change in the practice of medicine is faster than ever, and pathologists are in the thick of it. There is plenty of good news. So rapid are the increases in understanding in so-called “personalized medicine” that “PD-L1 guideline panels hustle to keep pace with drug advances”. Half the talks at the 2018 TSP annual meeting, carefully curated by Dr. Phil Cagle and the Educational Committee to address the most important developments affecting a typical pathology practice, focused on advances in molecular testing. And the era of molecular medicine, and all the advances it will bring, has only just begun. We live in an era of discovery and development.
But even as pathologists embrace new roles in molecular testing and seek new ways to turn their expertise into improving patient care, we also face unprecedented socioeconomic changes. In the context of uncertainty and shifts in health care at the national levels, payments for our work are decreasing. At the state level, anti-balance billing legislation threatens pathologists’ control over our fees. Insurance companies increasingly narrow networks and devise new strategies to decrease payment for pathology services. These actions, once primarily relegated to the biennial legislative session, are undertaken year-round, and require ongoing vigilance and response.
How do we, the Texas Society of Pathologists, stand in the face of this turmoil? Certainly, there are challenges. Vigilance and work is required. But there is every reason for hope. Today, the Society is stronger than ever: the membership is more committed than ever, the tool chest is up to date, and the residents and fellows in our midst are engaged and forward looking, serving as a reminder that our efforts today will resonate through the decades, as has the work of those who came before us. In the face of unprecedented challenges, the pathologists of Texas are pulling together in unprecedented ways to ensure the future of our profession, to the benefit of our patients.
Our advocacy toolbox is equipped. As has been true through the years, the Society’s Legislative Council and the more recently formed Economic Affairs Committee are composed of exceptionally experienced and committed pathologists who convene as the need arises – which can be, particularly during a busy legislative session, on very short notice, within the day – to consider the issues and options facing the Society and determine its direction.
The decision two years ago to engage a lobbyist group has been crucial, providing the Legislative Council with additional information, including granular and potentially critical movements in the legislative process and regarding key legislators germane to a given issue or bill.
Just as UHC’s Beacon program is a prime instance of the novel efforts by insurance companies to cut payments, it also illustrates that advocacy can be effective. A year ago, following initial discussions between the TSP Economic Affairs Committee (EAC) and UHC and Beacon, an indefinite delay in the rollout of Beacon in Texas was announced. The Legislative Council seized the opportunity to work toward a legislative fix. While none of the bills that might have served this function passed in the particularly contentious 2017 Legislative Session, TSP’s Legislative team did achieve significant education and consensus building on the issue within the broader “house of medicine”, as well as education of legislators, laying vital groundwork for the ongoing battles.
And those efforts continue, as expected. Since then, we have seen the rollout of what EAC chair Greg Hostler refers to as “Beacon light,” requiring preauthorization for a broad array of molecular testing. Meetings with representatives of UHC to discuss concerns with this program are underway.
And the membership is committed, pulling together in ways that reflect Texas pathologists’ recognition of the value of the work of the Society. The stepped up advocacy of our era requires effort and experience, and it requires numbers to increase our voice, and it requires money. Necessity is the mother of invention. We cannot hope for problems to disappear, only that the appearance of new problems will engender creative efforts to meet them. To this end, the TSP Board initiated a group membership program in 2017. Participation has increased the Society’s membership, which as of this year has met and exceeded the lofty goal set by illustrious past TSP president Dr. Joe Saad: a goal of 1000 pathologists by 2021.
The new membership goal is 100% of Texas pathologists. The work continues.
Finally, the advocacy work of the Society is essential. But of course the Society is, and does, so much more. At our annual meetings we come together for formal updates on advances in practice, and we learn from each other in informal conversations, all to the end of making ourselves ever better pathologists, the better to serve our patients. We celebrate our shared history, and recognize and are inspired by our remarkable colleagues, at the Andujar and Caldwell dinners. And we are heartened by the brightness and earnestness of our junior members, who continue to break new ground. This is exemplified in the work of Dr. Adam Booth and the Digital Content Subcommittee team. Dr. Booth, a UTMB resident, and his team comprised mostly of residents, in a terrific example of inter-institutional collaboration and can-do accomplishment, produced a resoundingly successful TSP Twitter account that saw a more than 8-fold increase in followers in 2017. The Digital Content team is letting world know of the quality and vibrancy of Texas pathology and this year, coordinated by Dr. Ziad El-Zataari, will surely continue to grow the TSP’s social media presence. If you’ve never logged into Twitter, the time is now! https://twitter.com/TexPathol
We don’t choose the times we live in. We can only choose to engage in the battles and the opportunities that come our way. It is a great honor to serve as President of the Texas Society of Pathologists. We have a top-notch leadership team in the Board, Councils and Committees. And we have the benefit of the hard work, born of a mix of realism and optimism, of those who have come before us. Today, as nearly a century ago, Texas pathologists are at the table, taking those opportunities, sharing our expertise, and playing our part in shaping the development of our times. As Jonas Salk knew, “The reward for work well done is the opportunity to do more.” And so, together, we continue.
Bekra Yorke, MD
President, Texas Society of Pathologists