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Multigenerational Physician Families in Shifting Times

Editorial by Jemshed Khan

In the eighties ASOPRS was smaller, more like a family. Spouses volunteered to assist with meeting registration. Children frolicked poolside at Spring Meetings, splashing and laughing and running. Over decades one watched them grow. Some of the generations of ASOPRS physicians that I observed included the Buergers, Schaefers, Epsteins, Rootmans, Katowitzes, Tses, Gavarises, Hollstens, Perrys, Solls, Stephensons, and Stasiors.

Studies of children who follow a parent into medicine reveal several common factors at play. The children recall visits to the medical workplace where enthusiastic coworkers asked if they planned on becoming a doctor too. The seed was planted. Inevitably, odd medical artifacts made their appearance in the home: a specimen in formalin, a bag full of sheep eyes, a glass prosthetic eye. These bizarre occurrences seemed normal in medical families. 

Nature and nurture influence career choice in physician offspring. Physicians are often competitive and intelligent: both traits favor a career that demands much sacrifice and effort, but also provides ample rewards. Physician households can bankroll tuition costs that would bankrupt middle class families; Ivy League tuition can exceed $90k/year. The intellectual and emotional challenge, altruism, income, and social status associated with being a physician all motivate career choices in multigenerational physician families.

Following a parent into Oculoplastics was easier when medicine was mostly solo or small group private practice.  Back then, after residency one either "hung out a shingle," or went on to a fellowship. Most preceptors were private practitioners who helped at the University. Private practice was a small business enterprise built upon personal excellence, local relationships, and patient care. The physician of that era was a highly autonomous being whose expertise spanned several domains, whose level of education often exceeded that of other health care workers, and whose judgement and skill would routinely make the difference between life and death. 

Much has changed. Especially the decline in solo practice, the increasing expertise of other health care workers, and the loss of status afforded physicians. Most of all, institutional and government policy is now driven by corporate rather than public interest. Let's explore these changes and how they relate to physician families.

For millennia, human offspring worked alongside parents and acquired their skills. This specialization of labor yields profitable efficiencies or "comparative economic advantage" (Ricardo's theory).  This advantage was passed down the family tree; offspring would inherit a parent's trade or practice without having to build a business from scratch. As privilege, power, wealth and skill accumulated across generations, they were subject to race and gender-based barriers. Fortunately, those barriers are breaking down. Unfortunately, transfer of business and skills across generations has become difficult because private ownership is being replaced by profit-driven corporate and institutional control. Let's examine the financialization of the medical sector; why it happened: in doing so, we can understand how medicine has changed.

Beginning with Medicare, American medicine became increasingly regulated, specialized, and bureaucratic. The real client was the third-party payor rather than the patient. Physicians responded by forming partnerships and groups to dilute overhead and centralize onerous insurance tasks. This led to formal compensation plans and detailed revenue statements. 

Group practice Profit & Loss statements were the beginning of the end because they attracted the attention of venture capitalists (VC). Venture capitalists feed off surplus capital generated by inequitable Federal tax policies and obscene tax favoritism (e.g., carried interest, long term capital gains). VC examined practice profitability and began acquiring practices. They folded practices into publicly traded entities whose stock then traded at multiples of earnings. Most private group practices could not resist the immediate personal wealth generated by selling out to private equity. Thus, between institutionalization, onerous regulation, and financialization, the practice of medicine was forever changed. Given the Federal tax policies at play, physician's taxed at 40% personal rates had zero chance of prevailing against VC on such an uneven playing field.

Some private equity physicians still enjoy practice, but many find the patient load, time demands, and loss of autonomy to be extremely stressful. Many employee-physicians and university physicians have been relegated to line-worker status. They function as relatively powerless and easily replaceable widgets in a profit-driven system that is evolving to provide efficient care at the lowest cost to maximize financial return.

In some places medicine has been dumbed down to the point that the doctor just needs to perform their assigned task. Shift work. This is reflected in Medical School acceptance criteria that no longer prioritize predictors of academic performance such as standardized testing. The knowledge and judgement that physicians once held in their heads is being replaced by AI, practice patterns, and non-physician providers. Diagnosis and treatment are relegated to algorithm. The patient's perception of their encounter and of their provider is often more important than tangible health benefit. Why? Because if the patient doesn't complain, management is free to demand higher productivity and insist that doctors smile through gritted teeth. Fortunately, the pendulum always swings.

In our own field we have seen fellowship oversight outsourced to AUPO. In effect, training has been transferred from a preceptor-centered model to a department-centered model.  This reflects the underlying migration of physician practices from solo to group to corporate/institutional. While this is contrary to the autonomy of our specialty, the younger generation faces a different future and seems willing to offload the administrative burden of fellowships to prioritize other unspecified goals.

The next generation of physicians will look at medicine as a less daunting occupation. They will gravitate towards definable hours and life-work balance. Medicine will become more of a nine-to-five job and less of a career. Many will favor institutional and organizational prestige over personal merit and will be required to demonstrate group allegiance rather than exceptional performance. Allegiance will shift from the patient and the profession to the employer. This is an intended and socially managed outcome designed to maximize shareholder wealth.

