In our sixth Ask a Pathologist Podcast episode we had the privilege to interview Dr. Jared Szymanski about his top tips for pathology fellowships and his thoughts and opinions on digital pathology as an early adopter.
Dr. Jared Szymanski graduated from the Midwestern University-Arizona College of Osteopathic Medicine in 2003. He works in Provo, UT and 2 other locations and specializes in pathology, dermatopathology and cytopathology. He was also one of the key founders and inventors of Lumea digital pathology when it was established back in 2013.
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Watch on YouTube Here: https://youtu.be/1C5taTbnB3U
Ask a Pathologist Podcast Episode 6 Transcript
James Thackeray: Well, welcome to the Ask a Pathologist Podcast sponsored by Lumea and the Digital Diagnostic Summit.
The idea behind this podcast is to provide good, helpful, useful information and resources for both current pathologists and pathologists in training. I’m James Thackeray, head of the Digital Diagnostic Board and the Chief Commercial Officer of Lumea, and I want to give a really warm welcome to our guest today, Dr. Jared Szymanski, someone who I’ve actually been working with now for, I think, some eight years or so. I don’t want to date us too much, Dr. Szymanski, but I know your background pretty well. But I think I’d actually prefer if you introduced yourself and gave us a little of your background before we jump into this.
Jared Szymanski: Okay, well, I can start with graduated medical school in 2003 from the DO school in Arizona. I was at Arizona College of Osteopathic Medicine. Went from there to Texas A&M where I did anatomic and clinical pathology residency. It wasn’t like a big academic center there, which I wasn’t really looking for a big academic center. I was more interested in general community pathology and I felt like I got great training there for that.
I went on, I stayed there for another year doing a cytology fellowship and then I stayed another year as junior staff. So I did six years in Temple, Texas. And then following that, I had an opportunity to move back to Utah where I was born and raised.
I did my undergrad at Brigham Young University. I got a chance to, I had kind of cultivated relationships with the pathologists at Utah Valley Hospital. And so when a job came open there, I was the person they called and I had a chance to go back and I took it. So I worked at Intermountain Hospitals at Utah Valley as a general pathologist for about 11 years.
And during that time I met Matt Leavitt, who was one of my partners. He was another pathologist that I worked with there. We used to talk all the time about ways we could make pathology better. Like some of our gripes about pathology, how we would do things differently if we could.
And, you know, one thing led to another, and pretty soon we had started a company to build the tools that we thought we wanted, because we could see this digital thing was becoming, you know, it was going to hit pathology like it hit radiology 20 years before, and we wanted to be involved with it.
So we started a company that eventually, after a few iterations, it became Lumea.
So yeah, Matt Leavitt and I were kind of the initial founders of that, pathologist founders, and we started building digital tools and a digital company and getting some clients and learning how to do all this. Well, mostly we started with prostate biopsies because they’re kind of one of the simpler things that you can do.
And we, you know, to teach a computer to do things, you know, you want to start with as simple as you can. And, yeah, it’s gone from there. Eventually, Matt quit his hospital job. I stayed for a while. And then, you know, in 2019, he persuaded me to leave Utah Valley and said he needed my help in the lab.
So at that time, Lumea had spun off the laboratory side of the business into a separate company called PathNet.
And so I was one of the original pathologists working for PathNet. That’s where I am now.
James Thackeray: Awesome. Well, we’re grateful. Those of us here at Lumea are really grateful for your vision and with Dr. Leavitt on what this could become and are excited about what it’s becoming. So your vision has been felt and I think will continue to be felt for a long time.
Well, let’s jump to the topic for today. This is kind of a fun one, but we’ve got today’s topic is tips for fellowship. And I mean, Dr. Szymanski, you’re fairly young still. You still remember those fellowship days. Yeah. Why don’t you just kind of dive into it? I have some follow up questions after that, but why don’t you just let us know what you would kind of give as far as advice goes or tips for fellowship.
Pathology Fellowship – is it worth it?
Jared Szymanski: So the first thing I would say is, if the question is to do a fellowship or not to do it, I would say definitely do it. I think there’s no substitute for having at least one area of pathology where you can really hang your hat on. When you go out into practice in a group setting, like, for example, I did cytopathology.
