Reminiscences from Past Presidents
To the best of my recollection – and this caveat goes for all that follows – my election to the presidency of the CAP was something of an accident. The pathologist next in the line of succession, whom I think was Des Magner, had fallen an early victim to the cardiac surgeons, and emergent scraping of the barrel came up with me. I had two qualifications – I was a westerner from a small (in population), remote and penurious province, and I was at that time competently bilingual.
Forty years on and with a notoriously bad memory for anything useful, trying to recollect is very much a “wrong end of the telescope” exercise. What does stick in my mind is my conviction that what mattered was “Canadian.” Pathology, then as now, was almost entirely a provincial affair, and we tried to apply global knowledge of pathology to our very local concerns with little or no relation to any national stage. I thought that one thing I could do was try to visit each province, and there to beat a nationalist drum, to convince the locals of the need for, and relevance of, a national organization. I didn’t manage to go to every province, but I did get to most of them, to be greeted with mild polite surprise; what was I doing here? And to try to convince them that the “Canadian” in CAP mattered. Maybe it took an immigrant, a “GFM,” to see this.
Forty years on, not much has changed in the basics, but a great deal in the emphasis. We still need the CAP for representation at the national level, as for example with the CMA and the Royal College. We are now discovering that the future of pathology in Canada will need new relationships with the politicians. As I write, in the hangover from a federal election, one of my local members, and a cabinet minister, regards deaths from a national outbreak of listeriosis as a joking matter. Another minister had the effrontery to come to the CMA meeting to address us on our errors in treating drug addiction as an illness rather than a crime. We are faced in the future with increasing contact with politicians who are not only by definition scientifically illiterate but also frankly anti-scientific, whose modes of thought are diametrically different from ours, the clinical scientists (or scientific clinicians).We have the problem that pathology mostly comes to public attention when things go badly wrong, and more things are going worse. One cause of this, it seems to me, is that we are still largely locked in to the provincial level, and only attain national attention in times of trouble.We may read, meet, and confer nationally and internationally but our practice is very largely stuck at the provincial level. There are crises in cancer diagnosis – which is us – in the Maritime provinces. There is a forensic pathology crisis in Ontario. Each of these is examined by the compulsive auto-omphaloscopy of provincial jurisdiction – a minor example is that the legal aid system in Ontario will not usually pay for an expert opinion from outside the province, in which all knowledge and wisdom are presumed to reside.
Forty years on, we are in much greater need of the Canadian in pathology, of easy, well-funded, routine local access to national resources, not shackled by provincial bureaucracy or circumscribed by petty barriers of legal jurisdiction. We are a country vast in area, comparatively small in population, and limited in specialist resources which are unevenly distributed. We need to get our provincial blinkers off, remove barriers, and free the practice of pathology. We need an effective, proactive, energetic CAP.
H. E. Emson
The letter from Dr. Harry Letts is reprinted from the CAP Fall 1999 Newsletter.
I had a 3-year term as secretary of the CAP (1973–1976) and president (1978–1979). During my tenure, symbols of office were finalized, including the gavel, the logo, and the chain of office.
Donald Patrick Hill
A reminiscence is a recollection, or a written account of usually pleasurable, wistful, remembered events or experiences, or of particular people. The key words in this definition are experiences, people, pleasurable and remembered. One’s memory tends to fade with the passage of time. As the CAP archivist, I have the advantage of possessing CAP documents, meeting agendas and minutes, and all the past CAP newsletters to refresh my memory
In spite of this advantage, reminiscences of my time as president, 1979 to 1980, are most often related to the fascinating individuals I met and the friendships I made. The fellowship, association, and collegiality with laboratorians across the country were to me of major significance. The regard, respect, and admiration I had for all these people are my most cherished memory. My personal involvement, or my contribution to the conclusions and decisions made, or the reports and papers produced by the executive and committees at the time were, in my opinion, of lesser importance.
Obviously, when one has the opportunity to share some of the responsibility for CAP executive activity with individuals like Don Penner, Don Hill, Ken Pritzker, Verne Waldorf, Vern Krause, Claude Lachance, and the late Frank McElligott, Harold Bell, and J. L. Bonenfant, it is no wonder I have only pleasurable memories.
Later, when I was fortunate to serve as newsletter editor (and in that role, a member of the executive), I got to know and respect others such as Gino Montessori, Anne Shuttleworth, Paul Manley, Alex Meisels, Drummond Bowden, and John Jacques. This period also brings wistful memories.
However, in spite of the above comments, I can also think of a few particular events (or decisions) in which I had some small role to play. These include the publication of the guidelines for storage time of reports, slides, etc.; the formation and continued growth of the section of experimental pathology; and the continued importance of the ISCLMC. Discussion with the Royal College on council structure, and election techniques and the training of general pathologists were also hot topics. The debate on plasma fractionation plants (which never came to fruition), the final publication of Don Penner’s “Guidelines for the Appropriate Use of Medical Laboratory Services,” and Fred Alexander’s on “Guidelines for Pathology Consultation,” as well as the beginning of the Boyd Lectureship program and the changeover of newsletter editorship from Penner to Mike McNeely occurred around this period.
