The Laureate Award is the Academy’s highest honor, recognizing an individual who has made an extraordinary and lasting contribution to the profession of ophthalmology. In addition to a distinguished career as an oculoplastic surgeon and professor of ophthalmology at the Mayo Clinic in Rochester, Minnesota, the 2020 recipient, George B. Bartley, MD, is widely known for his past and present leadership roles in many organizations. Among these are chief executive officer (CEO) of the American Board of Ophthalmology (ABO), CEO Emeritus of the Mayo Clinic in Florida, former editor-in-chief of Ophthalmology, past president of the American Ophthalmological Society, and member of the Foundation Advisory Board of the American Academy of Ophthalmology. Less known is the personal history behind these achievements. EyeNet spoke with Dr. Bartley to learn more about the influences and experiences that helped guide him to the summit of his profession.
Turning Points and Inspirations
What drew you to ophthalmology and to oculoplastics in particular? I entered university thinking I would major in psychology but, like most freshmen, really had no idea. I left school after that year to play in a jazz-rock band and spent the next 18 months traveling to 20 countries. During that time I crossed paths with several interesting physicians, in Eastern Europe and South Africa in particular, who seemed happy and challenged by their work. So, when I returned to school, I pursued a premed curriculum with a major in zoology and with minors in Chinese and religion. Once in medical school I knew early on that I wanted to be a surgeon, in either plastic surgery or neurosurgery. Then, on an ophthalmology rotation, I remember looking through a slit lamp for the first time and being entranced by the beauty of the eye. When I found out that there was a subspecialty that combined ophthalmology and plastic surgery, and even crossed paths with neurosurgery, the die was cast.
What were some important turning points in your life, education, or career? Who particularly inspired you? Life is indeed all about relationships, and it is amazing how events and conversations that, at the time, seemed unimportant turn out to have major influences on the vectors of our life. As a young boy, I was fortunate to get involved with a Boy Scout troop led by a dedicated Scoutmaster. He stressed advancement, and it was through scouting that I first appreciated the gratification of achieving a goal through hard work. In medical school, I remember scrubbing in with a cardiothoracic surgeon who was taking care of a patient with a gunshot wound to the chest. I was responsible for holding a sucker and was doing my best to keep a significant amount of bleeding out of the field. In the middle of the operation, the surgeon stopped, turned to me, and said, “You really enjoy this, don’t you?” I very much doubt that he would recall that comment, but for me it was affirming.
When I went to Mayo Clinic for residency, I was fortunate to have many outstanding role models. The most influential, in alphabetical order, are the late Richard Brubaker, who was astonishingly brilliant and could have had any job at Mayo, but he preferred to do his glaucoma research and take care of patients, on his terms; the late Jean Campbell, who taught me the little pathology I know and, although she had no children of her own, taught me a lot about being a parent; the late Thomas Kearns—who, by the way, served as Academy president in 1986—who described the first mitochondrial myopathy (Kearns-Sayre syndrome) and the retinal findings of carotid occlusive disease, using just a direct ophthalmoscope; and Robert Waller, who is probably the most beloved and revered physician I’ve ever met, a wonderful oculoplastic surgeon, former Mayo Clinic CEO, and a mentor to many. Outside of Mayo, I have dozens of role models but have been particularly inspired by Dan Albert, who knows everything about everything, has written about everything, yet is amazingly humble; Bruce Spivey, who has contributed so much to ophthalmology and to medicine and, in his mid-80s, is sharp as a tack and is often the first person to see something interesting and email it to me; and Brad Straatsma, whose equanimity and leadership style I have tried (usually without success) to emulate.
Achievements and Challenges
What do you consider your most important contributions in ophthalmology or medicine? Thus far, my most significant contributions have probably been outside of our specialty through my leadership roles at Mayo Clinic and particularly as CEO of Mayo Clinic in Florida. We had five major objectives during my tour of duty there, but the most important was to build a hospital on our campus and to integrate it with the practice (which included the busiest liver transplant program in the United States) and our research and educational activities. Our team built the hospital on time and on budget. Opened in 2008, it is now consistently ranked as either the top or one of the top hospitals in the state. Since it was built to withstand a Category 5 hurricane, the hospital should be there in 100 years; and given how many patients it has served and will serve, I feel privileged to have played a role in that project. In ophthalmology, my primary self-identity is as a surgeon, and I love the interactions with my patients. A busy clinical practice provides lots of opportunities for teaching and research, and I hope that my work on thyroid eye disease in particular has been useful. But I have enjoyed learning about and writing about a fairly wide range of topics over the past four decades. My first publication was a case report in the New England Journal of Medicine as a medical student about fenugreek ingestion mimicking maple syrup urine disease in a newborn—about as far from ophthalmology as one can get!
