- With which professional societies/organizations (e.g. AACC) are you involved?
I have been an AACC member since 1978, an NACB Fellow since 1982, an active volunteer with CLSI since 1995 and a member of the Endocrine Society since 1977.
- How did you get started in these organizations and what advice do you have for young people wanting to get involved?
I joined the AACC during my clinical chemistry fellowship and immediately began to attend the annual meetings. However, it was the local section that served as my gateway to meeting professionals, developing connections, sharing ideas, and building lifelong professional relationships. Although attending local section meetings often required long road trips and giving up precious personal time, the effort was rewarded a thousand fold in terms of career development. For young people today, AACC divisions provide complementary opportunities to network. My advice is to show up at a local section (or division) meeting, volunteer for an activity in which you have an interest, give your time, and always follow through with your commitments. If possible, identify role models or mentors. I am personally indebted to Gerry Cooper, Dick Gadsden and Chris Frings.
- What area(s) do you specialize in and what initiated your interest in this (these) area(s)?
When I moved to Kentucky in 1980, I was assigned oversight of 'Special Chemistry'. Endocrine lab testing became my main area of interest, which nicely paralleled experiences from my Mayo Clinic fellowship years. Eventually, our division director (Norbert Tietz) invited me to help write the endocrine chapters in his early textbooks. At the same time, I focused on developing lab tests for inborn errors of metabolism. My interest in both areas (endocrine and genetic testing) increased over time and my last sabbatical leave was split between two pediatric labs where I gained hands-on experiences with tandem mass spectrometry applications of steroids and inherited metabolic diseases. Today, as director of the largest clinical chemistry laboratory in Kentucky, I have a hand in all areas of our core lab (including chemistry, hematology, and urinalysis), toxicology, special chemistry and point-of-care testing. Since the retirement of my colleague and good friend, Bill Porter, I have also developed strong interests in clinical toxicology and laboratory automation.
- What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
Undoubtedly, my most important contribution in the field has been serving as a laboratory director in an academic medical center for 33 years and contributing to patient care. My main contribution in the area of education has been authoring/co-authoring the endocrine chapters in several early editions of the Tietz Textbook and the endocrine and amino acid sections of the Clinical Guide to Laboratory Tests. In the past ten years, my most important contribution to the field of lab medicine has been through service to NACB and CLSI.
- What were some of the most rewarding and/or challenging moments of your career?
The most rewarding moments of my career come when I am able to help physicians solve complex problems and make correct diagnoses. Rewarding moments also flow from my love for teaching clinical chemistry to anyone with an ear to hear. The most challenging moments have been administrative (pleading for resources, resolving personnel issues), teaching disinterested students, harmonizing the lab operations of two hospitals, balancing requests for more bedside testing, and learning to live (and thrive) as a PhD in an MD world.
- How would you recommend achieving an optimal work/life balance?
At this particular point in my career, I am unable to provide a successful formula. Work/life was in good balance until both of my chemistry colleagues retired and were unfortunately not replaced. Now work is never completely done and there is never enough time. I could offer obvious recommendations such as: be disciplined and productive at work but do not neglect family and outside activities, set defined time limits for various aspects of your work day, learn to limit your stress, try to delegate, learn to say 'no', be realistic about what you can accomplish, etc… But when the buck stops at your desk, these recommendations ring a bit hollow. My best advice: find an employer who values employee balance, who provides workforce support, and who understands your need for regular recharging.
- What are you predictions for advances in laboratory medicine and/or your area over the next 10 years?
Replacement of most immunoassays with tandem mass spectrometry; increased use of middleware (or rules-based computer systems) to manage lab results prior to release; increased automation of all processes in the lab to deliver faster results; movement of automated molecular/genetic technologies to the core lab; growing pressures to move testing closer to the patient; and continued calls for the lab to do more with less.
- What do you see as the challenges facing young scientists in laboratory medicine?
Two major challenges come to mind:
- Research/method development. When I came to Kentucky in 1980, I was afforded both time and resources to prepare a balanced portfolio of clinical, teaching and research accomplishments for tenure promotion. Today, productivity expectations and time demands are even more daunting. Traditional sources of research support are harder to find, and many hospitals are reluctant to provide resources for method development. New sources of financial support will need to be tapped. I recommend that young academic scientists fight for research time and forge relationships with clinical colleagues to do collaborative/translational research. You may be surprised to find that your clinical laboratory skills are valued and needed.
- Laboratory complexity. Successful leadership/management of the modern clinical laboratory requires combining your best scientific, clinical and business skills with a working knowledge of regulatory issues. Lifelong learning will be required.