A lot of pathologists just aren’t comfortable with cytopathology. And so I stepped in, even though I was like a new guy and didn’t have very much experience at all signing out cases and doing the things pathologists do, I was immediately like the go-to guy on cytology because having done a fellowship, I was already better qualified than most of the pathologists in the group in that subspecialty.
So, I think it definitely pays, I mean, if nothing else for your own confidence to have at least one subspecialty where you can really stand out to a group. Another thing, I’ve talked to a lot of groups that are hiring and a lot of times some people’s, this one guy told me well, we start out looking for a certain subspecialty that we want to hire, but we end up hiring who we like. So, you know, while it is important to have a subspecialty, it’s not the only thing.
And being somebody that the group feels like they can work with is probably more important than your fellowship training, but it gets you in the door. It gets your foot in the door. It gets you an interview.
James Thackeray: If you were to do it over, you would still, you would definitely do a fellowship training.
Jared Szymanski: Yeah, for sure. I think, I mean, some might be more valuable than others.
Like, where digital is concerned, like, I wonder about hematopathology. I’m not a hematopathologist, so I probably don’t know all the nuances I should know about it. But it seems like it’s very much algorithm driven. And that’s the kind of thing that lends itself to digital more so than other things. So, I mean, I feel like something like hematopathology, unless you want to go into research, I might avoid that one. Just because it seems like that would be, it’s really ripe for being taken over by a computer that can look at a slide and classify cells better than you can and faster, and then just apply all the algorithms, and it’ll know the algorithms better than you can, so why would you go into that? I don’t know. That’s just my gut feeling on it. Again, I’m not a hematopathologist, and maybe a hematopathologist could educate me on where I’m wrong there, but that’s just my initial thoughts on it.
Other things like, I think, informatics. I don’t know if there’s any digital type of fellowships right now. If you’re comfortable with information systems and embracing the new digital things that are coming down, that are going to take over the profession in the next 10 years, I think those could be extremely valuable.
Digital Pathology’s Impact on Fellowships
James Thackeray: Yeah, that’s great. I appreciate that. That’s very insightful. So let me ask you this, speaking, you brought up the digital side and certainly you’ve been very involved in that, not only from somebody who adopted early, but has tried to progress the digital transformation, I think, throughout the industry. If you were to go back as you were kind of deciding in medical school what specialty to go into.
How would the recognition of all the technology that’s becoming available within pathology influence your decision if you could go back, both positive and negative?
Jared Szymanski: As I was deciding, I wasn’t really interested in patient care so much, which worried my wife. She’s like, well, you’re a doctor. What are you gonna do? So I love diagnostic medicine. And so that’s mostly pathology and radiology is what you think of there. And if I’m in medical school today, looking at the landscape, I’m thinking, I don’t know about radiology. I think there’s always gonna be a role for radiologists, interventional radiologists. I mean, somebody has to make decisions on what to do and even if a robot is doing the procedure, which I think is probably gonna be, you know, something that’ll be happening there.
As far as interpreting images, radiology is already 20 years ahead of where pathology is right now, as far as going down that digital road.
And I think that there’s gonna be a lot less need for radiologists in the future. So the demand for your labor is gonna go down, the supply is gonna have to go down, wages could potentially go down. It’s just, it would make me nervous. Pathology is not as far down that road, but if I’m looking at a 40 year career, I’m kind of worried about that too, happening in pathology.
I think that one positive about going into pathology, you’re always gonna need some pathologists to babysit the machines, to deal with the edge case scenarios that don’t fit into the algorithmic boxes that we try to put things in as we’re using AI. And the good part about that is, if you want to have an interesting job, the pathologists who are still gonna be in the profession, will be spending our time doing almost exclusively those interesting, difficult cases that are kind of fun to work up. Right now, I get one or two of those a week, and they keep the job interesting. Well, what if every case was like that? Because the computer handles all that, the kind of boring routine stuff.
And you just get to focus your time on those interesting cases. It will be similar to clinical pathology as well, where you’ll have to troubleshoot problems when problems come up. Just like in clinical pathology, the machines will be handling a lot of this anatomic pathology like clinical does now, CP. So it’s going to be a lot of problem solving, troubleshooting, and then handling edge cases that don’t fit neatly into the kind of boxes that we try to put them in.
James Thackeray: Yeah, so that’s really interesting. I hadn’t thought of it that way, but basically ridding yourself of some of the mundane, you know, cases that you’ve have historically done, but then focusing more on some of the edge cases, like you said, that really couldn’t be done by, that’s not part of the algorithms currently.
