Building a Successful
Career: Advice from
Leaders in Thoracic
Sean C. Grondin, MD, MPH
I have been an attending thoracic surgeon for more
than 10 years and, like many surgeons, work hard
to provide exemplary clinical care, to be a good
mentor and teacher, and to publish valuable
research contributions. I have been fortunate to
have had mentors who have guided me through
my surgical training and early years of practice,
and a wife and children who help me to maintain
a delicate work-life balance. At midcareer, I realize
how much I have learned from and been influenced
by the experience and guidance of other surgeons.
With this in mind, an outstanding group of surgeons
(Box 1) were selected to each write a short
summary of what they deem to be key elements
for developing a successful thoracic surgical
career. These unique and informed perspectives
offer many insights that will provide useful lessons
to others in our field.
A career in thoracic surgery is rewarding but also
demanding, requiring substantial commitment
and serious dedication. Although thoracic sur-
geons make a major difference in patients’ lives,
they may also cause harm by choosing overly
aggressive operations, making a technical error,
or failing to operate at the right time. Developing
a successful thoracic surgery career is about mini-
mizing the harm and maximizing the benefit to
patients and their families. My section of this
article gives a brief introduction of the basics of
developing a career in this fascinating profession.
The foundation of any career, and especially one
in thoracic surgery where the stakes are so high, is
in obtaining the proper training. Most of the oper-
ations and techniques I use today in practice
were not invented when I was in training; therefore,
education should provide a platform on which to
learn. Students should seek to obtain a solid foun-
dation in anatomy, physiology, pathology, and
basic patient care. This foundation enables sur-
geons to adapt and shape their skills as new tech-
nologies arise to fit the needs of the patient and
provide a solid understanding of the reasons why
certain operations are chosen. Without a solid,
basic fund of knowledge, a surgeon will just pick
up whatever comes along and give it a try, floun-
dering in a sea of uncertainty, with no clear under-
standing of why some patients do well and others
do not. Knowledge is required to objectively eval-
uate a new technique or procedure to have some
reasonable hypothesis that the operation will be
of benefit to the patient. Acquisition of knowledge
is never complete. Learning must continue after
residency, sometimes even at a faster rate, for
thoracic surgery is advancing quickly. The suc-
cessful thoracic surgeon stays current and uses
this new knowledge for the patients’ advantage.
After initial, fundamental knowledge is obtained,
a surgeon must establish a practice. Today, this
almost always means joining a group practice.
The former chair of the department of surgery at
Massachusetts General Hospital, Dr G.W. Austen,
gave me some advice when I was a resident that
has proved to be useful. He noted that 3 factors
Division of Thoracic Surgery, Department of Surgery, Foothills Medical Centre, University of Calgary, 1403 29th
Street NW, Room G 33 D, Calgary, Alberta T2N 2T9, Canada
E-mail address: [email protected]
Career Success Advice Thoracic Surgery
Thorac Surg Clin 21 (2011) 395–415
1547-4127/11/$ – see front matter © 2011 Elsevier Inc. All rights reserved.

are important when choosing a practice to join. The
first is the individual partners themselves. These
are the people you will have to interact with on
a daily basis. It is vital that you can work well with
these people for, if not, every day is going to be
a challenge. Developing a solid working relation-
ship with your partners is of primary importance.
They should be trustworthy, honest, reliable, and
excellent surgeons. The second feature is the
department in which you are going to work. Inter-
action with the department is not as important as
with your partners, but the department will still
influence you, although less frequently than your
partners. The department should be supportive of
what you need and want to accomplish; not
controlling, but encouraging your career progress.
The final characteristic to consider when choosing
a practice is the institution you work in or are affili-
ated with. This entity should have a good reputa-
tion both locally and nationally. The goals and
objectives of the institution should be aligned
with yours. The institution you work in will charac-
terize you before anyone meets you, and will affect
your practice, so choose carefully.
The final aspect of developing a successful
thoracic practice is personal development. Medi-
cine can be an all-absorbing profession and the
needs of patients are limitless. Many physicians
have lives that are consumed with medicine, and
they turn into one-dimensional people, concerned
only for the welfare of their patients, ignoring
personal and family responsibilities, only to burn
out after several years. Successful thoracic
surgeons have other interests and are able to
successfully balance work with their personal life,
making time for their family, taking time off for their
own interests and hobbies. This balance allows
them time to unwind and come back to work with
a fresh outlook, often with new ideas, always with
a renewed energy level. Thoracic surgery is a phys-
ical activity, often requiring long stretches of intense
concentration in addition to standing, bending, and
pulling. Keeping in shape by exercising, and
controlling your weight by eating properly, are also
important characteristics of a successful thoracic
surgeon. It does little good to train for 30 years,
learning the craft of thoracic surgery, and then not
be able to perform in the operating room because
of poor fitness. Staying fit gives time to develop
experience as a surgeon, for, as everyone knows,
experienced surgeons are good surgeons, and expe-
rience takes time to develop.
Being a thoracic surgeon is one of the best jobs
in the world. Compensation is good, operating is
enjoyable, patients are challenging, and it provides
the opportunity to help people live longer, more
Box 1
Contributors to this article
Dr Mark Allen, MD
Mayo Foundation, Rochester, MN
Dr Robert Cerfolio
University of Alabama, Birmingham, AB
Dr Gail Darling
University of Toronto, Toronto, ON
Dr Jean Deslauriers
Université de Laval, Québec City, PQ
Dr André Duranceau
Université de Montréal, Montréal, PQ
Dr Mark Ferguson
The University of Chicago, Chicago, IL
Dr Richard Finley
University of British Columbia, Vancouver, BC
Dr Michael Johnston
Dalhousie University, Halifax, NS
Dr Mark Krasna
St Joseph Cancer Institute, Towson, MD
Dr Toni Lerut
Katholieke Universiteit Leuven, Leuven, Belgium
Dr James Luketich
University of Pittsburgh, Pittsburgh, PA
Dr Douglas Mathisen
Harvard University, Boston, MA
Dr Robert McKenna
Cedars Sinai Hospital, Los Angeles, CA
Dr Griffith Pearson
University of Toronto, Toronto, ON
Dr Carolyn Reed
Medical University of South Carolina, Charleston, SC
Dr Jack Roth
The University of Texas MD Anderson Cancer Center, Houston, TX
Dr Valerie Rusch
Memorial Sloan-Kettering Cancer Center, New York, NY
Dr David Sugarbaker
Harvard University, Boston, MA
Dr Manoel Ximenes
Planalto Central School of Medicine, Brasilia, DF, Brazil
Dr Anthony P.C. Yim
The Chinese University of Hong Kong, Hong Kong SAR, China

productive lives. It is hoped that these suggestions
and comments will help develop a few surgeons
into the leaders of tomorrow.
To write about what it takes to build a successful
career in cardiothoracic surgery the word success
must first be defined. The problem is that this defi-
nition is controversial and debatable. What does it
really mean to be successful? Is it how much
money you make, how happy you are, how many
operations you perform each year, how fast you
do them, how little blood your patients lose, how
well your patients do, how you are viewed by
your trainees or staff, and so forth? For most, it
is a combination of these factors and many others.
Webster’s dictionary defines success as “a favor-
able or desired outcome – the attainment of
wealth, favor or eminence.” I find this definition
to be shortsighted and perfunctory.
Because the definition or state of success is not
agreed on, the characteristics required to get there
are not be definable or agreed on either. Given
these caveats, I offer my opinion (and that is all
anyone can offer on this subject) of what I believe
are important attributes that lead to a successful
career in surgery, and list attributes that are unique
and different from those discussed by the other
contributors to this article.
Although this article is specific to a career in
cardiothoracic surgery, many of the attributes
that any of us list could probably be applicable
to success in any career. I am sure that every
author will mention hard work, dedication, com-
mitment, passion, compassion, honesty, knowl-
edge, intellect, timing, a supportive academic
environment, and so forth; however, in order for
my essay to be different and perhaps more helpful
to you, I offer some attributes that may be more
specific for a surgeon to be successful compared
with a lawyer or business person. The first word
that comes to mind, and one that is probably
unsuspected, is athleticism.
I define athleticism as the ability to perform a fine
motor skill again and again under high pressure
while working together with other team members
and while acting as a team leader. Surgery is the
ultimate team sport and a cardiothoracic surgeon
cannot be successful if he or she is not good in
the operating room. So, besides all of the obvious
characteristics that are required for anyone to be
successful in most any aspect of life (eg,
outstanding education and training, good men-
tors, industriousness, some element of luck, family
support), a successful thoracic surgeon has to be
adroit in the operating room. This ability entails
working well with others, being respected by the
other team members, and controlling one’s nerves
and emotions under pressure. This quality starts
long before residency and maybe even before
kindergarten; it may even be partially genetically
programmed. Either way, it is a critical aspect of
being successful.
Another attribute that my esteemed coauthors
may not mention is availability. I know many
talented surgeons who are skilled technical
surgeons and leaders with excellent people skills
but who are not successful. This failure is because
many lack the organizational skills to be available
and reachable. The best way to build a busy and
successful surgical practice is to always be avail-
able when a medical doctor needs your services.
Perhaps more than ability or affability, availability
is a critical aspect of a successful career in surgery.
Stamina is another quality that is often over-
looked. Our training is long; most of us do not start
our practices until we are in our early 30s. I have
seen many surgeons who become burned out by
45 to 50 years of age. They lack the passion to
keep going; they lack the emotional and physical
toughness and stamina that is necessary to rise
early every morning, day after day, and to enter
the operating room looking forward to the day’s
challenges of 8 or 10 operations.
Although I know all of my coauthors will mention
this, I would be remiss not to mention it because it
is the single most important attribute of all: work
ethic. No one gets into cardiothoracic surgery
without an outstanding work ethic, but I notice
that many seem to lose little bits of it after a few
decades of surgery. The mental grind of operating
day after day is taxing, but it takes a finely honed
work ethic to want to try to do it perfectly each
time and not to settle for a good job when we
know that we can and should do it perfectly each
My assigned task was to offer my reflections on
how to have a successful career in thoracic
surgery as if I was speaking with a junior colleague.
As a resident, clinical technical excellence is
usually the primary measure by which we are
judged. It is assumed that, once having passed
your examinations, clinical skills will remain at
a high level, but they must be continuously prac-
ticed, refreshed, and advanced for you to remain
at the top of your game. Clinical excellence is the
foundation of any successful surgical career.
Beyond that, the definition of success varies with
the individual. Indeed, the definition of success
may evolve over time. In my opinion, regardless
Building a Successful Career

