Profiles in ACS leadership: A few questions for Ronald J. Weigel, MD, PhD, MBA, FACS

Editor’s note: The Bulletin of the American College of Surgeons is launching a new series of articles profiling leaders of the College. This feature will be published monthly. 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.

In this second profile of American College of Surgeons (ACS) leadership, we interview Ronald J. Weigel, MD, PhD, MBA, FACS, Chair of the ACS Board of Governors. Dr. Weigel is the E.A. Crowell, Jr., Professor and Chair of Surgery, professor of molecular physiology and biophysics, professor of surgery (surgical oncology and endocrine surgery), professor of biochemistry, and professor of anatomy and cell biology, University of Iowa Health Care, Iowa City.

With all your diverse interests in science, how did you decide to pursue a career in surgery?

I suppose there are a couple of reasons why I chose to go into surgery. One is I tend to be a very active person. I like to do things and get things done. Surgeons are people who do things, whereas other specialties seem to do more talking about what could be done.

As a medical student, I noticed that surgeons seemed to be more involved in directly caring for patients. They seemed to be much more definitive and understood how to take care of patients. I remember rounding on the medical service, and people would be arguing about recent publications and details about relatively minor issues but not really recognizing that a patient was very sick and needed immediate attention. I also remember taking care of a patient on the medical service who was admitted with a fever of unknown origin. The patient languished for days without a diagnosis after numerous X rays, lab tests, and scans until a surgery consult was called. The surgeon diagnosed an acute abdomen on physical exam, took the patient to the operating room (OR), and removed a toothpick that perforated his small bowel. That was the kind of physician I wanted to be.

Also, I was attracted to the technology. Surgery offers a lot of cutting-edge new technology that can be readily applied to patient care.

And finally, I don’t like the fact that there are things we don’t understand, meaning that you don’t know how it works, and it’s a black box. I want to understand the full scope of what is known. Surgery offered the ability not only to train in medicine because we medically manage our patients, but we also took patients to the OR. We were in the intensive care unit and emergency room. We were everywhere in the hospital taking care of patients, whereas if you went into medicine, the patient would go off to the OR, which would be a black box, and you had no idea what was going on. Surgery allowed me to understand and be involved in the full care of patients, and that involved everything.

That’s also why I got my [doctor of philosophy degree] in molecular biophysics and biochemistry: because I wanted to understand the basic biology driving patient care and disease processes.

I ended up getting my master of business administration degree because when I started thinking about becoming chair of the department of surgery at the University of Iowa, I realized that I really didn’t understand much about business or finance or marketing or any of those kinds of issues, and I didn’t want those aspects of leading a department to be a black box. That’s why I was interested in learning about so many diverse fields, which I think helps me do my job.

Who were some of your mentors along the way, and what did you learn from them that you feel like you apply almost every day?

Obviously, it starts with your parents. It goes without saying that they teach you a tremendous amount and instill in you a sense of obligation to give back to humanity and to be the best person you can be.

I think the individual with whom I did my PhD—George Miller, MD [John F. Enders Professor of Pediatrics (infectious disease); professor of epidemiology (microbial diseases) and of molecular biophysics and biochemistry; and section chief, pediatric infectious diseases, Yale University School of Medicine, New Haven, CT]—really instilled a tremendous amount of understanding and approach to scientific problems that I have to say I use on a daily basis. I was strongly influenced by his approach, which is to look at your data and build your next question based on what you found and avoid bandwagoning and skipping from one project to the next based on what is hot—what is considered scientifically sexy at the time. I’ve fundamentally developed my entire laboratory investigation on that approach.

And then, clinically, I trained at Duke University School of Medicine [Durham, NC], and was strongly influenced by David Sabiston, MD, FACS, who obviously had a strong relationship with the ACS. Dr. Sabiston did a number of things that I still do to this day. For example, we had morning reports, and it was the chief resident on what was called “the green service,” who gave the report every morning at 7:00 am.

