Surgical Education in the United States: Navigating the White Waters

Members of the American Surgical Association, honored guests, ladies and gentlemen: I want to thank you all for coming to Boston in record numbers to attend the 126th Annual Meeting of our organization and for choosing to share your time with me this morning. Delivering this address as the president of the oldest and most prestigious organization of surgeons in the United States is a great privilege. Being surrounded by so many personal friends and colleagues makes it all that more meaningful. I remember vividly when, at the meeting in San Diego some 7 years ago, I received a call from Dr. Frank Spencer, who, on behalf of the nominating committee, told me I was going to be proposed as the new secretary. Knowing as I did that there was no paucity of qualified members for the job, I was surprised and I was deeply humbled. Becoming president, while not entirely a surprise, was still an unbelievable experience. Having now had some years to reflect on this fact, I have moved away from thinking that this was merely an accident in the history of the American Surgical Association. Indeed, as shown by those who have served in this position in the last few years, I believe this reflects a deliberate and courageous decision on the part of the American Surgical Association to incorporate in its leadership individuals with the most diverse backgrounds and ideas. Regardless, I consider myself extremely fortunate for the opportunity to serve in this capacity, and I thank you for the honor you have bestowed on me. I have often said that, to be happy and productive, a person needs to have a personal anchor. Like ships, human beings need to have something that keeps them steady, something that keeps them upside up when life becomes rocky. I am fortunate to have Kelly, my wife, who while attending to her career has always found the time and the energy to provide me with my personal anchor. Her love and support have been instrumental in getting me here, and I thank her from the bottom of my heart. I cannot speak of my good fortune without recognizing the fact that my own father is here today in the audience. He and my mother, both physicians in a small town in Argentina, were my role models through their service to the community and provided me and my sister with the inspiration to go into medicine. His presence along with that of other members of my family is precious to me. I was also fortunate to have had great mentors, and there is no better time than this to express my appreciation to them. Professor Juan Acosta, the architect of the theory that explains the pathogenesis of acute biliary pancreatitis and an honorary member of this organization, took me under his wing shortly after I graduated from medical school. He introduced me to the field of clinical research and, more importantly, to the fact that limited resources can be overcome with intelligence, hard work, and perseverance. My coming to this country was in great part facilitated by Dr. David Skinner, who introduced me to the field of esophagology and, more importantly, to academic surgery in the United States. Were he alive, he would have been proud of my position today. It was while working with Dr. Skinner that I had the good fortune to meet his own protégé, Dr. Tom DeMeester. It was Tom who launched me into the study of esophageal physiology, the one who taught me how to set up a productive laboratory and who spent countless hours teaching me how to speak in public. Our professional relationship extended far into our personal lives, and I have much to thank him for. During the 15 years spent at the University of California San Francisco, I was “adopted” professionally by Lawrence Way, one of the leading surgical gastroenterologists in America and a previous vice-president of the American Surgical. He taught me how to operate on difficult patients, and he tried his very best to transfer to me his unique ability to write clearly and concisely. I also had the privilege of working with Haile Debas, a previous president of the American Surgical, who has proved that a surgeon can be a leading scientist, a great educator, and an influential member of the global community. Each one of these individuals has helped shape my life and each has helped me reach the next step in my professional life. I am profoundly thankful to them as I am to my former fellows and residents, who have given meaning to my academic life, and to my extended family: the faculty and staff of the Department of Surgery at the University of Washington. I have been blessed to be associated with you all.