For sure, earlier times required a different level of commitment, a different mindset. Nowadays a career choice in Medicine is less influenced by family interests. Many young doctors aspire to executive or corporate leadership positions. Direct patient care to them is menial. Despite all of this, I would never discourage a career in medicine. It is a broad enough field that one can still carve a rewarding and challenging personal path while providing excellent personalized care. Old school for sure. But how is this not the highest calling for those who wish to better the lives of others? We are fortunate to have practiced through the best of times.  BACK TO Newsletter

SASOPRS Jonathan J Dutton Interview

SASOPRS Jonathan J Dutton Interview
Interviewed by John Woog, MD
SASOPRS:  Jonathan, we understand that your professional trajectory has been somewhat unusual, in that you had an illustrious career prior to pursuing medicine and oculofacial surgery, serving as an internationally renowned paleontologist and evolutionary biologist and a named Professor in the former field at Princeton University. How did you become interested in evolutionary biology?
J. Dutton:  In college, I became close to the chair of biology and a herpetologist, and I spent many evenings on Long Island observing, catching, and raising frogs, salamanders, and various snakes with him and his family. I volunteered as a research assistant at the American Museum of Natural History and spent several summers at the Museum’s research station on LI.  Because of my published research on fish behavior, I was awarded a fellowship at Harvard for PhD studies.  After a year with the icons of evolutionary biology and paleontology at Harvard, I decided to major in vertebrate paleontology and evolutionary biology and spent years collecting and studying fossils in East Africa. Princeton offered me a position as Sinclair Professor of Paleontology and Director of the Princeton Natural History Museum, which I accepted in 1970.

SASOPRS: We've heard that visiting your home is a little like visiting the Smithsonian, with a collection of fascinating artifacts from your paleontology-related travels around the world. What were some of your most unique destinations and most memorable academic paleontology projects?
J. Dutton: During my expeditions to Africa, I became fascinated with primitive art, which was used by the local peoples for social functions, religious symbolism, functionalism, and utilitarianism rather than purely creative purposes. I acquired many pieces from the local villages and from the doctors at a small one-room hospital near Lake Turkana in Northern Kenya who often collected artifacts in exchange for medical treatment. My most memorable project was working with Richard Leakey as co-investigator of several National Geographic-sponsored expeditions to Lake Turkana.  For my PhD thesis, I spent 14 months outside the US, traveling around the world studying fossils in 18 countries.

SASOPRS: Can we ask what motivated you to pursue a career in medicine, given your tremendous accomplishments in paleontology and evolutionary biology? And how did you come to choose ophthalmology and oculofacial surgery? 
J. Dutton: Fieldwork in East Africa was in the deserts where midday temperatures reached 120° F.  We always returned to camp for a few afternoon hours where most of my colleagues and staff took a nap.  Harvard had an intensive 2-week medical course for faculty and fellows who would be working away from medical help.  So, I was the medical officer for the expeditions.  While everyone else napped, I treated local tribespeople who came into camp with infections, spear wounds, cobra bites, and occasionally crocodile injuries. After doing this for five years, I decided that this was what I wanted to do. 

SASOPRS: You are known as an innovator in the discipline of oculofacial surgery. You developed an ocular oncology clinic, for example, and served as one of the principal investigators in the COMS (Collaborative Ocular Melanoma Study) study, the largest NIH-funded ocular oncology study to date, when this was not a common practice focus area for oculofacial surgeons. What prompted your interest in ocular oncology?
J. Dutton: I was on the faculty at Duke University in 1985 when the COMS study was created. Duke was asked to participate, and my chairman asked me to be involved since I took care of other ophthalmic malignancies.  I became the Duke COMS PI until 2000 and then moved to the University of North Carolina where I continued COMS participation.

SASOPRS: You've also made major contributions in thyroid eye disease, serving as board member and President of the International Thyroid Eye Disease Society (ITEDS) and founder of the ITEDS Tissue Bank. Can you tell us a little about the background and goals of this initiative?
J. Dutton: The International Thyroid Eye Disease Society (ITEDS) was originally founded in 2006. Since then, it has expanded to include members from nearly every continent. The goal of ITEDS is to promote and facilitate collaborative interactions among authorities to define clinical disease parameters, understand pathogenesis, and develop tools for the assessment and treatment of thyroid eye disease. Members of the society are interested in studying TED from basic science and clinical perspectives to evaluate patient-centered outcomes and foster therapeutic advances. The ITEDS Tissue Bank was created in North Carolina in 2013. The bank collects, characterizes, annotates, stores, and distributes biospecimens for research purposes to help support better understanding, education, and research for TED. 

SASOPRS:
  On behalf of ASOPRS/SASOPRS members and oculofacial surgeons worldwide, we’re pleased to celebrate the 15th year of your service as Editor-in-Chief of our flagship journal, OPRS. What have been some of the most notable challenges, rewards, and changes that you've experienced during your tenure as Editor?
J. Dutton: I was exceptionally fortunate to stand on the shoulders of five extremely talented previous Editors of OPRS who set the stage for OPRS being an outstanding international journal for oculofacial ophthalmology. During my tenure, the number of annual manuscript submissions more than doubled to more than 900 today. As with all medical journals, a major challenge is getting peer reviews from experts in the many subfields in our discipline.  Editors need to try to envision the future of their discipline and help direct it to some extent by the selection of key papers to publish. Readers need to be assured that the editor makes well-grounded and unbiased decisions. The rewards for me have been a contribution to the education of our colleagues around the world and in turn to help improve patient care, and help authors improve their publications.