What were some challenges in achieving those contributions? Not enough time! Mayo Clinic provides little protected time for scholarly activities unless extramurally funded, so pretty much all of my research has been conducted and papers have been written during evenings and weekends. On the other hand, the weather in Minnesota is conducive to such activities for about six months of the year. Also, when one is appointed department chair, which happened unexpectedly to me at age 36, one is expected to continue leading by example, so administrative duties typically are done during interstitial time between patients.
You have been deeply involved in journals, especially as editor-in-chief of Ophthalmology and Ophthalmic Plastic and Reconstructive Surgery. What were some of your experiences in publishing? Working with journals has been a delight and, of course, a wonderful learning opportunity, not only about the science but also about the authors. In the 1990s I was on the editorial board of both the American Journal of Ophthalmology and Ophthalmology, as well as doing at least one review per week for Plastic and Reconstructive Surgery, the journal of note in that field. I also served on the Archives of Ophthalmology editorial board. So during these times, there wasn’t a lot being published in oculoplastics that I wasn’t seeing in its original form. When it was time for Andy Schachat to conclude his term as editor-in-chief of Ophthalmology, I was honored to be asked to throw my hat in the ring, although I made it clear to the search committee that as an oculoplastic surgeon who had just spent several years as essentially a full-time administrator, I really didn’t know much about the eye. Nevertheless, I somehow got the job, and it was the most fun job I’ve ever had. It was a pleasure to work closely with razor-sharp people like Andy and Henry Jampel; and Academy Vice President for Education Dale Fajardo, Executive Editor May Piotrowski, and the journal staff are tops. Of course, I learned a lot in a hurry about contemporary ophthalmic research. It was a seven-day-per-week job, and every single day something came through the inbox that gave me pause—sometimes an amazingly brilliant idea and sometimes something completely nutty or, worse, potentially harmful to patients. But the greatest privilege was working with authors and reviewers and our fantastic editorial board—there are some incredibly smart people out there, which bodes well for ophthalmology’s future.
ABO: Past, Present and, Future
Have you made any substantial changes at the ABO? What are your thoughts on future directions in board certification? The ABO was founded in 1916, and some might argue that we have made more changes in the past few years than in our first century. And the emphasis here is “we.” The directors of the Board, along with approximately 500 examiners and volunteers, are intensely mission driven, taking on significant amounts of work to serve both the public (the primary stakeholder) and the profession (through which the public is served). Several years ago, my predecessor, John Clarkson and the superb ABO office staff began seeking information from the Board’s diplomates about how the ABO could better achieve its mission. These great suggestions helped inform some of the directions we have taken, such as sunsetting the decennial DOCK examination for Maintenance of Certification and replacing it with a less burdensome longitudinal assessment program, Quarterly Questions. We are committed to transparency in our policies, procedures, and finances, information about which is readily available on our website. We have established liaisons with all of the major ophthalmic subspecialty groups as well as interest groups such as the Young Ophthalmologists. We want to keep our fees as low as possible (and they already are below the median compared with other certifying boards), so we have looked for ways to cut costs, for instance, by transitioning in 2018 from a physical office to a virtual office model. This turned out to serve us well when the COVID-19 pandemic hit last year, as we were able to continue operations seamlessly. But the pandemic forced us to cancel the 2020 oral exam. After we did so, hundreds of dedicated volunteers worked with the ABO staff to administer the exam online. This was new territory for any certifying board. As regards the future, I am concerned that not enough physicians appreciate that society has given us the extraordinary privilege of professional self-regulation. It would be so easy for that privilege to be subsumed by the government or some other entity, which in my opinion would not be a step forward for the typical overworked practicing physician. So there is plenty of work to do, and we really cannot afford to fail.
Thoughts for Young Ophthalmologists
Is there any advice you’d like to give to those starting out in their training or career in ophthalmology now? I would encourage young people to pursue the broadest range of experience possible, outside of medicine, such as working odd jobs. I was a night janitor for a while. Cleaning restrooms at 3 a.m. is an educational experience. I also spent a summer working as a foreman in a General Motors plant. By rule, I couldn’t operate any of the machinery, so I learned a lot about the importance of working with the line workers to achieve our daily production quotas. Very helpful training for being a department chair or a CEO or medical school dean. Once people match into their ophthalmology residency and then fellowship, I encourage them to keep in touch with general medicine, for instance, by at least perusing the New England Journal of Medicine and JAMA each week. Ophthalmology is ridiculously interesting, but it is easy to get far down a sub-sub-subspecialty path very quickly.
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