Aleksandra: [00:00:00] You wanna stay up to date with pathology? How many books would you need to buy? Definitely all the W H O Blue Books and probably thousands of other different books, but you don’t have to because there is one online resource that’s being updated regularly and covers over 4,800pathology topics it’s called Pathology Outlines. And my today’s guest is Dr. Nat Pernick, the founder of this website.
Welcome Digital Pathology trailblazers. Today my guest is Dr. Nat Pernick and he is the founder of the website Pathology Outlines. Pathology Outlines has been a resource for me since I started working in digital pathology especially. I’m gonna tell the story a little bit later, but very much in my tissue image analysis work.
So welcome Dr. Pernick how are you today?
Nat: Great, thanks Aleksandra.
Aleksandra: So, I usually refer to my guest with the first name if that’s okay with you.
Nat: Sure, [00:01:00] that’s fine.
Aleksandra: And you can totally call me Aleks as well. Thank you so much for joining me and I’m gonna let you introduce yourself.
Nat: Sure. So, I’m Dr. Nat Pernick, and I’m the founder and president of
pathology outlines.com. We began in 2001, so we’re gonna be starting our 23rd year this August. Our business is in Detroit, Michigan suburbs, and I’m an APCP boarded pathologist, but I’ve got a long educational background. I have undergrad at Wayne State University in Detroit, and then I went to med school at the University of Michigan, and then I did something a little unusual.
I went to law school at the University of Michigan. I really wasn’t sure what exactly I wanted to do, actually. I was interested in computers in medicine, but it didn’t exist. This was back in 86 when I finished law school. Supposedly there were programs it was the next big thing, but I never actually found anything for a while, and so I practiced law for a little bit and then I started a residency.
I saw the light; I saw a residency. I started a residency at Wayne State in 95 and did a [00:02:00] APCP residency there and a fellowship in surgical pathology and finished in 2000 and then started the website in 2001.
Aleksandra: Is that your only job right now? This website is massive. It has so many resources. But are you also doing other things. You’re a lawyer and a doctor and a
Nat: Right.
Aleksandra: An online entrepreneur.
Nat: I used to do a lot more stuff, so at one point I was a computer programmer that’s actually how I paid my way through med school and law school. This is in the seventies and eighties and then at one point I was practicing law.
I had I was doing locums work for pathologists. I was starting the website, it didn’t make any money for many years, so I was doing three things. And then as I got older, I, and as the website started to make a little money, I started phasing out. So, I don’t practice law anymore I don’t sign out cases anymore.
I do write a lot; I write about cancer from an theoretical point of view and on our website, we’ve got a section called CCN Curing Cancer Network and I write papers on what we can do to reduce cancer deaths, and then I write a little bit on [00:03:00] politics and healthcare. But basically, I’m not signing out cases.
Aleksandra: Okay, so let’s talk about the website, let’s talk about pathology outlines, you say 2001, so almost 21 years. How did this even start? How did you, now you say it didn’t make any money at the beginning, but now it’s a source of income. What was the transition? How did this happen?
Nat: So, I was a resident at Wayne State, so I’d say there were two things that contributed the first was, so our chiefs were Dr. John Chrisman and David Grenian, who passed away unfortunately. But he was a great GU pathologist and we would have, I’m sure most of your listeners had it too, an unknown conference every Tuesday morning. And we had a lot of GU cases, but a lot of other cases. And we would take notes on our laptops.
They amazingly had laptops then. But I was there five years and after a while, we built, and we kept their notes and after a while we built up this whole list of notes. I had, in a way, a semi textbook just with all my notes together. So that started to get me thinking gee, maybe, and in [00:04:00] compiling these notes for the conference, I took all the resources we had the textbooks, the A F I P, fascicles, my notes from use cap conferences, everything I’ve got.
And I thought we should put this online and then the other thing that was an inspiration was a book by Dr. John Sinard, who I think is Yale called Outlines in Pathology and that actually was similar idea. The idea of taking pathology, putting the bullet, putting it in bullet points, no pictures, no references and I contacted him, I said this is a great book every year it’s more and more out of data. Are you going to update it?
And he said, no. So, we actually, the residents we all had the book and we
underlined it and then we taped in little things to update it. But I realized, we, it would be great to have something like this online, but we wanna update it and ultimately, we want to add links to references and other sites and pictures.
So, both of those together led to the website and I didn’t actually do anything to about a year after I finished my fellowship, and I had a friend who designed websites and he set up like a [00:05:00] backbone and I just would write, and I started with the thyroid chapter, and I wrote it in word.