SASOPRS: To close with an easy question, there has been a lot of excitement regarding the potential impact of AI on biomedical science and medical practice (topics that have been the subject of recent publications in OPRS). Can you share a couple of ways in which you feel AI may be particularly impactful in the field of oculofacial surgery?
J. Dutton: There is no question that AI is here to stay and will undoubtedly increase to become a major component of our personal and professional lives. The major beneficial impacts on biomedical science are already being felt in making clinical systems and administrative functions faster, smarter, and even more efficient. For many diseases, based on vast datasets, AI has been shown to improve diagnosis, both from clinical findings and imaging studies and to help with treatment planning. In research, AI can help in paper writing, constructing outlines, checking spelling and grammar, and verifying references. As with any new technology, AI also poses threats if used inappropriately.  These include information biases, inaccuracies, and possible violations of patient privacy, depending on the experience and care of the model creators.  BACK to Newsletter

ASOPRS JOURNEY IN THE WORLD OF ADVOCACY: MY QUEST

ASOPRS JOURNEY IN THE WORLD OF ADVOCACY:  
MY QUEST
Commentary by Stuart R.Seiff


As I began my career in medicine, I never thought that I would be sucked into the world of medical advocacy.  But I guess stranger things have happened. Don Quixote sought to save the world by slaying windmills.  Such has become my fate as well.
 
My first role was as an associate preceptor (program director) and then as a preceptor.  Somehow, I was asked to chair the Preceptors Committee, which got me a non-voting role on the Executive Committee, followed by a job as Secretary of Meetings.  From there came the three-year Presidential track, followed by the Chair position on the Committee for Government and Intersociety Affairs (a 10-year term). All of this provided me with a window seat on the EC for over 2 decades.
 
When I first entered ASOPRS in the late 1980’s, oculoplastic surgery was finding its way among the plastic surgery specialties, and it seemed that our relationship with ophthalmology and AAO was a bit of a ball and chain.  Facial Plastic Surgery was successfully battling general Plastic Surgery for its share of the pie. Although the AAO had recently brought all of ophthalmology under one umbrella, there was a sense ASOPRS needed to break free.  With the success of Facial Plastics in establishing a Board, such talk started among ASOPRS members as well in an effort to get the recognition we wanted among other specialties and the public.
 
Under the leadership of such luminaries as Mike Hawes, Bill Nunery, Russ Gonnering, Brad Lemke, Ralph Wesley, Chris Fleming and others, Board Certification became the holy grail.  We learned that this would need to be blessed by the ABO.  After many requests, Dennis Oday, then chair of the ABO, finally agreed to look at options for Board Certification of “Oculoplastic Surgery” if we could get buy in from the “Greater House of Ophthalmology”.  This meant approval by the AAO Counsel.  Our leadership group learned to advocate and “work the room.”  We next needed an ACGME curriculum, which was spearheaded by Bryan Sires.  We were successful and the curriculum, with positive modifications, still exists and is the model for our ASOPRS fellowships.  We were slowly learning how to advocate for ourselves in a very big house of medicine.
 
Roger Dailey took on ASOPRS Advocacy as his AAO LDP project and brought home the concept that “if we are not at the table, we are on the menu.”  Our destiny was cast.  We continue to struggle with the Board Certification issue, but that quest illustrates our need to establish relationships within and outside of ophthalmology.  Roger, Chris Fleming, Bob Kennedy, Jeff Nerad, and I really pushed that envelope.  This led to the creation of the Committee for Intersociety and Government Affairs that I had the pleasure to chair for 10 years.  I passed the chair to Mark Mazow, who has incredible insight into how to navigate the waters of organized medicine and government.  With this Committee, ASOPRS had the advantage of “institutional memory,” and we were able to engage medicine and government on many levels on behalf of our members.
 
A glimpse at what ASOPRS has accomplished is impressive. 
 
Roger Dailey encouraged us to become a part of the Physicians Aesthetic Coalition (PAC).  This enabled us to meet and find common ground with our aesthetic surgery Core 4 partners.  These contacts have been invaluable as we navigated the troubled waters of regulatory medicine.
 
ASOPRS became involved in the Surgical Scope fight because optometry perceived eyelid surgery to be an area where Ophthalmology might let them get a surgical foothold.  Their first win was New Mexico, and since then, ASOPRS has been at the table with AAO fighting, state by state, with impressive success to date.  However, I think we need to be flexible in this fight moving forward. 
 
The bundling of ptosis and blepharoplasty was clearly a blow to our members.  Although we have not been able to overturn this, our Society has provided members with work arounds.  That said, when CMS decreed that a Medicare beneficiary could not undergo a cosmetic procedure as part of a functional procedure, ASOPRS and AAO leadership, along with a coalition of our plastic surgery colleagues, promptly got this overturned.  These relationships are invaluable.
 
ASOPRS has worked with our AAO colleagues to limit Medicare RAC and SMRC audits.  We continue to try to reduce the burden of prior authorization, as well as these audits, in many areas of our field.
 
