5 Questions with Natalie Hoepp, DVM, MS, DACVP

A conversation about vets in industry and what will improve diversity in the profession

Today I am introducing a new, mini-interview format called “5 Questions with ____” where I highlight people with interesting careers in veterinary medicine and science. There are several in the works right now, and I’m excited to feature more frequent, shorter, interviews in the coming months.

Dr. Natalie Hoepp is a veterinary clinical pathologist who has worked in academia, corporate and start-up diagnostic labs, and now the pharmaceutical industry. Natalie and I have known each other since the beginning of my residency and we often learned from each other’s experiences through our mutually wandering career stops. In these questions, we discuss that journey, what veterinarians do in drug companies, and what might improve the diversity of the profession. This conversation was conducted through email and lightly edited.

I hope you enjoy!

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1. You have had such a wonderfully diverse career—you’ve worked as a diagnostic pathologist at IDEXX, a faculty member at the University of Pennsylvania, veterinary medical director at Scopio Labs, and now drug safety clinical pathologist at Merck. Can you tell me about your journey and how you’ve found your way in the pathology world? What would you tell someone early in their career that doesn’t feel like they’ve been able to find their niche?

First, don’t cave into self-doubt or rigid thinking while you are exploring different paths. If I had done either, none of my experiences would be on my CV. When I became a technician, I chose to do an equine internship to complete my degree. I had zero horse experience outside of being thrown off a pony as a kid. Significant self-doubt would have been a reasonable response and really there was no need for me to consider this option if I were following the standard companion animal trajectory. But I was curious and open (naïve, no doubt). The internship was at a large equine referral practice and my only skill on arrival was awkwardly haltering a horse. However, in every setting, there are people who will help you, mentor you, willingly be part of your success if you seek them out and open your ears. They are your teachers and allies when you are finding your niche. Show up and be a willing student. My residency supervisor, for example, often commented that cytology evaluation is a learned skill. The underlying message was “relax, you can learn this.” I had spent too long thinking that innate skill was required for everything. I did not think I was smart enough to be a veterinarian, so I wasn’t pursuing that option. I thought I had to meet the naturally-smart bar or I couldn’t learn the skills successfully. When I eventually left the equine practice for a university teaching hospital, the 3^rd and 4^th year veterinary students pushed me past that nonsense. As anyone who has taught knows, sometimes the students are right.

Second, be patient. My first job in a veterinary clinic was as a receptionist. That was in 1999. I became a boarded clinical pathologist in 2014. A solid 15-year stretch. I started as a vet tech in small animal general practice, moved on to ER, switched to large animal referral, then finally went to veterinary school at the age of 30. In the clinical pathology world, I was “early career” at the age of 40. I am not suggesting anyone needs to meander around like I did, but I have no regrets and at least for me, not rushing really served me from an experience standpoint. I have applied knowledge from every career stop to my current role. In veterinary medicine, the idea that you may not use information or experience because you are aiming for some specific area of practice is a myth. My success in finding my niche is strongly rooted in having worked with so many people in so many environments. Building up an understanding of workplace dynamics, as well as your own ability to be a decent human under stressful circumstances, takes time. Perhaps it took me longer than most!

“Every stop in between was critical to my personal development. I have no regrets.”

So that was how it started, and industry clinical pathology is how it’s going. Every stop in between was critical to my personal development. I have no regrets. I have found my niche and it I love it here!

2. Many people don’t realize that vets, let alone veterinary pathologists, work in the pharmaceutical and biotech industries. How do veterinary pathologists—especially clinical pathologists—contribute to drug development and safety testing?

I think that disconnect partly stems from the basic phases of drug development not being represented in any manner in our training, whether it is veterinary school or residency, and let’s be honest, those of us who go into industry do not typically return to academia where we can share this information with trainees. When a compound is being developed into a marketed drug, it goes through three major phases, discovery, preclinical/nonclinical, and clinical. These phases can overlap and there are phases within the phases, but broadly speaking, veterinary pathologists live in the nonclinical space. Depending on the setting, we certainly may venture into the others. Once a compound has checked the necessary boxes in discovery and is identified as a good drug candidate, it moves forward to nonclinical toxicity evaluation, or “safety assessment.” This is a regulatory requirement that includes animal models and the evaluation of tissues (anatomic pathology) and biomarkers (clinical pathology). Check out these resources on the steps of the drug development process from the FDA.