It was nothing fancy I was a programmer, but I didn’t program this, and I saved it in HTML, and I uploaded it and that was it. And then that was the first chapter and then I worked in the next one, it’s just a lot of work, but for many of us are obsessive compulsive. We like to get all our information together and make it organized.
So that’s what it was about.
Aleksandra: And it’s fantastic resource. So I started with that. I’m using this
website.
Nat: Right?
Aleksandra: I used to use it more. Did you know that? It is fantastic research for tissue image analysis.
Nat: I know one of the sites that the chapters people use a lot is our stains that.
Aleksandra: Exactly.
Nat: The market page.
Aleksandra: Yes, this was that page where I was getting all my information about how a stain should look like about what’s positive, what’s negative, which entities express the marker. I used to work in the company that the image analysis service is for immune oncology portfolio of a pharma company. So, we used to analyze [00:06:00] every time a new immune oncology marker.
And obviously I had no idea at the beginning about all those markers. Maybe I knew CD 3 and CD 4 when I interviewed for the job. Within a month, I had to familiarize myself with all those markers and teach others how they look and whether the staining is specific, non-specific. So, pathology outlines were my go-to resource and I have a course, an online course pathology 101 for image analysis.
And in this course, I’m mentioning your site and showing where to exactly go and check how as day should look like. So, this brings me to a question. Do you have any specific part for digital pathology there? Or did you ever think it’s a digital resource for pathology?
Nat: I think I, that’s what I initially thought that it would be is like a digital resource for pathologists.
But we actually have a chapter informatics chapter and we’re beefing it up and we have a lot of authors, the people in the digital pathology world would know who write or they write with other people. So, if there [00:07:00] are topics that you think are relevant you can email us and we will run it by, we have a couple editors for that chapter, and we’ll run it by them.
And if they think that it’s useful, then we’ll be happy to add it and then we’ll find somebody to write it. So, the writing of these topics, I don’t write anymore at some point, maybe, I don’t know, 10 years ago I thought, I should really have people write who are smarter than me and to our experts.
And so, they write, and we have a temp, we have a lot instructions, and we have a template. We have to vet them to make sure that they are experts, that they have published, that they have expertise. And then once they do write it and they follow our directions, which is tricky for some people, then we have.
Aleksandra: Yeah, following directions is not always the most straightforward thing.
Nat: And we have two editors typically who will peer review and then people wanna write. That’s great, but they have to respond to the editors. Editors will say I have questions, or they say, you should add this, and that’s how it gets done. So, we’re very responsive. My email is very simple nad at pathology outlines.com.
If you write to me, unless you’re selling something, I typically will [00:08:00] respond, so if you have an idea. Sometimes people find typos. Somebody actually just sent me one on some staging criteria. They said you said less than or equal, and I think it really should just be less than. So, we looked it up and they were right.
So, we changed it, and we wrote to the author of the topic and to get her approval and, so it’s a little bit of a bureaucracy because it’s so big we wanna make sure that everything is as accurate as it can be, and it’s a living textbook, it changes every day we make changes.
We have 4,800 topics. It’s a lot of work, we have 300 plus people writing at any time, we have, I think about 60 editors right now, we have 24 staff, there’s a lot of moving parts. So, we try to do the best that we can, we’re not perfect, but we’re moving, we’re trying to make the textbook as good as we can make it be.
Aleksandra: This is amazing and a huge resource. So, I can confirm that you guys are very responsive because before our podcast, you appointed me to the pathologist directory and I’m gonna ask you a question about that and suggested I make a profile there and I’m like, what is this pathologist directory? Let me [00:09:00] check. And after two days, I got an approval and I have my profile on your pathology outlines pathologist directory, where there are over 18,000 pathologists registered there.
Can you talk about this directory a little?
Nat: Sure. So, it occurred to me after, I don’t know, maybe three, four years ago, I thought, we have pathologists all over the world and we’re disjointed. We don’t necessarily connect with each other, maybe if we see them at conferences, but this is really a tremendous resource.
We have a lot in common and we’re in different time zones, maybe we speak different languages, when we get together, we really have a lot in common. And it seems like there should be some way of using that. And so, some people might remember, I used to have these banners on the website. What are your ideas on how we can connect pathologist, and I don’t know that I actually got any ideas from anybody else, but I got an idea for myself.
Which is why not have a directory of all the pathologists in the world that we can find and that are agreeable? They can opt out. This is a way so that when we see somebody’s published a study or we see them at a [00:10:00] conference, they’re giving, they’re in the newspaper.