My participation at this time with the Royal College Examining Board, the Accreditation of Training Programs Committee, and CAP’s role with affiliated societies’ meetings were all very important to me.
Perhaps though, my two most memorable moments were being introduced as the association’s new president at the AGM in 1979. This took place in the Fort Kent room of the Quebec Hilton. The entire Quebec City meeting was such a wonderful event and most pleasurable for me since I was born and raised in Quebec (St. Lambert). With Serge Massé’s assistance, I even spoke a few words in French! Then, 1 year later, in June 1980, in St. John’s Newfoundland where my ancestors came from, I passed the presidential gavel to Verne Waldorf, a former colleague when we worked at Women’s College Hospital in Toronto.
Needless to say that later, in 1994, when John Jacques and I saw the publication of our “A History of the CAP,” this was another happy experience and one which we frequently reminisce about!
Harry Letts
C’est pour moi un honneur et un privilège de participer à la rédaction de ce numéro inaugural du Canadian Journal of Pathology. Je suis assuré que cette revue viendra affermir le rôle et l’importance de l’Association çanadienne des pathologistes tout en apportant une importante contribution à la formation médicale continue de nos membres. J’applaudis à cette initiative et lui souhaite longue vie.L’année 82–83, celle de mon passage à la présidence de l’ACP, fut surtout marquée par des efforts soutenus en vue d’accroitre nos relations avec les différentes associations provinciales de pathologistes.
Ainsi furent établies deux nouvelles pratiques soient d’abord la participation du président de l’ACP ou de son délégué aux congrès annuels de plus leurs associations provinciales de pathologistes et ensuite la participation active des délégués provinciaux au Conseil Général de l’ACP.
II fut même suggéré de transformer l’ACP en une fédération d’associations provinciales de pathologie ce qui aurait eu pour effet d’augmenter considérablement nos effectifs et notre présence sur la scène nationale. Ce concept n’était pas nouveau et avait fait l’objet de discussions de la fondation de notre association en 1949. Cette proposition ne fut pas retenue mais reviendra peut-être à l’ordre du jour d’une future réunion!
Sur une note plus légère, votre humble serviteur fut le premier président a arborer, non sans fierté, la toute nouvelle « chain of office » une magnifique pièce de joaillerie réalisée par Jan Waldorf et son époux Verne, un autre ancien président.
R. Claude Lachance
Congratulations on the first issue of Canadian Journal of Pathology. It has been only 25 years since I was CAP president! Accordingly, I looked into Harry Letts’ A History of Canadian Pathology and found this assessment of CAP written during my presidency.
It is useful to ask ourselves what it is amongst our diverse practices that unites us in the Canadian Association of Pathologists. The quick answer may be negative in tone. We are against bureaucratic fiscal constraints insensitive to the larger issues relating to the quality of patient care; we are against inappropriate hospital arrangements which deny us our role in the planning, development and delivery of our professional medical services; we are against those faculties and forces which do not appreciate that laboratory physicians as a group are greying and minimum lead time for replacement is five years.In contrast, the long answer is more positive. We are for developing confidence and standards in every area of laboratory medicine practice; we are committed to a continuing education program of the highest standard and relevance; we are for residency training programs which will fill the varied needs of laboratory medicine; we are for the role of laboratory physician as director of laboratories with all the fiscal, managerial, entrepreneurial and scholarly leadership responsibilities which that position entails. Above all, we are committed to fostering communication and interaction with other medical disciplines, within laboratory medicine amongst other specialty societies, and between provincial specialty societies and the CAP.
We know that in 2008, our problems are recognized more by other constituencies; but are the solutions any closer?
With best wishes for the success of the Journal.
Kenneth P. H. Pritzker
When I look back at my year as the president of CAP in 1985, and as I remember the previous years of work in the executive committee, I experience again that mixture of excitement, anxiety, and satisfaction always present when doing an interesting and challenging job. Those were years of intense professional work, of hard, sometimes frustrating administrative duties and of alternating successes and disappointments.
At the national level, we were involved in discussions with the representatives of the Royal College, regarding the training and the future of the general pathologists, of the anatomic pathologists, and of the laboratory specialists. These discussions focused on trying to foresee the needs of the practice of laboratory medicine in Canada and ensure an adequate supply of skilled physicians.
We had long, sometimes heated discussions with pathologists across Canada, representatives of commercial laboratories, and governmental agencies about the different models of outpatient laboratory testing in Canada and the need for tighter regulation. Much time was spent on the role of the pathologist in the running of the private clinical laboratories. We drew guidelines for the accrediting provincial agencies that would include adequate supervision of medical specialists, and we insisted for the inclusion of these laboratories as part of the medical practice.
At the international level, we were starting exchanges with the ASCP for scientific events inviting speakers, and sharing workshops. Much work was done with the World Association of Societies of Pathology to prepare for the World Congress of Pathology later held in Vancouver.
