Editor’s note: The Bulletin is collaborating with the American College of Surgeons (ACS) Surgical Research Committee to present a series titled “Profiles in surgical research.” These interviews are published periodically and highlight prominent surgeon-scientist members of the ACS.
Henri R. Ford, MD, MHA, FACS, FRCS, FAAP, is vice-president and chief of surgery at Children’s Hospital Los Angeles, CA; and vice-dean of medical education and professor and vice-chair for clinical affairs, department of surgery, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Ford’s research has been funded by the National Institutes of Health (NIH), the Robert Wood Johnson Foundation through the Injury Free Coalition for Kids, the National Trauma Registry for Children, and the American College of Surgeons (ACS).
Dr. Ford has served on the editorial boards of numerous professional publications and at present is an associate editor for the Journal of Pediatric Surgery and Pediatric Surgery International. He has served as Vice-Chair of the ACS Board of Governors and is an ACS Regent. Dr. Ford is past-president of the Association for Academic Surgery, the Surgical Infection Society, the Society of Black Academic Surgeons, and is the current president of the American Pediatric Surgical Association.
Angela M. Ingraham, MD, MS, FACS, assistant professor of surgery, University of Wisconsin, Madison, and the liaison between the ACS Surgical Research Committee and the Resident and Associate Society, interviewed Dr. Ford in November 2017. A summary of their discussion follows.
What aspects of your upbringing have influenced you as a surgeon and a researcher?
I was born in Haiti. My dad was a preacher; my mom was what I call a “prayer warrior.” We basically grew up in the church learning a lot of things, including the importance of faith in God and excelling at school.
Just before my 14th birthday, my family moved from Haiti to the U.S. It was a bit of a challenge because I didn’t really speak English, so it was quite an adjustment to go from Port-au-Prince, Haiti, to Brooklyn, NY. However, that really paled in comparison to the culture shock I would experience going from Brooklyn to Princeton University, NJ, which was exponentially more dramatic. Nonetheless, because of some of the guiding principles I had learned, as well as my parents’ teachings, I knew the importance of excelling in high school even though I didn’t speak English. I applied myself, did well, and got a full scholarship to Princeton. At Princeton, I was blessed to also do well and end up at Harvard Medical School, Boston, MA.
Who are some of the key people that have been critical to your success?
Along the way, there were always people who served as what I call mentors or perhaps even sponsors. In high school, a tough English teacher was one of my first supporters. In the 9th grade, every time I opened my mouth in English class, I was a source of ridicule from my classmates because I was butchering the English language. We were reading the novel, The Outsiders. Everyone would read a paragraph, and whenever it was my turn, everyone would just burst into laughter because they were anticipating all the mispronunciations. Mr. Stewart told me, “Don’t listen to them. Just keep trying.” That ongoing encouragement was really important to me.
I spent the following summer taking English and drama classes, which forced me to read and to do some public speaking. One instructor that summer was a young lady named Linda Colon. Linda was entering her junior year at Princeton. She told me about Princeton and suggested that I consider it for college. That summer program turned out to be extremely valuable because the following year I excelled in English sufficiently to be placed in honors English my junior and senior years.
My honors English teacher, Mrs. Levine, was really great. When I first arrived at John Jay High School as a freshman, the football players harassed me regularly; they grabbed my lunch tray, called me names such as “Frenchie,” yet I couldn’t respond. I couldn’t say anything or fight back because I didn’t speak English, and they were intimidating. During my junior year, I made a significant effort to assimilate, become integrated and accepted by this group, sometimes to my detriment. Mrs. Levine told me, “You have to be you; you have incredible talent and potential, and this is what you have to focus on.” She too became a sponsor. She was strict, but I think it was because she saw something in me that was worth supporting. She is largely responsible for pushing me to the point where I was going to be highly competitive for a place like Princeton. Science and math were never an issue for me, but because of her, I was really able to excel in English, social studies, and the humanities in general. She turned me into a much stronger high school student.
Fast-forward to Princeton: there again, I found a series of role models and mentors whom I wanted to emulate and who were instrumental in building the confidence necessary for me to excel in a place like Princeton. One source of inspiration was Randall Kennedy, JD, who was a senior when I was a freshman and is now a professor of law at Harvard. He won the Moses Taylor Pyne Honor Prize, the highest honor bestowed on a Princeton undergraduate, and then he became a Rhodes Scholar. I was inspired by his accomplishments, and he motivated me to excel.
