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The Dotted Line: 5 Tips for Navigating the Laboratory Management Structure

In all my years of education, I never took a business class, and when I started my first job post residency, I had little training or experience in management. As a newly minted pathologist, maneuvering through all the people, roles, and responsibilities of the laboratory was overwhelming. I had been trained to make diagnoses but figuring out my role in leadership wasn’t as straightforward.

Pathologists, especially medical directors, are ultimately responsible for the testing, quality control, staffing, and safety of a laboratory. We are tasked with working alongside people we do not manage/directly supervise. In some organizational schemes, this type of guidance without a direct supervisory role is denoted with a dotted line.

Effectively Working Dotted Line Leadership

For pathologists to be effective in dotted-line leadership roles, they need to positively influence the work practices within the laboratory. The pathologist must be viewed as an approachable, knowledgeable, and helpful advocate for quality testing and employee and patient safety.

So how can you be perceived as an approachable, knowledgeable, and helpful leader?

1. Know Your People

Learn names and use them. Ask questions and share about yourself when appropriate. Eat lunch in the break room. Everyone appreciates someone taking an interest in them. Spending just a few minutes each day checking in with your team is a great investment in your lab.

2. Never Miss an Opportunity to be Appreciative

Thank people for their contributions. Always. Bring the good coffee one morning or cater a lunch if possible.

3. Prepare to Learn

Pathologists may have many years of education However, bear in mind that many techs and supervisors have years of experience under their belts. Let them teach you what they have learned about common issues with specimens and instrumentation, the laboratory information system, and troubleshooting. 

4. Be Available to Help Solve Problems

Answer your phone, and respond to emails promptly. Leave your office door open as often as possible.

5. Support Supervisors 

Regularly ask supervisors how things are going. Have a good working relationship so that you can report observed policy violations to them. Remember there are some situations where you must take action. If you learn of deviations from approved testing or specimen handling policies or mishandling of proficiency testing material, you must speak up.

You will likely have a lot of questions in your new role. If possible, find a mentor. A more seasoned colleague, supervisor, or faculty member from your residency may be able to provide guidance when you encounter difficult situations.

Pathologists Responsibility in Laboratory Management 

As pathologists, we have a responsibility to remind our team that the larger goal of our organization is to provide healthcare professionals and their patients with accurate, timely, and useful diagnostic information. The tests that we perform each day have the potential to dramatically alter each patient’s treatment plan and access to healthcare. This message is best received in a laboratory culture of care and mutual respect.


Dr. Rothrock is an AP/CP certified pathologist who currently serves as Associate Medical Director at a large reference laboratory. He has served as CLIA Laboratory Medical Director for small satellite laboratories as well as community hospital laboratories. He lives with his family in Tampa, Florida.

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