The most rewarding personal experience was the opportunity to work in close association with exceptional individuals across Canada, like Ken Pritzker, Harry Letts, Verne Waldorf, John Jacques, and many others. For all this I am deeply grateful.
My heartfelt congratulations for your success in starting the new Journal and my wishes for many years of happy and rewarding professional activity.
Gino Montessori
As CAP president from 1985 to 1986 I would like to congratulate all those who have had a part in the creation of Canadian Journal of Pathology. I know how much work a project of this kind involves. I am looking forward to reading it.
Your president has asked that, as a past president, I outline my view of the CAP during my tenure. As this was over 20 years ago this is not an easy task, made all the more difficult by the fact that I have moved four times since 1986 and some of the material has “disappeared.” I am sure that I will find it the day that the first Canadian Journal of Pathology arrives in my mailbox!
During my tenure as CAP president the bylaws were revised – the “discussions” over appropriate wording became heated at times!
I had always considered that fostering the partnership between medical laboratory technologists and laboratory physicians was very important, so I was happy to welcome Miss Valerie Booth, the executive director of the CSLT, to the CAP Council. As recognition of the key role that medical laboratory technologists play in laboratory medicine, an award to the chair of the annual CSLT Congress was initiated. This took the form of a silver paper knife beautifully crafted by Mrs. Jan Waldorf, and I was privileged to make the first presentation at the 1986 CSLT Congress in Newfoundland to Ms. Betty Ann Smith. (The CSLT has changed its name to Canadian Society for Medical Laboratory Science.)
As thorough initial training in any field is crucial to efficient performance in the workplace, it is important that training programs be evaluated periodically. I served as chairman of the Conjoint Committee on Accreditation of Training Programs for Medical Laboratory Technologists and participated in accreditation surveys of training programs.
International relations were also fostered through my attendance at ASCP and the World Association of Societies of Pathology (WASP).
I trust that I thanked all the executive for their support during my term as president; but in case I was remiss 22 years ago, I would like to offer my sincere thanks now and in particular a special thank you to Dr. Mike McNeely, the secretary-treasurer, whose help and advice were invaluable.
In the 60 years since the CAP was founded, many changes have occurred in laboratory medicine – pregnancy tests that used to involve injecting frogs can now be done by the (potentially) expectant mother from a drugstore kit. What changes can be expected in the next 60 years?
Anne Shuttleworth
I came to the Canadian Association of Pathologists through the Continuing Education Program in 1976. Robert More, previous head of Queen’s and then McGill, had suggested the program first at the USCAP and then at our CAP. As the director at the Halifax meeting in 1976 and then chairman of the Committee on Continuing Education until 1983, I expanded the program from a few courses to its current 2 full days.
My path coloured my view of the CAP. Our goal in an era when general pathology was thriving was to be the major national presence in laboratory CME covering all disciplines. Our workshops and programs were competitive in quality to those of the USCAP and ASCP. We were also the only national forum for residency program directors and residents to socialize and address educational and developmental professional issues. To build on this intrinsic strength Roman Szumski and I initiated the first resident section of the CAP in 1988.
The CAP has always suffered from its broad national mandate as an umbrella organization of all disciplines of laboratory medicine for all of their activities while having no regulatory authority and being peripheral to most critical service operational issues such as income, workload, and laboratory quality, which are defined within multiple jealously separate provincial jurisdictions. Researchers also increasingly prefer more prestigious international settings or smaller intradisciplinary groups for significant research presentations. In my era we tried to focus on education and practice issues of national import as they arose. One opportunity was through promulgating quality assurance standards for glucometers, which was perhaps similar to the role available to the CAP recently in quality assurance in anatomic pathology. We also attempted to expand our international role by reinstating our association with the World Association Societies of Pathology and developing a Commission for Pathology in the Developing World, of which I was the first chairperson. Compared to many other regions, and especially Australasia and the United Kingdom, Canadian pathology suffers from competition among diverse fee collecting groups with overlapping interests but widely differing authority including the CAP, the Royal College of Physicians and Surgeons, provincial colleges, and provincial medical associations. As laboratory professionals in Canada we need one national pathology association to make a meaningful and thoughtful contribution to continuing education of laboratory professionals, and to residency teaching and preparation for their future professional careers. The major recent problems in technical and professional quality assurance demonstrate the need of this national body to combine the best of existing provincial QA programs and professional standards and help promulgate them federally. Our best national candidate is the CAP, reconstituted modelling the very successful Australasian model, and incorporating all responsibilities the Royal College currently holds for residency education and certification.
Paul N. Manley
News of the inauguration of the Canadian Journal of Pathology reminded me of discussions we held that year on the feasibility of embarking on such a venture. There was considerable support for the idea but funds were short, and when estimates of cost were received the executive committee decided not to proceed.
