• The Heed Ophthalmic Foundation and Post-residency Fellowship Training

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    Late in the fall of 1945, Thomas D. Heed, a prominent and wealthy Chicago businessman, appeared in the office of Derrick Vail Jr., MD, the chairman of the Ophthalmology Department at Northwestern University Medical School in Chicago.

    Heed told Dr. Vail that he would like to establish a foundation for the purpose of funding the post-graduate training of young, talented ophthalmologists.

    As Dr. Vail recalled, both Heed and his wife, Ruth, had a personal history of serious eye disease. As a young man, Heed endured several severe attacks of what has been interpreted as bilateral iritis. Years later his wife suffered a retinal detachment which was successfully repaired by Dr. Harry S. Gradle, a respected Chicago clinician and a leader in American ophthalmology.

    The manner in which these events played out was a remarkable coincidence. Heed describes in his own words his and his wife’s eye problems and the ensuing events.

    “I spent three months in a dark room when I was a boy of 19. At that time, I faced the possibility of complete blindness. A boy can do a lot of thinking in three months and I determined then that if I could ever do anything to prevent blindness, I would do it. Years later my wife suffered a detached retina, which resulted favorably after a desperate operation. The success of this operation was due to the experience, skill and devotion of one of the world’s great eye doctors, Dr. Harry S. Gradle. It was Dr. Gradle who told me that anything which helped the blind was praiseworthy, but that the vitally important thing was to prevent blindness. This, he said, could best be accomplished today by skillful and extensive eye surgery and eye research. He instituted the advances being made in detached retina operations, corneal transplants, removal of certain types of eye tumors, cataracts, etc. After conferences with leading eye surgeons in this country it was decided that the best line of approach was to provide fellowships for the most promising young eye doctors who had determined to spend their lives in eye work. To this end, the Heed Ophthalmic Foundation was established to provide advanced education and training for post-graduate eye studies for both men and women.”

    It is important to understand the history of residency training in ophthalmology and the situation in the 1940s. During the late 1800s and early 1900s, most physicians practicing ophthalmology in the United States had little or no specialty training. Some eye specialists established themselves by serving short periods of time with a practicing ophthalmologist, usually no longer than a year.

    Some general practitioners simply announced they were eye, ear, nose and throat specialists while others might have attended proprietary schools which provided several weeks or months of lectures. By 1937 in the United States, there were only eight residencies for eye training of three years or longer duration. At this time, the majority of residencies offered one or two years of mainly clinical training. The American Board of Ophthalmology was established in 1916 and the first examination was administered in 1917. This was the first attempt to establish standards for being recognized as an adequately trained and competent ophthalmologist.

    However, there were no accepted standards for residency education and clinical training. The Residency Review Committee was only established in 1956, and it still took many years before there was acceptance and implementation of the basic and clinical residency training requirements for ophthalmology. In the early 1940s, residency training still consisted of mainly observation with little or no basic ophthalmic education or personal “hands on” supervised surgical experience.

    In 1946, there were no post-residency fellowship programs and certainly no funds to support them. The Heed Ophthalmic Foundation (HOF) provided the first resource for not only the encouragement of post-residency training, but also funding for that training.

    With funding guaranteed by Heed and the advice of Dr. Derrick Vail Jr. and Dr. Hayward Post of St. Louis, the Heed Ophthalmic Foundation was incorporated as a private foundation in 1946. The articles of the trust agreement stipulated that the board of directors would consist of five members, three of whom at all times would be the heads of Eye Departments of Harvard Medical School, Columbia University College of Physicians & Surgeons, Johns Hopkins University School of Medicine, University of Pennsylvania School of Medicine, University of California Medical School, Washington University School of Medicine and Northwestern Medical School.

    The other two directors would be chosen from the membership of the American Ophthalmological Society. The original board of directors consisted of Dr. Vail as chairman; Dr. John Dunnington of Columbia University; Dr. R. Townley Paton, Manhattan Eye & Ear Infirmary; Dr. Frederick Cordes, University of California, San Francisco; and Dr. Hayward Post of St. Louis as secretary.

