President Barry Mills addressed the New England Surgical Society’s 93rd Annual Meeting Sunday at the Samoset Resort in Rockport, Maine. Mills, the first non-surgeon to address the group in years, was invited to deliver the 28th Annual Samuel Jason Mixter Lecture by NESS president Tom Tracy P’10.
Good morning. It is a special honor for me to be invited to address the New England Surgical Society.
I have learned about the history of your organization and its impressive contributions to our society. And, it is humbling to be before so many very talented surgeons who do such important work for so many.
As you’ve heard, I am the president of Bowdoin College, a liberal arts college founded in 1794 and located not very far from here in Brunswick, Maine. Bowdoin is a fantastic place with many graduates over our long history who have gone on to become accomplished physicians, scientists, and researchers.
Among them is Dr. Richard Hornberger of the Class of 1945, who spent his long career as a thoracic surgeon serving people in the small towns that dot the Maine coast. You may not have heard of Dr. Hornberger, but you surely know his work. Dick Hornberger served as a captain in the U.S. Army during Korea. Upon his return, he wrote a novel about his experiences called M*A*S*H. He modeled the character Hawkeye Pierce after himself.
Another Bowdoin grad was orthopedic surgeon Edville Gerhardt Abbott – Class of 1906 – born an hour up the coast from here in Hancock, Maine. Dr. Abbott was famous around the world for his “non-blood” treatment of scoliosis known as “Abbott’s Method.”
And among the most current Bowdoin connections to medicine is actually a “virtual” graduate: Dr. Derek Shepherd (a.k.a, “McDreamy’) from “Grey’s Anatomy,” played on the show by Maine native Patrick Dempsey. A few years back, Dempsey received a long petition from industrious Bowdoin students and agreed to adopt our college as his character’s own. The result is that we frequently see our tee shirts and sweatshirts on the show, mostly when McDreamy is in bed!
Our emphasis on the liberal arts – and the sense that our students should be educated in the broadest way – are grounded in an understanding that, as citizens, we should recognize how our world was, how it is, and how it may change in the future.
There was a medical school in Maine and located at Bowdoin College from 1821 until 1921, with over 2,000 physicians trained at Bowdoin. It is an important part of our history, but as president of Bowdoin, it is fair to say that my job is a whole lot easier because we don’t have a medical school to support.
I am here today as a friend and great admirer of your leader, Tom Tracy. Tom’s son, Adam, graduated from Bowdoin a few years ago and was an excellent student and accomplished lacrosse player. I spent a lot of time on the sidelines with Tom watching Adam, even times when my own son, Henry, was playing for Williams against Bowdoin – a very tough day, indeed, for this dad! Tom and I spent many halftimes talking about the state of healthcare and medical education, partly because of my role at Bowdoin but also because I have spent the better part of four years now among the best and the brightest in medicine as our oldest boy struggles with an incredibly complicated and seemingly insoluble medical condition. I speak with some knowledge about the current state of healthcare, since – as I have described to the Bowdoin faculty – our son has received care in every department of a world-class hospital except obstetrics and gynecology.
I will offer brief comments today because I’d like to leave time for questions and discussion on whatever topic is on your minds. I’ll begin with my perspective on those of our students preparing for careers in medicine, and I also want to give you my general sense of this generation of young people, their career goals, and their life perceptions. I suspect I won’t tell you anything you don’t already know, but stating the obvious isn’t all bad, as it is often important to remember the obvious.
It will come as no surprise to you that as president of a very prominent liberal arts college, I am confident that we are educating our students in a manner that allows them to be ready for whatever challenges they face in life. Our emphasis on the liberal arts – and the sense that our students should be educated in the broadest way – are grounded in an understanding that, as citizens, we should recognize how our world was, how it is, and how it may change in the future. The study of history, economics, English, philosophy, all of the humanities, and the social sciences is fundamental to our education of the complete citizen, and through our requirements and our culture, we encourage students to learn in these areas-even students who aspire to be scientists or physicians. We have a requirement at Bowdoin that no one can graduate without seeing a “number.” Everyone must take a course in the arts, and everyone must take a course designed to expose them to social and personal difference (the latter requirement being important, in my mind, for future physicians as they deal in very personal ways with our diverse America and the world).
And yes, we also require our students to be exposed to science-not a burdensome experience for most of our students heading off to medical school. These days, we are also exploring computational thinking as a critical new component of the liberal arts-a mode of inquiry and way of thinking that is fundamental to our technological society.
The liberal arts education is not designed for the dilettante. At its best – and this is a focus of mine – a liberal arts education is designed to ensure that our students graduate knowing an area, and knowing it deeply and rigorously. In my view, this is among the most important educational lessons for our students, because they must actually know something substantive at a sophisticated level and they must have the life skills required to explore a subject in a rigorous manner.
[S]tudents trained in our residential liberal arts tradition are – more than most students – “the complete package” for the practice of medicine.
Our residential life experience – whether on the playing fields, in the residence halls, or as part of an a cappella club – also educates our students to become community members, citizens, and leaders. Bowdoin’s historic and genuine commitment to the Common Good – an imperative articulated originally by our first president in 1802 – and the work we do in support of the Common Good further educates our students to be citizens in their communities, working together and leading for the good of their families and society.
So, it is no surprise that in an age where medical schools are turning to a “more holistic” approach in admissions, students from liberal arts colleges are very attractive candidates and are very successful at being admitted to these schools. These students are very bright, accomplished academically, and possess important leadership skills and a community perspective. My own bias, not surprisingly, is that the students trained in our residential liberal arts tradition are – more than most students – “the complete package” for the practice of medicine.
