Plastic surgery at Stanford has had several weekend retreats and has concluded that the light directing our paths undeniably indicates that the P.S. training program should have one more year of intense education. The current 6-year program if extended will produce astounding super residents with the addition of one additional year. The plan is to insert a mini sabbatical year between the years 3 and 5 of residency. This magical 4th year will be to show the world that Stanford follows the tradition of being innovative, out of the box, ahead of its time and different. Stanford will include the value of international humanitarian surgery in the curriculum, along with the fantastic opportunities in basic research Microsurgery and cranial facial are part and parcel already. The Stanford super resident program is the best way to affect hundreds with new ideas and millions with great values.
The purpose of the Stanford seven year plastic surgery residency is to produce the best residency training program in the United States. The Stanford Plastic and Reconstructive Surgery (PRS) super residency will place the program at the high position: the most intense, the most comprehensive, the broadest in scope in many PRS training programs. Advanced teaching methodology (i.e. Educational Psychology) and completely new concepts in aesthetic surgery beckon the minds of “our sons and daughters” working in these seven years. They will be the next version of “trained killers” and super residents – the very best and very top. And why this lofty goal? Am I crazy? I would love to relate to you the inspiration for the Stanford Super Residency Program.
The first international case and the initial $500 investment from Robert A. Chase sparked a spontaneous growth of 54 residents performing 270 gratis cases per year in cleft lip and palate, burns, and hand surgery for those without access to care in developing countries. If each case is valued at $5,000, then the total amount of professional services donated by Stanford graduates is $1,350,000 per year; and for 20 years that comes out to an astounding sum of $27,000,000. There are 50 other organizations, such as the 20 Interplasts doing the same work simultaneously, which means an estimated total of $1.7 billion of professional services have been donated – the result of a multiplier effect related in some way to the initial $500 spark. Perhaps a $10,000 investment in the education of a “trained killer”*1 super resident is not a bad idea.
Since then, there have been 184 plastic surgeons trained at Stanford who have helped thousands of patients and have further impacted families and communities around the world. These surgeons are successors of a legacy bequeathed by our fore-bearers, beginning from our beloved founder, Leland Stanford. As an example of Stanford’s spirit, he was undeterred by critics in the trotting horse industry who labeled his 650 acre Palo Alto farm the “Stanford Circus,” Leland Stanford brought 200 brood mares for use in an intellectually-based breeding program to produce a champion trotting horse. He set to define what we now define as “entrepreneur “. He boldly stuck his head out of the box with an idea. As far as his close friends and colleagues were concerned, Stanford was careful to stay rooted in their political alliance and friendship. However, he did not yield to his critics and stuck to his avant-garde endeavor despite the bad press. Finally, he produced a world champion trotting horse, Electioneer; its bronze sculpture stands near the Stanford Medical Center.
When Stanford founded his university, he faced similar derision and skepticism from the Eastern Universities. The West coast was still considered primitive and uncivilized, but Stanford saw this new frontier ripe for innovation and unhampered by tradition. He purchased adjoining properties totaling more than 8,000 acres to build a pre-eminent academic institution – “a university for the children of California” – to psychologically replace the loss of his only child who died of typhoid fever at the age of 15. Similar to his successful horse breeding program, Stanford used a very out-of-the-box method of breeding for excellence: very top faculty, a most attractive location in the country, little regard for orthodoxy, and a clear vision without fear of change. The University produced Nobel Laureates who made immense contributions to a growing fund of technology: the laser, vacuum tube, chips and microchips, and DNA synthesis. It also spawned the idea of bringing a professor visionary into the market in as little as six months by synergizing the brilliant faculty inventor with a venture capitalist who furnished him with a patent, a building, personnel, and accounting. In other words, the response was to send “lawyers and money,” allowing faculty and students to start their own companies (i.e. Google, HP, etc.).
These are not merely features, they are big ideas – what I like to call transforming the basic ideas. We have to keep up with it. By inheriting the legacy and achievements of Leland Stanford, Nobel Prize winners and great contributors of our society, we must uphold the reputation of being out of the box, grounded in excellence, and dedicated to serving the greater good. And these are the thoughts and motivations which mandate the lofty goals mentioned.
Not only is a fantastic institution and a great method required to achieve greatness, but also great individual persons are vital. In fact, great persons are the most important building block in this story. My point is this: We have great persons within our group. A few who might belong in a mythical Stanford Plastic Surgery Hall of Fame: Drs. Knapp, Strauch, Ott, Pearl, Iverson and Dibbell who are products of the Stanford “combined” Residency Training Program demonstrate that good persons are as important as the other factors. Each of these persons, specializing in slightly different subspecialties of plastic surgery, is an outstanding example of excellence, service, and fearlessness in tackling world-size problems – a “trained killer”.
Although a real business-medicine synergy is an unrealized goal, many agree that business-medical synergy will benefit the USA and may be a key factor in both the economic and medical health of the nation. We have a good start toward this goal, right here among us in the form of TRK. Terry R. Knapp founded Collagen Corporation while still in the capacity of a brilliant resident in plastic surgery. He has repeatedly put the tip of the wedge into this massive goal of bridging medicine and business, and helping to solve the massive problems in each area.
