Profiles in ACS leadership: A few questions for Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon)

Editor’s note: The Bulletin of the American College of Surgeons is publishing a monthly series of articles profiling leaders of the College. The questions are intended to give readers a look at the person behind the surgical mask and to inspire other members of the College to consider taking on leadership positions within the organization and the institutions where they practice.

For this month’s profile in American College of Surgeons (ACS) leadership, we interviewed Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon), Vice-Chair, ACS Board of Regents, and Director, Digestive Disease Center, Cleveland Clinic Florida, Weston.

Why did you choose to become a surgeon?

I think it had to do with a few experiences as a very young child: one, my grandmother, who had a heart attack and passed away, and two, my sister, who developed a very high fever requiring emergency hospitalization. Those two medical encounters that I witnessed made me realize that I wanted to go into medicine, in a field that would allow me to quickly intercede to help people. I don’t know that I realized at that young age that surgery was necessarily the best way to do that, but it became apparent as I learned more about medicine that in my opinion it was the attractive way. I came to that realization if not in elementary school, in junior high school, for sure. I knew that I wanted to be a doctor as a very young child, and not too many years later I wanted to be a surgeon.

What about colorectal surgery specifically interested you?

At the time I was a general surgery resident, I found a couple of things very appealing. One was the variations in patients—young patients, old patients. Second, the variation in procedures, ranging from big abdominal operations to minor anorectal operations—the ability to do endoscopic procedures, dealing with diseases that were both benign and malignant. It could be hemorrhoids or could be colon cancer. All of those things interested me.

Lastly, I found it to be a nice group of people. Rick Brabbee, MD, and Thomas Dailey, MD, started bringing me to meetings when I was a general surgery resident, and I found those meetings to be populated by a warm, welcoming group of people. They were very friendly and encouraging. I found working in an environment where you really like your colleagues to be a very logical thing to do.

Describe your journey to becoming Vice-Chair of the Board of Regents.

I was involved in many activities at the ACS. I was active in the South Florida Chapter of the ACS, including being Chapter President for two terms—a total of four years. I was an ACS Governor for six years. I served on the Advisory Council for Colon and Rectal Surgery and, subsequently, as Chair of the Advisory Council for Colon and Rectal Surgery. I was involved in the Video-Based Education Committee. I was involved in the very early days of the ACS Oncology Group (ACOSOG, now known as the Alliance), and many other groups within the College. I submitted work on colon-rectal surgery and was called on to speak at or to moderate sessions at the ACS Clinical Congress. So, I’ve been very involved with the ACS since the beginning of my practice almost 35 years ago.

How did you get involved in these activities? What drew you to them?

The surgeon who recruited me to Cleveland Clinic Florida, my late partner David Jagelman, MD, FACS, was an Englishman and a wonderful mentor, who, unfortunately, passed away my fifth year in practice in 1993. He was involved with the ACS, but not in a leadership position. I kind of got involved on my own, almost from the beginning.

What interested me in the College was the ability to interact with surgeons in all different specialties. What struck me, as it still does to this day as Vice-Chair of the Board of Regents, is that the College represents the entire House of Surgery. I was involved in my specialty societies, including serving as President of the American Society of Colon and Rectal Surgeons and President of the American Board of Colon and Rectal Surgery—wonderful groups, but all colon-rectal surgeons. I was President of SAGES (the Society of American Gastrointestinal and Endoscopic Surgeons). It’s all of general surgery but not all of surgery. I recognized pretty early on in my career that the ACS represented all of surgery—neurosurgery, orthopaedic surgery, ophthalmologic surgery, gynecologic surgery, and so on and so forth.