of the metric by which it is measured, to be
successful requires 4 key elements: know yourself,
do what you love, focus, and reevaluate.
Know Yourself
This is perhaps the hardest step of all: to reflect on
what motivates you, what gives you satisfaction, to
identify your strengths and weaknesses, and
decide where you want to go in your career.
When I was initially writing my list, I did not list
this as the first step but, as I thought about my
career, I realized that once I had thought about
these things and really identified who I am, what
drives me, and where I wanted to go, my career
really started to move forward. It is important to
identify your own definition of a successful career.
Success for one person may not be success for
another. Perhaps even more important is to recog-
nize that what you once considered success may
change over time.
Once you have completed this step, the next
step is to accept who you are, to be comfortable
in your own skin. Accept that what you want for
yourself may be different from what others be-
lieved, or even what may have once been your
own goals for yourself. Accept your weaknesses
and work to overcome them if possible. Focus
your career in areas of strength and interest.
Do What You Love
We work many hours in our careers. If you do not
love what you are doing, you cannot be success-
ful. You have to identify what motivates you,
what makes you jump out of bed in the morning
eager to start your day. Of course, we all have to
do the other things, but try to carve out a niche
for yourself in an area that you find interesting
and motivating. It is important to work with people
you respect and trust in an environment or culture
of like-minded individuals.
To have a successful career, you must focus.
Focus your clinical practice, focus your adminis-
trative activities or service activities, focus your
teaching, focus your research, and then write or
present seminars, lectures, and research papers
in your area of interest. You must become the
go-to person. There are many questions to be
answered, and it helps if you chose a less-
studied area. Think of good questions and set
about answering them. Structure your tasks in
readily achievable components so that each part
is successfully achieved. You can build on each
step until you complete the entire project
successfully. Present or write about each step;
do not wait for the grand finale.
Avoid distractions. Develop a list of criteria by
which you assess each task asked of you. Does
it fit in your area of focus? Is it something you
love to do or always wanted to do? Does it move
your career forward? If the request does not
meet your criteria, you may try to decline the
request or minimize the time spent on it, but
consider all requests carefully. Look ahead: is
this request or task a building block to something
more substantial?
As your career progresses, make time to reevaluate.
Are you going in the desired direction? Are you on
target? If not, why not? Where did you go off track?
What will it take to get back on track? Are your goals
still the same? Do you need a change? A new chal-
lenge? What is required to follow a new course?
Know when it is time to move on.
Academic careers are usually measured in pa-
pers published, grants awarded, invited lectures,
and academic standing. Equally important are the
students we teach and motivate toward careers in
surgery, residents and fellows we have taught and
mentored who will provide care to patients and
who will go out and teach new generations of
surgeons who will in turn provide care. However,
the foundation of success is the excellent clinical
care to those who entrust their lives to us.
Thoracic surgery is a challenging and rewarding
profession in which academic surgeons have the
unique potential to make significant contributions
through their integration of clinical duties, ac-
ademic work, and research efforts. To do so,
several considerations must be kept in mind. My
personal thoughts about such considerations will
hopefully help junior colleagues be better pre-
pared and thereby contribute to their short-term
and long-term successes.
Early Years
I had the good fortune to grow up in a favorable
family environment. Both of my parents under-
stood the importance of early education and sent
me to boarding school for 12 years (ages 6–18
years). In their opinion, this was the best place
not only to learn how to read and write but, most
importantly, to develop a rational approach to
analyzing and solving problems. In those years
(1952–1964), boarding schools were also a good
place to learn to be disciplined, a factor that

I consider critical to being a successful academic
surgeon able to sustain his or her intellectual drive.
Once I completed medical school at Laval Univer-
sity (1968) and knew that I wanted to pursue an
academic career in surgery, my parents were
also instrumental in the selection of the University
of Toronto Surgical Gallie Program for my post-
graduate education. At that time, the University
of Toronto had the best Canadian residency
program in cardiothoracic surgery. In retrospect,
this decision proved to be most rewarding and
one of the defining moments in my career.
Residency Years
During my residency years at the University of Tor-
onto, I was fortunate to have outstanding personal
mentors (Drs F.G. Pearson, R.J. Ginsberg, R.J.
Henderson, and N. Delarue) who were great
leaders in thoracic surgery and had strong clinical,
academic, and educational records. These
mentors gave me the opportunity to build on my
strengths and they continued their support well
after I had completed my residency program.
They helped mature my judgment through
balanced clinical experiences and assumption of
responsibilities, as well as develop qualities of
commitment, motivation, and willingness to work
with high ethical standards. I not only learned
how to do surgery and look after patients but also
to understand thoracic diseases and their investi-
gation. I learned to write papers and how to be
part of clinical research teams. I met with interna-
tional leaders in thoracic surgery who regularly
visited Toronto and later gave me an opportunity
to present on the international circuit of thoracic
surgery. When I was Chief Resident, I was encour-
aged to foster an esprit de corps with more junior
residents for whom I had became a mentor and
these residents became, and still are, among my
best friends. To this day, I recognize the value of
my training experience, which helped me become
a good surgeon, a better human being, and
a person who learned that I was capable of much
more than I originally believed.
Early Years in Practice
Because of my background at the University of
Toronto, the transition from Chief Resident to junior
faculty member was smooth. Right from the begin-
ning (1975), I was integrated into a medical group
that understood the value of a multidisciplinary
approach to the investigation and treatment of
thoracic diseases and the importance of being
academically productive. I was able to improve
my clinical competence because my first surgical
partner (Dr Maurice Beaulieu) was exceptionally
good. He could and did get me out of many prob-
lems and was instrumental in guiding me through
the early stages of establishing my academic foun-
dation. This type of mentorship was not the same
as what had occurred during residency, being
broader in scope and encompassing clinical,
academic, educational, professional, and personal
guidance. Most importantly, I had an opportunity
for progression, which is a critical feature of an
academic and research career. Starting in clinical
research was done through the writing of retro-
spective analysis on series of patients, but all this
changed when I became one of the principal inves-
tigators of the Lung Cancer Study Group at the
suggestion of one of my mentors, Dr Ginsberg,
from the University of Toronto.
Because there is life outside the operating room,
it is almost impossible to be successful without
some degree of harmony at home and, indeed,
success and performance in the hospital is depen-
dent on happiness and security at home. Therefore,
critical to becoming an academic surgeon is paying
particular attention to family. In my case, I was lucky
to have a wonderful wife who, despite periods of
anxiety, anger, or even sadness, always supported
my work as a clinical surgeon and academician.
She was able to appreciate the difficulties in estab-
lishing an academic niche in the current market-
place and to adjust to such difficulties.
Late Years in Practice
In recent years, I have had the opportunity to add
to my surgical and personal education by being
involved in the People’s Republic of China, where
I spent 1 year as a Thoracic International Consul-
tant in 2008 to 2009. That year was invaluable
both personally and professionally, but it changed
my portfolio of value concepts and reinforced the
importance of the prior education I received during
my residency and early years in practice.
The keys for success as an academic thoracic
surgeon are probably more individual than has
been discussed in this essay but, overall, they
include a good surgical education, opportunities
for progression, continued need for mentorship
and support, respect of family values, and intellec-
tual honesty.
The 4 most important pieces of advice that I have
received from experienced and respected
mentors are as follows: be a good physiologist
as much as a good surgeon, focus on 1 area of
Building a Successful Career

expertise, and learn to define the problems and
report objectively.
A surgeon starting a new academic career
needs such advice. Candidates are selected early,
based on their personality, character, education,
and accomplishments during their training.
However, the true motivation of any individual is
difficult to assess. The level of excellence for
recruitment must be set at the highest tier: ask
for more and recruit better than yourself. The result
in time will be a high-quality group instead of
a successful individual. New positions in our divi-
sion are now available to candidates with a PhD
degree in an effort to favor expertise for investiga-
tion and research. Expectations and planned
progression in academic activities must be ex-
plained to these surgeons.
Security and support for the surgeon starting in
thoracic surgery is essential, which requires an
easy integration into a well-organized group prac-
tice. Solo practice is unacceptable, especially in
a university environment. Group practice should
offer fair remuneration but also protected facilities
and time for research and encouragement for
academic participation. Our group practice model
is an adaptation of the Duke Private Diagnostic
Clinic where the base principle is the need to
invest in your own development to succeed. This
model includes transparent governance, an equal
base salary, and recognition of both clinical and
academic productivity. Expenses for meetings
are reimbursed for up to 20 days per year. Partic-
ipation in professional societies is encouraged and
their membership fees are covered. All incomes
generated by professional knowledge are pooled
and 5% of the clinical income is put into a research
and development fund, fiscally recognized as
a public foundation.
The additional expertise required by the
extended training needs to be recognized by the
university. A university position with a tenure tract
offers the best opportunity for an academic evolu-
tion. It represents security but also applies more
pressure for research and academic productivity.
With the support of our group practice and its
research and development fund, we have suc-
ceeded in creating 3 named university professor-
ships, recognizing the academic distinction of
those recruited in our Thoracic Surgery Division:
1 in lung transplantation, 1 for thoracic surgery
oncology, and 1 for esophageal diseases. These
positions are financed by funds held in endow-
ment. In time, they should guarantee support to
the thoracic surgery division for excellence in
care, education, and research.
Possibly the most difficult challenge that
remains, especially in a socialized environment,
is the unconditional support of the hospital to
meet our goals. Although these goals should be
the same for the administrator working on
a fixed-budget basis, physicians and patients are
often considered as liabilities. When asking for
new technologies and asking for more space and
personnel, the final say too often belongs to
a manager reporting to a politician.
With the best training in hand, a successful
thoracic surgery career depends on an easy inte-
gration into a successful group practice. Recogni-
tion of the outstanding expertise by the university
is essential with a teaching position that includes
a tenure tract. The hospital must commit to
providing the proper working infrastructure.
My approach to this question centers more on how
to build a satisfying career than how to build
a successful career. Success in a career is easily
measured: are you respected by your colleagues,
coworkers, and patients; is the work you do impor-
tant; do you have good outcomes; have you contrib-
uted to the art and science of your specialty? Many
of the other contributors to this article outline reliable
pathways to success. Notably, just because
success is easily measured does not mean that it
is easily achieved. Following those pathways is often
difficult, and success is by no means guaranteed.
Satisfaction in a career is a more challenging
and potentially rewarding goal. Its definition can
be elusive and, being uniquely personal, is
different for each individual. Many physicians
achieve success in their careers without ever
being truly satisfied personally or professionally.
Other physicians never achieve what is generally
defined as success in their careers but derive great
satisfaction from what they do. I make no claims at
being an expert on achieving job satisfaction. I
often have been challenged by the difficulties of
making decisions that affect career success and
career satisfaction in opposite ways, and believe
the following observations are relevant. The astute
reader will note that there are conflicting sugges-
tions provided here.
Define what satisfaction means to you. Identify
what your priorities are in your personal and
work lives. Ensure that you devote as much
thought and energy to your personal priorities as
you do to your professional ones.
Learn to say no. Not everything that you are
offered, or everything that attracts you, serves
your midterm and long-term goals. Prioritize your
opportunities, identify what you can reasonably
expect to accomplish in the allotted time, and
decline what does not work for you.