A veterinary pathologist may be in a large pharmaceutical company, a biotech/biopharma, or a contract research organization (CRO). There are other options, but those tend to be the big three. I am going to lump pharma and biotech together here for ease and say these are the “drug developers”. At a CRO, studies are often conducted for the drug developers. A pathologist at a CRO is evaluating studies for external companies, which creates a large variety of study design and compound experience. However, some drug developers conduct required studies internally and employ veterinary pathologists directly. These are usually the larger pharmaceutical companies, but not always, and companies can do their studies both internally and externally, often out of necessity to complete the work in a timely manner. The CRO setting has grown significantly in the last 10-20 years and employs many veterinary pathologists who no doubt can speak to it better than I can. In my current role, I am very fortunate to participate as a subject matter expert across the drug development pipeline, including when issues arise or a scientific question needs to be answered or investigated.

3. Can you walk me through a typical week in your role?

A typical week for me includes meetings to discuss studies and findings with clinical and anatomic pathologists, as well as with scientists across functional areas that are participating in compound management, from chemists to physicians. I review clinical pathology data for studies and provide reports that will eventually be incorporated into the FDA submission. These reports have a different format and interpretative approach than diagnostic reports, but in industry, you often learn how to do the work on arrival, not before. You have the pathology knowledge in place, but will need the learned skill of interpreting and reporting nonclinical toxicology studies. Most employers understand where you are starting out and provide the training. Be cautious about settings where you won’t have a potential mentor or other pathologists to interact with directly. I also work with the amazing scientists in our clinical pathology laboratory during the week. My days can be routine, performing study evaluations and attending meetings, or can include answering a question from a regulatory authority in another country or an FDA inspection. You never know!

4. Veterinary medicine—and pathology—has a problem with diversity. More women are entering the field, but we still see far fewer of them are making tenure or full professor rank at universities compared to men, and they comprise a small fraction of senior leadership positions across sectors ranging from non-profits to large corporations. The stats are even more appalling for men and women of color. What are some of the barriers and structural factors that contribute to this disparity? How can we improve this situation?

I consider time a large barrier, which is a mundane and disappointing answer, but when I think about people at or nearing retirement age currently, they often entered the workforce in the mid to late 1980s. Look at American popular culture when they were laying the foundation of their workplace experience. Jane Fonda, Dolly Parton, and Lily Tomlin in the movie “9 to 5” were representing women in the workplace in their roles as secretaries, a word we don’t even use anymore. Do we still have sexist, egotistical, lying, hypocritical bigots like Mr. Hart in management? Yes, perhaps just not as overtly, but my hope is that we have fewer and fewer of them. 

In reference to veterinary medicine, I worked with a female surgeon who was asked during her vet school interview what business she thought a woman had applying to vet school. In other words, I overlapped in the workforce with a woman who had that experience, which was so different than my own.

“I worked with a surgeon who was asked during her vet school interview what business she thought a woman had applying to vet school.”

While the media often focuses on millennials and younger generations in the workplace, depending where you are, they may not be the majority. Their generational inclusivity has not moved all the way up the ladder. Yet. Despite the glacial pace of generational change and all the setbacks of late, particularly when it comes to treatment of people of color and gender identity, I believe we continue to move forward.

5. I love giving people suggestions to indulge their curiosity and learn something new. What are three things you’d recommend to the audience, and why? These can be books, podcasts, movies, anything!

Everyone has told me to read “Lessons in Chemistry” by Bonnie Garmus. I actually had a colleague drop her copy on my desk for me to borrow. It looks like the themes will be relevant to this discussion and most importantly, it includes rowing. This is the real reason everyone suggests it to me. There is an excerpt from the book that discusses a character named Calvin, noting that “Worst of all, he was a rower.” The subsequent description of all that is obnoxious about rowers is completely accurate. I plan to start this book tonight, but probably won’t get too far because I rowed for about four hours today and plan to do the same tomorrow. We’re the worst.

I listen to the podcast “We Can Do Hard Things” with Glennon Doyle when I am at the microscope. Definitely targeted at my demographic and not for everyone. Glennon Doyle, Abby Wambach, and Amanda Doyle are the hosts. They have great guests, really interesting life experiences, and generally it just clicks for me.

I’d love to mislead people into thinking that outside of work, I am intellectually curious and always trying to learn new things, but I am here to make people feel better about their consumption of mindless entertainment. I shamelessly watch trashy TV, the kind you don’t recommend in a public post, and recommend turning your brain off as needed.

Thanks to Natalie for her time and insight! Do you have any questions or comments? Leave a message below 👇