When COVID struck, ASOPRS and AAO worked with Congressional contacts and, ironically the restaurant industry, for modifications to PPP Loan rules that allowed a larger percentage of the loan to be used for operating expenses. We also worked with our colleagues in the House of Medicine to modify FDA limitations on office compounding of drugs.
 
The role of an organization such as ASOPRS is to provide education and advocacy for our members and patients.  However, advocacy is a bit like Don Quixote’s quest to make the world a better place.  Slaying windmills is a good place to start, but beware that even when many of the windmills are eliminated, more will grow.  Thus, as our Senior members fade into the sunset, ASOPRS needs the next generation to pick up the torch and protect the interests of our members and patients. BACK to Newsletter
 

Meet the Schafers...Three Generations of ASOPRS Members

Three Generations of ASOPRS Members
By Dan and Jamie Lea Schaefer
Featuring Drs. Arthur, Daniel, and Jamie Lea Schaefer were inducted into ASOPRS in 1973, 1989, and 2020, respectively, and two Past Presidents of ASOPRS, Arthur in 1988 and Daniel in 2019.

ARTHUR J. SCHAEFER, MD, FACS 
Dr. Arthur Schaefer was born in Buffalo, New York, in 1923, the son of an Optician and professional musician.  He helped pay his way through Canisius College by working as a lab instructor, a shoe salesman at Sears, and a pianist in a band.  Before Frank Sinatra became famous, he asked them to perform a song or two with his band, but since he was unknown to them, they did not know if he could sing, and he was not from Buffalo, so his request was denied.  Art graduated from SUNY at Buffalo Medical School in 1947.  He completed his Residency in Ophthalmology at E.J. Meyer Memorial Hospital, now Erie County Medical Center (ECMC).  He did his informal fellowship with Dr Bryon Smith, where every several months, he would fly to NYC to spend the day in surgery picking Byron’s brain and again while dining with him that evening.

In postwar Korea, he served as a captain in the Army Medical Corps and as Chief of Ophthalmology at the 121st Evac Hospital, where he worked with and taught the Korean army’s chief eye surgeon, among others.  He was then transferred to Japan, where he was appointed Chief of Ophthalmology at the 8169th Hospital in Zama, Far Eastern Army Headquarters, where he also taught the Japanese Ophthalmic Surgeons.
 
Art established Buffalo’s first Oculoplastic Surgery Clinic in the early 1960s. 

He was a clinical professor of ophthalmology and a clinical assistant professor of otolaryngology at the University at Buffalo School of Medicine and Biomedical Sciences. He was also a consultant at several hospitals in the area and served as director of ophthalmic plastic and reconstructive surgery at ECMC and the Buffalo General Hospital.

In 1995, he was the 22nd individual and first Buffalonian to receive UB’s Lucian Howe Award and medal for his contributions to ophthalmology.

He was a Canisius college regent and, with Betty, his wife, established a Scholarship Fund at the college to assist pre-med students.

Art and Betty were recipients of the Knight and Lady of the Equestrian Order of the Holy Sepulchre of Jerusalem.  In 1994 they were awarded Christ the King Seminary’s Cure of Ars Award for “faith-filled and dedicated service to others.”

He received many other awards and honors for his volunteer involvement from his alma mater, high school, college, medical school, religious organizations, and hospitals.  
His wife of 50 years, the former Elizabeth Ann “Betty” Cain, was his scrub nurse, surgical assistant, and office manager for 35 years. She should be an honorary member of ASOPRS for her support of society over the years and for running the registration desk for the Spring and Fall Meetings with some of the other spouses until the management teams take over.

DANIEL PAUL SCHAEFER, MD, FACS
Dr. Daniel P. Schaefer is a native of Buffalo, New York.  He graduated from Canisius College with a B.A. in Biology and received his Doctor of Medicine degree from SUNY at Buffalo in 1981.  After serving his internship in Internal Medicine at the University Program, SUNY at Buffalo Affiliated Hospitals in 1982, he completed his residency training in ophthalmology at the New York Eye and Ear Infirmary in 1985. He was elected and served as Chief Resident from 1984 to 1985.  An American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) sponsored a fellowship training program in Oculoplastic, Orbital, and Reconstructive Surgery, which was completed at the Wills Eye Hospital and Jefferson University, Philadelphia, PA. 1985 to 1986 under the preceptorship of Dr. Joseph C. Flanagan.

Dr Schaefer joined the Department of Ophthalmology, SUNY at Buffalo, New York, in 1986 and was promoted to Clinical Professor in 2001. He was appointed Co-Director of the Oculoplastic, Orbital, and Reconstructive Surgery department in 1989 and promoted to Director from 1997 to 2022 while maintaining a private practice in Buffalo, New York. He has served as the Chief of Ophthalmology at St. Joseph Intercommunity Hospital for over 20 years and served as its President of the Medical Staff from 2001 to 2003.

Dr. Schaefer has served as Visiting Professor and lectured throughout the United States, Central America, South America, Africa, and India, has written numerous chapters and articles in the field of Oculoplastic, Orbital, and Reconstructive Surgery, and has traveled frequently to several countries in Central America, South America, Africa and India, lecturing, providing medical services and surgeries in the field of Oculoplastic, Orbital, and Reconstructive Surgery for those in need, while also teaching the local Ophthalmologists.