Use your time efficiently; in particular, do not let
others waste your time. Feel free to leave meetings
that are not being run effectively, that are straying
from their agendas, or that conflict with other
personal and professional commitments.
Find a niche that you love and that, within your
own sphere, you can own. This sphere will expand
substantially as your interest and expertise grow.
There are so many opportunities within our
subspecialty that it should not be a challenge to
find 1 or 2 areas to which you can fully devote
your energy and enthusiasm.
Be flexible in your thoughts and behavior. Being
open to new ideas or new ways of doing routine
tasks creates opportunities for improvement.
Change itself is not always good: there needs to
be a rationale for it, but being open to change is
always good.
Be a lifelong learner. There is nothing more
rewarding than learning new concepts, clinical
approaches, or operative techniques. Having
methods for staying on the top of your game is vital
to enjoying a career that may span 30 or 40 years.
Share your knowledge with others. Although this
is easy in an academic setting when you are sur-
rounded by residents and medical students,
opportunities still abound in a private practice
setting. Nurses and other physician extenders
will benefit from your teaching, as will your
patients, and the community at large is always
hungry for knowledge about our subspecialty.
Humbly appreciate the talents you were blessed
with and the accomplishments you have achieved.
Be thankful that you have the opportunity to work
in a respected profession that serves others.
General thoracic surgery has provided a chal-
lenging and rewarding professional career. After
30 plus years of practice, I still look forward to going
to work and helping patients with complex thoracic
surgical problems. I believe the key elements in
developing a successful thoracic surgery career
include education and mentorship, teambuilding,
teaching, and personal development.
Education and Mentorship
Under the direction of Dr Angus McLaughlin and
Dr John Duff, I received an excellent surgical
education at the University of Western Ontario.
The former was an outstanding educator whose
tireless effort to prepare me for the arduous
profession of surgery set the standard for my
further development in thoracic surgery. Dr John
Duff was an outstanding surgeon, educator, and
researcher. He strived to create new knowledge
in the management of uncontrolled sepsis, which
stimulated me to take further training in basic
surgical research at the Harvard Medical School.
This training allowed me to answer important
surgical questions in the area of esophageal and
thoracic surgery.
Following my general surgical and basic science
training, I was fortunate to train under Dr Griffith
Pearson and Dr Joel Cooper at the Toronto
General Hospital (TGH), at the peak of the divi-
sion’s academic and clinical accomplishments.
Dr Pearson stimulated me to follow my dream of
an academic career in general thoracic surgery,
which has come to fruition thanks not only to the
mentorship of Drs Pearson, Cooper, Ginsberg,
Todd, Delarue, and Henderson but also to
colleagues who understand the role of academic
surgery in the care of the patient needing general
thoracic surgery.
Based on this experience, my advice to resi-
dents and young academic general thoracic
surgeons is to get the best education you can
and establish yourself as an excellent surgeon
whose primary interest is the safe care of the
patient. Be professional in every encounter with
patients, colleagues, and staff. Become an expert
in 2 or 3 areas in general thoracic surgery, study
the history and development of these subspecialty
interests, and join societies in which these inter-
ests can be nurtured and a network of colleagues
can be fostered. Develop research questions in
these areas that can be answered with good
science, followed by presentation and publication
at peer-reviewed meetings. In addition, thoracic
surgery will continue to change. General thoracic
surgeons must practice lifelong learning through
reading journals and attendance at meetings. It is
important to keep up to date in new technology
and processes in order to play a leadership role
in the management of the patient with thoracic
Team Building
A successful career depends on excellent multi-
disciplinary patient care, education, and research
teams. First and foremost are your fellow general
thoracic surgeons in your division. These col-
leagues need to be excellent clinical surgeons
with dedication to the development of the
academic thoracic surgery team. Although their
interests may vary, their primary focus is on treat-
ing the patient who needs thoracic surgery in
a caring and evidence-based manner. Secondly,
the clinical support staff is an essential part of
dealing with the complex and arduous workload
associated with general thoracic surgery. The staff
Building a Successful Career

needs to be well trained and dedicated to patient
safety and quality improvement. Stimulating part-
nerships with respirologists, gastroenterologists,
otolaryngologists, anesthesiologists, oncologists,
and pathologists are essential for excellent patient
care and creative research.
The most satisfying aspect of my job is ensuring
that our students, residents, and fellows receive
the best clinical and academic training available.
I recommend that the resident should have at least
a Masters degree in epidemiology, education, or
a basic science research in order to sustain their
academic career. After these residents have grad-
uated, it is important to maintain communication
with them to support their development.
Personal Development
In order to lead others, you must manage yourself.
Many brilliant thoracic surgeons have destroyed
their careers with unprofessional activity. You
need to make time for yourself and your family.
You must keep yourself fit, mentally and physi-
cally. Develop hobbies and a life outside surgery
in order to broaden yourself. Despite the chal-
lenges of modern thoracic surgery I envy those
who will practice this rewarding specialty in the
Success means different things to different
people. To me, it is being able to do what I want
to do when I want to do it. This view may be
a simplistic, but it encapsulates what I think are
the most important prerequisites for becoming
a successful thoracic surgeon:
1. Broad training that leads to broad perspectives
and more opportunities
2. Research experience keeps the door open for
academic pursuits in the future
3. Always striving to be an effective educator
4. Awareness that mentoring involves much more
than educating
5. Being an effective, compassionate communi-
cator builds trust and confidence in patients
and their families.
Success is a career-long pursuit. Some of us
may be fortunate enough to practice in the same
location and rise through the ranks for our entire
career. But for most of us, including myself, during
those 30 or 40 years of our professional life,
options are encountered by choice or by necessity
that will significantly alter our career pathway.
Whether it is promotion, or salary, or protected
time, or research support, at some point you
believe you need to draw a line in the sand.
“Meet my demands or I leave.” Just remember, if
your demands are not met and you stay, your
credibility is worth about as much as a subprime
mortgage, so know your alternatives before you
issue your ultimatum.
When career options arise, the choice may be
obvious and is usually dictated by that old adage
“Never make a lateral move.” If only it were that
easy! But factors seemingly extraneous to our
career often get in the way of the obvious. Factors
such as family, friends, geography, politics, and
even health may make a seemingly easy decision
difficult. Transitions are hard and do not always
end up being career enhancing. My advise is to
carefully weigh the choices, make the decision,
and never look back.
Once in a new position, possibly a new hospital
or university, or, in my situation, a new country,
one has to look at the opportunities available,
which is where broad training and experiences
really pay off. I moved from the University of Colo-
rado in the early 1990s to the University of Toronto
just as the likes of Cooper, Ginsberg, and Patterson
were heading south. Bad timing or good opportu-
nity? It could have been either, but I believe (admit-
tedly in hindsight) it turned out to be the latter.
To be recognized as a leader and an expert, one
eventually has to narrow the scope of practice,
probably from both clinical and research perspec-
tives. Thoracic surgery is just too large a field to be
proficient in all areas. I must confess that I mostly
decided what I no longer wanted to practice rather
than actively deciding what to pursue. I was always
drawn to thoracic oncology, but along the way I
dropped cardiac, thoracic vascular, transplant,
and benign esophageal practices. A combination
of interest and opportunity were undoubtedly the
determining factors.
Once you see yourself heading in a certain career
direction, it is time to actively focus. Research and
clinical practice should reflect that focus, as should
educational pursuits. Join the appropriate highly
focused organizations (over and above the national
thoracic societies) and take courses that will
enhance your knowledge in that focused area, be
it surgical education, minimally invasive surgery
(MIS), or biomarker validation. Spending time with
experts in that particular field is essential. After 3
years at the National Cancer Institute, I had
a reasonable idea of cancer clinical trial design,
but only after an in-depth experience with Drs
Mac Holmes, Griffith Pearson, and other notables
in the Lung Cancer Study Group could I comfort-
ably claim to be proficient in the field.

