Pathology is not practiced in a vacuum or a single market . Even those working in the smallest clinical settings are influenced in part by the flutter of butterfly wings in China, which is to say that the globalization shift that has happened in other economic sectors is underway in pathology practice as well. Assuming that the economic moat that surrounds a practice because of geographic isolation, captive referral sources and solid long-term contracts cannot be breached is like assuming that the borders of a modern country can be secured by Maginot Line-like physical barriers alone.

Of course markets can expand as well as contract or shift, and we will have more to say about this in the entrepreneurial segment later on, but the important thing to recognize is that the health-care market is becoming a much bigger and more fluid market than it has been in the past.

Simultaneously, one of the biggest risks in the market is that a single large customer, such as CMS (Medicare), can, with a single regulatory shift, change drastically how profitable or unprofitable your segment of the market is (or if a type of specimen or procedure is even covered). This is a major reason why organized medicine and organized pathology have taken such an active advocacy role through the various national organizations. The vested interests of the profession and individual practices are sufficiently great that it is prudent to monitor and actively participate in the educational and relationship-building activities to ensure that regulators and legislators properly consider a correct and broad view of the market and profession. This is one key to managing the market risks associated with regulatory and legislative action. Become engaged in and monitor what is happening on the national stage that can affect your practice and learn to become an effective advocate. One of the lessons that should be emphasized here above all is that when the need to exert influence arises, the time for building an effective relationship is usually long past. These relationships with both local leaders and national representatives are based on history and political currency, principally money in the form of contributions, and organization, the kind of organization that gets additional contributions and mobilizes voters and public opinion. These are activities that are best carried out in advance of the acute needs. Build individual relationships based on contact and communication, such as through hosting laboratory visits for legislative leaders, while engaging in the political “game.”