- How did you discover lab medicine/science?
Very early on when I was in high school I realized I liked biology, biochemistry and medicine. I trained in clinical biochemistry in my home country (Argentina), and when I moved to the United States the career path that best matched with my original training was lab medicine.
- With which professional societies/organizations (e.g. AACC) are you involved?
I am an active member with the AACC and the ABCC. For the AACC, I serve at the local, national and international level in different roles. For the ABCC, I serve as a chair of exams for Chemistry and vice-president for continuing education.
- How did you get started in these organizations and what advice do you have for young people wanting to get involved?
During my postdoctoral training I was fortunate enough that my mentor introduced me to volunteering opportunities for the AACC. Networking at the AACC meeting I started to know more people and eventually instead of me looking for opportunities, the opportunities found me. My advice to young people or to people that are very new to the field of laboratory medicine is to join AACC, come to the meeting, and don't be shy. If you already know someone in the field, ask that person to introduce you around. Always be respectful, be professional, and think about how you want people to remember you. You never know, that person you are meeting today may be your boss or colleague tomorrow.
- What area(s) do you specialize in and what initiated your interest in this (these) area(s)?
I specialize in General Chemistry. The laboratory I currently oversee is a large operation and does not perform very specialized testing. However, we serve as the central testing site for other hospitals and medical centers in our health system. Because the large testing volume we analyze daily, I am very interested in operations, Lean management, and error reduction schemes. My interest in this area originated during my postdoctoral training when I learned many different processes to avoid errors and maintain a Lean operation.
- What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
My most important contribution has been demonstrating the accuracy and reproducibility of gene expression profiles using laser capture microdissection on normal and tumor tissues. I performed this work while I was a post-doctoral fellow at Washington University and represented the first attempt at demonstrating the use of amplification techniques on microdissected material. Our team demonstrated a proof of principle helpful to others that followed in this line of research-clinical discovery.
- What were some of the most rewarding and/or challenging moments of your career?
Definitely the most rewarding moments of my career were when I was doing my postdoctoral training. That was a very special time where I had the opportunity to meet great people, learned many things about my field but most importantly learned about friendship, professionalism, and work/life balance. The most challenging moment of my career was during graduate school. Looking back at those challenging years, I realize I had learned as much from the science as I had from the friendship of those around me.
- How would you recommend achieving an optimal work/life balance?
Each of us has a very different set-point for work/life balance. The most difficult part is figuring out that set-point. It may take a while until we realize what we like (work and life) and what we definitely do not like. Creating that perfect balance depends on knowing ourselves (knowing that set-point). Once we are aware of our own set-point, balancing work and life depends on setting our priorities and use them to organize the daily activities. For me the set-point has changed with the years. My career goals and my personal and family needs have changed. Most importantly, since balancing work/life may take into account family life, sharing the weight of the responsibilities helps attaining the balance.
- What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
Due to the decrease in reimbursement, tests in the General Chemistry laboratory that do not have a demonstrated clinical utility will not remain as part of the hospital menu. Test utilization will be more scrutinized by hospital committees, and evidence-based medicine will be used by the Center for Medicare Services to decrease the reimbursement even more. Quality indicators and customer satisfaction indicators will be used for reimbursement purposes as well. Reliable Point of Care devices will be even more popular and may in some cases replace the central laboratory altogether. Personalized medicine may become more prominent to decrease the number of unnecessary tests performed in individuals that do not need them.
- What do you see as the challenges facing young scientists in laboratory medicine?
The biggest challenges for young scientists are to have to do more with less. Because hospitals are centralizing services and standardizing processes to reduce cost, professional services are also being reduced. In the coming years, and perhaps already now, young scientists (and not so young) will need to be experts in multiple disciplines, able to keep up with information, and able to create effective solutions at a quick pace. In addition, young scientists will need to be creative to invent new tools to effectively address issues in the fields of personalized medicine, informatics and automation.
- What is an average day like in your life?