    The stated purpose of the Heed Trust was: “of furthering the education of and research by, promising men and women of exceptional ability who are citizens of the United States, who are graduates of approved medical schools, who desire to further their education in the field of diseases of the eye and eye surgery or desire to carry on research work and investigation in said field.”

    Fellowship candidates were required to conduct their training in the United States. Heed’s gift of $6,000 in 1946 funded the first fellowships.

    The five original directors of the HOF were all members of the American Ophthalmological Society (AOS). The AOS was the preeminent ophthalmological society in the United States beginning in 1864 and continuing through the 1940s. Subspecialty organizations did not exist and the main sources of post-graduate education were through the meetings of the American Academy of Ophthalmology, the American Ophthalmological Society and the AMA Section on Ophthalmology.

    In the early years, there was little awareness of the Heed fellowship opportunities and the first fellows were appointed from the Directors own residency programs and the fellowship training was held within the various Director’s departments. The early fellowships were limited in number and consisted of three rotations of two months duration at different institutions. The fellows were mainly observers in surgery and attended the institutional lectures and teaching rounds. The first fellowships were of six months duration with a monthly stipend of $200 and a small additional grant to cover travel expenses. The money to support the fellowships was provided by annual gifts from Thomas Heed and, following his death, from Ruth Heed. The early Board meetings were frequently held at the AOS meeting in Hot Springs, Virginia and at the annual Academy meeting in Chicago. Heed attended Board meetings held in Chicago.

    In 1957, Heed died. At that time, the balance in the Heed account was $18,879. Ruth Heed continued to provide annual gifts which totaled $20,000 per year. The monthly stipends had been increased to $350 per month in 1951. Ruth Heed died in 1964 and following the probate of Thomas and Ruth Heed’s estates, the HOF Trust was funded with a total of approximately $2,000,000.

    In the 1940s through the 1960s, the stipend provided by the Heed Foundation was the only monies received to support the fellow during his or her training. The Heed Fellowship stipend during these years had increased to $4,800 for a one year fellowship. However, by the 1990s, the institutional salaries for residents and fellows provided a living wage and the Heed Fellowship stipend became financially less meaningful. With this in mind, in 2005, the board of directors of the HOF designated the Heed Fellowship grant as a Merit Award with a stipend of $10,000. At that same time, the Board of directors established policy stating that there could be no reduction in institutional salary, benefits or overhead for the individual receiving this Merit Award. Prior to this policy, some institutions were reducing the fellows’ institutional compensation by the dollar amount provided by the HOF. This, in effect, meant that none of the Heed Fellowship monies directly benefited the Heed Fellow. This policy was put in place to insure that the Heed Fellowship monies were retained by the fellow without other modifications to their compensation.

    In 1958, former Heed Fellows established the Society of Heed Fellows (SOHF), an alumni group, which was subsequently incorporated as a charitable, scientific and educational foundation. The SOHF has raised monies to support the mission of the Heed Foundation and currently funds six of the average 24 Heed fellowships awarded annually. The SOHF also selects a former Heed fellow as the recipient of the Heed-Gutman Award which is presented at the Society’s annual luncheon meeting. Criteria for the award include evidence of major contributions to ophthalmology as a clinician, educator or investigator.

    In 2005, the Heed Foundation board of directors established a program known as the resident retreat. The purpose of the retreat is to acquaint talented residents nominated by their training program with the opportunities for a career in academic ophthalmology. The retreat brings together current university faculty with residents selected from programs around the country. During the informal sessions, residents are able to mingle with academic ophthalmologists and learn how young faculty members make the transition from trainee to clinician-scientist faculty.

    The retreat has rapidly become very popular and the AOS, Research to Prevent Blindness and the SOHF are current co-sponsors. Post-retreat surveys have shown that 70% of the resident attendees have an academic position as their first job.

    The history of the HOF tells how the personal eye afflictions suffered by Thomas and Ruth Heed resulted in the first post-graduate fellowship training opportunity in ophthalmology, an extraordinary program which has been and continues to be of benefit to ophthalmology, our patients and society. Over these past 74 years, the HOF has awarded 1,278 Heed Fellowships with a total funding of over $14 million.

    Additional information about the detailed history of the Heed Foundation, the SOHF, Heed Award recipients, and the roster of Heed Fellows may be found on the foundation’s website heed.org.