We can look them up very quickly cuz it’s on our website. And it’s also a way for them to educate other pathologists about themselves. They’ve got their picture, their subspecialties, they can put in their favorite image, words of wisdom for other pathologists, the secrets of their success. They can, and they can link to their own webpage.
You might be able to find it on Google, but maybe not, and some people have very common names. Which is one of the things we discover in the directory. Sometimes there’s three pathologists with the exact same name in the United States, so we at least can separate them. We give every pathologist; we have to be able to verify that you are in fact a pathologist and we have our own definition.
It’s what you’d expect but we also include PhDs who have certification in a pathology specialty chemistry might grow transfusion medicine and we will maintain the profile for your life plus five years.
Aleksandra: I was impressed with that one. And I wanna share, because for those who are looking at this on YouTube, I think I have a way of sharing.
Nat: So basically, that means that every pathologist can have their, you can have your own [00:11:00] webpage.
So, you have your own URL, and we will maintain it. Within reason, if you have changes, you email us, and we’ll get back to you within one or two days and we’ll, we’re not gonna obviously do anything offensive or inflammatory or whatever. So, we include veterinary pathologists. I actually feel bad about saying it, but I really didn’t know that there were veterinary pathologists.
I never thought about it.
Aleksandra: No, don’t feel bad about it because I am on a mission to, on two missions. One mission is to bridge the gap between computer science and pathology to advance digital pathology. But the other one is to advocate for veterinary pathology as a subspecialty of pathology. Because if you look at the A F I P, different departments, veterinary pathology is one of them.
So, it’s GI pathologist, soft tissue and bone but very few people know about it. And there are not too many of us compared to other pathologists or maybe around 2000. Probably between 2000, 3000 in the whole world of veterinary pathologists that board certified.
Nat: So, we invite [00:12:00] you to tell all your veterinary pathologist friends and anybody listening to sign up and we actually have a subspecialty.
So, if you look on there, it says veterinary, and we actually also have on our jobs page, and I think we have jobs for veterinary pathologists. We don’t get a lot of them. So here we could see, you could put in your favorite image, secrets of success, words of waste, them, and then you could put in all your links.
And just so people know, you don’t have to create a webpage. We have the
pathologist fill out a survey. And then we will put it together. If we have
questions, we’ll get back to you. And then it usually takes a couple days. So, it’s not too long, but this is in fact better than a lot of institutions.
Aleksandra: This was super fast.
Nat: Yeah. A lot of people, they work for a big institution, the university of whatever, and it might be six months before they’re actually online and we’re in a day or two. And if they wanna make a change, if they’re moving around, it takes a long time. With us, in fact, what we do is for each institution we offer this, or for each society, what we call an ambassador.
So, this is somebody who’s gonna help us keep the directory up to date. As for the academic programs in the [00:13:00] us, June, July 1st, everyone changes.
We don’t keep track of what year you’re in. People come in and they go out, then we wanna know, and we do keep, and your title may change, so we, the ambassadors help keep us up to date. It’s an impossible task to get.
Aleksandra: 18,000 people or over almost 19,000 there. This is really amazing directory.
Nat: But our goal is, So now it’s March, but the goal is by the next couple
months to have all the US and Canadian pathologists that we know of that want, unless they wanna be inactive, to have them listed, and then we’re going to work on other countries.
Some other countries. It’s a little tricky to, what we do is we post it using public information, and then we tell people and say, is this okay? And you, and if you wanna opt out, you can. But in some countries, you can’t actually do that it violates the privacy laws. So, in the EU countries, for example, we can’t do that.
We can’t figure out a way around it, but we’ll see what we can do despite that to get as many of them as possible. But if you’re listening from an EU country, just fill out the survey that’s the best way it only takes a couple minutes and it [00:14:00] helps get yourself known. So, you’re applying for a job.
I think in the future people will look up a pathologist cuz it’s so easy to do. It just takes a couple.
Aleksandra: Yeah. It’s like a mini personal page at a very renowned pathology website. So, it gives credibility once you told me that there’s this option, I didn’t know you had a veterinary subspecialty. I was like, I’m going, I’m gonna, and for those who follow me on LinkedIn, you are gonna see a little video about this.
I’m gonna show it to my followers as well, where this is with the link and how to apply for this. And also, all the links that we are mentioning today are gonna be in the show notes. So obviously pathology outlines the directory, your YouTube channel, right? You also have a YouTube channel?
Nat: Right?
Aleksandra: You’re a full online entrepreneur, a programmer lawyer, a doctor pathologist, turned online entrepreneur and that.
Nat: One other thing I wanna mention, so I’m in business my first.
Aleksandra: That was my next question.