The best way in my mind to really offer benefits to our patients is by working together for the common good, learning from each other—a lot of cross pollination, which single-specialty societies don’t afford. In addition, it struck me even at that time more than 30 years ago that the College had wonderful resources for developing educational and quality programs, such as the Commission on Cancer (CoC), and now I’m on the Executive Committee of the CoC and the founding Chair of the National Accreditation Program for Rectal Cancer (NAPRC). So, the resources of the ACS seemed very different than those of other societies. Again, the College seemed like it had great opportunities to improve patient outcomes by working within the context of this very established, very broad-reaching organization, touching all facets of surgery in a well-organized manner.

Who have been your mentors along the way, and what did you learn from them that you apply on a daily basis?

I definitely was privileged to have mentors within colon-rectal surgery. The first would have been Drs. Dailey and Brabbee. They’re both retired colon-rectal surgeons, but in my years of training in general surgery at Roosevelt Hospital, New York, NY, they’re the ones who got me interested in colon-rectal surgery. I decided to be a physician when I probably was five years old and to be a surgeon certainly by the time I was 15, but not until I was in general surgery residency did I decide that I wanted to be a colorectal surgeon, and that’s when I met Drs. Dailey and Brabbee. I had two more major mentors after that. One was Stanley Goldberg, MD, FACS, who is very active in the ACS, and the other is Richard John (“Bill”) Heald, MD, FACS(Hon). I would say that Stan Goldberg, Bill Heald, and David Jagelman were my main mentors in colorectal surgery.

What I learned from them is to always work with anyone who wants to be mentored. Always find the time to help them with their careers. They helped me, and I learned willingness to engage, their passion for surgery, their incredible devotion to teaching. I’ve tried to perpetuate those legacies. I think those are attributes that don’t relate to surgical technique but that correlate with being a leader. Listen to people, work with people, help people, and your passion will affect those around you. Like anything else in life, if you love what you do, you will have a much better chance of being good at it than if you don’t love what you do. Those gentlemen loved what they did, and I love what I do. They taught me to harness my passion and how to focus my enthusiasm to try to help other people have those same experiences.

The best leadership is leading by example, so residents see me with patients, they see how hard I work, and they see the volume of work I do and the outcomes of that work. They see my multifaceted interest in research, in teaching, in critical care, in leadership, and in administration. Leading by example is the best way to do it. It’s not so much what you tell them, but it’s showing them how you do what you do.

However, a level of mentorship and sponsorship that didn’t exist when I was first in training now does. Social media has provided me with the opportunity to interact with people around the world and to help them with their careers—collaborating on studies, offering them advice, giving them counsel. Many of these people with whom I’ve interacted have subsequently come to spend time with me to observe what I do in the clinic or invited me to visit them and speak at their meetings. Those types of mentorship and sponsorship opportunities did not exist before this current era. It was always one-on-one teaching or group teaching.

Now, with the coronavirus 2019 (COVID-19) pandemic, we’ve got the whole dimension of videoconferencing, virtual meetings, and webinars. So, for example, now when a surgeon anywhere in the world wants to have international faculty at their meeting, they can do so at much less expense than if they had to pay for travel, and we can help them by participating as faculty in their virtual meetings. At least once every week, I’m moderating and/or speaking at a meeting in some part of the world—whether it’s Asia, Latin America, Africa, the Middle East, Australasia, North America, Europe. This electronic era has enabled a whole other level—multiple levels—of sponsorship, teaching, and helping people with their careers.

What hobbies or interests do you have outside of surgery?

I try to take care of myself with physical activity—bicycle riding, walking, and working out in the gym. I enjoy eating out, eating good meals. I am happy spending time with my friends, many of whom are in walks of life very remote to medicine. I think that these frequent interactions with people in myriad occupations from diverse backgrounds help maintain a good perspective on life and on my work. But mostly I enjoy traveling, which COVID-19 has abruptly curtailed. I enjoy seeing and experiencing different parts of the world. Whenever time allows, I like reading nonmedical things ranging from history, to humor, to fiction—not so much fiction unless it’s humorous fiction—but a lot of nonfiction, particularly history.

How do you achieve work-life integration?

