"That child is gonna become President of the United States someday", declared the prescient Mrs. Brennan in 1954 to my mother as they observed
their respective male offspring from the front stoops of adjoining duplexes in Bronx, New York. She was partially right; seems I've become
President of the United States and Canadian Academy of Pathology, arguably a better position, albeit with a more
narrow term limit. As those of you who had the pleasure of raising children soon come to appreciate, there is little you can do to modify an
individual's core personality. I was born in Manhattan to first generation Italian-American parents whose mission of raising a family was delayed
by my father's service in WW2. They were also first in that, although their hard working parents never finished high school before immigrating to
this country in the second decade of the last century, they became college educated. They were also first to depart New York City for the quietude
of a small former mill town in mid Connecticut where I was raised since the age of 3 along with my sister and brother. This suburban lifestyle was
no small undertaking as my father had to learn to drive a car at the age of 36 to commute rather than take the subway to work at United
Technologies where he served as Export/Import Administrator. My creativity was supported, challenged and nurtured by my mother, who had masters
degrees in social work and education, and taught elementary school with recognition as Connecticut State Teacher of the Year. This background of
parents who loved culture and knowledge opened my world to many opportunities and pushed me to reach my full potential.
In retrospect, it is clear to me that who you are now can be explained not only by the nurture of family and the nature of personal effort but by
circumstances of fate that bring new people of influence to bear on a life. As I reflect now, I can hear my father reciting a very memorable and
pertinent line written by Alfred Tennyson in his poem Ulysses- "I am a part of all that I have met; … How dull it is to pause, to make an end, to
rust unburnish'd, not to shine in use!" So, if I have shined in this life, to merit your recognition with this presidency, I must share with you
the educational tangents that I traveled and the fortuitous moments that caused my life to be intersected by those professionals who have had a
hand in making me a better product than what they found.
My early path out of High School was to join most of my buddies at the University of Connecticut (UCONN) in a huge freshman dorm complex known
appropriately as "the jungle." This wasn't all bad during the military draft era of the Vietnam conflict that was being escalated by President
Nixon. In my freshman year, when I pulled draft # 170, I escaped that year's draft quota for 18 year old males. Now I could settle down and not
consider every chance to party as my last. Subsequently, as an honor's scholar and biology major, I had access to small classes, academic journal
clubs and professors seeking undergrads to conduct independent study projects in their laboratories. And so was a budding biochemistry research
career fostered by Cell Biology Professor Paul Goetinck at UCONN. With his letter of recommendation I was able to secure a junior year summer
research fellowship in biochemistry at the Massachusetts Institute of Technology.
Now here's the explanation of why I also hold a dental degree of Doctor of Dental Medicine (DMD). Oddly, this MIT program was aligned with a PhD
training program in nutritional biochemistry for academic dentists who were probing the etiology of the world's most prevalent infections, dental
caries and periodontitis. When they heard of my plans to get a PhD in biochemistry, I received unanimous counsel to obtain a dental degree first
in order to be more competitive for grant funding. And so it was that I, the kid who never had the pleasure of a dental experience other than a
cleaning, applied and as was accepted to the 8th class of the University of Connecticut's School of Dental Medicine. As fate would have it, the
newly founded schools of medicine and dentistry at Connecticut had a shared curriculum and classes for the first 2 academic years, even requiring
dental students to take and pass part 1 of the national medical boards to progress to 3rd year of the dental program. At this I excelled which
made up for my lack of talent with a high-speed drill.
The original game plan now came to be modified through the influence of the Professor of Oral Pathology, David Krutchkoff. This is when I came to
realize that I had a sincere interest in pathology, the underlying nature of disease and the good fortune of possessing the "microscopic eye".
This lead to a residency year in Oral Pathology at Connecticut under Dr. David Krutchkoff. That first year was anatomic and surgical pathology
rotations where I was introduced to the only bible of training academic surgical pathologists, Ackerman's text. Dr. Peter Ward was then chair of
pathology and head of my research committee. I fondly recollect spending many hours in the dark staring at electron microscopic features of tumors
with my fellow resident, Dr. Craig Alred, in our naïve attempt to refine diagnosis. At this time in the late 1970s, immunohistochemistry was
limited to probing for kappa and lambda immunoglobulin light chains. As that year progressed, I adopted a very challenging goal, to move on from
dentistry to become renowned as an academic surgical pathologist. But first, I had to retreat back to medical school. Through the encouragement
of my chief resident and life-long friend, Dr. Kent Johnson, I matriculated in medical school at the 3rd year level, to complete an MD degree at
Connecticut. I next interviewed across the USA in search of pathology residency training programs with expertise in head and neck and oral
pathology. I found both in the University of Michigan's Schools of Medicine and Dentistry. Here Ken McClatchey, descendent of John Batsakis, and
Joseph Regezi, disciple of Donald Kerr, contributed to my maturation as an oral and head and neck pathologist.
After completing clinical pathology training at Hartford Hospital, I took the only reasonable academic position available in that economically
depressed year, courtesy of federal changes to hospital reimbursement, as an assistant professor at Wayne State University back in Michigan. There
I teamed with John Crissman to investigate squamous neoplasia and to develop the technology of diagnostic immunohistochemistry to characterize a
variety of human neoplasias on a level never before explored. Here I sought the mentorship and collaboration of two generous gentleman and giants
in this field, who had a great influence on my maturation as an immunohistochemist: Allen Gown and Hector Battifora, a previous USCAP President.