Dr. Schaefer was a member of the ASOPRS Education Committee 1991 to 2002, and its Chair 2000 to 2002, and CME Committee 1991 to 1998 and its Chair 1994 to 1998, Chair of the Committee for Transition of ASOPRS to Board Certification/Equivalency 2002 to 2009, was on the ASOPRS Foundation Board, President of the ASOPRS 2019, President of the Upstate New York District #1 American College of Surgeons and has served on its Committee for Membership Applicants since 1996 for 25 years, has been on the Medical Advisory Board of the American Society of Ocularists  1992 to 2009, was elected Chief Resident at the New York Eye and Ear Infirmary in 1984 to 1985, received the SUNY at Buffalo, New York Ophthalmology Resident Teaching Award five times, was presented the 4th Kanchan Memorial Oration Award from the Kanchan Eye Hospital and Research Center, Murlidhar, Hyderabad, India in 1994, Recipient of the Signum Fidei Award from St. Joseph’s Collegiate Institute and inducted into the Society in 1999, Marlene and he were Bestowed Knighthood in the Equestrian Order of the Holy Sepulchre of Jerusalem in 2001 and advance to its highest order of Knight of the Grand Cross in 2011, received the Caritas Award from St. Joseph Intercommunity Hospital in 2002, received the Lifelong Education for Ophthalmologist Continuing Education Recognition Award and Achievement Award from the American Academy of Ophthalmology, and inducted into The American Ophthalmological Society in 2008.

He was also very honored that his father had the pleasure of inducting him into the society when Art was President of the ASOPRS and presenting the ASOPRS diploma to him at the Business Meeting in Las Vegas on 10/7/88.  I just missed that honor with my daughter during my Presidency of ASOPRS in 2019.  My daughter, Dr. Jamie Lea Schaefer, finished her ASOPRS-approved Fellowship on 6/30/19.  She was the first and only third-generation ASOPRS member in 2020.

Dr. Schaefer is married to Marlene Ann Schaefer, and they have three daughters, Dawn Marie, Jamie Lea, and Alyce Daniela. They enjoy flying single-engine airplanes and motorcycles, scuba diving, snorkeling, traveling, sports, and music.  

JAMIE LEA SCHAEFER, M.D. 


























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My Father...Dr. Alston Callahan

My Father, Alston Callahan, MD
by Michael Callahan, MD
My father, Alston Callahan, was raised by my grandmother Effie, essentially as a single parent, as my grandfather passed away in an accident at an early age. She was a very stern and strict woman who lived in a small apartment in Vicksburg, Mississippi, and pushed Dad academically so that he finished high school, Mississippi College, Tulane Medical School, and residency training younger than most students.  One of his favorite professors at Tulane was Dr. Mims Gage, who endeared himself to students by teasing them about their errors in presentations and sometimes giving them nicknames.  My Dad’s nickname became “Mr. Edema” after misdiagnosing an osteogenic sarcoma of the leg.  This was not a form of belittling but rather a way of prodding students to do their best.  This professor-student relationship came back to assist Dad years later.

At the age of 26, my dad’s first job was joining his half-brother Edley Jones, MD, in an EENT practice in Vicksburg, Mississippi.  However, he soon began yearning for a bigger challenge and moved to the big city of Jackson, Mississippi.  This was 1937, and my dad was a single man living in a YMCA apartment while practicing ophthalmology, which mainly consisted of performing refractions with loose lenses.  In 1938, he became the first ophthalmologist in the state of Mississippi to become certified by the American Board of Ophthalmology.
In 1941, Dad married my mother, and by this time, war was raging across Europe.   Even though the United States was officially neutral following Pearl Harbor, President Franklin Roosevelt declared war on Japan, and World War II began.

Dad enlisted in the U.S. Air Force but soon learned that the U.S. Army was to implement specialty care hospitals across 
the country to handle the head and neck casualties from the War. He knew he wanted to be a part of this medical network, and he set his sights on Northington General, located in Tuscaloosa, Alabama. It was slated to be a Southeastern tertiary care hospital with 400 beds for facial, head, and neck plastic casualties.

The dilemma was that he was in the Air Force, not the Army, and had to somehow get transferred to the Army. After much consideration, he concluded that the only way he could do this was to tell his commanding officer that he was afraid of flying (even though he had previously earned a private pilot’s license). Word spread down the line that Callahan was trying to bamboozle the armed services, and because of this, his new commanding officer decided to deploy him to the South Pacific to punish him.

Looking up and down the chain of command, he realized that the superior commanding officer in his district was none other than his Tulane professor, Dr. (now Colonel) Mims Gage, who fondly remembered “Mr. Edema” and who conveniently outranked the army officer who was sending Callahan to the South Pacific. So, Dad appealed to Gage to intervene and reverse his orders, and this came through just in the nick of time, so he was placed in the U.S. Army Hospital in Tuscaloosa, Alabama, instead of the South Pacific.  This event altered his future forever. 