In my career I have worked with some excep-
tional surgeons and basic scientists. I have prac-
ticed both cardiac and general thoracic surgery
in private, university, and Veterans’ Affairs settings
and in 2 countries with very different health care
systems. I have held peer-reviewed funding for
both basic and clinical research. However, for
me, the most gratifying and personally rewarding
element of my career has been the mentorship of
students, residents, and fellows. Being a mentor
is more than merely educating these bright young
people. It is role modeling and leading by example.
It is advising and counseling for their best interest.
It is also critiquing and criticizing in a manner that
constructs rather than destructs. The rewards are
the pure satisfaction of having influenced and
shaped a career, and a lasting bond of gratitude
from a group of eager, but highly vulnerable,
trainees who now are your peers.
After a nearly 20-year academic career, what
makes a thoracic surgeon get up one morning
and say “I’m going to do something different”?
One is satisfied that you have helped hundreds
of patients each year. You even believe that you
have developed those unusual skills of knowing
when not to operate, as well as the audacity to
know that there are certain procedures that you
can do that few others would ever try to do. You
have enjoyed training students, residents, fellows,
and postdoctoral students who have themselves
gone on and become successful thoracic
surgeons around the world. So why stop? What
would be the career move that would give the
most satisfaction? The next step can be more of
the same: a lateral move to another institution
where you can make a new or larger program or
develop an existing program successfully. One
could always go to the obvious next step in the
academic food chain and become a chairman of
a department of surgery. Having worked within
the department at many administrative levels, the
department head option was not for me.
What I wanted was to make the greatest impact
on patient care and the future of thoracic surgery,
integrated with the other oncology disciplines. I
had successfully developed a thoracic surgery
division and initiated a thoracic oncology program.
In addition to implementing biweekly prospective
cancer conferences, we developed true multidisci-
plinary thoracic oncology clinics. We began repli-
cating this model in other disease sites when I
served as associate director for multidisciplinary
care within the Cancer Center. Then I realized
that the next step was obvious: become a cancer
center director! Although I was able to perform 400
thoracic procedures a year, and my division as
a whole was able to perform more than 1200
procedures a year, my thoracic oncology program
treated almost 3000 patients a year. As cancer
center director, I would be able to have a unique
impact on the care of thousands of patients.
Although I looked at many opportunities at single
institutions in academia and the community
setting, I ultimately chose to join a large health
care system. The system included 79 hospitals
from coast to coast, and would enable me to reach
more than 60,000 new patients with cancer a year,
with a total of more than 250,000 patients with
cancer within our system. This impact was what I
was looking for.
What are the skills that enable a thoracic
surgeon to become a cancer center director?
We thoracic surgeons are uniquely situated to
understand the value of multidisciplinary cancer
care. We understand team work and team
building. We can learn to leave our big egos at
the door when we enter the examination room or
conference and put the patient’s needs first while
implementing multidisciplinary cancer care.
The additional skills that thoracic surgeons
possess to accomplish this include leadership,
compassion, reliability, and our let’s-get-things-
done approach. This impatience helps us achieve
more hard-to-reach goals faster than others. We
are used to thinking outside the box and rapid
problem solving, with unique abilities to adapt to
changing realities. We respond well to change; we
recognize a problem, analyze it, make a decision,
and then launch into action. Autonomy is one of
the traits that thoracic surgeons crave, and, in the
milieu of health care, this is one that is often chal-
lenged. The ability to maintain autonomy and affect
health care on a broad scale is, again, one of the
attractions of being a cancer center director, where
a reporting structure directly to the CEO or Board of
Directors is possible. Although there is no formal
training in most residency and fellowship programs,
thoracic surgeons become leaders naturally in the
course of their training. Bringing a whole team
together to follow a strategic vision is challenging,
but thoracic surgeons are used to being the captain
of the ship and leading by example. This ability is
learned when performing major cardiac and
thoracic complex procedures that require commu-
nication with a large team made up of different
specialties. Leading that team by example, earning
and then commanding respect and rewarding team
members, is one of the first lessons that the resident
develops in training.
Once the decision is made to become a cancer
center director, thoracic surgeons needs to marshal
Building a Successful Career

their skills to best succeed, which includes multi-
tasking, continued learning, and, in particular, ex-
panding the scope of our knowledge base:
understand the other cancer specialties by reading
their literature and participating in multidisciplinary
conferences and educational programs. This
process positions thoracic surgeon leaders to be
serious and knowledgeable contenders among
their colleagues, and be respected for decisions
that affect all aspects of cancer care. In addition
to participating in annual thoracic surgery confer-
ences, I have also maintained a presence, at least
once a year, at national oncology conferences.
In addition, surgeons must learn and understand
the business of medicine and of cancer care in
particular. This learning does not necessarily
mean getting a Master of Business Administration
(MBA), but at least a basic knowledge of budgets,
strategic plans, and vision goals is required. Suc-
ceeding on the business side of health care today
is a necessity in order to achieve a greater impact
on improving patient care. Seeing the forest and
understanding each of the trees and their
surrounding environment is a gift that thoracic
surgeons generally have. We realize that patient-
derived revenue is generally dependent on refer-
rals, which is dependent on relationships with other
physicians. As thoracic surgeons in a competitive
environment, we know better than most the impor-
tance of communication with referring physicians
and keeping primary care doctors in the loop and
not feeling left out. Other sources of revenue that
the thoracic surgeon director can bring to the insti-
tution include fundraising and grant procurement.
Leaving academia does not mean leaving
academics. A thoracic surgeon cancer center
director in a community setting should strive to
publish programmatic data, and encourage other
staff from the various disciplines to do the same;
this not only is good marketing and public relations,
it truly allows the team to assess its own results
critically and contribute to the body of scientific
knowledge. In addition to involvement in clinical
trials through cooperative groups or industry spon-
sored research, National Institutes of Health (NIH)
grants are available for clinical as well as basic
science research in the cancer arena, including in
nonacademic centers. Our current NIH/National
Cancer Institute (NCI) grant and subcontract
awards exceed many academic departments in
dollar amount and scope of projects.
In conclusion, I paraphrase what I learned from
Dr Denton Cooley on grand rounds one day in
the Children’s Hospital in Boston, “Codify (your
ideas), modify (to fit the specific environment),
simplify (the process to make it easy and repli-
cable), and apply (the new paradigm to your
setting).” If one can transcend the personal satis-
faction of doing a case, rise above the challenges
of leading an operating room team, a thoracic
surgeon can make an even greater difference as
a program leader.
For more information on leadership, 2 classic
books I suggest are Leading change by J.P. Kotter
(Harvard Business School Press; 1996) and On
Leadership: Essential Principles for Success by
D.J. Palmisano (Skyhorse Publishing; 2008).
In November 1973, when I was in the final phase of
my residency in surgery, my Chief Professor Jac-
ques Gruwez invited Mr Ronald Belsey to be
a keynote speaker at an international symposium
at our institution. Six months later, a letter from
Mr Belsey arrived on my desk announcing
a vacancy for a senior resident in his department
at Frenchay Hospital, Bristol, United Kingdom. I
was offered the position and went off to Bristol
for what became a dazzling experience and the
turning point in my career.
Being a brilliant surgeon, original thinker, and
superb teacher, Belsey, in those days named
The Pope of Esophageal Surgery, shared his skills
and knowledge through personal example with the
benefit of a masterly command of the language.
Not surprisingly, this unique experience triggered
my interest in thoracic surgery, as it most likely
did for many of the approximately 45 other interna-
tional trainees who became influential leaders in
thoracic surgery.
Following residency, it was not clear to me
whether I would pursue a career in private practice
or in an academic environment. Being inspired by
Mr Belsey and realizing that only a few centers
focused on thoracic surgery, I decided to pursue
an academic career.
Some years later, again through Mr Belsey’s
influence, I was offered a scholarship to the
University of Chicago where I met Drs David
Skinner and Tom DeMeester. They both intro-
duced me to the wonders of esophagology and
widened my thoracic horizons by bringing me in
contact with Drs F.G. Pearson and Joel Cooper.
My exposure to their pioneering work in lung trans-
plantation became the basis for starting our own
lung transplantation program. Other inspiring
leaders who have influenced my career include
Dr Alberto Peracchia from Italy and Dr Hiroshi
Akiyama from Japan. From this review of my
career, it is clear that building a successful career
is a gradual and multifactorial process.
To begin, I clearly had a great deal of luck. To be
trained and mentored by a giant in thoracic