It’s interesting because you’re in an interesting, I mean, you have an interesting perspective to this as an early adopter of digital pathology, right? I’d love to hear, because that’s just transitioned over the last four or five years really, what that transition has been like. And so I’d love to hear just some of the feedback on that transition to digital and how that’s impacted you as a pathologist. And then also looking forward, how you think it will continue to go based off of your experience of what’s just happened in the last four or five years.
Benefits of Digital Pathology
Jared Szymanski: Well, one thing that’s nice is I do a lot of my work sitting in my living room on my iPad. So lifestyle-wise, you know, I’m still a lab director, so like I come into the office for a few hours to the lab to be a presence here. But like I spend the whole morning signing out cases on my iPad. And so lifestyle-wise, that’s huge.
I mean, I can, you know, like this morning I went for a run and a bike ride. Then I sat down. I worked for three hours signing out. I got all my cases signed out in three hours, which I think is pretty fast.
I mean, thinking about how many prostate cores I looked at in three hours, it was probably around 150 cores. And the way we’re doing this digitally, I can just fly through that work. I don’t have to be sitting behind a microscope at a desk dictating. It was just all on the iPad at my convenience. I can do it when I want, where I want. So these are huge things lifestyle-wise for pathologists. What else?
Challenges of Digital Pathology
James Thackeray: Have you felt like anything has, from a, see how do I want to put this, from a sign out perspective, you have the convenience, but has anything fallen off? Or do you think that the new technology has been up to speed enough to where you’re confident in the way the technology handles the image, if that makes sense, as opposed to the microscope? What was that transition like, I guess?
Jared Szymanski: For me, it was pretty intuitive. I mean, I trusted it from the beginning.
There’s some things that I still struggle with. Like we’re trying, right now we’re trying to figure out how to do cytology digitally. But I’m like, at least on the things that we’ve done and that we’re doing well, I’m pretty comfortable that I can do a prostate as good or better digitally than I could on glass. I’m pretty comfortable with GI. There’s some things that just don’t, like really big sections, they take a long time to scan. They take longer to look at. So I think there’s still room for improvement.
But for small biopsies and prostate, I think the digital works really well, and for me it was pretty easy to transition to it. It’s really, I mean, especially like young people these days that have grown up in this digital world, it’s just second nature to manipulate images on their devices. I don’t think that most people, most medical school graduates today would have much trouble adapting to a digital world. Whereas I think some of the older pathologists, there’s still a lot of kind of old school feeling and maybe not quite as comfortable doing this.
James Thackeray: Yeah, which I would understand I mean you get so good at what you have You know available to you and you kind of master that technique and and then to switch you late in the career is difficult for sure.
So there’s the convenience factor, which is awesome.
That adds a lot. I’ve been I’ve been able to watch you as you’ve worked with other pathologists on a particular case. Can you just speak to that aspect of it the ability to work and get peer reviews and consultations from a digital perspective and how that’s impacted patient care a little bit?
Digital Pathology’s Impact on Patient Care
Jared Szymanski: Oh yeah.
I don’t hesitate to ask my digital colleagues for consults, and it’s so easy. I mean, it really is like we’re across the hall from each other when in reality, we could be across the country. And I’ll just text one of them and say, hey, can you look at this case? And usually within minutes, I’ll get a text back and they can pull up the case, they can look at it, they can give me a consult. So that’s kind of a game changer. Whereas in the past, unless it was somebody that was literally across the hall from you getting a consult, you would have to, it would take like weeks to get slides sent, and then generate reports and all the back and forth and materials that you have to send. So this is super convenient and easy.
And having it be so easy makes it so that I don’t hesitate to do it because yeah, like literally minutes.
I mean one time I was at a national park in southern Utah where I had some cell reception and somebody asked me for a second opinion on this case for a clinician like, you know, it was, well, I think I was signing out the case, but it wasn’t a diagnosis I had made before. It was a weird case. So, you know here I am a dead horse point in the middle of nowhere in Utah I just call my buddy in Connecticut who’s a GI pathologist, have him look at the case and minutes later I have this diagnosis from an expert and I’m able to release the case. You know that kind of highlights like well, I can be on vacation and I can still sign out cases. I mean, there’s good and bad with that right? You can see where my wife sometimes resents it when I’m on vacation and I’m like pulling out my iPad and doing consults.
