Dr. Tara Mahar (pictured at right) is the chief medical examiner for the Erie County Department of Health, in Buffalo. She attended medical school at the University and graduated from Pathology residency in 2011.
In addition to her role as the M.E. she is a clinical assistant professor of Pathology and Anatomical Sciences at the University of Buffalo’s Jacobs School of Medicine.
We caught up with her to hear more about her career path, her interests, and to see what advice she has to offer anyone interested in pursuing pathology.
Where are you from originally?
I’m from Rochester! I grew up in East Irondequoit and attended Eastridge High School. My parents and one of my sisters still reside in the Rochester area.
How did you become interested in pathology? Was there a specific person or moment when you knew it was the career for you?
I’m a visual learner, and I find working with my hands very gratifying. I really enjoyed anatomy and histology in medical school, but also loved my surgery rotations. I did a surgical internship after graduation, and quickly discovered that I was very interested in the surgical specimens and the intraoperative consultations.
I ultimately found that pathology – and specifically forensic pathology – played to some of my strengths as a learner, and best integrated my desire for hands-on work with my thirst for additional medical knowledge. Forensic pathology enjoys relative freedom from some of the limitations placed on the practice of medicine by our system of health care, and that also helped with my career decision-making.
In 1 or 2 sentences, describe what you do every day.
I work with an awesome group of people to investigate non-natural deaths in Erie and surrounding counties. A large part of my job involves doing autopsies.
What do you enjoy about your job?
I love being able to provide answers for people – whether it be a grieving family, a treating physician, the police, a district attorney, etc. I also enjoy educating others, such as medical trainees, families of the deceased and members of a jury. Medical examiners have an important role in public health, as well.
I love that every day at work is different, and that there are always new things for me to learn. I’m also fortunate to enjoy the people that I work with.
Are you working on any research – now or in the near future? What special research interests do you have?
Not really. I hope to have the time to do so once my office has a full physician staff. In the meantime, the docs at my office have tried to share the new things we’ve learned by presenting at national meetings.
I have a number of interests, many of them with an eye towards public health. I would love to research effective ways to further decrease unsafe sleep-related deaths in infancy. I also have an interest in sudden unexplained death in the young, and would love to see genetic testing become more widely available.
Tell us about your family. Do you have a spouse, kids, pets?
Yes, my significant other and I have an 18 month old son and a cat. My significant other is a retired detective and a stay-at-home dad. He’d probably tell you that the dad gig is harder!
I’m close with my parents and my two sisters, even though I don’t get to see them as often as I would like.
When you look back on your time as both a medical student and resident in Rochester, what’s something you remember most or miss about UR?
The people! I made some lifelong friends at the UR, particularly during residency. Although we live in different parts of the country now, we still keep in touch. I also miss and fondly remember some of the faculty. Although there were many great faculty, Drs. Hicks and Johnson immediately come to mind.
How do you like to spend your free time? Do you have any hobbies or interests?
Free time? What’s that? In all seriousness, what I enjoy most is spending any free time with my family. Other interests include cooking, gardening, travel and small home improvement projects.
In your opinion, what is one way to help promote pathology to medical students?
The first, second and third ways are all exposure. There’s very little exposure to what pathologists actually do during medical school, largely because there are no required rotations. This results in, I believe, a lot of confusion and misconceptions about pathology on the part of students.
What career advice can you give students or trainees interested in your chosen field?
The trend in pathology education seems to be the completion of at least one (and often more than one!) fellowship. Do your research early. Many of the best fellowships fill quickly and/or require an “audition” rotation of sorts.
A $1 million gift from Milton J. Finegold, M.D., an alumnus of the University of Rochester School of Medicine and Dentistry, will support a new pediatric pathology fellowship.
URMC looks forward to enrolling its first ever pediatric pathology fellow in the fall of 2020.
“Having a fellowship in our institution may help to retain some of our own residents who are interested in this subspecialty,” said Philip Katzman, M.D., a pediatric pathologist at URMC. “The presence of a fellowship program also helps with providing more teaching opportunities in the medical school and in clinical services that the pediatric pathology subspecialty serves,” he said.
Finegold (pictured at right) is a native of New York City. He attended URSMD from 1955-60, during which he completed medical school and a year-out student fellowship. He went on to have a long and successful career as a pediatric pathologist. He is now Professor Emeritus of Pathology & Immunology at Baylor College of Medicine.