Now in Tuscaloosa, married and a father, Dad, and his colleagues worked furiously in surgery three days a week; the clinic was also three days a week, and there were conferences on Sunday. Patient presentations were enhanced by illustrations and photographs that the Army photographers took of the injuries, often with preop and postop results.  This was a kind of “grand rounds” and Dad and his colleagues confronted each other just as fiercely in this arena as the soldiers did on the battlefield.  I once asked Dad just how busy he was. He responded, “Mike, the wounded soldiers were shipped in so rapidly that we could hardly catch our breath.  The plastic surgeons and oral maxillofacial surgeons did not have time to handle many of the patients, so we ophthalmologists began to learn how to best care for various orbital and adnexal injuries.  Because of the volume, we could try various techniques to see which one was the best, so in short order, we learned how to repair these injuries in as few steps as possible.”
Wounded soldiers from all over the world were sent to Northington, one of the most technologically advanced Army hospitals of its time, for operations that most hospitals were not capable of performing. Word spread around the medical core that groundbreaking work produced never-before-seen outcomes in Tuscaloosa, and many senior ophthalmologists began to desire Dad’s position.  Competition was so intense that pressure was applied to Colonel Gage to have Dad replaced.  Colonel Gage requested that Colonel Derrick Vail (who, after the War ended, would become the editor-in-chief of the American Journal of Ophthalmology and a revered figure in ophthalmology in Chicago) evaluate Dad’s work.  Colonel Vail spent a week in Tuscaloosa, literally buried in work with all the surgeons, and reported back to Gage that no one was better qualified to lead the team in Tuscaloosa than Dad.  Later, Vail put into action a brilliant order for the Chiefs of the various eye hospitals to organize an oculoplastic symposium in Cleveland, Ohio.  These other regional ophthalmologists were none other than Crowell Beard, Byron Smith, Merrill Reeh, Charles Iliff, and Wendell Hughes.  This symposium, one of the very first meetings of those war-trained physicians, served as a catalyst for those who would later become known as the forefathers of the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Following the surrender of the Axis Powers, my dad, who was located in Birmingham, Alabama, was offered the Chair of the Department of Ophthalmology at the University of Alabama School of Medicine.  It was soon apparent that a private eye hospital, much like what was created in the Army, could prosper and become more efficient, separate from the University. The Eye Foundation Hospital was created and admitted the first patients in 1963. An ophthalmology residency was approved by the American Academy of Ophthalmology in 1965.  In 1999, the Eye Foundation Hospital was named the Callahan Eye Foundation Hospital. 

Crowell Beard, MD

Crowell Beard, MD

Crowell Beard is renowned as one of the three major founders of Oculoplastic Surgery. His career accomplishments include helping found ASOPRS, developing Oculoplastics as a specialty, authoring the first definitive textbook on ptosis, training many of the second generation of Oculoplastics preceptors, and developing the eponymously named Cutler-Beard staged bridge flap. 

Beard was one of three sons of J. Edgar Beard and Mabel Crowell Beard. The Beards were an early pioneer family in the Napa Valley and co-owners of the Thompson, Beard & Sons mercantile store in Napa.  Crowell was born in Napa, California, on May 23, 1912.   He attended the local schools in Napa for his early education and, as a member of a musically talented family, learned to play the violin.  Following his father’s pathway, he attended the University of California at Berkeley, initially studying Chinese, economics, and statistics before changing his major to pre-medicine. At UC-Berkeley Crowell transitioned from playing violin to playing the banjo on a weekly half-hour radio show in Berkeley.

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Special Guest SASOPRS Member: Richard Angrist, MD Interviewed

 For the Love of the Game...

SASOPRS: I understand that you’re a big baseball fan. When did your interest in baseball begin?

Richard: My interest in baseball began when I was about seven years old.  My first baseball game I attended was in 1963 at the old Polo Grounds. The Mets were playing the Cardinals that day, and, of course, lost. I began collecting baseball cards.  In those days, we would put the cards in the spokes of our bicycles, use them to "color", trade, etc. I remember attending about 20-25 NY Met games a year at Shea Stadium with my father who was a Deputy Chief Inspector in the NYPD.  My father commanded half the precincts in Brooklyn.  We would go on "rounds" after the game and officers in the precinct stood up and saluted him when he entered.  We would then go to either Peter Luger Steak House or Crisci's restaurant for dinner. I remember car rides with my dad. We would talk about current events and other topics and really "bond." 

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pecial Guest SASOPRS Member: Richard Angrist, MD Interviewed

 For the Love of the Game...

SASOPRS: I understand that you’re a big baseball fan. When did your interest in baseball begin?

Richard: My interest in baseball began when I was about seven years old.  My first baseball game I attended was in 1963 at the old Polo Grounds. The Mets were playing the Cardinals that day, and, of course, lost. I began collecting baseball cards.  In those days, we would put the cards in the spokes of our bicycles, use them to "color", trade, etc. I remember attending about 20-25 NY Met games a year at Shea Stadium with my father who was a Deputy Chief Inspector in the NYPD.  My father commanded half the precincts in Brooklyn.  We would go on "rounds" after the game and officers in the precinct stood up and saluted him when he entered.  We would then go to either Peter Luger Steak House or Crisci's restaurant for dinner. I remember car rides with my dad. We would talk about current events and other topics and really "bond." 