surgery was the result of a coincidence, and that
training allowed me to stand on the shoulders of
a visionary leader and thus to be able to look a little
bit further than my fellow colleague residents at
that time. Perhaps luck favors a prepared mind.
The willingness to leave one’s own safe environ-
ment and to take on the challenge of a foreign
environment and medical system was critical to
my success.
Second, building a successful career requires
the capacity of self-assessment. You need to
assess yourself continuously in order to know
what you really want to obtain in life (eg, to choose
between a career in private practice or an
academic career).
Third, because today’s medicine is evolving at
an incredible pace, it is of paramount importance
to prepare for a lifelong learning process and a crit-
ical analysis of one’s own results. These goals can
be accomplished locally but also by attending
international meetings and by fostering interna-
tional contacts through international scientific
society activities.
Fourth, building a successful career requires
teamwork. This teamwork needs to be first of all
within your own group. It is of paramount impor-
tance to be surrounded by outstanding col-
leagues. Taking advantage of having built an
international network allowed me to offer my
coworkers and future partners the possibility to
obtain additional training in centers of excellence.
These colleagues were sent to these centers to
focus on 1 or more particular areas of interest
that would later allow them to return to our group
with this expertise. Offering such opportunities to
excel creates job satisfaction and team spirit that
is essential for guaranteeing the highest quality
of care. The result has been that I have been priv-
ileged to work with an outstanding group of
thoracic surgeons during my career. The other
essential component of teamwork is multidisci-
plinary. Surgeons need the interdisciplinary skills
of a wide spectrum of disciplines with whom we
have to work on a daily basis. To work in such
an environment requires sufficient emotional intel-
ligence and social skills.
Building a successful career in thoracic surgery
requires a permanent belief in your dreams. To
quote Eleanor Roosevelt, “the future belongs to
those who believe in the beauty of their dreams.”
The development of a junior faculty member in an
academic setting is a challenging endeavor. After
a long and arduous residency, a young faculty
member will face many challenges at any institution.
There are various pathways that can be pursued to
climb the academic ladder. It is important to have
a detailed discussion with the Cardiothoracic Chief
or Chairman as to your goals and his or her expec-
tations. Make sure that you do not choose a path
determined only by what a Chairman or Division
Chief is seeking, but also find a position with
a pathway that excites you and is best suited not
only to your background and skill set but also to
your personal strengths and passion. Preliminary
discussions of your goals and the Chairman’s
expectations are crucial to your ultimate success
and happiness in your new environment. The ideal
institution is one that has adequate resources and
mentoring that will allow you to succeed and one
that places an emphasis on research at a level that
is compatible with your personal goals.
The potential tracks for junior faculty surgeons in
an academic setting include both a tenure track
and a non-tenure track. It is critical to identify
a focus for your work whether clinical care, teach-
ing, research, or program development. Advance-
ment in the tenure track is most frequently
accomplished by the route of the surgeon-scien-
tist, whereby one develops a focused research
effort, characterized by originality of work, publica-
tions, grant funding, sustained productivity, and
achievement of national/international reputation.
This has traditionally been laboratory-based basic
science research. Generally, a junior faculty mem-
ber is expected to obtain extramural funding within
1–3 years of his or her appointment in the form of
a start-up grant. Following this early success,
achieving tenure in most institutions requires
peer-reviewed publications, national presentations
and additional grant funding at a more senior level
such as Research Project Grant (R01) funding.
For most competitive academic institutions, tenure
promotion is a slam dunk if a clinical faculty
member obtains R01 funding, assuming other
requirements are met (for example, teaching
medical students, institutional academic service,
and a track record of publications in the area of
the funded research).
Having a focused effort that encompasses basic
science work and clinical and teaching efforts has
certainly been a part of my success. I was interested
in esophageal surgery, so I devoted significant time
and energy to developing a clinical practice that
included benign and malignant esophageal surgery.
I developed early collaborative relationships with
local and regional medical oncologists, gastroen-
terologists and other surgeons interested in esoph-
ageal disorders. The availability of corporate and
industry funding to develop research and clinical
studies related to minimally invasive esophageal
surgery also facilitated my success. All of these
Building a Successful Career

led to peer-reviewed publications. Referring doctors
began to associate our research with good clinical
outcomes for their patients, and my clinical volume
continued to grow. The relationships I developed
with basic scientists helped me strengthen my
own hypothesis-driven basic science research
and improved my grant writing skills. While having
a busy clinical practice that is directly related to
your research is not essential, it gives you obvious
advantages. Your clinical material can also support
a tissue bank to facilitate your basic science
projects and that of your colleagues. If you focus
on research, focus your efforts on a specialized
area of concentration. A common error is the
tendency to be too diffuse.
Another route that can be pursued is one of
a clinical investigator, although advancement for
tenure promotion may be more difficult compared
with the classical basic science model. This route
may also provide satisfying advancement along
a non-tenure track. These efforts can start with
a more modest time commitment to research
and can result in leadership positions in intergroup
Outstanding contributions in teaching or innova-
tion can also demonstrate that one’s work and
career path are worthy of tenure. If you have spent
considerable time successfully developing or
improving a technique, as documented by publi-
cations, invited lectures and professorships, and
other indicators of prominence in thoracic surgery,
this may be considered a strong factor for tenure.
A clear focus on education, particularly developing
and providing medical student education, is
necessary for advancement as a physician-
educator. To be a surgical educator, you have to
gain formal knowledge in education. Teaching
awards provide documentation of excellence.
At our institution, advancement in the non-
tenure track is similar to tenure track advance-
ment, with a few notable exceptions. This track
focuses on individual accomplishment, program-
matic contributions and progressively increased
responsibility over time. Being considered a role
model by medical students, postgraduate trainees
and junior faculty and a record of high quality
patient care are also important. Less emphasis is
placed on leadership and the ability to obtain
external funding.
Although it is evident that you have to work hard,
it is important to maintain some balance. Finally,
be persistent and organized in your efforts.
Building a successful academic career starts in
medical school. The fund of knowledge acquired
is the foundation for the rest of your medical
career. An academic interest usually develops
while in medical school and sets in motion the
necessary elements to a successful academic
career. Performing well in medical school opens
the door to the best available residency training.
The place in which you train creates an imprint
that follows the rest of your career, and this is
especially true for your cardiothoracic residency.
Where you train influences your abilities as
a surgeon. You will have a lifelong association
with your fellow trainees, those who precede you
and those who follow. You become members of
the same club! Your cardiothoracic residency
has a great impact on getting your first job. Next
to choosing a mate and whether or not to have
children, fellowship training is one of the most
important decisions of your life.
Residency training usually introduces you to the
most important mentors in your life. They will be
the ones who nurture you, educate you, and point
you in the right direction. They are likely to bring
out the desire in you to become an academic
surgeon and educator.
Your first papers and presentations in your field
are likely to come from your time as a resident.
The cardiothoracic residency should be devoted
to mastering the fund of knowledge and honing
your technical skills. No matter what your ultimate
career goal, being an outstanding surgeon clinician
is the foundation on which to base everything else.
During general surgery residency, many choose
to pursue time in a research laboratory. This
choice may relate to what you pursue after
completion of residency, but not necessarily.
However, it should lay the foundation for scientific
pursuit. With luck, it will still be applicable years
later. In addition to being productive in the labora-
tory, this time should also be devoted to expand-
ing your knowledge base; in surgery in general,
and cardiothoracic surgery in particular. There is
never enough time to read but, if you delay it, to
your fellowship you will always be behind. Read,
read, read.
As a young faculty member, it is important to
choose a strong institution and a great person to
work with. Choosing the right people to work
with is the most important factor in early job selec-
tion. If you have chosen wisely, they will support
you, provide you with opportunity, come to your
aid in a crisis, and be there to fill in when you are
away. Great colleagues ensure that you will look
forward to coming to work every day.
Early on in your career you must develop the
discipline to become productive. It is difficult to
acquire later in your career; clinical demands will
monopolize your time. You must extend yourself

to write, give lectures, and participate in meetings.
I always adhered to the philosophy of never saying
no. If I said yes, I always did what was required and
preferably on time. A good mentor should provide
opportunity. What you do with it is up to you. I
believe you should not narrow your interests too
soon, but start to develop an area of special
interest. It is then important to develop a body of
work around this area of interest. This work can
be clinical, basic research, outcomes research,
or any number of things. It should be something
you enjoy: it is not work then, it is fun! There are
many pathways to academic prominence.
If you choose to pursue a basic science labora-
tory effort, it is best to start early in your career
before clinical demands make it impossible. It is
important to have a supportive mentor to help
navigate all of the vicissitudes of laboratory work
and funding. Joining an established laboratory
accelerates your career and is the best approach.
A laboratory effort brings personal satisfaction and
acclaim to your group. One must recognize the
challenges of trying to balance all of the demands
of clinical, research, education, and family life. One
should emphasize the importance of developing
a balance between your professional life and
family life, especially in the ascendancy of your
career, when family and professional demands
are often in greatest conflict. Your family must
not be shortchanged! Every person is different in
how they achieve balance; there is not 1 prescrip-
tion that works for everyone. It is important to find
what works for you.
Throughout your academic career, making the
residents you train a priority will always be effort
well spent. You will develop a loyal following who
will always add to your success. They will work
for you, produce academically for you, and help
you recruit other great residents in the future.
Focusing on residents and their training is amongst
the best investments in your academic life.
If you are fortunate enough to then be involved in
the direction of a surgical group, putting together
that group requires a great deal of thought. I
have always thought of it as building a puzzle.
Each piece is important and must fit.
Each member should contribute in a specific
way. I have always believed each member has
something to call their own. This approach allows
the group to have broad interests. Carving out
a niche for each develops expertise and improves
work satisfaction. The group must be compatible,
respectful of one another, supportive of one
another, and put the interests of the group ahead
of the interest of the individual. This collective
effort will work to strengthen the group and
generate recognition for your group.
This approach creates a collegial atmosphere
and a desirable place to both train and work for
others. Groups that are not put together with fore-
thought and with an eye toward compatibility often
become dysfunctional. As the leader of the group,
one should strive to treat each member fairly,
trying to promote their interests. If the members
of your group are successful, you will be success-
ful. It is important to devote time to promote your
colleagues in their career. They will respond in
kind by contributing to the group effort and remain
committed to your vision.
I have always believed it best to stagger recruit-
ments so that there is a range of ages within the
group, allowing advancement and progression of
the individual. This range also allows for orderly
transition of people coming and going within the
group or, ultimately, the retirement of you as the
leader of the group. It is important to plan for
succession to maintain the integrity of the group
and have a long vision, not just ending with your
Planning for retirement is just as important as
any other stage of your career. It is not just finan-
cial planning but how to keep your mind engaged
and physically involved. If you have done a good
job of organizing your group, you will continue to
be a valued member well into your retirement.
The wisdom and judgment that you have acquired
over the years will be seen as a valuable contribu-
tion even in your retirement years.
Careful planning at all phases of your profes-
sional life creates a rewarding career, in which
you also contributed to your profession, devel-
oped your own professional life, and contributed
to the development of your colleagues.
Building a successful career starts during training.
Find a gimmick. Although it is difficult to predict
the future, pick an area of cardiothoracic surgery
that really interests you. Get training that makes
you marketable and unique. When I was in medical
school, I told my wife that I would not be just
another general surgeon who could perform
a cholecystectomy like 10,000 other surgeons in
Los Angeles. Take courses or additional fellow-
ships (eg, video-assisted thoracoscopic surgery
[VATS] lobectomy, MBA) that make you different
from others so that potential employers want you.
Find a job in an environment that allows you to
be successful. It is important to operate, so you
need a job that gets you busy soon. Ask from
where your cases will come. What is the marketing
plan? Find a niche in the group, such as maze
procedures. Select patients who will do well after
Building a Successful Career