Nat: Computers. So, I am a capitalist, but I also think it’s important to be charitable. If you’re one [00:15:00] of my LinkedIn followers, I don’t really talk about this so much on the website, but I put it in LinkedIn.
I think it’s important for all of us in business, it’s not just about making money, we have to make money, but it’s not about making absolutely every dollar that we can. I think we have to treat our employees and treat our visitors well. So, one of the reasons I think we have strong loyalty is we don’t do things that are obnoxious to our visitors.
And actually, we just got somebody who asked, and they said, oh, we wanna put in an ad that blows up. And we said we don’t do that, and they say why not? And I said, because people don’t like it counterproductive because then they won’t come to the website, they won’t see your ad at all.
And when I started the website, I said, we’re not gonna do that stuff but we also promote other charities. So, one big thing we’ve done is we promote scholarships, so we promote public school scholarships this year. We’re starting a scholarship for pathologists at my alma mater, the University of Michigan.
So, if you’re going into pathology, we have a scholarship that will help pay a little bit of your costs. And we’re having a scholarship in the math department at Wayne State, which is, I was a math [00:16:00] major, so I think it’s important.
Aleksandra: Yeah, of course. How else?
Nat: So, it’s a point that we’re charitable. It’s good for business, I think people like that. But it also keeps us grounded. There’s a lot of business leaders, you see them in the paper and their ego seems to have gone to their head. And I think when you work with charities you realize, hey, we’re pretty lucky and we have to help other people who have not been so lucky, at least yet.
That’s one of the themes that I try to, what we do, we, it’s a business, but we give our product away. We give the textbook away; we give it away.
Aleksandra: Yes, so tell me about your business before we dive into the
business because that’s, this is a digital pathology business podcast and that’s also one of my questions.
But yeah, I totally agree with the ads and banners. I also made the conscious decision to promote the sponsors debt I have in a way that does not annoy my audience. My audience is super important to me. This is why my website is online, because there are people who want this information, and I wanna expose my sponsors [00:17:00] to my audience on my own terms.
And that comes for the podcast as well there is an option to have ads on the podcast.
Nat: Right?
Aleksandra: I was shortly entertaining the thought, but then I said, no, I, there are different ways to make money. Online slash pathology business and that are nice to your audience so.
Nat: That’s great.
Aleksandra: That’s my question to you. How do you run your site as a
business? Because you just mentioned you give the content for free. The
textbook is for free. What does the revenue come from? Who do you work with and how can people work with you?
Nat: We actually follow the Google model, so you, if you know you, you use Google, you don’t pay for that, but they have ads, right?
Ours are not quite as obnoxious they can track you and people don’t like that. So we sell, for the most part, we sell ads on the homepage and on the chapter pages we have e-blasts that are sponsored. So we have our biggest one is a What’s New in Pathology newsletter, we have three to four come out each year.
It’s written by our editorial board; I think the next one is what’s new in soft tissue pathology. So, people [00:18:00] can sponsor that, the homepage ads, we try not to have.
Aleksandra: There are a couple of them.
Nat: We change over time, we charge them. But so initially we had ads and then people say they’re all flashing it’s annoying. So, we got rid of the flashing on the homepage ads because it was too much, and I had thought about it and I thought, yeah, you’re right it is annoying and we don’t have popup ads, so we have salespeople of our 24 people, we have three salespeople, and we have three sales support people.
And then we also sell ads for jobs, fellowships, and conferences. So we have 900 some ads if you wanna hire a pathologist. We have the biggest job board, so people come to our site, they send us an email. I like to post an ad and we post it for up to six months. They can pull it sooner. We post it usually within a couple hours.
And a lot of people see it because.
Aleksandra: You have a lot of traffic to the website.
Nat: Right? They’re going to the link; they can come to our website for a lot of things and a lot of people they look at the jobs even if they’re not looking for a job. The funniest job story I had, I was at a conference, and somebody wanted to look at the jobs page.
Then they turned white, and they said, that’s my [00:19:00] job.
Aleksandra: Somebody was advertising their jobs, see very useful research.
Nat: Yeah. So they, we all stopped talking. We didn’t know what to say, but that’s how he found out that he was on his way out, and then we do it very quickly.
So, you can advertise in a journal, which is fine, that could take six weeks to, actually shows up and with ours, usually right away you’re gonna, they’re gonna start getting calls. That’s what pays for it, we don’t charge people, we have really no interest in charging people.
We charge the advertisers. But we don’t, and just to point out, we don’t, again, we try not to do anything that people don’t like, we don’t give out information, we don’t collect information from people. We do for our e-blasts, we do have people’s email, we do not give it out to anybody.