- What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
Develop good communication skills. I cannot overemphasize the importance of fine-tuning your writing proficiency. I am grateful to my retired colleague, Norbert Tietz, for his red pen! Also, identify an area of interest and strive to increase the depth and breadth of your technical and clinical knowledge...the means are literally at your fingertips. If your goal is to work in a dedicated healthcare facility, then the young scientist should seek postdoctoral training through a ComACC accredited clinical chemistry training program and then take/pass appropriate ABCC exams. Be active in your professional societies and interact with colleagues and senior scientists. Be sure to sustain strong research skills, whether working in an academic or an industrial R&D position.
- What is your favorite line from a movie or book?
From the cult sci-fi movie, The Day the Earth Stood Still, three secret words kept the robot Gort from destroying the earth: 'Klatu barada nickto.' These words should be memorized along with the Pledge of Allegiance and your social security number...just in case.
- How did you discover lab medicine/science?
I was reared in a small town located in the foothills of north Georgia (pop. 2000). My initial interest in science was sparked with a Christmas toy: a Gilbert chemistry set. My decision to become a scientist, however, can be traced to a 7th grade science teacher (Mrs. Thomas), whose classroom was an amazing experimental wonderland. I discovered lab medicine quite by accident. After completing my PhD in organic chemistry, I was invited to the Mayo Clinic as a research fellow in molecular medicine. Providentially, my work with follicle-stimulating hormone brought me in contact with the clinical lab and its new chief of chemistry, Don Young, who invited me to join Mayo's inaugural training program in 1978.
- If you could start your career again, what would you do differently?
I struggled with a decision to pursue graduate research in either synthetic organic chemistry or biochemistry. Medical school was not on my radar. If I could, I would consider combining medical and research training to pursue a career as a physician-scientist. I think clinical credentials, combined with research lab experiences, afford increased opportunities to influence patient care and the practice of laboratory medicine, particularly in an academic environment.
- What are your top three favorite laboratory tests and why?
- Vitamin D. My first clinical chemistry research project involved use of liquid chromatography with amperometric detection of a vitamin D derivative to replace existing receptor/antibody assays. It was 30+ years later that we helped develop a robust tandem mass spec method for this same hormone.
- hCG. I had early research interests in pituitary hormones, but interest in placental hCG was awakened when my lab uncovered "heterophile antibody" interferences in patients with autoimmune Addison's disease.
- Amino acids. Early in my career I developed a two-dimensional thin-layer chromatography method to identify amino acids in body fluids. Just recently, we developed a rapid tandem mass spec method for Phe/Tyr in blood spots. It's true: what goes around comes around.
- What is the riskiest thing you've ever done?
Introducing my northern 'Yankee' wife to my southern 'Dixie' family
- What is an average day like in your life?
The typical day for me has tremendous variety. I often arrive at the hospital around 7AM for an early morning meeting. Meetings are a necessary part of life I guess… I serve on 8 hospital committees right now and if you add intra-laboratory, departmental, College of Medicine, vendor meetings, new hire interviews, etc…into the mix it can fill up a day very quickly. After a cup of java, I walk through the labs and meet with techs to discuss pressing/pending analytical issues that may range from troubleshooting broken instruments to managing quality concerns. Some mornings include running to the lecture hall to teach 100+ medical students or to the conference room to teach and talk with pathology residents. Once back at the office, I meet with senior techs to discuss an array of topics, such as fiscal/operational/personnel issues or method development/validation/implementation projects. As the morning wears on, I am usually on the phone or computer explaining test results to physicians or responding to their complaints. After a quick lunch in my office, I meet with the pathology resident assigned to chemistry to interpret electrophoresis reports and review interesting patient cases. Throughout the afternoon I'll sign QC/PT reports, work on an invited lecture, prepare for a capital equipment meeting, or work on a dozen other tasks from my to-do list. Around 7PM I turn off my computer and head home.
- What is one thing that most colleagues in AACC do not know about you?
I'm an avid hiker/backpacker (climbed Kilimanjaro three years ago at age 62) who is looking forward to many happy trails with his 7 grandchildren.
- Do you have any other specific comments or advice that you like to provide to the members of SYCL?
If you are a hospital-based chemist, then I strongly encourage you to attend clinical conferences and accompany clinicians on rounds soon after you are hired. As you interact with clinical caregivers, your knowledge of lab medicine will become increasingly appreciated (free consults!). Unfortunately, some administrators inside and outside your department may see you as a 'glorified' med tech and fail to understand/appreciate your contributions to the clinical enterprise. To help justify your existence, be seen as a value-added asset by establishing your clinical and academic credibility. Here is my advice: work hard; be knowledgeable and clinically adept; be scientifically productive; and be known around your department and hospital as the go-to person for questions about clinical lab testing (right test, right time, right price, and right result). Postscript: I am surrounded by phenomenal medical technologists. Develop the habit of thanking your co-workers for their dedication and commitment. Good luck in your career!