• Serendipity and Service

    I have been asked to write about myself because I had the honor of receiving the Laureate Award from the AAO last November 2015. With an open agenda, I thought I would share something of the often serendipitous 61 years I have traveled through ophthalmology.

    How I wound up in medicine

    The mother of my best friend in high school, who was a nurse, was absolutely hell-bent on her little Billy becoming a doctor. I had no ideas of my own, and that seemed like a very good option. So I followed Billy and two other close pals into pre-med as we entered college and later went onto medical school.

    …and then became an ophthalmologist

    The summer before I entered the University of Iowa medical school, I worked as a section hand laying new rail track and I had a nearly fatal railroad accident. In addition to some fractures, I also had an eye injury that no one in Cedar Rapids, Iowa could figure out. Soon after entering medical school, I got an appointment in the eye department with a faculty member, who said “I have no idea what you have, but do you need a job?” Phil Ellis, subsequently Chief at Colorado, took me across the hall and introduced me to Herman Burian, a European who was a noted strabismologist and electrophysiologist. I began doing electroretinography in 1955 and have been involved with ophthalmology since.

    My interest in global health

    After I entered the United States Army in 1964, following my residency deferment by the Berry Plan, I was sent to Fort Polk, Louisiana. There was no equipment, no hospital and no need for an ophthalmologist, as it was a training center. I complained bitterly to the assignment officer for ophthalmologists, beginning my letter, “Dear Sir, you are in dereliction of your duty.” I wanted to make sure he read the entire letter, during which I made the same statements plus a horrendous boast that I was the best trained ophthalmologist in the Army, and they were not utilizing my skills appropriately. Based on this immature and undoubtedly inaccurate challenge, I was sent to Fort Dix, New Jersey, which actually did have instruments, a hospital and even elevators. BUT, soon after, guess who was the first ophthalmologist sent to Vietnam? 

    Vietnam was the most intense and greatest learning year of my life, particularly understanding myself. Besides becoming the triage officer for the 85th Evacuation hospital, I was the first ophthalmologist for 1100 lepers nearby Qui Nhon, South Vietnam. This year in South Vietnam left me with an understanding of developing countries needing ophthalmic care and physician education, a Bronze Star and a career dilemma.

    A pivot to medical education

    Not being sure I wanted academic medicine, I returned to the faculty at the University of Iowa to test this career direction and rapidly realized that those in academia need a niche to identify them in their ongoing careers. There were many subspecialties that I liked, and just as many that I did not. I observed my more senior faculty and realized that they were magnificent preceptors, but not really educators. I then focused on medical education and obtained a Master’s degree in medical education at the University of Illinois, traveling weekly to Urbana and Chicago while maintaining an RO1 grant. I believe I was the first ophthalmologist to obtain an M.Ed. While not truly serendipitous, this was considered a bit crazy and unusual by all but me.

    How I (and the newly formed AAO) ended up in San Francisco

    In 1971, I felt I needed to test the world outside the cocoon of Iowa City. There were some marvelous opportunities in various places, but I selected Chairmanship of a small but historic residency program in San Francisco. This program was the oldest residency program in the West, having started in 1873. It is now California Pacific Medical Center (CPMC). Again, while not completely serendipitous, it was risk-taking and unusual. As the American Academy of Ophthalmology and Otolaryngology divided into two organizations, it was clear that the new American Academy of Ophthalmology would need a CEO. This was the only time in my life I applied for a job and was lucky enough to receive it. This was a non-serendipitous event that was a tremendous 17-year experience. Living in San Francisco, I moved the new AAO to my city from Rochester, Minnesota. At the same time, I had been appointed as President and CEO of CPMC. It was a challenging time balancing the direction of two evolving organizations while continuing to practice ophthalmology.

    Introduction to ophthalmology’s global stage

    In 1982, Ed Maumenee became President of the International Council of Ophthalmology. He found the Council to be occupied by very senior, quite passive ophthalmologists and wanted a younger group to stimulate a seemingly moribund board. Ed appointed me Chairman of this junior ICO. Thus began in 1985, my 33 year relationship with the ICO, during which time I served 12 years as Secretary General, 8 years as President and will end in 2018 when my service on the Board is completed.

    Expanding my management horizon

    I was traveling 46 weekends a year as CEO of the AAO and during the week, serving also as CEO of CPMC and a hospital system (California Healthcare System). I have an observation that a CEO institutionalizes his/her errors after 7 years, and doubles them after 14 years. Having been 17 years in the first two roles, I needed to make a decision to pursue one or the other. Out of the blue, an offer came to develop a hospital system in Chicago, related to Northwestern University, which I accepted. After five years in Chicago, I was recruited to New York as CEO at the combined Columbia and Cornell clinical medical school faculty for a five-year period. At that point, having options to live in New York, Washington, Chicago or San Francisco, my wife Amanda and I selected San Francisco, where we have lived to this day.

    Lessons learned and my leadership philosophy

    Being an educator by training but later assuming various management roles, though I never had any formal management training, has afforded me a continuous learning experience. Management requires common sense, liking people, and a great support team. I have served as a CEO for 73 aggregate years and have developed my own philosophies.

    Today I am not sure I would have been afforded so many opportunities for on-the-job training. Always be open to a new idea or new challenge Your family, contemporaries, colleagues and students will lead you in a helpful manner. Recruit people better and brighter than you are, entice them and trust them, give them true responsibility and authority. They will make you better and more successful than you could be alone.

    Don’t burn bridges or hold a grudge

    Don’t be afraid to take on a task or committee or activity – and especially one that others believe is impossible – if you understand a way to success. These are breakthrough opportunities for career development. Try to understand yourself and don’t assume roles that are not a fit for your talent, knowledge or interests. Be grateful for what comes and be happily astounded by good fortune in health and service. Always count your blessings!

    My years in ophthalmology have been blessed in so many ways, including wonderful children and grandchildren, an unbelievably supportive wife, marvelous opportunities, spectacular friendships, inspiring mentors, seemingly grateful trainees, more travel than wise, and an idyllic specialty in which to work. I consider myself one of the very luckiest people.

    Still active

    My wonderful journey through ophthalmology is not completed. Back in San Francisco, I have become Chairman of Pacific Vision Foundation. Our commitment is to develop a new Eye Institute, including the CPMC Residency Program, based on many tenets of the Aravind Eye Care system. This is focused on providing a major amount of uncompensated care. We will open the first phase in August of 2016 and while a challenge, it is an exciting and unique venture in the United States. I am certain many of you have lived a serendipitous life experience. I hope yours has been as rewarding as mine.

    Thank you Ophthalmology!

    For more stories from Scope, download the summer Scope 2016 [PDF].