TRK is an idea man. He thinks big. A real game changer. He invented injectable collagen, the original filler of tissue deficits – all the way from wrinkles to sphincters, which are vital to bodily function. All the while, TRK has participated in innumerable international humanitarian surgery adventures (many with me). He is the “complete” surgeon with left and right brain in full gear and with the good of others always at heart. His latest Magellan Global Health, an organization that provides anyone in the world with immediate medical access has been coming in the direction of all of us.
Dr. Ricard Ott was President Broward County Medical Association and leader of the medical response team during hurricane Andrew. He also organized physicians to confront the trial lawyers association by physicians going “bare” – ending malpractice insurance premiums, and organized and led Interplast Florida to its magnificent 10,000 cleft palate results in Florida. Ronald Iverson has been the president of every professional plastic surgery organization and is one of the best organizers I’ve known. Dr. Pearl is CEO of all of Northern California Kaiser Permanente. Dr. Strauch is the foremost expert in a new subspecialty of microsurgery, president of that medical association, editor of the Journal of Reconstructive Microsurgery, and inventor of a useful product using an electric current to enhance wound healing immediately after surgery. Dr. Dibbell is one of the world’s best academic heads of the Plastic and Reconstructive Surgery Department – courageous technically, a magician, and an artist. Each had a role model: Robert A. Chase, founder and mother of combined general and plastic surgery program at Stanford; Harry Buncke, a founder of microsurgery; Donald Laub, founder of Interplast, the Stanford Primary Care Associate Program, the Burn Unit, the Stanford Gender Dysphoria Program, and co-founder of the combined general and plastic surgery program. Each person was expert in slightly differing subspecialties, but all carried these characteristics for sucess: professional reputation with hardly a peer, expertise in administrative professional medical work, innovation in a fledgling subspecialty spawning a new product, and role model for an academic physician educator. Each contributed significantly.
Other “trained killers” selected from the original glory years and from the subsequent last 20 years are: Lars Vistnes, Steve Schendel, Rod Hentz and James Chang. All of these four horsemen* 2 came to Stanford with balls and brains. Their exploits earn them the title of “trained killers.” In fact, all 184 graduates of Stanford Plastic Surgery are “trained killers,” highly qualified as rated by the criteria of their times. They have all been programmed with a compass bearing pointed towards excellence and service and have directed themselves towards helping solve significant world problems – to the point of being scary.
But to keep the Stanford tradition alive, we need economic legs that will allow us to pursue big ideas. The economic legs consist of $10,000 dollars from each of you in 5 divided doses – my first installment of $2000 is forthwith delivered. This grant will be used for fundraising to raise 3 million dollars, which will be money used for the lucky residents, lectures and supplies.
The mini sabbatical means that this resident will obtain the very top training in the world in his chosen sub-specialty. An additional idea is that the resident be accompanied by a friend whom they meet as a colleague during an international humanitarian trip or research opportunity, leading to the best of both worlds – research and humanitarian – coming together. Perhaps the Chase lecturer, an endowed appointment, will be the contact point for the linkage. Thus, two colleagues will travel together and in future years use their influence in respective countries to reduce war-like tendencies. The wisdom of Stanford may catalyze the start of a friendship between two countries. (Everybody loves peace. And they like ice cream and motherhood too.)
In order to further propel our new program, there are some possible extramural source of funds: Michelle Obama, Baxter foundation and Melinda Gates. Here is the proposed Obama fellowship (Michelle Obama):
OBAMA NATIONAL SERVICE FELLOWSHIPS
Modeled after the original Physicians for Peace
Stanford Global Health Volunteers
- For the purpose of Service
- To promote academic careers useful in life
- to strengthen the country
- To grow peaceful relationships between countries not perfectly friendly
The idea is that the friendship formed between counterparts from two countries during an international health service project at an undergraduate level is a long lived one. The mutuality usually continues to grow through graduate school. At the postgraduate stage I propose that the pair enter this two year fellowship, working together with the parameters of advancing their young careers with their commitment to service and absolute excellence, and providing medical/surgical service for gratis in developing countries.
Working in both emerging countries and their own developed country, they grow. The project involves academic research, humanitarian service, exposure to the very best experts in their field of interest, and solving a problem that is significant at an international level. This will be a great opportunity to forge new friendships while giving one year of service or research in a developing country. They will gain favorable standing by virtue of their service, and be able to inspire a new generation of corps members. These lifelong friends will naturally be highly accomplished in their field of interest, and emerge as influential, leading citizens in their respective countries. Their friendship will set a favorable stage for peace between countries with difficult working relationships, as these friends work towards fostering peace, not war.
1* “Trained Killer” is neither the term of the Special Forces nor a secret organization of the government. Trailed killer merely means to get the job done. These persons would be the Lieutenant Colonel Rowen in the Letter to Garcia (qv).
2* Referring to the four horsemen in the back field of Knute Rockne’s innovative football scheme at Notre Dame. Grantland Rice of the Chicago Tribune coined the name “Four Horsemen of Notre Dame” for these four winning American football players: Harry Stuhldreher, Don Miller, Jim Crowley, and Elmer Layden.