Another key individual was Gary Gibbons, MD, now the director of the National Heart, Lung, and Blood Institute. Gary was a pre-med junior who took me under his wing and basically taught me what it takes to succeed, namely that you have to work hard and that you have to apply yourself in order to reach your goals.
What were some of the critical moments in medical school and residency that prompted you to pursue surgery and academic research?
I followed Gary to Harvard, where he continued to be a source of guidance and inspiration because he seemed to know exactly what to do. I went to Harvard with few aspirations. I didn’t really know anything about academic medicine per se. I remember the first week during orientation, several classmates introduced themselves, and one of them said, “I’m going to become a plastic surgeon at Massachusetts General Hospital;” another one said, “I’m going to become the dean of the medical school;” and I said, “I must be in the wrong place. I just want to graduate so I can become a doctor.” That attitude was to change soon enough.
I didn’t have any preconceived notion as to what I wanted to do when I started medical school, and by the time I became a third-year medical student, I thought I was going to pursue every clinical rotation that I did; that is, until I found my passion.
It was toward the end of my third year, and my life was all set. In July, I was going to take a year off, go to the John F. Kennedy School of Government at Harvard University and get a master’s degree in public policy, and then apply for residency in internal medicine; but then, I fell in love with surgery. This story leads me to my next major sponsor or mentor at Harvard, Richard “Dick” Wilson, MD, FACS, chief of the division of surgical oncology at the Brigham and Women’s Hospital, Boston. I really liked surgery. I was all jazzed up to get up at 4:30 am to make rounds. One day, we finished an 8- or 10-hour case, an esophagectomy, and I’m waiting at 10:00 pm to catch the elevator to go to my fiancée’s place for a late dinner, and who walks over—Dr. Wilson. This messenger of God comes over and says, “Henri, have you considered going into general surgery? I think you would have a brilliant career in academic surgery.” Just imagine Moses parting the waters or the voice of God from on high saying, “Behold….” That’s really how it felt. I found the answer I was seeking, and, honestly, I never looked back. This was what I had been waiting for, this guidance. It was unequivocally the correct answer, and Dick Wilson became my advisor and helped me craft my path in surgery. He may be largely responsible for where I am today.
How did you decide on a career in pediatric surgery specifically?
I wrestled between pediatric surgery and surgical oncology. Dr. Wilson arranged for me to do a rotation at Cornell, New York, NY, because I was interested in surgical oncology. However, I was also interested in pediatric surgery because of my chief resident, Kurt Newman, MD, FACS, who is now the chief executive officer at Children’s National Medical Center, Washington, DC. Dr. Newman matched in pediatric surgery at the time that I was on the service with him. He was the happiest man I had ever seen on Earth, and I told myself that I needed to explore pediatric surgery. So, I did a rotation in pediatric surgery at Boston Children’s Hospital working with Judah Folkman, MD, FACS, who was fantastic.
I also went to Cornell as Dr. Wilson suggested, and I realized it was a fantastic place. I was at Memorial Sloan Kettering, New York, NY, and I saw that they were doing bigger operations there than they were doing at the Brigham. At the time, I think we were brainwashed at Harvard to think no significant surgery occurs outside of Massachusetts General Hospital or the Brigham, so it was an eye-opener when I went to Cornell and Sloan Kettering and saw what was going on. Eventually, I matched in surgery at Cornell.
What motivated you to pursue academic medicine?
As I was going through my residency and reflecting on medical school, I realized that I have been really blessed to attend some of the best institutions in the world, but one of the striking realizations I had was that I did not have many instructors who looked like I do. Whether at Princeton, Harvard, or as a resident at Cornell, I was one of only a handful of nonwhite persons in the program. So, it dawned on me that given the pedigree that I had and the blessings that I had experienced, I needed to do something so that others coming through would have professors and would be taught by people who look like I do. That was when I decided to pursue academic surgery.
How did you decide on your area of focus?