A further debate occupied much of our time. Most pathologists practice medicine in close association with their clinical colleagues, and in keeping with this we wondered whether we should reschedule our annual meeting to coincide with that of the Royal College. Since we had recently expanded the number of sections in the association I wrote to all the respective chairpersons asking them to poll their members and to present the results at the 1990 meeting in St. John’s, Newfoundland. There, having kissed the cod, we got down to business. Based on their polls, all the section heads recommended we meet with the Royal College for an experimental period. The proposal passed by an overwhelming majority.
For me, the highlight of the year was the meeting of international presidents at the Royal College of Physicians in Dublin, Ireland. Confused by the designation “Royal” in the Republic of Ireland, I discovered the college received its Royal Charter from King Charles II over 300 years before the founding of the Irish Republic.
I can’t recall what business was transacted at this meeting. I do recall a fine dinner with excellent wines. After dinner our hosts sang Irish folk songs and not to be outdone, Dillwyn Williams, president of the Royal College of Pathologists, and I offered songs in Welsh, our native tongue; Australia followed with “Waltzing Matilda” and the president of the College of American Pathologists gave a fine bass rendition of “Ole Man River.” And so ended a memorable day.
Drummond Bowden
It was my honour to be a member of the CAP Executive for 15 years. I started as newsletter editor in 1977 and departed as past president in 1992. For 6 years we hosted the CAP secretariat in our lab’s offices in Victoria. So, when asked to note the highlights of my time as president, I have to admit that the years have blended together.
Over this time, we struggled to define whether we represented only anatomic pathologists or the entire field of general pathology (including microbiology and chemistry). We sought to build closer relationships with the American Society of Clinical Pathologists and the Royal College. We debated the issues of who runs the lab, whether general pathology was a lost art, how recruitment into pathology could be improved (particularly with the tour de force manpower survey undertaken by Vern Waldorf), and how to survive the introduction of SI units.
Of particular relevance today was the “almost” creation of a national histopathology QA program in 1980. The idea (including a review of estrogen receptors) shrivelled because of the demise of the ICLMC (the Intersociety Council of Laboratory Medicine, a forum for the collaboration of Canadian lab organizations) and an inability to deal with the established jurisdictions of the provinces.
Over a number of years we debated but obviously never initiated a Canadian Journal of Pathology. We simply didn’t have the confidence that we could “make a go of it” either scientifically or financially. The closest we came was to bundle together the abstracts of the annual meeting (congress) into what we called “The Canadian Review of Laboratory Medicine.” The efforts of the current executive to finally take this significant step are most commendable.
All this aside, my personal highlight was to be president when the CAP hosted the World Association of Societies of Pathology (WASP) meeting in Vancouver. I didn’t do much of the organizing work but, as often happens, I received an undue share of the fame. At the same time, Gino Montessori and John Jacques who did most of the work, did so in anonymity.
When I began my tenure with the executive, the CAP was emerging from the amazing singular organization of Don Penner and moving through the strong and decisive but broader structure developed by Ken Pritzker. By the time I left, the secretariat was securely located and the association was moving forward of its own accord. CAP has changed over the years and is obviously now a strong and cohesive organization. I am pleased and proud to have been part of this evolution.
Michael McNeely
It is not particularly easy to recall specific details regarding the 1 year when I was the president of the Canadian Association of Pathologists (1992–93). Perhaps this is a good thing since I have become convinced that pathology, like most other aspects of our lives, changes and hopefully improves gradually with small steps rather than single large steps followed by gaps for many years. I had been involved with the Canadian Association of Pathologists for many years prior to being president and continued to do so for many years following that one year. It is very reassuring to see the growth that has been taking place in the organization. At one time, it was a relatively small organization with very little political influence and a relatively small academic contribution to the pathology profession in the country. We frequently discussed methods of encouraging the media to participate and publicize information from our meetings and usually there was very little success. This specific issue seems to have rapidly changed in the last year or so, and I am certain that the current executive under your guidance will be able to utilize the media interest in a positive way for the profession and, hence, ultimately for the patients for whom we provide services in Canada. If we consider advancing pathology under three general areas, I have no doubt we will continue to have even greater successes than in the past. These three areas are: (1) patient care, (2) accountability, and (3) sustainability. Although it is difficult, we have to make certain that our personal and financial interests do not get in the way of these three goals.