your procedures. If you turn down cases that
should not be done, referring doctors will respect
that good judgment. Spend plenty of time with
your patients. A good consultation for lung cancer
includes showing the patient the computed
tomography scans and discussing diagnosis,
natural history, treatment options, and recovery.
Patients will appreciate the time that you spend.
A happy patient is your best marketer by telling
their doctors and their friends how happy they
are with you. Communicate well with referring
doctors regarding consults, postoperative results,
and follow-up.
Get involved in hospital activities. After a few
years in practice, time for committees becomes
limited, but there is plenty of time when starting
a practice. Committees and hospital activities
help you to get to know physicians at the hospital.
Other marketing can also help to build a career.
Give as many continuing medical education
(CME) talks as possible. Clinical research helps
keep you current and leads to journal articles
that can be the basis for the CME talks. Giving
a talk about your own experience and your data
helps others to recognize you as a knowledgeable
leader in the field.
Find a mentor. A job with cardiac surgeons who
want you to develop a general thoracic program is
not ideal. It always helps to have another surgeon
whose specialty is the same as yours so that you
can discuss cases and the program. It is difficult
to be isolated as the only one in the group to do
a specialty.
Ultimately, thoracic surgery is a great specialty.
As Dr David Sugarbaker says, “Find a job, and
make it the right job.” Good luck.
When I began surgical residency in Toronto in
1955, general thoracic surgery was still a subspe-
cialty within the Division of General Surgery in
North America. I was appointed to this subspe-
cialty group in 1960. My professors at Toronto
General Hospital and the University of Toronto
were Drs Robert Janes and Frederick Kergin.
Both were general surgeons who made pioneering
contributions to the subspecialty of general
thoracic surgery.
Cardiac surgery became an exciting and rapidly
growing discipline during the 1950s, and residency
programs were established in the combined
subspecialties of Cardiovascular and thoracic
surgery in almost all centers in North America
and Europe. However, Toronto established a sepa-
rate training program in Cardiovascular Surgery in
1958, headed by William Bigelow. Bigelow,
another TGH General surgeon, was a pioneer in
Cardiac and Vascular surgery, but was never
a thoracic surgeon.
In 1967, Dr Norman Delarue and I requested and
were granted the opportunity to restrict our clinical
practice to general thoracic surgery in a separate
surgical division. Approval and support for this
initiative was given by the then Professor of
Surgery at University of Toronto and TGH, Dr Fred-
erick Kergin. This approval provided the University
of Toronto and TGH with a unique early opportu-
nity to develop an academic residency training
program in general thoracic surgery. A history of
the evolution of this surgical specialty in Toronto,
and subsequently throughout Canada, is detailed
in Pearson’s Thoracic and Esophageal Surgery
A Successful Career in General Thoracic
Clinical training
All candidates should seek the best possible clin-
ical training experience. The program should
include general surgery, ideally providing 1 year
at the senior resident level. Proficiency in both flex-
ible and rigid endoscopy is an invaluable asset
which is not sufficiently emphasized in some North
American programs.
The inclusion of esophageal surgery is strongly
advised. Esophageal surgery is often difficult,
and technically challenging. Good results in
benign conditions may be demanding, but are
very rewarding for patient and surgeon. Further-
more, esophageal surgery remains in no man’s
land, and is not perceived to be the province of
any particular specialty.
An important mentor was my elementary school
science teacher, Dr A.G. Croal. His interest, skill,
and enthusiasm made the biologic sciences
a fascination. In my final year of high school, he
persuasively advised me to become a physician
rather than a high school science teacher. His
message was, “Medicine provides many more
options, and you may still end up teaching
science, among many other opportunities.”
Surgical mentors include Professors Janes and
Kergin in Toronto. They arranged my residency in
Ronald Belsey’s Regional Thoracic Unit in the
west of England. Belsey profoundly influenced
my career, transmitting his unique experience
and his original and innovative technical skills. He
imbedded in me, and in many other international
trainees, the critical importance of a good history
(listening to the patient), unbiased observation,

and learning from one’s mistakes. In the history of
thoracic surgery, Belsey plays a pioneering role in
championing the educational importance of long-
term follow-up. He was an inspiration, friend, and
supporter until his death in 2007, at the age of 97!
In a residency training program, the opportunity
to act as a meaningful mentor is a gift and
a rewarding opportunity.
Team building
The ability to work effectively in teams is invaluable,
and becoming increasingly the norm in relation-
ships with other specialties. Thoracic surgeons
perform more effectively and more enjoyably
working in collaborative groups and partnerships.
Diminishing the incentive for economic competi-
tion between partners is potentially a positive
feature in most successful, enduring groups.
Learning and education
Change and new information are increasing at ever
more daunting rates. The need to assimilate and
adapt is fundamental to our discipline, and
increasingly favors identifying foci of special
interest and expertise.
To quote Ronald Belsey at the beginning of my
residency on his service, “Young man! You must
begin planning for your retirement on the day you
begin practice!” He was referring to the pleasure
and importance of outside interests and hobbies
in a busy surgeon’s life. He lived his philosophy,
and pursued his extrasurgical interests throughout
his career and long after his retirement from the
British National Health Service.
As I sit and interview candidates for cardiothoracic
surgery, I am awed by the intelligence, talents,
motivation, and altruism of these individuals.
However, some actually ask me how I became
a successful thoracic surgeon! It forces me to think
back over a 25-year span of time, realize how
much has changed in medicine, and focus on
what enduring traits and activities are important
to initial and, more importantly, ongoing success.
The first requisite is passion. Passion for your
work fuels the long days and nights, overcomes
the disappointments, and sustains the drudgery
(eg, bureaucracy of paperwork, politics) It may not
be immediately apparent how to focus this passion,
but inevitably, in the first 5 years of your career, the
niche that makes you tick becomes evident and you
become more focused. There are many areas in
thoracic surgery in which to excel, whether it is by
clinical patient-oriented expertise, translational or
basic science, education, administration, or health
care policy. It is unlikely today that one can be
successful in all the components, but it is important
to recognize and value the whole.
To be successful, you must recognize and seize
opportunities. Such behavior implies flexibility,
willingness to welcome change and innovation,
and the lack of fear to risk failure. The ability to
change is difficult for individuals, and as people
grow older, they tend to narrow the scope, not to
widen it. Nowhere is it more clear than in the recent
developments in thoracic surgery that such
behavior invites failure.
This brings me to the third requisite to a success-
ful career: a dedication to self-renewal. In medi-
cine, particularly in emerging technologies,
molecular medicine, changing climates of health
care delivery, and so forth, the potentialities are
endless. I recommend the book Self-Renewal by
J.W. Gardner (WW Norton; 1995) to my colleagues.
Inevitably, some candidates, particularly women,
ask how these enduring qualities applied personally
to me. I first would say that it was a different time and
place, but specifics may be helpful. I was never
going to be a cardiothoracic surgeon, but I found
the passion (general thoracic oncology) during
a surgical oncology fellowship. I seized the opportu-
nity to do a cardiothoracic residency and never
looked back. I chose a job in which I felt I could
make a difference in patient care and resident
education, and there was nobody but myself to
build and lead a multidisciplinary team in general
thoracic surgery. As a woman in a field populated
by the other gender, I was often the token
committee member at the local or regional level. It
did not bother me because I used the opportunity
to learn new skills, broaden my horizons, and
meet new people, some of whom would become
mentors. I was fortunate that my senior colleagues
fostered my national career, and it was important
to me and the women who have followed, and will
follow, that these activities were successful. I think
I put some cracks in the glass ceiling.
My success in thoracic surgery will always be
embedded in my clinical work. Caring for the
patient is the bedrock of medicine. It is bother-
some that some individuals stray away. Each
patient’s thanks, hug, or letter is a measure of
a successful career. Over the years I have kept
a record of these tributes, and it is stark evidence
that one can make a difference. I try to instill in my
residents that everyone is capable of this measure
of success. I suggest that prerequisite reading for
all residents should include How Doctors Think by
J. Groopman (Houghton Mifflin Co.; 2007).
The imparting of my skills, judgment, and values
to the future of thoracic surgery, the residents, is
Building a Successful Career

