Dr. Gregory Tsongalis: Molecular Diagnostics and the Road Less Traveled
Gregory J. Tsongalis PhD
Director, Molecular Pathology
Department of Pathology
Dartmouth-Hitchcock Medical Center, Dartmouth Medical School
What are some of the major factors that influenced you to choose a career in molecular diagnostics as opposed to academia? Did you consider any other nonacademic careers?
Prior to attending graduate school for my PhD, I received my masters degree as a P.A. in Pathology. It was during this program that I appreciated the role of the pathologist in studying disease and making diagnoses. Also at that time, the first oncogenes and tumor suppressor genes were being discovered and it made me realize that there was more to disease processes than just what we saw at the gross or microscopic levels. That is when I decided to get a PhD and traveled the usual course through the program at UMDNJ. Afterwards I accepted a post-doctoral position in the Department of Pathology at UNC Chapel Hill with David Kaufman to do cancer research. During this time I happened to share an office with a woman who was the chief resident in Pathology and she asked me what my plans were when I finished. I hemmed and hawed but responded that I would like to do something a bit more clinical given my PA background. She took me by the hand and walked me over to the hospital labs to introduce me to Dr. Cross who headed up a clinical chemistry training program for PhDs. It just happened it was the only program in the country that was exploring training options in molecular diagnostics as an up and coming part of the clinical laboratory. The rest is history.
Many graduate students feel pressured to choose careers in academia, have you found this to be the case in your experience?
While some pressure may be applied by mentors for students to stay in academia, you have to understand the commitment that a mentor makes both financially and personally in each and every student. The hopeful end result is an outstanding and successful researcher that will lend a lot of pride to the mentor. I do not think this pressure is as bad these days as it was when I went to graduate school. Back then, if you went to industry, you were crossing over to the dark side and almost black balled. Today, some of the best science gets done in industry and laboratories outside of the traditional research lab. Mentors and students have to redefine how success is measured and realize that there are many different ways to be successful as a scientist. An open dialogue about all possible career options benefits everyone.
Can you briefly define molecular diagnostics and illustrate how this technology has impacted the field of personalized medicine?
The field of molecular diagnostics encompasses any and all uses of nucleic acid (DNA or RNA) analysis to provide a diagnosis, prognosis or therapeutic decision option for patient management. The technologies that are used to do this can vary tremendously from lab to lab but include the simplest PCR followed by gel electrophoresis, to the more complex real time PCR, to the even more complex array analysis, to the most complex next generation sequencing analyses. The impact these technologies have had over the years has been tremendous with respect to personalized medicine as this can include genetic counseling efforts for an individual and their family, tailored therapy for the viral infected patient, and the most recent targeted therapies for patients with specific tumor types. It is interesting to think of the future of diagnostic testing and the re-categorization of disease processes. Typically this would be performed by some phenotypic measure. In the era of personalized medicine, diseases of all types could be re-categorized based on response to therapy or outcomes.
How is the work that you do different from a traditional academic career? Describe a "typical" day if you have them.
Clearly, there are significant differences in my career compared to someone doing basic science research. As a clinical laboratory director, salary and benefits are usually paid for by the institution in return for the clinical service I provide. Therefore, there is no pressure to apply for grants or external funding. This sounds great but the downside is that clinical testing is very routine and the regulations that we are required to meet can often times seem mundane. Also, as a provider of a clinical service, there is very little room for error from the clinician and patient perspective. At the end of the day, the impact a laboratory result can have on a patient and their family is enormous. This lends itself to a different kind of pressure. We have similar teaching responsibilities for medical students, residents and fellows, as well.
In the molecular diagnostics arena, I get to experience the best of both worlds. My lab provides clinical service as far as clinical testing for various diseases. However, the field and technologies are so new, that we also get to explore, develop and assess new markers for different disease processes all the time. While we do not think of this as basic science research, many times we categorize our R&D work as translational science at its best. On a typical day, I will attend several administrative meetings, a tumor board or two, check in with the supervisor and techs in the clinical molecular lab, check in with the techs in the translational (R&D) lab, meet with the assistant directors of the lab, be on one or two conference calls, respond to physician pages, review clinical test results, try and write a section of a manuscript and maybe even get to read a paper or two when I am not traveling to give lectures.
What kinds of positions are available for graduate students and postdocs in molecular diagnostics? What are opportunities for careers in this discipline and related fields?
I am not aware of any graduate programs in molecular diagnostics but there may be one. The best advice I can give to anyone that is interested is to get your PhD with a solid foundation in one of the biological sciences. Afterwards, you can choose from numerous different post-doctoral training programs to become a board certified director of a clinical molecular lab. Not everyone has to become a director. There is a tremendous need for individuals with experience in bioinformatics, microarray analysis and next generation sequencing. Board certification is also available for these folks who do not want to pursue the PhD. The number of molecular diagnostic labs around the world is increasing rapidly and we expect a major shortfall in qualified personnel to direct and work in these labs, especially as we move into the next generation of technologies. However, the clinical lab is not a career option that is for everyone. If you are interested, you should visit several clinical labs and talk to as many technologists and directors as you can to get a good feel for what it is really like on a day to day basis.
What suggestions would you make to graduate students interested in pursuing alternative careers in pathology? Coursework, internships, informational interviews, etc…
As I alluded to in the previous response, you are responsible for your own destiny so do your homework. If you are currently in a graduate program, you have committed a significant amount of your time to the sciences, so don't let that go to waste chasing after career opportunities that do not really interest you. Talk to as many people as possible. One of the nice things about professional societies is that thru them you have access to many people in the membership that have already gone thru this and are willing to share opinions and advice with you. Know what all of your options are. For example, I have highlighted what it is like to be a clinical molecular diagnostics lab director, but did you know there are similar positions in clinical chemistry, clinical microbiology, clinical virology, clinical immunology, and even in some anatomic pathology laboratories. What about other options outside of the academic vs clinical lab such as industry, scientific writing, professional societies, journal staff, etc. At the end of the day, you want to be in a position that you are happy with and doing what you have a passion for. Let me leave you with a quote that was on the inside of a high school graduation card I received from my grandmother, even though she did not speak English. It said, "The key to happiness is having dreams and the key to success is making your dreams come true!" I hope that everyone reading this gets to experience that because I have and it is fantastic!