The question then is: why are so many students who have the talent, education, and the grades to be admitted to medical school showing up in my office as juniors and seniors to tell me they have decided against a career as a physician and to ask if I can help them think through what other career they might pursue?
Clearly, the national debate on healthcare and the story the media tells us about physicians’ job satisfaction are affecting their decision. The students are also affected by the number of years it takes to attain a medical degree and then to learn a specialty. The rise in the number of our students becoming nurse practitioners speaks to this issue. Students comment on the extraordinary expense associated with a medical education (making even a Bowdoin education look inexpensive) and the prospect of crushing debt is unacceptable to them. Many of you sitting here may say – the students have it right, they are making the right call. I think not.
I explain to them a medical education is a “door opening'” not a “door closing,” as so many students perceive. The education is vital and one that has many options post med school to fashion a career that is rewarding and satisfying. In fact, today, the options are much more extensive than ever before. And, I explain that in today’s world of policy and legislation, one actually needs to know something substantive in order to make good policy. A medical education is clearly central to the most vexing issues in our society. And so, for the many students who care about public policy, a medical education provides a vital base of knowledge for them.
It is true that the cost of the education is too expensive and the debt burden can be crushing, even if the student chooses a lucrative specialty. I remember a student who came to Bowdoin from one of the poorest parts of our country, worked hard, was admitted to a premier medical school, and a week before graduation came to see me to say she couldn’t go because she just could not see taking on all the debt. I worked hard with this student to talk about the financial implications and encouraged her nonetheless to go to medical school and to get her education. The debt, I told her, was a problem she could handle over time. As it turned out, she graduated from medical school a few years ago, and is working today as a physician and working herself out of debt.
Medical education is a good investment. But we must, as a country, recognize that physicians are providing a service to the Common Good and address its cost. Medical education is an investment we should all be contributing to in order to ensure a pool of talented physicians who serve our people. And, the debt component is a crucial part of that discussion. Our national goal should be to provide more physicians in all critical specialties including general practice doctors to provide health care to all who need it regardless of personal wealth and access. In my view, this is a discussion that is central to the future of health care and the issues of access, opportunity and affordability of a medical education should be even more at the core of the current conversation nationally.
Medical education is a good investment. But we must, as a country, recognize that physicians are providing a service to the Common Good and address its cost. Medical education is an investment we should all be contributing to in order to ensure a pool of talented physicians who serve our people.
These students also need to hear from you. They need to know the enthusiasm you have for what you do. I understand to some extent the pressures you are under – the long hours, the limits on reimbursement, and the complexities and annoyances of the medical bureaucracy that is healthcare in America today. But when I speak to our physician alumni and the many physicians and surgeons I know about the care they provide, I see enthusiasm and great pride in the work they do. It is tremendously important for that enthusiasm and pride to make its way to our young people at a time when our country needs so many more talented and dedicated physicians. And so I encourage you to get more committed to the colleges and universities where you started out on your quest for education; colleges and universities where I am certain you found mentors and role models and friends who have had a profound effect on your personal and professional lives. You can make a difference with young people who are attempting to figure out their futures by getting connected to your college or university and talking directly to these students. It is important for the students to hear your message and I am confident that you will achieve a high level of personal satisfaction from the interaction with these young people.
From you as physicians and surgeons, I am asked often the corollary question – why are our students today – and young people in general – less “serious,” “hard nosed,” tough, and driven like we were as young people. I hear often that the young are less committed and too focused on quality of life. In hospitals, you hear grumbling from colleagues about the restrictions on the number of consecutive hours young physicians may be required to work. And I hear from physicians, and, by the way, from lawyers, bankers, consultants, accountants, and even academics that young people are not as willing to commit themselves to their jobs the way we were when we started out-that they are too focused on a career/life balance.
Maybe so. It is surprising to me, given how I watch their lives while in college. They work very hard, and play just as hard. Our students are involved in complex academic studies and way overcommitted in their activities. It is curious that they can’t work consecutive long hours at 28, but at 20, they can stay up all hours of the night in their residence halls for weeks on end! The reality is that this is a generation that is more concerned about career/life issues, but I don’t think you can point the finger at our colleges as the culprit. Ours is a society where the economic challenges are high, and where the pressures on individuals and families – particularly two career or working families-are more complex.
I know you consider these issues often in your practices. What you do is sophisticated and as Malcolm Gladwell suggests, to be excellent at something requires at least 10,000 hours of practice, and in your case, surely many more hours. It is crucial to be trained up and confident, and nothing short of experience can achieve these results.
In order to balance these complex goals, one approach is for those of us from an older generation to show young people a path – for each of you to model that path for young doctors that demonstrate for them a path that has allowed you to succeed in life and allowed you personal satisfaction. This involves modeling a life and an approach to practice for men and women of enormous talent. It involves recognition that the pressures and demands on men and women at different points in their career and life are real and must be accommodated to allow for both men and women to succeed at the highest levels in the practice of medicine and surgery. It also involves demonstrating to your younger colleagues that the personal satisfaction one achieves from arduous work can actually foster the career/life balance they so often seek. My experience, and yours, I’m sure, leads us to understand that mentoring is important. But even more important is modeling on a day-to-day basis and in real time a path to personal and professional success.
It is my genuine pleasure to be with you today. I do spend a lot of time in hospitals and I know physicians don’t hear a simple “thank you” from their patients and families nearly enough. I have seen the complicated work you do on a routine basis in what is a remarkably stressful environment. And I have seen you save lives, change lives, and create miracles. I congratulate you on your commitment to your profession and to your patients. Thank you for inviting me to be with you today.