a daunting task. However, the reward is great.
When a resident calls with excitement and pride
to relate how he or she has accomplished
a complex procedure you taught, you experience
I do not know if I belong in the category of influ-
ential thoracic surgeons. However, in the eyes of
my patients and residents, I know I have made
a difference, and that is enough for me.
I have been asked to describe from my perspec-
tive what it takes to build a successful career.
Success is in the eye of the beholder. I would first
advise that one not strive for career achievements
that will be believed to be perceived by others
as hallmarks of success. Success should be
measured by personal satisfaction and does not
require external validation. In my experience,
pursuit of success as a goal is elusive and the
real rewards are to be found in the journey. I
have been fortunate to have a career that
combined thoracic oncologic surgery with clinical
and laboratory research, resident and fellow
education, and departmental administration. This
combination does not appeal to everyone, nor is
it in any way a prerequisite or formula for
a successful career. Although this was a career
track that defined many prominent academicians
in the past, the complexities of contemporary
surgical practice, research, and education have
contributed to the abandonment of the triple threat
as a realistic goal. Career success can be
achieved by pursuing 1 of these areas in depth.
The choice of thoracic surgery as a career was
critical for me. As a medical student, I was fasci-
nated by the anatomy in the chest and also real-
ized that there was an unmet need for treatment
of thoracic cancers, with few surgeons in the
specialty. Planning your fellowship training to
meet future unmet needs in areas with a shortage
of specialists can make one very much in demand.
I have been privileged to practice thoracic surgery
in 2 great institutions: the NCI and the University of
Texas MD Anderson Cancer Center (UTMDACC). I
have also been privileged to have worked with
many outstanding surgeons as mentors and
colleagues. Although much of my career has
been devoted to clinical and laboratory research,
the uninterrupted practice of thoracic surgery has
always been important to me because it is person-
ally rewarding to treat patients, intellectually chal-
lenging to deal with complex cases, and useful to
keep in touch with the critical clinical questions
and current technical advances in diagnosis and
treatment. Clinical and laboratory research has
been an important component of my career. The
surgeon scientist contributes to progress in our
specialty, and thoracic oncology presents many
novel and important research opportunities with
the potential to make advances in patient care. If
you choose this path, a 2-year to 3-year research
fellowship in a top-tier laboratory is a requirement.
The variety and consistent challenge of combining
research and patient care contributes to career
longevity and avoidance of burnout. For those
readers interested in a thoracic surgery research
career, I present a brief perspective on some prin-
ciples that have been useful to me in choosing
areas for scientific investigation.
Maintain an Active Clinical Practice
Throughout Your Career
Technical mastery and expertise in thoracic
surgery is required. Continuous exposure to chal-
lenging clinical problems provides inspiration for
formulating important research questions. You
will also be prepared to translate new diagnostic
tests or therapies to clinical practice.
Focus Your Research on Problems Related
to Your Specialty
The clinic and operating room are laboratories.
Many of our treatment strategies have suboptimal
or unproven efficacy. In designing clinical re-
search, it is important to be pragmatic as well as
innovative. A clinical trial may be interesting but
impossible to complete because of a lack of
patients or resources. Investigate the most impor-
tant clinical problems despite their difficulty.
Answers to trivial questions result in only an incre-
mental advance at best and still require great time
and effort. An important corollary is that problems
should be chosen that can be solved with current
technology or technology that can be readily
developed. My clinical research early in my career
exemplifies this concept. The outcomes from
surgical treatment of lung and esophageal cancer
were dismal when I began my career at the NCI.
However, for the first time, new platinum-based
chemotherapy was shown to cause tumor regres-
sion in a high percentage of cases. Because most
relapses were systemic metastases, it seemed
logical to give chemotherapy preoperatively
when metastases could not be detected clinically
and tumor shrinkage could facilitate surgery. I initi-
ated the first randomized trials in preoperative
therapy in lung and esophageal cancer.2–4
Although the trials were small, the results provided
direction for future clinical trials and stimulated

Investigate Research Questions that Have
Biologic Relevance
If you have a laboratory or collaborate with labora-
tory scientists, investigate research questions that
have biologic relevance. Cancer research prog-
resses in increments, and the likelihood of making
a major therapeutic breakthrough is low. However,
carefully designed experiments and clinical trials
yield important biologic insights that may point to
a new direction. For example, for many years our
research group has been studying genetic abnor-
malities that contribute to lung cancer develop-
ment. This work has led to a novel therapy that
replaces defective genes in lung cancer cells
with normal functioning copies of the gene. This
work progressed from the laboratory to successful
clinical trials in a period of 20 years.5–7 Funding this
research was, and remains, a challenge and
involved obtaining grants from the NCI, founda-
tions, philanthropy, and industry. When designing
research protocols, it is important to let science
dictate the technique. Searching for applications
for techniques or devices rarely leads to conceptu-
ally significant results.
One of the most personally gratifying experi-
ences for me is acquiring new knowledge that
can benefit patients. Surgeon scientists have
contributed greatly to advancing scientific knowl-
edge and patient care. This career path is chal-
lenging and ultimately deeply rewarding.
Some surgeons seem to have followed a nearly
charmed path to academic success and interna-
tional renown. They are often the beneficiaries of
outstanding residency programs and excellent
mentoring, and seem to have had great wisdom
early on about their career development. For
various reasons, including the paucity of senior
women thoracic surgeons when I was training,
my career path has developed through patience,
persistence, and fortuitous circumstances, with
both good and bad decisions. The academic
career advice that I give trainees is based on
nearly 30 years of these professional life lessons
and can be summarized in the following 8 points:
Select an Academic Focus
This should be a topic; a disease or a scientific
question that interests you the most. Achieving
international respect from your colleagues takes
years of effort and requires making a lasting scien-
tific contribution. You cannot achieve this unless
you are intellectually challenged by the topic. In
addition, the subjects on which you publish and
are deemed an expert will influence the scope of
your clinical practice. Consider this carefully as
you select your academic focus.
Acquire the Correct Skills to Pursue Your
Academic Focus, Even if this Requires Some
Retooling After the End of Clinical Training
For instance, it is fairly common for surgical resi-
dents to spend 2 years in the laboratory in the
midst of clinical training only to decide later on
that they prefer to be clinical investigators or
educators. They then start their careers without
the requisite skills for these career pathways.
Given a supportive division chief and the appro-
priate infrastructure, additional training leading to
a Master’s degree in fields such as clinical investi-
gation, biostatistics, or education can be com-
bined with starting a clinical practice and will
greatly enhance the productivity and skill sets of
a young academic surgeon.
Become a World’s Expert by Studying Your
Chosen Academic Topic to an Unparalled
Ask and answer fundamentally important and well-
designed research questions about your primary
area of interest. Do not publish trivia or superficial
studies. Do not allow yourself to become academ-
ically diffuse, publishing on such a wide range of
topics that you become the jack of all trades and
master of none. Apply to your research the same
drive for excellence that thoracic surgeons bring
to clinical care.
Build the Correct Infrastructure for Your
Research Because You Cannot Do it All
Such infrastructure is more easily defined for labo-
ratory investigators where there are traditional
parameters for surgical fellows, laboratory techni-
cians, and postdoctoral scholars. Clinical and
translational investigators require different and
varied infrastructure such as data managers,
research nurses, and tissue banks.
Develop Collegial and Productive
Whether your research is clinical, translational, or
basic science, the best research these days is
multidisciplinary. Be inclusive and supportive of
your research collaborators, especially with
respect to publications and grants. Cross-
disciplinary research is interesting, fun, and
Building a Successful Career

Seek Mentors
Peer review and senior advice is frequently helpful
and most senior academic physicians are de-
lighted to provide this. Mentors may be surgeons
but are also often found in other specialties or
even nonclinical settings.
Carefully Guard Your Most Precious
Commodity: Time
Balancing clinical care demands with academic
work and your personal life is extremely chal-
lenging and only becomes harder as you advance
in your career. Figure out what really matters to
you academically, create time for it, and do not
be afraid to say no to other demands on your
time, especially tangential administrative ones.
Develop 5-Year Plans
It is important to take stock every few years (and 5
is usually a good number) of what you have
accomplished and where you are heading.
Consider whether your goals and interests have
shifted. Plan for where you want to be academi-
cally in 5 years. Make midcourse corrections, but
systematically and strategically.
Developing a successful academic career is
difficult given today’s many competing demands
on every surgeon’s time. It is hard not to be over-
whelmed by the need to sustain a busy clinical
practice, by ever-increasing regulatory require-
ments and administrative tasks. Setting the
parameters that allow academic success through
meaningful contributions to our field is challenging.
It is hoped that some of these guidelines, garnered
through life lessons, will help younger surgeons
achieve their academic goals.
The path to establishing yourself as a general
thoracic surgeon is unique for every individual.
No single formula exists. Concrete factors that
influence the direction your career or practice will
take include geographic location, patient demo-
graphics, local competition, referral patterns, and
whether you are operating in an academic or
private setting. Although areas under your direct
control, like refining your craft and acquiring new
technical skills, may consume much of your time
when you are starting out, establishing yourself
as a leader is one of the best and quickest ways
to build a practice and effect change. When
patients and consultants need a thoracic surgeon,
they seek the local, regional, and sometimes
national leaders in the field. In this regard, it is
difficult to overestimate the value of being a
good communicator.
What are the elements of leadership in surgery?
Scientific advancement is certainly paramount, as
is identifying changes that will result in quality
improvements in services provided at your
hospital or medical center. Being willing to get
involved with hospital administration and the local
medical community is also key. The overriding
question you must ask yourself is “How can I, as
a thoracic surgeon, take action to initiate change
that will improve patient outcome?”
Leadership begins at the local level. Tiny steps
that initiate improvements in the delivery of
medical care in your local hospital or community
can lead to sweeping changes. Actions you take
may affect the physical outcome of your patients.
What can I do to avoid complications or enhance
therapy or improve my patient’s functional status
measures? Other actions may improve service
outcomes. These actions affect the physician-
patient relationship. Such actions are measured
in terms of satisfaction, and the benefits extend
to families, communities, other caregivers,
vendors, and employees. You might ask, “How
can I make changes that turn the experience of
being a patient or caregiver from a hassle to
a convenience?” Other actions important to the
modern era include cost outcome measures.
How can I reduce the cost of a clinical process
to make it more affordable for patients? How can
I stretch the health care dollar? How can I reduce
the overall financial burden of disease on the
health care system?
Leadership at the national/international level
relies on scientific advancement, multidisciplinary
collaboration, and participation with peers through
membership in professional societies. Scientific
advancement at the basic research level takes
time because of the complexity of the biologic
systems involved in the interpretation of disease
in this molecular-genomic-proteomic-informatics
era. In this regard, it is helpful to focus your efforts
on a particular thoracic disease or difficult clinical
problem. Become an expert. Establish a record
of excellence through the publication of your
In our profession, we have all experienced the
unique benefits of mentoring. We can learn a great
deal from these relationships, whether you are the
mentor or mentee. You do not have to be in
academic practice to get involved in mentoring,
teaching activities, and CME. Medical conference
participation may arguably be more important for
individuals in private practice than staff surgeons
at an academic center where there is greater
exposure to interdisciplinary case conferences,