The most enjoyable part of my year as president was the Annual General Meeting, which was held at the Banff Springs Hotel in June 1993. The attendance was great and as president I had the honour of being involved in giving awards to a number of individuals who either were leaders in pathology, or who went on to become leaders since that time. Drs. Ian Dubé and Paul Thorner received awards as Leica Lecturers at that meeting. Of particular interest was the William Boyd Lectureship, which was awarded to Dr. Feroze Ghadially. Dr. Ghadially delivered a presentation that would have been very much appreciated by Dr. William Boyd; I had the good fortune to be able to review Dr. Ghadially’s curriculum vitae prior to the award and it was very humbling to read about his very wide interests and accomplishments both within and outside the field of pathology. We know of his publications in electron microscopy, but he also had publications in other fields such as the raising of tropical fish – “Advanced Aquarist Guide.” It is my understanding that, following retirement in Saskatoon, Dr. Ghadially relocated to Ottawa, where he has been using his methodical research to successfully challenge and beat the stock market.At the time of the meeting in Banff, two pathologists from Kenya were able to participate not only in the scientific sessions, but also in the business meetings in order to glean ideas regarding our processes and professional activities, which they could use within their own societies. I do not know whether the link with Kenya is still in existence, but I am very aware that members of CAP continue to maintain links with our pathology colleagues in many countries which are very short on resources and continue to assist them. This is an extremely important role for CAP and it should receive the support of the federal government. I can recall being at one of our business meetings in Banff where we were complaining about a shortage of pathologists in this country, only to haveone of our guests from Kenya point out the fact that there were more pathologists sitting around the table at our meeting than there were in several of the African countries combined.I recall taking our two Kenyan guests for lunch at Num-Ti-Jah Lodge on Bow Lake. The main building had been erected by Jimmy Simpson, one of the early legendary guides and outfitters in the Canadian Rockies. I had forgotten that in fact Jimmy Simpson and his friends had also been on safaris in Africa. On arrival I was rather embarrassed to discover on the wall the stuffed heads not only of Canadian wildlife, but also a good number of what are now likely endangered animals in Africa. My two guests were quite polite and did not make any comment regarding this matter.CAP will always have some difficulty addressing national health care issues in view of the fact that health care is viewed as a provincial rather than a federal matter; and it is difficult to have influence in all of the various jurisdictions. We need to get government officials to wake up to the fact that the federal government is ultimately responsible for the care of the people from whom it receives taxes. We also need a national credentialing system to encourage pathologists to see more of Canada by taking long- or short-term positions throughout the country.The complexity of all aspects of pathology has increased dramatically since my year as president. Simply maintaining the status quo in healthcare is not acceptable to the citizens who live in Canada anymore than it is to the pathology community. If we are going to make certain that government and the public listen to us, we will need to be delivering care at the highest possible level and this will require some rethinking concerning the need for specialty and subspecialty practice within laboratory medicine. If we do not move in the direction of more highly specialized practice, we will be left behind by our clinical colleagues, who will find other ways to obtain the high level results which they and their patients deserve. With the ease of communication and movement of specimens that now exists, we have no excuse for not advancing subspecialty practice. At a CAP meeting in Halifax many years ago, there was a presentation by a Nova Scotia pathologist. He described “inspecting” a pathology laboratory in a hospital in that province. Following a leisurely cup of tea with the administration, one of the staff was directed to “bring in” the laboratory for inspection. The practice of medicine has changed. It is time that we recognized that no one individual can keep up with all aspects of laboratory medicine. If we do not take up the challenge ourselves and introduce “change,” then we will “be changed.” The latter may be done in a manner that we may not enjoy.I wish CAP all the best wishes for the future and in particular for the future of the new Journal.James B. Cullen When I took over the presidency of the Canadian Association of Pathologists in June 1993, it was at the time when the federal and provincial governments were accumulating annual deficits. This led to a series of measures that had a big impact on our profession. Remember the budget cuts, the “cost-saving” hospital mergers, the cutbacks in the residency programs, the shortage of manpower, the increased workload and ceilings just to name a few. The table was set for the newly elected executive.In September 1992, under the initiative of Doctor Kim Solez from Edmonton, a Consortium on the Future of Pathology/Laboratory Medicine in Canada was created. Funded by CAP, with a 2-year mandate, this group identified the problems faced by the profession and put forward solutions. As a member of it, I was in a position to facilitate communication and collaboration between CAP and the consortium. Anticipating its report, I announced in my presidential acceptance speech in Banff that “in order to achieve success, Canadian pathologists need a strong, efficient, responsive, representative national organization. Reorganization under a unified umbrella will become a major task of your newly elected executive.” Moreover, in order to address some of the issues related to education, we considered that it was important to strengthen our relationship with the Royal College of Physicians and Surgeons of Canada.Therefore, with these two objectives in mind, I called a meeting in January 1994 with the presidents of our major partners in laboratory medicine, the Canadian Association of Medical Biochemists, the Canadian Association of Medical Microbiologists, the Canadian Association of Neuropathologists, and with the chairman of our section of haematopathology. The meeting was to open discussion on the means and ways by which each national organization could best serve the interest of our specialties across Canada having in mind the creation