Qihui “Jim” Zhai, current president of the College of American Pathologists (CAP), has built his career on persistence, scientific curiosity, and a clear sense of purpose. Spanning his early years as an international medical graduate to now leading one of the world’s largest pathology organizations, his perspective is shaped by personal experience and a deep commitment to the profession.
We spoke to Zhai about the challenges facing pathology, the realities of adopting new technologies, and why he believes the field must become more visible to remain strong.
How did the challenges of moving from China to the US early in your career shape the leader you are today?
I came to the US with just two suitcases and $166 on a J-1 visa, but with determination and a strong passion for science.
It was not easy. I had to overcome barriers – language, culture, visa challenges, and sometimes discrimination. But those experiences taught me that you have to be persistent, strong, and clear about your goals. You have to keep going, even when the future is uncertain.
That mindset still shapes me today. I believe in working hard, thinking boldly, and planning for the obstacles ahead. My leadership philosophy is about connecting, inspiring, and embracing new ideas – but to do that, you also have to be bold.
What do you think are the biggest challenges currently facing pathology?
One is advocacy, especially around reimbursement and payment cuts. The cost of running a lab keeps going up, but physician payment keeps going down. That creates real pressure on laboratories, hospitals, and ultimately patient care.
Another major challenge is workforce shortage – not only pathologists, but lab staff as well. In my own lab, we do not have enough people, and that affects quality and efficiency.
The third is technology. We need to move forward with digital pathology and AI, but that requires validation, funding, training, and regulatory support. The technology is here, but using it well in real clinical practice is much more complex than developing it.
How do you think AI will reshape the role of the pathologist?
I am not worried that AI will replace pathologists anytime soon. What I do think is that pathologists who understand AI and know how to use it will replace those who ignore it.
The real issue is not the technology itself – it is validation and application. In medicine, we have to make sure tools are accurate, consistent, secure, and useful in real clinical settings.
AI can help reduce burden and improve efficiency, especially for repetitive tasks, but pathology still depends on expert judgment. I see AI as a tool that supports pathologists, not one that replaces them.
What do you think are the benefits of supporting international medical graduates and maintaining a diverse workforce in pathology?
Pathology has always attracted people with strong scientific and research backgrounds, and many international medical graduates come with that experience. The specialty aligns well with their training.
At the same time, the US healthcare system benefits greatly from international physicians. That diversity brings different perspectives and ultimately strengthens the profession.
From my own experience, I know how challenging it can be to adapt to a new country. But when given the opportunity, people contribute tremendously. It is a win–win.
You’ve said that pathologists are physicians, but are not always seen that way. Why do you think pathology is still misunderstood?
Traditionally, pathologists have worked behind the scenes. We focus on diagnosis and accuracy, and less on visibility. Because of that, people may not always see the direct connection between what we do and patient care.
But in reality, everything depends on pathology. Without an accurate diagnosis, you cannot treat a patient properly.
We are physicians, and we are central to medical decision-making. I think we need to do a better job of communicating that.
When you speak to policymakers, hospital leaders, or patients, what do you most want them to understand – not just about pathology, but about pathologists?
I want them to understand that pathology is essential to modern medicine. A hospital cannot function without a laboratory, and you cannot deliver care without accurate diagnostic information.
Pathologists may not always have direct contact with patients, but the information we provide determines what happens next.
I also often say that we are patients too. We go through the same healthcare system and rely on the same laboratories. Supporting pathology is not just about supporting a profession – it is about protecting patient care and ensuring quality across the system.
What is exciting you most about pathology right now?
The impact. Our work directly affects patient care – diagnosis, treatment, and outcomes.
What excites me is that we now have tools and knowledge we did not have before. With molecular pathology and precision medicine, we can guide more targeted therapies and make a real difference for patients.
What are your priorities for your presidency of CAP?
I hope to help CAP become stronger, more efficient, and more responsive to the needs of pathologists in practice. That includes continuing to focus on advocacy, lab quality, precision medicine, and the responsible adoption of new technology.
I also hope we will strengthen collaboration across organizations and continue building a healthy culture within CAP.
This is a critical time for the profession. I want to help lay a strong foundation for the future – one that keeps pathology central to patient care and helps the profession adapt and lead in the years ahead.
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