The average day in my life is mostly full with meetings. I do have operational/managerial tasks to take care every day. These include daily management of laboratory indicators such as turn-around-time, instrument performance issues, reagent and quality control issues and any missed critical value calls or results modifications from the previous day. This task may be spread throughout the day and depending on the issue it may take from just over an hour to the entire day. In addition, we consistently use meetings to communicate progress on projects, implement actions on processes or make decisions that involve more than one location. Some meetings are obligatory but can be done over the internet on my computer. I do teach pathology residents and many times have one-on-one lecture, follow-up clinical consultations, help them prepare presentations and work on laboratory projects to present at the AACC or ACLPS meetings. Lastly, I oversee clinical chemistry at other associated laboratories (not only on the main campus) and travel to visit these locations at regular intervals. There are many other small task I perform daily, weekly and monthly as needed. For example, at the present time I am working on implementing a new process in managing some of the daily performance indicators, reviewing the analytical performance of few assays we are bringing in-house, validating a different tube to collect urine, analyzing data collected on a project driven by the Emergency Department, collaborating with Internal Medicine on a project to re-visit the normal distribution of values for ALT, and optimizing testing for patients with thyroid cancer. My days go very fast, the environment is extremely dynamic and engaging. Even though at the end of the day my 'to-do' list does not seem to shrink much, I still feel I want to do more and want to go home with the feeling that I had made a difference in a patient's life because of what I do every day.
- What is your experience and thoughts about assay standardization efforts (eg. Vitamin D, HbA1c, other)?
Standardization efforts are well overdue for many of the assays we routinely use in the laboratory. Standardization of an assay is a long process many times the manufacturers may not necessarily see the economical advantage of standardizing an assay. As medical directors responsible for assay accuracy we should strive and support assay standardization.
- Please describe the "best fitting" culture that you have worked in. What interviewing tips do you recommend for evaluating work culture and identifying "best fit"?
The best fitting culture I worked in is one that values my skills, capabilities and allows me to excel. An interview starts well before the personal (face-to-face) interview takes place. Learning about the employer ahead of time, talking with current or previous employees, looking up at the employer's track records are all good examples of investigating if the prospective employer may have similar goals in mind and may allow you to grow the way you expect yourself to grow. See how others like you are doing in that environment. It's good to be among individuals that have similar goals and perspective but is also very good to be part of a diversified workforce. Diversity of ideas helps deal with diverse problems we see day-to-day (think about it as a gene-pool of ideas). Always make a list of what your ideal job would look like and use that list in an interview. No job is perfect but there must be an imaginary cut-off between what you are willing to accept and what not.
- In your opinion, what is the most important leadership skill?
Play well with others. A leader may have vision, knowledge, organization skills, and discipline to remain focused. All these are excellent skills, but without being able to engage and motivate others there is no leading.
- How do you approach proposing and implementing change(s) in the laboratory/hospital?
When implementing changes, involving those that are going to be affected by the change is very important. In the laboratory/hospital, processes many times are product of multiple rounds of changes occurring through the years. Many times we use a process without necessarily knowing why certain steps are needed. Engaging the individuals directly involved in the process is a great way to implement change. Other elements that may help implement and sustain change are monitoring improvements, sharing the ideas among different teams to promote confidence and learn about tools to use, use management tools such as value stream mapping, communicate findings using visual tools (posters, monitor screens, or white boards). Most importantly, value everybody's opinions when brainstorming ideas and implementing solutions.
- What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
- Always aim to improve writing skills: No matter what field of science one is in, scientific writing is a must. On my own experience, I wish I had had many more hours of training.
- Expertise: if you have the opportunity to become an expert on a field that interests you, do it! Contradictorily, continue keeping up with new methodology and advances in laboratory medicine. Our field is ever changing and very dynamic.
- Networking: if a tree falls in the forest and nobody hears it, did it really fall. Do not underestimate the power of networking. Meet your clinician colleagues at your institution. Discuss their issues and provide solutions. Be available as much as you can to help resolve lab issues for the 'customers' and for the technologists. Network with your colleagues at meetings. Networking is part of job security. We are dispensable and needs in today's job market change at a fast pace.
Unfortunately the only suggestion I have on achieving these goals is work, work, and work.
- Do you have any other specific comments or advice that you like to provide to the members of SYCL?
Yes, read "Desiderata" by Max Ehrman.