of an all-encompassing national society. We also discussed the creation of a division of laboratory medicine within the Royal College of Physicians and Surgeons of Canada. This new division would then interact with the divisions of medicine and surgery in a co-equal fashion to promote initiative which would benefit the laboratory component of medicine. With a strong mandate from this group as its spokesperson, I initiated discussions with the Executive Committee of the Royal College. From those resulted the creation of a Laboratory Medicine Advisory Committee directly related to the Executive Committee of Council. As its name implies, the role of this committee was to advise the authorities of the Royal College on issues related to laboratory medicine. Unfortunately, our hospital being victim of a shortage of pathologists, I was unable to accept a second-year mandate as president of the CAP as it was proposed to me by the nominating committee. Therefore, sadly, I had to leave in plan the creation of a unique National Society of Laboratory Medicine for Canada. Hoping that this project might eventually come into being, I said in my departure speech, “unity within the diversity is the best lead to success.” Vincent Bernier The early 1990s, leading up to my presidency in 1994–1995, was an interesting and challenging time for pathologists in Canada and for the Canadian Association of Pathologists. We faced the external pressures of regionalization and consolidation of services, the impact of new technologies, increasingly onerous standards of practice at a time of low recruitment into laboratory medicine, and an aging (greying) of the profession. Internally the CAP was not only addressing these issues, but also examining the whole future of pathology and laboratory medicine, its own role and constitution, and its relationship with the Royal College of Physicians and Surgeons of Canada.The years 1994–1995 in particular saw several significant changes. At the 1994 Annual General Meeting the executive agreed to participate in the fledgling Royal College MOCOMP program. During the following year the final report of the Consortium on the Future of Pathology in Canada, established in 1991 and chaired by Dr. Kim Solez, was received by the executive and several changes were put in place to address its recommendations. The constitution and bylaws were revised and rewritten and the committee structure reworked to reflect future needs. The secretariat was moved from Kingston to the Royal College in Ottawa where it successfully remains to this day. The 1995 AGM was held in Montreal, in September, concurrent with the Royal College meeting, but, after a few such joint sessions, the CAP reverted to holding separate meetings.During those years discussions at the consortium and the executive wondered, amongst other things, about the future of evolving technologies, such as molecular and immunohistochemical technologies. The desirability and possibility of a scientific journal was also frequently debated, championed by Dr. Ken Pritkzer and others, but the timing was not right. Now some 14 years later the time has come and the Canadian Journal of Pathology is finally a reality. And, I am sure, all members of the 1994–1995 executive wish it well.John Jacques
The mid-1990s ushered in many changes to the practice of laboratory medicine. There was some significant restructuring with consolidation in many provinces with displacement of personnel; on a national level everyone in laboratory medicine was affected. The enrolment in medical schools had decreased based on projection models of physician oversupply, and coupled with curriculum changes in many medical school programs which diminished the exposure of students to pathology, there were fewer pathology resident positions and even fewer candidates from within Canada. Dr. Kim Solez, chair of the Consortium on the Future of Pathology, reported on the potential impact of the environmental change at the annual meeting, a framework for the future to support continued anatomical and clinical pathology practices. Dr. Marg Norman compiled a Code of Ethics for Laboratory Medicine, so important in defining practice. It had followed a previous position paper, “Medical Directors of Laboratories: Qualifications, Responsibilities and Roles,” thus encompassing our practice. The CAP was fortunate to have these position papers as a national medical organization.
There were several deficiencies identified by the membership as we were at our third joint meeting of the CAP with the Royal College. It was apparent the organization was losing more than gaining from the integration; the CAP identity at the annual meeting was diminished, financially the CAP was having to rely on reserves as sponsorship was declining, few exhibitors aligned with the expectations of laboratory medicine practice, and workshop sponsorship virtually ceased to exist. The CAP recognized it had to steer a different path; hence, the quote “a bend in the road is not the end of the road unless you fail to make the turn.” The bend would bring us back to our roots as a separate entity from the Royal College.There was a great interest in adopting clinically significant reporting of cancer cases. Drs. Fred Alexander and Jane Thomas provided direction and leadership in engaging the CAP in the early development, communication, and application of synoptic reporting for lung, breast, and bowel cancers.The clinical pathology practices in Canada were particularly vulnerable to the restructuring processes. There was an emphasis on centralization which tended to support a commodity versus medical mode. Many colleagues in Canada ably supported a continuing major stakeholder role for laboratory physicians.The executive of the CAP had a very rich cast of talented pathologists. Dr. Joan Sweet and Dr. John Jacques were great guides. Our newsletter provided an excellent forum for communication and, as expected, sometimes opinions expressed engendered controversies. Dr. Rick Fraser ensured the workshops remained a vital part of our meeting despite a general sense of paralysis/malaise in the membership, a loss of identity of the CAP, and diminishing numbers of attendees at the annual meeting. Dr. Ken Pritzker was instrumental in having the CAP as a recognized sponsor of international journals, in particular, the American Journal of Surgical Pathology. It was an honour to serve the organization. Most of the major accomplishments were due to the efforts of others; only some of the contributions have been recognized. The strength of the organization was the membership. The significance of our secretariat in Ottawa was immeasurable. The spirit, purpose, and focus of the entire CAP Executive of 1995–1996 remain my most profound memory of my tenure.Gordon Hoag While we continued