Based on that model, when I became chair of surgery at the University of Iowa School of Medicine, I started doing exactly that. I did that this morning at 6:45 am. Every morning, I meet with the chief resident on the administrative services and do exactly what Dr. Sabiston did, which is to go through all the emergency admissions over the last day, go over the operating schedule for the day, discuss any problems on the service, and add whatever the current problems are. So, for example, at this morning’s report, we discussed whether there are any resident work-hour issues, whether there are COVID 2019 (coronavirus) infections among the residents or faculty, and we went over whether there were any deaths or complications on the surgery service. That’s what I’ve done since the first day I was chair. That, again, was based on Dr. Sabiston’s belief that you need to keep your finger on the pulse.

Later in my career, I’ve had tremendous mentorship from leaders in surgical organizations. For example, Timothy J. Eberlein, MD, FACS [ACS Regent and editor in chief, Journal of the American College of Surgeons], is a tremendous confidant with whom I talk on a regular basis and who has provided a wealth of advice. He is about eight or nine years ahead of me, and I think that my career and relationships within organizations and societies have paralleled what he has done to the degree that I’m able to do that. He’s obviously much more accomplished and has done a whole lot more in his career, but I’ve done my best to meagerly follow in his footsteps.

What interests or hobbies do you have outside of surgery?

Probably first and foremost is my family, which is one of the reasons we were attracted to coming back to Iowa from the northeast. My wife grew up in Des Moines and went to and graduated from the University of Iowa, and when I had the opportunity to come back here, it made a lot of sense because it allowed us to focus on the two things that matter most to me, which are my family and my job. By coming back to Iowa, I was able to do that. I’ve been back here now 16 years—we moved here a week after my fourth child was born, and we’ve been here ever since­—and it has really allowed me to focus on our family and on work.

We have a place in Colorado that we try to get to whenever we can, and that’s to do things that we enjoy, such as skiing in the wintertime, and hiking and fly fishing in the summer.

What is your proudest accomplishment so far?

Personally, it’s the kids that we’ve raised and what they’ve been able to accomplish. Professionally, I think it’s the influence I’ve been able to have locally and nationally with surgery. I’m quite proud of the department of surgery that we have managed to build at the University of Iowa, and I say “we” because although I’ve recruited a lot of people, they’ve done a tremendous amount to advance the department and build an academic medical center.

I think the next thing I’m proud of is the people I’ve trained and then watched build their own careers.

And third would be trying to have influence over supporting research as a surgical science. I have managed to keep my lab funded for the entire time that I’ve had a career in surgery. I think that’s important, and I’m very proud of the residents, medical students, and postdoctorate fellows who I’ve trained in the lab and who have gone on to run their own laboratories and develop their own surgical careers.

What advice do you give to young people who are interested in going into surgery?

Number one is be true to your passions. You have to have a very strong moral compass and a strong direction in your career to stay on path. There are a lot of forces that try to distract individuals because of the complexity just of daily living. I think health care financing and those sorts of things have a powerful influence on what we do on a day-to-day basis, but I try to encourage people to keep true to their passion, to try to remember why they went into surgery in the first place, and to continue to renew that passion on a daily basis.

What I’m trying to get at is that being in academic surgery allows you to continue to renew your interest in surgery, and the reasons why you went into it. If you’re involved in research and discovery, that discovery is new every day. There are so many things that we don’t understand about biology, about clinical care, and staying in academics allows you to renew that interest and to pass it on to the next generation.

Learning and education is one of those things that the more you try to give it away, the more it is ingrained in yourself. So, by taking the time to teach the junior people, the residents, the more it reinforces in yourself the understanding of what we’re doing on a day-to-day basis.

And I think it’s important to try not to get bogged down in the constant drudgery of doing the same thing over and over again. Even in the College, we talk a lot about how to avoid burnout, and I think that individuals who are five to 15 years out of their training can begin to get burdened by the repetition of what they do and sometimes forget how incredible it is what we do on a daily basis. I think that being involved in a training program, being involved in research, helps you come to each day renewed in knowing the amazing things that we do on a daily basis.

Anything you would like to add?

People who know me understand that I’m committed to quality surgical care, and to training the next generation of surgeons, researchers, and educators. One thing I would add is the role that the College has played in facilitating our ability to do that. The College gave me one of my first grants and has been supportive throughout my career. Other people who are members of the College have been extremely supportive of my career, and I rely heavily on them. The College has provided me with a network of people who I can call when I need advice or when I need help getting something done, and I think that’s only become a greater force in my professional career as I’ve gotten older.