His original intention as a trainee was to become a hand surgeon. When he decided surgery wasn’t for him, he was thankful to receive mentorship from UR Pathology faculty, especially from the late chairman, Dr. Lowell Orbison.
Over the course of his training, he developed a passion for learning about how children become ill and how to determine what causes these illnesses.
While at NYU and then Baylor, he served as the director of a pediatric pathology fellowship. Looking back to his own days as a student and fellow, Finegold says that sponsoring this educational opportunity is one way he wants to give back.
“Like anybody in academic medicine, your greatest satisfaction is getting to see the progress of your students,” said Finegold. “It’s wonderful to witness what they become and what they do.”
He noted that pathology is generally low on the list of attractive areas of study, especially for medical students. Pediatric pathology is an even rarer program, forced to compete with more popular subspecialties like forensic pathology or surgical and neuropathology.
“In order to get people interested in pediatric pathology you want to generate an opportunity in the area of children’s disease, and you have to do whatever you can to make it attractive,” said Finegold.
Bruce Smoller, M.D., chairman of Pathology & Laboratory Medicine at URMC, said the gift will expand the department’s offerings for potential trainees.
“This prestigious new fellowship opportunity enhances the range of training opportunities that our department provides, increasing our national visibility and improving what is already a very strong educational program,” said Smoller.
Dr. Finegold lives in Houston with his wife, Jan Goddard-Finegold, MD, and their dachshund, Trixie. They have three children and two grandchildren.
Dr. Abraham Loo is a practicing surgical pathologist/hematopathologist at Monmouth Medical Center in Long Branch, NJ. He was a fellow in Hematopathology at URMC from 2014-15. Here, he shares more about his career and what makes his work rewarding.
Residency: AP and CP from Madigan Army Medical Center
Fellowship: Hematopathology, URMC (2014-15)
Medical School: SUNY Downstate College of Medicine
Where are you from originally and where do you live now?
I was born and raised in NYC. After medical school, I went active duty in the United States Army and lived out west for eight years before returning to the east coast to do a Hematopathology fellowship. I currently live in Red Bank, NJ.
What was something that made your experience at URMC a positive one?
I really enjoyed my time as a fellow and I left feeling well prepared to sign out heme path cases. I am grateful to have met many wonderful people as well. Dr. Richard Burack was a supportive fellowship director, Pat Leary was a patient teacher of flow cytometry, and Leslie Antinarella was always a kind person in the department. After finishing residency, I did not feel prepared to work with residents, but as a fellow with prior experience as a staff pathologist I enjoyed working with the residents (Sapna, Nisha, Chad, Hani, et al) that rotated through.
When did you first “discover” pathology and what or whom first sparked your interest in it?
I had limited exposure to pathology in medical school and I cannot remember when exactly I “discovered” pathology, but I can say I genuinely enjoy my job. There are good days and bad days, but I enjoy doing impactful work that uses my education and can positively affect people’s lives while keeping me divorced from the emotional aspect of medicine.
How would you describe your job to someone who knows nothing about pathology?
After a biopsy is performed, the tissue (breast, prostate, etc.) is processed and read under a microscope by a doctor, who is the pathologist. The pathologist renders a diagnosis to the clinicians, who directly take care of the patient. If a clinician is concerned for blood cancer (leukemia or lymphoma), I am the pathologist in my practice that looks at those specimens.
Tell us about your family.
I have two wonderful daughters, Calista (7 years old) and Naomi (5 years old), who are my everything.
How do you like to spend your free time? Do you have any hobbies/interests?
I have been practicing Brazilian Jiujitsu/No-Gi grappling since 2006. There are few things as pure as a combat sport, and there aren’t many venues where people from all walks of society can share space engaged in a physical struggle, yet not have any social, political or personal conflicts.
What’s one piece of advice you have for pathology students or trainees looking to start their careers?
Have long term goals in your professional and personal life, but there will be unexpected twists and turns. Don’t neglect your soul on the journey.
Can you imagine working in a lab that has no electronic database and limited technology?
That’s exactly the case in many parts of the world, which is why a subgroup of the American Association for Clinical Chemistry (AACC) traveled to three different countries in Asia this summer to provide training in areas of need.