to celebrate 50th anniversary of the Canadian Association of Pathologists (CAP), we recognized that our role as laboratory physicians and health care professionals was expanding and changing as health care continued to undergo restructuring. Over the year, the Canadian Medical Association (CMA) recognized the national shortage of physicians. The CMA worked closely with affiliate societies including CAP to validate physician workforce requirements in the short and long term and to develop or revise policy statements in order to ensure that the policy reflects a consensus among the profession.The CMA also provided the CAP with an opportunity of outlining some of the specific concerns facing laboratory medicine in the implementation and access to new laboratory technologies. The CMA had put forward a proposal to the federal government to establish a National Health Technology Fund to increase country-wide access to needed health technologies. The 2000 Canadian Association of Pathologists (CAP)/Ontario Association of Pathologists (OAP) Annual Meeting was held June 17–21, in Ottawa with a theme, “Transplantation.” We had an interesting and successful meeting with an excellent scientific program. It was important for our association to mobilize its efforts in the area of physician resource planning to meet the anticipated increased needs of pathologists and to maintain a healthy balance with our subspecialty colleagues. A special symposium addressing the human resource issues in pathology/laboratory medicine was held at the annual meeting with Dr. Hugh Scully, president of the Canadian Medical Association.The Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada was officially launched on January 1, 2000. The initial cycle of this program was 6 years in duration, instead of the typical 5 years to earn the required 400 credits to maintain fellowship status in the Royal College. Physicians could earn credits by selecting from the following six continuing professional development options: (1) accredited group learning activities; (2) other learning activities; (3) accredited self-assessment programs; (4) structured learning projects; (5) practice review and appraisal; (6) and educational development, teaching, and research. Dr. John Parboosingh, director of the Office of Professional Development at the Royal College, addressed the members and answered questions at a town hall meeting which was held during annual meeting. Thanks to Dr. Jack Butany for his involvement and leadership in the Maintenance of Certification program.At CAP Council meetings we discussed with Dr. Erik Larsen a plan for pathology workload guidelines for practice. Dr. Murray Treloar, chair of professional affairs, provided us with a good basis of data for income and manpower planning, and progress was noted in the area of the CAP website under the direction of Dr. Jeremy Squire.The CAP Council is made up of dedicated professionals who are making a difference in our association. I would like to take this opportunity to acknowledge and thank all of you who have dedicated your time and support in bringing the association to its current status. Your commitment over the years is greatly appreciated. Overall, it was a gratifying and rewarding year for me as the president of the CAP. Physician resource issues (recruitment, retention), remuneration issues, and national guidelines for workload were some of the challenges that the executive undertook to address with some degree of success. We worked closely with the provincial associations and with the CMA in resolving some of these issues.Jawahar (Jay) Kalra Thank you for providing me with an opportunity to participate in the launching of the Canadian Journal of Pathology. It is with great pleasure that I submit this letter which provides a perspective on my tenure as president of the CAP. I had the honour of serving on the CAP Executive at the beginning of the new millennium. My term as president was from 2001 to 2003. I believe that it marks the first time that a president had served a 2-year term in the CAP and this set the stage for stability and continuity of leadership at the national level in pathology over the next 7 years. Perhaps the most enduring accomplishment of my tenure was the development of a new mission statement for CAP – the one that you see in each CAP Newsletter. However, there are other achievements: for example, we developed a Position Statement on Pathologists’ Assistants, which served as the impetus for the recent creation of the section of pathologists’ assistants. The History of Pathology Club was initiated and this has blossomed nicely into an enduring legacy for Dr. Guillermo Quinonez, its visionary creator. Our national meeting became accredited for the first time for Royal College credits. It is very satisfying to see how, in 2008, the CAP has been able to provide the leadership in accrediting its own continuing education programs. We have come a long way from the early days where we had to rely on Memorial University, due in large part to resource constraints internally at the time. The CAP Newsletter continued to grow as a vehicle for continuing education with new features on immunohistochemistry in surgical pathology diagnosis. However, we also began to realize the important role that the CAP website could have as a vehicle of communication and took several steps to enhance the web design and formally included the website editor as a member of the CAP Executive.During my term, I tried to reach out beyond the Canadian pathology community onto the world scene. For several years, the CAP had been dormant, in part again due to resource constraints. However, my participation at the International Liaison Committee of Presidents (ILCP) was warmly welcomed by other Western world leaders in pathology. I continue to believe that in a shrinking global village, Canada has much to contribute on the world scene. Interest by Canadian pathologists in providing education and laboratory services to pathologists in developing countries is an important step in that direction. The launching of this new Canadian pathology journal could also play an important role on the international stage. I also believed that it was important for pathology to be a player at the national table with other medical and surgical specialties. I accepted an invitation to attend a national meeting of the Canadian Medical Association in my role as CAP president. I also participated in a series of meetings that led to the CAP being one of the national specialty societies that sponsored a full-page article in The Globe and Mail to voice our concerns against Bill 114 – the coercive and punitive legislation that threatened to damage medical professionalism and patient care in the province of Quebec. During my tenure, we also prepared a written