teaching conferences, and lecture series. If you
are working with mentees in the academic envi-
ronment, as a chief or program leader, there are
several important goals to bear in mind. First,
you must help them develop their personal skills
by providing the necessary resources. Second,
you must guide them to find a clinical niche that
best matches their experience, skills, and interper-
sonal abilities. Third, you must help them identify
their academic niche. Where can they best apply
their knowledge? Where can they make a differ-
ence? What questions need an answer? Forth,
and most important, you must help them to define
the next step. What are your expectations of
them? What should they do to get to the next
step scientifically or personally? What is keeping
them from advancement or promotion?
In the end, we are all grounded by what we do in
the clinic and in the operating room for our patients
and their families. The decisions we make on
a daily basis are often difficult and demand prepa-
ration, attention to detail, patience, and sacrifice.
We cannot be afraid to make tough decisions or
take difficult stands. Our reward comes from
knowing that we have made an important contri-
bution, whether to science, surgery, or society.
My first role models in surgery were my professors
of surgery at Ceara University School of Medicine
in northeast Brazil. My interest in thoracic surgery
began during my internship at Euclid General
Hospital in Ohio while watching 2 general
surgeons, Drs J.W. Coburn and Jorge Medina,
care for patients. After finishing my internship
and considering many options in both Canada
and the United States, I decided to train in the
Huron Cleveland Clinic Health System. During
my senior year as Chief Resident, I had the privi-
lege of meeting Dr John Storer, Head of Thoracic
and Cardiovascular Surgery. Dr Storer was a skill-
ful surgeon who taught me a variety of procedures
including valve replacements under extracorpo-
real circulation, peripheral vascular surgical
techniques, as well as bronchoscopy and arterio-
grams. Dr Storer also taught me how to start,
write, and publish a scientific paper involving clin-
ical case reviews and prize-winning basic science
work from the laboratory.8
On my return to Brazil, I worked at Federal
University of Rio Grande do Norte in Natal, RN.
In 1974, I became a full Professor of Surgery at
University of Brasilia and Head of Thoracic Surgery
at Hospital de Base of Federal District where I am
currently located. To date, we have cared for more
than 10,000 patients at both the private and public
hospitals. In my position as Professor of Surgery, I
was able to complete my PhD degree.
To learn and practice new techniques I visited
several medical centers including: TGH to learn me-
diastinoscopy with Dr Pearson and lung transplan-
tation with Drs Patterson and Cooper, University of
Michigan to learn transhiatal esophagectomy with
Dr Orringer, Maine Medical Center to learn lung re-
section techniques with Dr Hiebert and the Massa-
chusetts General Hospital to learn surgery of the
trachea with Dr Grillo.9,10 For more than 30 years, I
have attended the Toronto Refresher Course and
all the information obtained in these meetings has
been conveyed to allied health professionals, resi-
dents, and attending staff. I would also recommend
the postgraduation course at Oxford University,
England, as a source of good learning.11,12
In 1976, we established a training program in
general thoracic surgery and have graduated 27
thoracic surgeons thanks to our affiliation with the
University of Sa˜o Paulo. All of our residents are
encouraged to do research and write papers. To
date, our group has published 173 scientific papers,
3 textbooks, and 25 book chapters, and has given
1250 presentations at various surgical meetings.
Our residency program also has a strong commit-
ment to education, with most of our residents
completing a 3-month rotation at a major medical
center such as the TGH, Cleveland Clinic, and
Mayo Clinic. Our teaching program also includes
journal clubs and weekly grand rounds with case
presentations and didactic presentations.
At 65 years of age, I considered retirement;
however, 10 years later, I continue to perform the
same tasks that I am used to doing (ie, teaching,
operating on major cases, keeping long office
hours, and attending surgical meetings all over
the world). I also enjoy walking (no elevators) and
regular tennis and fishing.
In summary, if a young individual wants to
become a thoracic surgeon, my advice is to (1)
be prepared to deal with difficult cases, (2) love
the specialty, (3) be available to patients and
colleagues 24 hours a day, (4) pass on all the infor-
mation and share your experience, (5) be open
minded to learn from success and mistakes, (6)
read every day, and (7) recognize that it is time
to retire when you no longer are capable of doing
your everyday routine.
It is truly an honor to be asked to contribute to this
monograph as the only surgeon from Asia. I
received my medical education in the United
Kingdom and surgical residency in the United
States. I returned to Hong Kong in 1992 to
Building a Successful Career

practice. This experience allowed me to gain first-
hand information on health care delivery in some
vastly different systems. I would like to offer the
following advice to our younger colleagues drawn
from my own experience.
Attention to Detail
If I have to single out 1 character to differentiate
a good technical surgeon from an average one,
attention to detail (almost to the point of obses-
sion) tops my list. For a technique-based specialty
like surgery, this is crucial to achieve consistent,
reproducible results. During residency, we were
exposed to a wide spectrum of perioperative
routines adopted by our attendings. Variations
breed selection. With time, we formulate our own
routine. However, learning does not and should
not stop after residency. The biggest enemy of
success is complacency. We must be reminded
not to let our best performance so far set the stan-
dard for the rest of our career.
Attention to detail also does not stop at tech-
nique. When you are treating a patient, you are
not just treating a disease, but a person (and
sometimes a family). Patients and their families
often take to heart every word we say to them. A
good surgeon is someone who does not only
know how to operate but also knows how to effec-
tively communicate with others.
Think Outside the Box
Cardiothoracic surgeons, by their nature and
training, tend to be conservative. We spend nearly
a decade of training to do just a few operations
well. We inherit a set of routines from our teachers,
and we tend to resist changes that, by their nature,
introduce an element of uncertainty to the
outcome. Although there is nothing wrong with
this approach from a purely technical standpoint,
this mindset does not prepare us well for a rapidly
changing world. We therefore must keep an open
mind to new ideas, even though they may seem
farfetched at first sight. A good case in point is
VATS lobectomy. Two decades ago, this was
a heresy. Today, it has become the approach of
choice for early lung cancer.13
It is important to look beyond our own field,
because the role of surgery as we know today
will change. MIS will become more refined, and
more procedures will become either catheter
based or endoscopy based. The boundaries
between surgery, interventional radiology, and in-
terventional endoscopy will eventually disappear.
Many medical specialties of today will be trans-
formed into the organ-specific, integrated disci-
plines of tomorrow.
Stay Focused
If you are pursuing an academic career, it is impor-
tant that you should stay focused on your area of
research. You should also collaborate with your
peers, both within and outside your field. Early in
my career, I saw the great potential of applying
the minimally invasive technique to the thorax,
which arguably is the most ideal body cavity for
this. During that time, several groups of surgeons
in the United States and Europe were pursuing
the same goal. It did not take long for me to get
to know each of these great individuals well, and
some of them remain close friends to this day.
We published together our collective experience,
and the initial success of my career owes a lot to
this collaboration. Within my university, we have
collaborated with departments outside surgery to
look at MIS from other perspectives, such as
with the Department of Physiology on immune
function, and the Department of Engineering on
virtual reality training modules. When you have
written more than 20 major publications on the
same theme, you will be recognized by your peers
as an expert in that field. Once you are a recog-
nized expert on 1 subject, it will be much easier
for you to expand your research scope into other
Watch Your Back
Whenever you become successful in your own
field, you are prone to become a subject of jeal-
ousy. There is an old Chinese saying, “Only the
fools don’t attract jealousy.” Your very existence
could be perceived as a threat to others (and not
only to your peers). This jealousy is human nature
and we are bound to face challenges. We should
be constantly reminded that our primary responsi-
bility is to our patients. Success is not only
measured by how smooth your career sails, but
by the tenacity and determination to rise again
after a fall.
In conclusion, I would like to thank the contributors
of this article who have been recognized as
outstanding leaders in thoracic surgery. From their
own unique perspectives, they have each
provided valuable insights that are important in
developing a successful thoracic surgical career.
1. Pearson FG, Fell SC, Lerut T. History and develop-
ment of general thoracic surgery. In: Patterson GA,
Cooper JD, Deslauriers J, et al, editors. Pearson’s

thoracic and esophageal surgery. 3rd edition.
Philadelphia: Churchill Livingstone (Elsevier); 2008.
p. 6–8.
2. Roth JA, Fossella F, Komaki R, et al. A randomized
trial comparing perioperative chemotherapy and
surgery with surgery alone in resectable stage IIIA
non-small-cell lung cancer. J Natl Cancer Inst
3. Roth JA, Pass HI, Flanagan MM, et al. Random-
ized clinical trial of preoperative and postopera-
adjuvant chemotherapy
vindesine, and bleomycin for carcinoma of the
esophagus. J Thorac Cardiovasc Surg 1988;
4. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemo-
therapy followed by surgery compared with surgery
alone for localized esophageal cancer. N Engl J
Med 1998;339(27):1979–84.
5. Roth JA, Nguyen D, Lawrence DD, et al. Retro-
virus-mediated wild-type p53 gene transfer to
tumors of patients with lung cancer. Nat Med
6. Swisher SG, Roth JA, Nemunaitis J, et al. Adeno-
virus-mediated p53 gene transfer in advanced
non-small-cell lung cancer. J Natl Cancer Inst
7. Ji L, Nishizaki M, Gao B, et al. Expression of several
genes in the human chromosome 3p21.3 homozy-
gous deletion region by an adenovirus vector results
in tumor suppressor activities in vitro and in vivo.
Cancer Res 2002;62(9):2715–20.
8. Barrett NR. Publish or perish. J Thorac Cardiovasc
Surg 1962;44:167–79.
9. Pearson FG. Adventures in surgery. J Thorac Cardi-
ovasc Surg 1990;100(5):639–51.
10. Hiebert CA. Seldom come by: the worthwhileness of
career in surgery. Arch Surg 1989;124(5):530–4.
11. Buckley MJ. I would like to be a thoracic surgeon.
J Thorac Cardiovasc Surg 1996;112(5):1135–42.
12. King TC. Teaching surgeons to teach. Bull Am Coll
Surg 1987;72(11):5–9.
13. Yim AP. Video-assisted thoracic lung surgery: is
there a barrier to widespread adoption? Ann Thorac
Surg 2010;89:2112–3.
Building a Successful Career