It’s always a balancing act; fortunately, my work-life integration works for me, although it may not always work for other people. I try to keep up with communications and my tasks whether I’m at work, at home, or seeing patients. I find that gives me a more measured tempo than turning everything off for some period of time and coming back and being inundated. However, I definitely have time periods when I unplug—not for weeks, but for hours or days—when I decide I’m not going to take my phone with me or I’m not picking up. I think it’s important to focus on other things.

Both of my sons, Wesley and Trevor, live in New York, NY, and I make a point of frequently visiting and spending time with them. I think they, like perhaps my surgical mentees, have learned from watching me, and both have a strong work ethic. I used to travel a lot with them when they were younger. I took them with me as often as I could, and they both continue to enjoy travel.

Thankfully, my life-partner, Mariana Berho, MD, understands me. She’s our chief of staff, chair of pathology and lab medicine, former chief wellness officer at Cleveland Clinic Foundation and an internationally renowned colorectal pathologist. I am proud of her for the acclaim in which she is held around the world as a pathologist and as a leader, and I am grateful to her for understanding me. She is a role model for work-life integration.

What do you consider your greatest professional accomplishment to date?

I have two answers. In terms of the ACS, I think the fact that I was able to work with many other people from other societies to create the NAPRC is a legacy that will live on, grow, and improve outcomes for patients with rectal cancer throughout the country and, perhaps, throughout the world. That effort required the assistance and hard work for the last 10 years of people from eight societies, including the ACS and the CoC. It wasn’t a one-person operation, but I would say I was the catalyst, being the founding Chair of the NAPRC.

On the local level, in 1987 I was recruited by Dr. Jagelman to work for Cleveland Clinic Florida before the institution even opened. I helped him, and then he passed on, and I helped it grow from no clinic and no department to one of the most recognized and prestigious colorectal programs. The colorectal program that I helped build was the cornerstone of all of Cleveland Clinic Florida, and it remains the most recognized program that we have. The opportunity to have gotten in on the ground floor to build a department of surgery, a digestive disease center and, ultimately, a clinic and hospital was incredibly gratifying, and I think a major accomplishment that could have national and international impact.

What advice do you give to young people who are looking to make their way in the field and into leadership positions in the ACS?

Find wherein lies your passion. Maybe it’s not colorectal surgery, maybe it’s pediatric surgery or neurosurgery or orthopaedic surgery. Find your passion, and then, ideally, find someone at your institution who will mentor, guide, and sponsor you to develop your career. If that’s not possible, then, in this day and age, reach out to someone through some electronic forum. Let them know you are interested in developing your career along the lines that they did. I would be amazed if anyone said no. Those of us who are in leadership positions are only too happy to perpetuate our respective specialties through potential future leaders.

Also reach out and let people know that you’re there to help write a book chapter or to work on a research protocol. Ask if you can collaborate on a study or a committee. Volunteer to do things; do those things, do them well, and do them ahead of schedule. The worst thing you can do is offer to do something and then not produce. It’s better to say no, but don’t say no very often because if you’re really serious about something, you have to show people you’re really serious; otherwise, people won’t believe that you are. You can get away with “no” once or twice, but don’t make a habit of it. Once you’ve committed to something, you have to put in the effort. But, again, if it’s your passion, it shouldn’t be an effort. It should be a pleasure.

Anything else you want to add?

I’m absolutely honored to have had the opportunity to serve as Vice-Chair of the Board of Regents, as well as a member of the leadership group of the Comprehensive Communications initiative. I’m thrilled with it, and I hope I have lived up to everyone’s expectations. I would encourage everyone who is interested in surgery and in leadership to be active in the College. The College has many, many opportunities for people to lead. It’s a big organization, with a lot of capacity, and a lot of opportunities for people to help get all of the things we are doing done. Lastly, I thank you and the ACS for asking me for this interview and sharing my thoughts in the Bulletin.