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Byron Smith and His Fellowship Prior to ASOPRS

Byron Capleese Smith was a renowned pioneer in Oculoplastic Surgery. Born in Tonganoxie, Kansas, in August of 1908, he received his B.A. and M.D. from the University of Kansas in 1931. Early in his career, he trained in psychiatry at Topeka State Hospital from 1931-34.  Knowing his personality, I suspect that he quickly realized psychiatry was not his calling. Byron continued on to New Haven Hospital, completing a residency in general surgery in 1938. Finally, he completed a two-year residency in ophthalmology at The New York Eye and Ear Infirmary in 1940.

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SASOPRS Member Interview of John J. Woog

SASOPRS: John, I understand that you and your family have faced a major medical challenge. Can you tell us a little about your story?
John: Sure. I was in my mid-40s with two young kids when I was diagnosed with advanced stomach cancer. Despite aggressive surgery and postop chemo, I developed liver metastases. I failed additional conventional chemo, RF ablation, Phase 2 and 1 clinical trials, and partial hepatectomy prior to responding to last-ditch experimental therapy. I’ve fortunately remained stable for the past 11 years. While, like many cancer patients, I have ongoing medical issues and concerns about recurrent or secondary malignancy, I’m profoundly grateful to be here.

SASOPRS: That’s remarkable. I heard that you and your wife recently published a book about your story. What motivated you to write about your experiences?
John: When I was diagnosed, and especially when my metastatic disease was progressing relentlessly, we wished that there was a step-by-step reference to help guide us. In addition, over the years we’ve shared advice with a soberingly large number of family members and friends (including dear ASOPRS colleagues) who have faced their own challenges with cancer. Several folks asked if we would consider sharing our lessons learned during this process.

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Marvin Harold “Marv” Quickert

I had the privilege of knowing Marv Quickert as a mentor and co-director of my ASOPRS fellowship at the University of California, San Francisco (UCSF), as well as a friend and extraordinary human being. He tremendously influenced my life, and I am sure he did all those fortunate enough to know him.

Marv was President-Elect of ASOPRS in 1974 when his life ended unexpectedly while scuba diving at the age of 45. His death, after only thirteen years of practice, was a true loss to his family, friends, ASOPRS, and oculoplastics. One of the brightest minds in oculoplastics and a perfectionist, he constantly sought a better understanding of orbital anatomy and eyelid function, thus improving operative techniques and outcomes. The field of oculoplastic surgery has progressed significantly in the last fifty-plus years since his death. Still, man of his ideas were the basis for a better understanding of anatomy and function. Surgical procedures and techniques, especially with lacrimal and eyelid problems, are still influenced today by his understanding and development of knowledge. One can only imagine what additional contributions he would have made to oculoplastics had he lived a longer life.

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My Mentor, Albie Hornblass

Albie Hornblass
by David Reifler

My mentor, Albie Hornblass, is well remembered by many senior Society members as an ASOPRS past president, skillful surgeon, preceptor, author and textbook editor, decorated military veteran, volunteer leader, philanthropist, and beloved family man. Many details of Albie’s life and his several awards are to be found in the ASOPRS 50th Anniversary Book. I learned of Albie’s passing on January 17, 2007, while at work at a local Grand Rapids hospital. I remember pausing to say a traditional blessing acknowledging God as the Judge of Truth, just as Albie would have said it of another. I then returned to the operating room to lead a surgical team and employ techniques that I had learned by his side. What better tribute than to practice what I had been taught by a mensch who was a giant in our field and an exemplar of living an ethical and loving life of service? Among his military decorations, Albie had earned a Bronze Star as Chief of Ophthalmology at the Pleiku Evacuation Hospital in South Vietnam, but he was most fond of remembering his humanitarian service to Montagnard Highlanders.

My year in New York City with Albie was probably the most consequential year of my training. It was also of great importance in shaping my world view and my personal aspirations of continued self-improvement and service. In Albie’s memory, I have continued to support one of his favorite charities, the Keren-Or Jerusalem Center for Blind Children with Multiple Disabilities, whose board he led for many years. With neuro-ophthalmologist Ron Burde, Albie also co-organized the American Israeli Ophthalmological Society, which eventually outgrew its raison d’être as the resources and technological innovations of Israeli ophthalmology advanced to world-class levels. Over many years, I have likewise found meaningful involvement with other non-profit organizations, including pro bono work here and abroad. In retrospect, wittingly or unwittingly, I have attempted to emulate Albie’s finer qualities. I had apparently followed an ancient Jewish precept to “make for yourself a rav” (i.e., a mentor). 

Albie approached life seriously but with a sense of humor. His intense concentration on detail was imbued with a relaxed, Zen-like stoicism. During my fellowship, I sometimes felt the pressure of Albie’s high expectations. When I experienced some additional financial stresses at the mid-point of my fellowship, he carried me through that thankfully brief time. In great measure, he personally showed me the kindness and compassion that he quite naturally showed to patients and co-workers. Albie was good with people, whether one-on-one, in groups of all sizes, or in the service of broad causes and ideals. He had a profound sense of duty and leadership that came to him naturally. 

The lyrics of “New York, New York” maintain that if you can succeed in a tough city like NYC, you can succeed anywhere. Albie Hornblass succeeded in New York City and beyond, and he succeeded in the most meaningful of ways. His good works will continue to reverberate for many generations.