So, you know, you do have to like establish boundaries sometimes, and that can be a challenge. Another thing that I was going to say about that as far as consults, like I can be anywhere and I don’t have to just be in my office. I can get a call from one of my clients, or a clinician, and if they have a question about a case, you know, they can call me up and I can just pull up the case instead of like, oh, let me get back to you on that and then call, have them pull a slide, bring it, I can look at it tomorrow, I can tell them, you know, I can just immediately while I’m on the phone with that person bring up a case, look at it, answer any specific questions because I’ve got the images right there at my fingertips anytime I want them.
So I’ve taken advantage of that too.
James Thackeray: Yeah, that seems to be such a huge factor towards positive patient care to me when it comes to this digital pathology aspect. We’ve had experiences in our own family where we’ve waited up to six weeks on a consultation on a pretty aggressive type of cancer that was ultimately misdiagnosed in the first place.
So you’re waiting on the second opinion in order to change treatment.
The ability to do that digitally in a matter of, really, as soon as somebody has access to whatever device they’re looking on is truly a game changer and certainly offsets a lot of the infrastructural changes that are needed to go digital.
I mean, those are the real positive downstream effects, I think. And I love that you’re highlighting those, just the intuitive nature of going digital, but also the patient care side of it as well.
Final Thoughts
Well, this has been really helpful, and I think our listeners will love this episode.
Just drawing from both your experience pre-going digital and then post-digital, and just that transition, what that has looked like. Any last comments on where you see this digital transformation going? I don’t want to put words in your mouth. If you were to try to project out how quickly this will continue throughout all of pathology, what does that landscape look like in your mind?
Jared Szymanski: I think in 10 years, you won’t really recognize pathology. It’ll be so different. I think that there’s gonna be AI algorithms that are gonna do most of the heavy lifting on a lot of things. And, you know, we’re working on some right now. We’re building them and we’re trying to figure out how to use them.
But yeah, that’s where it’s gonna go. I think it’s inevitable.
I think that we need to embrace that rather than, I think a lot of people’s first instinct is to kind of build a moat so that, well, we don’t want computers taking our jobs, so how can we build like, let’s talk to our congressmen and make regulations so that this doesn’t happen to us, and I don’t think that’s the approach we wanna take. I would rather be leading this change than kind of being victimized by it. That’s how I see it. It’s coming, like it or not, so let’s figure out how to work with it instead of trying to fight against it.
That’s kind of how I’ve always been, and I think that’s, if I’m in, I mean, bringing it back to the initial question of advice for people going into fellowship, you wanna have skills that aren’t gonna be able to be taken, that a computer can do better, let’s put it that way. You don’t want your skills to be just the ones that a computer can do better than you can. So that means management skills, you know?
You’re gonna be the lab director. You’re gonna be in charge of all the things that the techs and that the computers are doing. So you need management skills to do that. So I think that pathology is gonna become as much about that as anything. Being able to work with these computers, informatics, you know, all these types of things are the skills that are gonna make you successful as a pathologist in the future. Not so much image recognition and, you know, I have all these years of developing skills on image recognition that I can train a computer to do that in minutes, you know? You can’t compete with that.
So you’ve got to think of what can I bring as a human to this profession that can’t be automated away, that’s going to add value in the future, assuming, as I think we all do, that AI and digital is the future here in diagnostic medicine.
James Thackeray: I love that. What a great summary. That’s a great summary. Well, hey, we really appreciate Dr. Szymanski for coming on, really a true pioneer in this digital transformation in pathology. It’s been so fun to get to know you over the last eight years, but it’s so great to be a part of your vision as this thing continues to move forward. Certainly appreciate having you on, and wish you all the best.
Jared Szymanski: Okay, thanks, James.
Outro: Tune in next month for our next podcast. Thank you to the sponsors of our program, Lumea and the Digital Diagnostic Summit, our listeners, and our guests for making this possible and for your support.
Dr. Szymanski and Dr. Leavitt were pathologists with a vision for the future of their practice. Check out a few of the technologies Dr. Szymanski helped create: a digitally-enabled LIS, a combined IMS/Viewer, and unique tissue-handling tech that improves pre-analytical specimen quality.