I was interested in doing immunology research at the time, so I spoke to G. Tom Shires, MD, FACS, Past-President of the College and chairman of the department of surgery at Cornell at that time, and he said, “Okay, I’m going to send you to work with the best surgical immunologist that I know.” Frankly, I told him I was going to go to the Rockefeller Institute next door, which had some of the most brilliant immunologists out there. He said, “No, you need to train with a surgical immunologist.” So he sent me to meet Richard “Dick” Simmons, MD, FACS, who was, at that time, at the University of Minnesota, Minneapolis, and had a great reputation as a researcher and mentor. Dr. Simmons accepted me into his lab to spend a couple of years doing research, but just before I was to move to Minnesota, he became the chairman of surgery at the University of Pittsburgh, PA.
So I went from Cornell to Pittsburgh to do research in immunology, and Dr. Simmons became my godfather in surgery. He taught me how to think critically and how to conduct quality science. He taught me to never get discouraged because what you think are “negative data” can be a potential source of funding. You have to keep an open mind. You may start with a particular hypothesis, but when you do the experiments to test it, it may be completely wrong. The results that you get may open a door to a new thought process and could lead to new seminal discoveries. This approach was so refreshing and illuminating—the thought that when things aren’t working the way you expect them to, you need to keep an open mind and think critically about what else could be going on; you have to reframe the hypothesis. This mind-set is essential when you are doing basic science work.
How did you find the balance between clinical and research activities?
I had two wonderfully productive years in Pittsburgh. One of my research partners was Tim Billiar, MD, FACS, the current chair. I was fortunate to be around a lot of good people. I went back to Cornell and finished my last two years, and then I matched in pediatric surgery at the University of Pittsburgh. I stayed on staff and rose through the ranks and became the chief of surgery at Children’s Hospital of Pittsburgh.
Dr. Simmons was instrumental in ensuring I did not get sidetracked. After I became an attending at Children’s Hospital of Pittsburgh, I had great clinical mentors but not really great mentors in basic science, so it was easy for me to get ensnared in clinical practice. I suddenly became the second-busiest surgeon just a few months after I became an attending. People liked me. I was competent, and I was loving it. On November 11, 1993, I got a memo from Dr. Simmons saying, “Rumor has it that we have not seen your shadow in the lab. I did not hire you to do hernias and whatever else. I hired you because of your potential as a surgeon-scientist.” That was it; it was terse. I read that memo and immediately marched down to his office, threw it on his desk, and said, “What do you mean? I’m the second-busiest guy here. I’m doing this and I’m doing that.” He barely raised his eyebrow and said, “If you have the fire in your belly, you’ll figure out how to do this.” I sat down, and he reviewed everything I was doing. I said, “I’m making rounds on my patients at least two or three times a day,” and he said, “Why? You can see them once in the morning, and then you have to trust your fellows and your residents and your partners. Then, if you want to see them one more time on your way home at night, that’s fine too, but if something else happens, people will let you know.” Basically, he taught me about time management, to find the necessary time to devote to my research. That conversation was key, as you can tell.
How have you integrated your work and personal lives?
I changed my approach, and the challenge then became managing the home time versus the research and clinical time. I came to realize that life is a zero-sum game. For everything you do, something else has to give. So I came to define balance in a different way. Basically, when a grant is due, I am all into it; when it’s done, then I put that down, and I reconnect with the family. The clinical part is an ongoing piece. We all have to find different ways of balancing time, but for me, that’s the only way it could work because I needed to have total immersion to be successful in getting my grants.
What were some of the other key moments in securing grant funding?
It took me two years; I think it was the end of my second year on faculty. I don’t know how many grants I submitted. I submitted to a number of different societies, and then finally the second year, my second submission to the ACS Faculty Research Award, I got it. That was one of the most important days of my life because it built my confidence, and I thought, “I can do this, I can really do this.”
Dr. Simmons told me that academic life really is a marathon. You can’t be expected to be rewarded overnight. The people who win are the people who are tenacious, the people who are determined. If you don’t give up, you’ll be fine. Other attributes are important. You have to have curiosity. You have to have creativity, but tenacity and determination are the essential attributes. So, if you get rejected by four or five granting agencies, you have to say, “Well, we will do better next time.” We eventually went for the NIH grant and did not succeed on the first try, but I went back to the drawing board. Back then, you would get those pink sheets; we addressed every single issue that was raised, did more experiments, and lo and behold, I got an NIH grant. Then it almost became too easy. I went for a second NIH grant, no problem. I said to myself, “Aha! Now I know what they are looking for.”