They have since become good friends who I very much look forward to seeing each year at USCAP. After a brief 2 years in the basement of Harper
Hospital, I literally saw the light, and became fully employed, above ground at Henry Ford Hospital in midtown Detroit. And I have never looked
Henry Ford is one of those unique healthcare institutions; a multi-specialty clinic-based, employed group practice model that staffs hospitals,
outpatient clinics and an independent medical teaching and research enterprise. Here I was given much opportunity to continue my professional
growth as an academic surgical pathologist. My first charge was to lead and develop new clinical and research laboratories in immunohistochemistry
and DNA flow cytometry. Within 3 years of joining Ford I was challenged at a young age to direct the Division of Surgical Pathology, then to lead
as Vice-Chair for Anatomic Pathology and eventually to become Chair of Pathology in 2000. I now serve as Senior Vice-President for Pathology and
Laboratory Medicine of the Henry Ford Health System, comprised of 6 acute care hospitals and 30 laboratory service delivery sites.
I never had any intention of an administrative career in medicine, let alone in Detroit, but circumstances often dictate otherwise. Making the
best of a situation is a personal trait for surviving with a smile. Or as they say- "when presented with lemons, make lemonade!" The wake-up call
came with the realization that all testing, that is millions of tests, was performed under a federal license held in my name. Before long it
became eminently apparent that if I were to take my leadership role seriously, it required me to look at laboratories and pathology services in a
different way than from the perspective of an academic. Hundreds of employees would rely upon my judgment for their livelihood as we attempted to
survive as a hospital in a challenging inner city environment. And over a thousand practitioners would expect more rapid turnaround time and
seamlessness from those laboratory services to accommodate their pressure for more productivity in the practice of modern medicine, from primary to
quaternary care. Moreover, countless patients, whom we would never meet, would be expecting perfection; never to be recalled for a blood redraw
due to a mis-identified specimen or an apology for a lost biopsy. The impetus to change the status quo was immense considering the opportunities
for disappointment would arise over 11 million times each year, potentially almost a quarter of a billion times on the rest of my watch as
chairman. It was clear to me that this would require an entirely different approach to quality and the culture of work.
My initial introduction and foray into the field of quality was also fortuitous, owing to a telephone call in 1988 from Peter Howanitz, then
director of clinical laboratories at UCLA and chair of the CAP Quality Assurance Services Committee. He was looking for a young turk anatomic
pathologist to sit around a table of clinical pathologists to develop his vision of what eventually became known as Q-Probes- the first
subscription quality program that attempted to define what was quality assurance through the voluntary participation of hundreds of laboratories
across the US and Canada. In that role I was given a platform to define benchmarks of quality in anatomic and surgical pathology that still stand
to this day and underscore the basis for many accreditation service standards in anatomic pathology. Over the span of 15 years of quarterly
meetings, I became schooled in diplomacy witnessing the stylistic extremes of graceful Paul Bachner to pugnacious Dan Wilks. I eventually chaired
the successor Quality Practices Committee and introduced a continuous benchmarking quality program known as Q-Tracks, still in existence after 10
years. But my experiences here informed me over and over again that the meaningful opportunities to initiate, advance and sustain quality were all
So after a few frustrating years as Chairman employing the same old executive encouragement about the need for increased quality, benchmarking,
focused education, competency, re-training and reliance on new technology, it was clear that a bold vision was in order. My vision was to
implement a paradigm shift in the nature and approach to work at all levels in our workforce- to lead and manage through quality, focusing on the
requirements of the 'customer'. It was time to jettison the Western management style and transition to the original Henry Ford, Deming and
inspired management culture that was so successful for Toyota Motor Corporation. With grant funding in hand and the good fortune to team with a
very gifted and passionate quality professional, Rita D'Angelo, we created a vision of what could be and the structure and pathway to achieve it.
This culture of an empowered workforce continuously contributing to evolve higher quality through better work processes has become known as the
Henry Ford Production System, now practiced by over 600 laboratory leaders and employees in the Henry Ford laboratories. We came to understand the
words of our Founder, Henry Ford, when he spoke of his own challenges in creating the efficient manufacturing model for the 20th century- "We do nothing at all in what is sometimes ambitiously called research, excepting as it relates to our single objective."
To that end, as good academics, we have shared our own challenges, successes and failures in creating a Lean culture in peer reviewed
publications and national courses.
Likely the most significant administrative management contribution I will have made to those who rely upon my leadership, has been an almost
decade-long quest to position the Henry Ford Health System for success by integrating all hospital-based laboratories and pathology practices into
one corporate unit. As of this writing, I can say that we have accomplished that vision and I am grateful to the many leaders in their own right
who have done bold things to help me make that happen. First of those is my administrative partner, John Waugh. I have learned that change is
never comfortable: it takes significant communication, investment of personal time, recruitment and dedication of others who share the same vision
and perseverance and that ultimately, your success has many fathers. To my many fathers, I sincerely thank you for my success. I couldn't have
done it without you.
In closing, I recognize that in my own role as father, have my contributions been most significant. And I'm not speaking of the hundreds of
resident trainees and over 40 senior staff recruits that I have had the pleasure to know. I am most proud of my daughters, Allison, premed at the
University of Michigan, and Meghan, prelaw at Michigan State University and my very creative son Steven who has yet to claim his potential.