And we have had advertisers that they push hard, and they say, oh, we promise we’re not gonna use it for anything.
Aleksandra: And no.
Nat: I tell, you know, I wouldn’t even give it to my mother, so we just don’t do it. Sorry. You can, if you give us your ad, we’ll put it in our e-blast, and it will reach these people.
And if they want to give, if you say sign up for this and they wanna give it to you, that’s up to them. But we don’t give it to you, so that’s our best [00:20:00] motto and we didn’t make any money. I think maybe about five years we started to break, we started to make some money we’re, overall, we were taking in more than we had paid out.
But and I think that’s the way it is for a lot of businesses it just takes a longtime before you make money. And that’s, and I wasn’t, and so I was working and not getting paid at all for it. I was doing other work; I was doing the law work and I was doing some locum tenants work as a pathologist.
And the good thing is that now when we have an idea like the directory, we don’t make any money on that. Now, I think at some point, maybe we’ll put banners on the directory page. I don’t know. I have some ideas, but again we’re not gonna be offensive about it. So, it’s great to make money, but there are a lot of people, they think they can make money by annoying people I just don’t.
Aleksandra: That’s very short-lived strategy, I would say.
Nat: It seems like, it’s I’m, I like to preach this just because I don’t think my fellow businesspeople should do that. guess I can’t, they can only do what I can do.
Aleksandra: Because everybody, finds the best way for them to do business. And when your model is, audience aggregation for sponsorships or for [00:21:00] advertising. Your biggest asset is your audience.
Nat: That’s right.
Aleksandra: And you are like the bridge from the other people that reach you and the advertisers. You’re the bridge between them and your audience. And if you do not act according to the preferences of your audience that made them, come to your website in the first place, you’re gonna breach the trust that you have with them.
So that’s totally our role, I would say, some of us who have audiences.
Nat: They don’t have to come to us, we can’t take them for granted, so we want them to be welcome to come.
Aleksandra: All trailblazers. That means we very much appreciate you and we appreciate you listening to our content, reading our content, coming to our website.
A really big shout out to you. Without you, this would not exist.
Nat: So, I respond to emails and like I said, unless it’s, unless they’re trying to sell something and it’s obvious, and even then, I might just say not interested. because people don’t have to come here and there’s also, there’s, we don’t really have too much competition, but there could be competition and we don’t wanna take anybody for granted.
Somebody has an idea, maybe we could do it, maybe [00:22:00] we can’t. But I try to listen to it and actually we’ve gotten a lot of good ideas over the years and sometimes it took a couple years, we’d say, it seemed like a good idea. I just didn’t know how to do it or we weren’t ready. So actually, one of the things people have said why don’t you do an app?
So, we are now thinking about doing that for, so it might not be this year, but we’re started working on it. And so if anybody listening has any ideas, let us know.
Aleksandra: Fantastic. Thank you so much for letting us know about it. I’m gonna link to all the resources, and I still recommend your website to my chorus participants, to everybody who’s doing image analysis, tissue image analysis on I H C markers.
This is invaluable resource. There’s nothing like that out there in the web, and I did research the web. Thoroughly. I do have an article on my blog, all the resources you need to good image analysis or to start in image analysis. And there’s not a more comprehensive thing than your website. It’s really [00:23:00] my go-to resource for I H C markers.
Nat: So, if anybody’s interested in writing for us, we do have an author tag in the header and we have author information and instructions, pretty much you’re writing for the world, and you have to be an expert or work with an expert or have expertise. So, we do have qualifications, it has to be something that, we, you could demonstrate that you know about.
And we have 4,800 topics they all have to more or less look the same or people will be confused. So, you have to follow our instructions.
Aleksandra: It’s a book.
Nat: So, it’s like a textbook and you have to have your own images and
everything is peer reviewed. And when our editors give you feedback, you have to respond.
But we are looking for people who are willing to do that. So if you’re interested, send me an email nat@pathologyoutlines.com with your CV and we’ll review it, and we will get back to you. So, thanks so much Aleks, for having me on your podcast. I really appreciate it.
Aleksandra: Thank you so much. Have a fantastic day.
Nat: All right, thanks, you are too. Bye.
Aleksandra: Thank you so much for listening till the end. Grab all the
[00:24:00] resources, check all the links that Dr. Pernick mentioned, and if you are starting your journey in digital pathology, I have a special gift for you. It’s called Digital Pathology Starter Kit. I’m gonna put the link in the description as well, and you can also take your phone out and scan this QR code that you’re seeing on the screen and get directly to my digital pathology starter kit, and I talk to you in the next episode.