URMC's Dr. Victoria Zhang leads the Asia Pacific working group, which is part of the AACC's Global Lab Quality initiative. In August, the group of clinical lab professionals delivered two-day workshops in Nepal, Sri Lanka, and the Philippines. The sessions included interactive lectures on laboratory quality specifically designed and targeted to their audiences - many of whom lack basic instrumentation and resources so commonly found in labs across the U.S.
“It is amazing what they can do with what they have,” said Zhang. “They are so excited about the AACC team being there to help. People were so eager to learn and absorb information like a sponge. I was truly humbled by this opportunity to work with a talented team to support this initiative for developing countries.”
The workshops covered topics like assay selection and validation, how to establish and monitor quality control programs, proficiency testing, reference intervals, ISO standards, and total quality management.
The team also visited local hospitals and labs during the tour. The photos shown below were taken during the group’s visit to an academic teaching hospitals at Kathmandu, Nepal.
The specimen management work is very manual.
Test results are entered by hand into the medical tracking book.
The surgical pathology grossing area.
The chemistry lab has one automated analyzer.
It was a record-breaking year for the flu in the Greater Rochester Region. Just ask anyone working in the Clinical Microbiology Laboratory at Strong Memorial Hospital (SMH), which saw a 37 percent increase in the number of flu tests performed at SMH between July 2017 and June 2018 over the previous season. Our labs performed 17,862 tests in total.
Why the increase? Kim Handley is the supervisor of Clinical Virology, and her team collects weekly data to report to the CDC and also post online. This year’s testing volume was even higher than when the swine flu epidemic hit in 2009.
“It was a record breaking year for testing volume due to several factors,” said Handley. “It was the perfect storm.”
As is typical for the time of year, there was a sharp increase in flu cases during and after the holiday season, when family and social gatherings lead to germ sharing.
Locally, there were more than 6,600 confirmed flu cases in Monroe County, with Influenza A-H3N2 being this year’s primary strain. There were also many cases of seasonal Influenza A-H1N1 and an unusually high number of Influenza B and RSV at SMH.
Handley said that although the lab ran lots of tests, the number of patients who actually had flu was much lower. “Our volumes were up so much but our positivity rate was lower because we were testing so many people,” she said. This could be due to many patients coming to see a doctor when they experience flu-like symptoms.
Flu Hit Country All at Once
Normally, flu season starts in one part of the country and spreads to other regions. But this season, the majority of the United States experienced a simultaneous onset of influenza. This put pressure on manufacturers of the flu testing kits (which contain plastic pipettes and cartridges that are loaded into a machine that gives the results) and the collection swabs and transport materials used to gather the samples from patients.
Testing Materials in High Demand Nationally
The demand for all of these materials grew not only locally, but across the country. In fact, so many people were being tested for flu that URMC was one of many healthcare institutions placed on allocation by their main kit manufacturer. This means the hospital received a limited number of testing kits because demand was so high.
One interesting byproduct of these shortages was collaboration among neighboring healthcare institutions. Lab personnel at Strong shared testing kits and supplies with Rochester Regional Health’s ACM Laboratories and vice versa. When one was running low on something, the others would share.
“It’s not unusual for labs to call each other up when flu season is at its worst,” explained Handley. While this has happened in years past, the collaboration this season was noticeably more frequent.
Lab volumes were high for other reasons. In February, the Food and Drug Administration pulled a widely used rapid antigen test from distribution because it was found that the test had poor sensitivity. This forced several UR Medicine-affiliated hospitals that relied on these tests kits to send their specimens to SMH.
Through it all, however, the laboratory team of medical technologists at SMH rose to the challenge during this particularly difficult season. This according to Nicole Pecora, M.D., Ph.D. is the Assistant Director of Clinical Microbiology at SMH.
“I am proud to be part of such an amazing team,” said Pecora. “Not only did our clinical virologists rise to the challenge of an exceptional flu season, but virtually every member of our laboratory pitched in to deliver the best care for patients, starting from those who received and accessioned the samples to those who picked up extra work and shifts to get through such a tremendous volume. It truly showed the patient and team-directed mentality of our staff.”
In photo: Medical Technologist, Lauren Brooks loads a specimen into a flu testing analyzer at the Clinical Microbiology Lab at Strong Memorial Hospital. This year, the hospital’s testing volume was almost 40 percent higher than last season.
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