I recently had the opportunity to speak with Bonnie Whitaker, Anatomic Pathology Operations Director at the Department of Pathology at The Ohio State University – Wexner Medical Center. Bonnie has an obvious passion for histology and great insights into the future of immunohistochemistry (IHC) and molecular pathology. I hope you enjoy reading her interview as much as I did conducting it. Thanks, Bonnie!
How did you get started in histology?
I started off in a medical technology program. The program that I went through had an eight week rotation in anatomic pathology, where I was able to learn some of the basics, and to do some tissue processing, embedding, microtomy, staining, and assisting with gross and autopsies. I fell in love with it, to the point where if I could skip what I was supposed to be doing to help with anatomic pathology I would do it. If I could miss out on a day or two of a different rotation then I would approach the pathologist to ask if I could help in histology for the day.
After that, I needed to stay in the geographical area where I was living at the time, but I wasn’t able to find a full time job in anatomic pathology in the area. This was in a rural area, and many small hospitals didn’t have pathologists on site. They would send their AP specimens to a reference lab; because of this, I had to stay in the clinical laboratory for a few years. I’d been working for about seven years when I moved to a larger area, Atlanta, and took a job in another clinical lab, but with a tech who worked full time at Emory as a pathologists’ assistant and part time at Scottish Rite Hospital, where I was working. He told me a lot about his job, and about Emory. I ended up working at Emory as an on-the-job trained pathologists’ assistant, then later, I moved into IHC and image analysis at Emory, and later accepted a position as a Histology Manager at a private lab.
After that, I haven’t had a job that wasn’t associated with anatomic pathology.
What made you fall in love with histology?
Looking at the tissues, patterns, and colors. The fact that you could look at slides and see so much about a person’s disease process, or lack thereof.
What other types of labs have you worked in?
I have worked in industry, for a couple immunohistochemistry (IHC) companies. I spent probably four years total in industry as an applications specialist. I really enjoyed industry because could go to other labs and see what they did, but the travel got to be too much.
I have worked in three academic settings. One, UT-Houston, was a clinical setting but we processed a fair amount of research specimens for both our department and other departments as well. I also worked in two privately owned laboratories.
What are your favorite aspects of working in histology?
Unfortunately, I don’t get to do a lot of histology anymore! I love histology – my favorite thing is probably IHC. It provides so much information. It is very dependent upon a histotech that knows what they’re doing, is able to troubleshoot. It’s also is a little bit of art, a lot of science, and requires attention to detail.
If I had an opportunity to be a part of molecular pathology, that would be exciting. Unfortunately FISH and a small amount of PCR is the only molecular path that I’ve had a chance to do hands-on.
Are there any areas that you are an expert in, or consider a specialty? Technical or other (e.g., IHC, LEAN histology, safety)?
Up until a few years ago I would have considered IHC to be my specialty, but now since I haven’t been physically in the lab for ~5 years I can’t consider myself an expert anymore. In administration you have to keep up with everything in anatomic pathology.
As Anatomic Pathology Operations Director I do a little bit of everything: proposing budget items, scheduling pathologists, overseeing the managers of all labs, e.g., IHC, gross room, cytology, quality, renal pathology. I have 10 direct reports and eight of them manage laboratories. I was promoted from histology manger to this role after the person that had the position before me was promoted up to chief administrative officer for pathology.
What is your favorite part of being on the administrative side?
Trying to anticipate what direction things are going to go, e.g., anticipating and preparing for equipment for PDL-1 testing. Anticipating the next thing that clinicians are going to be demanding, and positioning ourselves between them.
What are the biggest challenges of your role?
It can be frustrating, particularly in a state institution because there’s a lot of inertia. Decisions have to go through so many levels before they can be implemented.
It’s difficult to lure and keep the best techs in the geographical area. Histotechs switch jobs between hospitals based on who can raise their pay rates. There’s a shortage nationally – the number of histology training programs is decreasing and the need for histotechs is increasing. I think Ohio has just one program now.
We are hoping for approval for a certificate program, open to college graduates. The students would spend a couple of semesters in the lab, attend lectures, and get experience in histology. If we are successful, it won’t be a NAACLS program at first, because we can’t wait the two years for accreditation – we need techs now, but we would aim for the NAACLS accreditation.
What are the biggest innovations you’ve seen in histology? Most helpful?
Honestly, if you leave out IHC and molecular, just focusing on histology and special stains, there’s not been a lot of innovation. The biggest innovation has been the automated stainers. Processing, microtomy, and embedding haven’t seen any huge changes in years. Microtomes and embedding centers are better, more ergonomic, and mechanics are a little better, but the principles remain the same.
So many people worry with automation coming into the field – are they going to be displaced, are they going to get laid off. I’ve been in the laboratory now for 40 years and I’ve never seen anyone get laid off due to automation. Automation allows you to do things your lab couldn’t do in the past.
Where do you see the future of the field going? Is there anything your lab is preparing for, or doing more of than they were a few years ago?
The volume on our IHC continues to grow, that will likely continue. A few years ago people thought that molecular will replace IHC, but it is more expensive and IHC is sufficient in many ways.
Prognostic (HER2, PD-L1, etc) IHC that drive treatment will surge for a while. Beyond that I’m not on the cutting edge to know what will happen, maybe it will be that the molecular testing will be financially more feasible, and more necessary as therapies improve and become more and more targeted.
What advice would you give to new histotechs?
Take advantage of all of the opportunities that you can. I don’t mean job-hopping, but I’ve averaged about 6-7 years at each job and I’ve learned something important while working at every job that I’ve held. Every new job that I’ve taken has depended on a foundation that I’ve learned at the previous job. Don’t just view it as a job, view it as a career and take advantage of the opportunities that present themselves to you.
Thank you so much, Bonnie!