submission for the Romanow Commission into the Future of Health Care. I participated in several Royal College Specialty society meetings about a greater role for specialty societies within the Royal College’s organizational structure. More recently this has led to a new strategic plan for the college. I had very few regrets about serving as president. Perhaps my greatest disappointment was the dissolution of the section of clinical pathology. For many years, especially in the 1980s, the strong leadership provided by this section resulted in several important national guideline statements in clinical laboratory medicine, some of which are still used today. However, perhaps as a sign of the times in the early years of the new millennium, leadership in general pathology began to wane and with it, the infrastructure surrounding it: GP residency programs and clinical pathology leaders in the community and in the academic setting. I tried valiantly but fruitlessly to find a new group of general pathologists to take the torch from the previous generation. In 2008, the Royal College is still trying to come to grips with what to do with general pathology as a specialty. My own view is that there remains a demand for properly trained general pathologists in many communities across Canada but the current vacuum that has resulted is being filled with a product that does not optimally meet community needs. The notion that two divergent streams are required, that is, one moving towards sub-specialization and the other moving towards generalization (not unlike general internal medicine or general surgery), seems not to have resonated with the Royal College or even with some of our own colleagues.Finally, in closing, I wish to thank the Canadian pathology community for giving me the opportunity to serve as president at an important time in our organization’s history. The CAP has been blessed to have had strong, distinguished leadership in its 60-year history and I feel privileged to have played a small role in this. I am delighted that the current leadership of the CAP has taken the bold step of launching this new Journal which will not only find an immediate niche for Canadian pathologists and residents but will help to put Canada on the world stage. Sandip K. SenGupta I would like to congratulate the CAP Executive and the CAP membership for having the courage to launch a brand new journal that we can proudly support as our official channel for informing the world of the exceptional research and educational activities by Canadian pathologists and clinical laboratory scientists. This idea has been debated over the years and finally I feel the CAP has matured to the point of being confident of its identity and place in the world. I am particularly grateful to Dr. Maire Duggan for having steadfastly insisted that the CAP launch its own Journal. Well, it has finally happened.As I am one of the past presidents of the Canadian Association of Pathologists, Dr. Jagdish Butany has kindly extended an invitation to me to write an outline of my view of the CAP during my tenure as president.When I stepped into the role of president, the CAP was struggling with some of the unilateral decisions made by the Royal College of Physicians of Canada regarding restructuring of the laboratory medicine training programs, especially the fate of neuropathology and cytopathology. I had the distinct impression that the membership felt helpless about the situation. There was uncertainty about manpower planning, workload standards, national quality standards, and, indeed, the viability of our organization. It is encouraging to see how much progress has been made in each of these areas and how motivated our executive and membership are to deal with these challenges in a proactive way. Not only has the Royal College’s neuropathology decision been reversed, we now have two new sections within the CAP: the section of neuropathology and the section of pathologists’ assistants. Our membership grew to 914 by 2006. The federal government is seriously considering implementing national standards and a mandatory accreditation process for pathology as I write this letter. This can only lead to a stronger profession in the future.It is time for pathologists to take charge of their destiny. Strengthening the CAP’s mandate and showcasing our talent through our official journal would go a long way towards this goal.Diponkar Banerjee As past president of the Canadian Association of Pathologists (CAP), I am extremely proud and delighted that the CAP will inaugurate its official journal, the Canadian Journal of Pathology, in March 2009. This Journal will provide a Canadian flavour to pathology and will serve as an important vehicle for dissemination of information and exchange of dialogue amongst Canadian pathologists. It must be noted that the first edition coincides with the 60th anniversary of the founding of our association.During my tenure as president from 2003 to 2005, I strongly believed that Canadian pathologists needed a strong national association to represent their interests and speak on behalf of all members from coast to coast. Across the country, laboratories faced extreme pressure to downsize and reduce expenditures based on poorly devised benchmarks and indicators, often without any consideration given to quality outcomes. Years of restraint resulted in manpower shortages, increased workloads, and stress imposed on our members. This, despite the fact that we were held accountable to the highest possible care while at the same time we saw hospital laboratories increasingly controlled by non-laboratory physicians. Recruitment of medical students into pathology training programs is still a major issue in many, but not all, provinces. Advocacy for the profession is severely limited with provincial and federal governments, and lobbyists are non-existent. National standards for quality assurance and pathology practice do not exist.However, the unfortunate events in the Atlantic Provinces with ER/PR in Newfoundland, concerns about pathology reports in New Brunswick, forensic pathology troubles in Toronto, and further turmoil in Owen Sound and Winnipeg have thrown pathology into the Canadian spotlight as never before. Yet there is opportunity here for our association to lead the charge and to advocate for our members and the Canadian public. There will probably be no better time to push for more human and financial resources for our battered profession. In closing, I encourage all pathologists in the country to support the CAP and take an active role in the running of the organization by attending annual meetings and volunteering to sit on CAP committees. By becoming involved in the CAP, you can make a difference.Donald M. Cook
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