On being a pathologist.

It has been 50 years since I completed my undergraduate training in the College of Literature, Science and Arts at the University of Michigan. I was admitted to Medical School in the fall of 1955 after three years of undergraduate training. I immediately began doing research in the Department of Microbiology/Immunology under Professor Arthur Johnson and in the Department of Pathology under the tutelage of Professor Murray Abel, trying to figure out how lipopolysaccharide (LPS) derived from Escherichia coli causes enhancement of the immune response (1). After the first two years of Medical School, I was persuaded to accept a U.S. Public Health Service Post-Sophomore Research Fellowship in the Medical School, being the first medical student to follow this route at the University of Michigan. My classmates were aghast that I would temporarily drop out of Medical School to undertake such a daring task, but I was determined to pursue a full year of research while also taking some undergraduate courses in the College of Literature, Science and Arts in order to complete requirements for the Bachelor of Science degree, which was issued in the summer of 1958. Most Pathology Departments in those days were focused on Surgical and Autopsy Pathology and, while the clinical diagnostic laboratories were just beginning to become organized under the leadership of pathologists, Laboratory Medicine (Clinical Pathology) was a nascent part of Pathology in the late 50’s. Specialty clinical diagnostic laboratories were often fragmented, being under the control of individuals who were either basic scientists or physicians with a particular interest in a diagnostic laboratory specialty. For example, at the University of Michigan Hospital, Microbiology was headed by a surgeon with an interest in post-operative infections, tissue typing was supervised by a Ph.D. in the Department of Surgery, and much of hematopathology was supervised by the hematologists in the Department of Internal Medicine. This fragmentation ultimately became moot in 1985 when, under President Ronald Reagan, the Tax Equity and Fiscal Responsibility Act (TEFRA) was passed, effectively abolishing financial incentives for these special, limited function clinical laboratories. At Michigan, this resulted in the transfer of nearly all such laboratories into the Pathology central clinical laboratories. Hospital officials embraced this change, since it took away from them financial decisions that had to be negotiated separately with each one of the “splinter” laboratories. In the 1960’s and 70’s, the attitude in Pathology was that a really capable surgical pathologist could cover nearly every aspect of surgical pathology efficiently and reliably. The inexorable trends towards sub-specialization in both Surgical Pathology and Laboratory Medicine would accelerate as it became clear that pathologists could no longer be all things to all people, either in the setting of Surgical Pathology or Laboratory Medicine. Even within these two areas, there would be an inevitable super-specialization as new information and progress made it nearly impossible for one person to master all of the data in either arena, at least in the setting of hospitals with large bed capacity (>500).