Friday Jerry Popham 2023 Bart Frueh Award Winner...What it means to me

The Friday Jerry Popham, MD winner was Benyam Kinde, MD, PhD for his “DNA Damage Checkpoint Kinases and Traumatic Optic Neuropathy” presentation.

To be selected for the Bart Frueh Award from a cohort of outstanding projects is a humbling experience. The groundbreaking research presented at the Fall 2023 meeting is inspiring, and I feel deeply honored to be a part of ASOPRS and to be selected for this award. This award underscores the shared commitment to advancing our understanding of complex conditions, such as traumatic optic neuropathy, and seeking innovative solutions to improve patient outcomes.

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ASOPRS Foundation 2023 Michael Hawes Lecture

ASOPRS Foundation 2023 Michael Hawes Lecture - Patrick Bryne, MD

ASOPRS Foundation 2023 Michael J. Hawes lecture was presented by Patrick Bryne, MD, entitled Advances in Facial Reanimation 2023.  Dr. Patrick Byrne is a Facial Plastic and Reconstructive Surgeon and the Enterprise Chief of the Cleveland Clinic Surgical Specialties Institute, encompassing Cleveland Clinic’s surgical specialties worldwide. He also serves as the Chairman of Cleveland Clinic’s Head & Neck Institute, which comprises the specialties of Otolaryngology-Head and Neck Surgery, Oral and Maxillofacial Surgery and Dentistry, Audiology, and Speech and Language Sciences.

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Thursday Bart Frueh Winner...What it Means to Me

 

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SASOPRS...What is it? What’s in a Name? Why is it Needed?



Senior American Society of Ophthalmic Plastic and Reconstructive Surgery (SASOPRS) is two years old. It was started of a concern for the needs of ASOPRS members who have contributed much over the years to ASOPRS but who are sometimes forgotten as they age or feel they don’t fit in with the active clinicians.

“Senior” admittedly is a loaded word. While the dictionary says a senior is one who is “more experienced,” some may equate senior to “senile,” “retired,” or “old and out of touch.” But those of us who are more experienced beg to differ. We still have something to offer!



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International Outreach...Honduras

The ASOPRS Foundation is excited to support ACE Global’s Oculofacial Plastic and Reconstructive Surgery Fellowship Committee to bring to fruition a first-of-its-kind fellowship training program in Honduras. This program will train Honduran oculofacial surgeons to serve as a steadily growing resource for the people of Honduras, where there is a demonstrated need for this specialty. The first-ever Fellow, Nicolle Andrea Ruiz Rodriguez, MD, is training now and is dedicated to improving patients' lives in Honduras.

Honduras faces a significant shortage of oculofacial plastic and reconstructive surgery providers, which has a profound impact on the health of its citizens, especially the poor. According to the World Health Organization, there are only 0.2 oculofacial plastic surgeons per 1 million people in Honduras. This limited access to specialized care leads to delayed diagnoses, inadequate treatment, and increased rates of preventable blindness. Honduras has one of the highest poverty rates in Latin America, making it difficult for many patients to afford the medical care they desperately need.

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Meet the 2023 Dale Meyer Rising Star

2023 Dale Meyer Rising Star, in my own words. 

                When I started my ophthalmology residency, I didn’t know much about the field of oculoplastic surgery. Working with Dr. David Tse in the clinic and operating room opened my eyes to a unique side of ophthalmology. I found myself drawn to complex cases requiring multidisciplinary care, and I felt inspired by the life-saving care we often provided. I was fortunate to care for a patient with lacrimal gland adenoid cystic carcinoma (LGACC) who had received trimodal therapy. This inspired my research into obtaining intraoperative margin clearance in tumor removal, which remains the highest risk factor for mortality.

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Why I Give...Patrick Flaharty's story

Why I Give...Patrick Flaharty's Story

When I attended the 50th anniversary of ASOPRS in San Francisco a few years back, it dawned on me that I had been a member of ASOPRS for more than half its existence. Over the years, I have built many great friendships with ASOPRS colleagues and watched the organization grow with the addition of many outstanding new members. As a cosmetically oriented physician, I’ve enjoyed and learned from my colleagues in the other core disciplines, but in the final analysis, I am most closely allied with my ASOPRS colleagues. We have the same core training, come from the same family tree, and need to nurture the continued growth of that tree for the next generation of ASOPRS physicians. Donating to the ASOPRS Foundation is one easy way to give back to the organization that has supported us over all these years and to help strengthen that organization to have an even greater impact on the world in the years to come. 

Why I Give...John Fezza, MD

"I encourage you to donate to the foundation; it makes a difference!" ~ J. Fezza

ASOPRS and the Foundation have always been like a family to me. There are so many incredibly talented, smart, and inspirational members, and I truly enjoy my interactions. More importantly, ASOPRS has been a platform for meeting old friends and making new ones. ASOPRS has been the gold standard for oculofacial plastic surgery and most advances in our field have been championed by ASOPRS members. I feel ASOPRS and ASOPRS Foundation are truly one and strive to educate physicians, set excellence in patient care, and provide a space for innovation in our field.

The Foundation has grown in the past decades to emerge as an outstanding charitable organization. It supports mission work in foreign countries training of foreign physicians in places where care is difficult, and it creates a platform and support for new research. In the past 20 years, the Foundation has provided unyielding philanthropic assistance, and its impact can be felt globally.

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