It’s been extremely rewarding, and as Dr. Simmons said, “It’s a marathon.” I tell my fellows and mentees, “This is not a 100-yard dash; it’s not even the 400-meter hurdles. This is a marathon—a marathon with hurdles. You have to be committed. You are going to get knocked down. It’s not about how many times you get knocked down; it’s how many times you get up. If you continue to get up, eventually, you are going to get there; “no” simply means “not now.”
Has your philosophy changed since you went into practice?
Somewhere along the way, I shifted from what I call the pursuit of excellence to the quest for significance. I became chief of surgery at Children’s in Pittsburgh early in my career. I think I barely had turned 41 years old. Then Dr. Simmons challenged me, as he always does, and said, “I know you’ll have been successful when the residents in Pittsburgh start choosing pediatric surgery as a subspecialty.” Nobody had gone into pediatric surgery in almost two decades because it was perceived as such a toxic environment. So we turned it around. By my third year as chief of pediatric surgery, almost all the best residents wanted to do pediatric surgery, so much so that Dr. Billiar said, “What are you doing? All of my best residents are picking pediatric surgery; I want them in my lab.” I said, “I’m not doing anything. I’m just making sure they enjoy pediatric surgery.” That was very satisfying for me because one of the objectives was to make sure that I delivered on Dr. Simmons’ challenge.
How did you build research as chair of the department of pediatric surgery?
I was the only person who was funded in the division of pediatric surgery when I started, and I wanted to build it up, so I recruited some really top people, such as David Hackam and Jeffrey Upperman (both MD, FACS). I managed to structure their time such that by the time they finished their fellowship, they already had a K08 grant waiting for them. That was our model. I also structured their clinical schedules in such a way that they had sufficient time to devote to research. Pittsburgh was unique for me to be able to pull that off, but that’s when I knew we were well on our way to developing the right model for mentoring future academic surgeons.
This is all part of that quest for significance. It’s no longer about me; it’s about what happens to the people whom I train. At some point during my fourth year as chief of surgery at Children’s Hospital of Pittsburgh, I decided that I wanted to make a bigger difference in the lives of others and in my community, and that’s why I left Pittsburgh for Los Angeles. I got recruited to the Keck School of Medicine of the University of Southern California and Children’s Hospital Los Angeles, which had enormous potential. This is a place that had a lot of clinical volume but had underachieved academically. There was not a single funded surgical investigator in the department of surgery, and I said, “I can fix that.” We went to work; we built what I think is a great department. I have a bunch of superstars, including the following (all MD, FACS, FAAP): Tracy Grikscheit, Jeff Upperman, Eugene Kim, and Kasper Wang, to name a few. It’s been very satisfying to see these stars rise to positions of leadership in academic surgery and become well-respected scientists themselves.
What are some of your guiding principles?
I adopted my guiding philosophy from the biography of Arnold Beckman, one of the foremost chemists of our time. Everybody on my team has to abide by Mr. Beckman’s rules, five of which are paraphrased as follows:*
- Rule 1: There is no satisfactory substitute for excellence. That’s the currency with which we work. We’re not born to be good. We’re not born to be very good. It’s excellence or bust.
- Rule 2: Absolute integrity in everything. Integrity is the essential scaffold for success or excellence. If your work is not anchored in integrity, no matter how far you go, you’re going to come crashing down.
- Rule 3: Moderation in everything, including moderation itself. Sometimes you can have moderation, but at other times you have to say, “The heck with moderation; I’m going to go for it.”
- Rule 4 is part of my own leadership philosophy: Hire the best people, and then stay out of their way. You can’t micromanage. You just have to make sure you hire the right talent, and nurture and empower these individuals to exercise their craft.
As a surgical community, we talk about the attributes of a great surgeon, surgeon-scientist, and surgeon-leader. I think first of all it starts with intelligence—that’s a given, but it’s also curiosity, creativity, tenacity, determination, leadership, and then, last but not least, social skills. Because medicine, and science in general, is all about teamwork; we have to be comfortable interacting with people from different disciplines if we are going to come up with seminal discoveries. Our job is to promote discovery that will translate into clinical intervention for the health of the patients entrusted in our care. That is our job—that is what we’ve got to do—and it’s got to be done in the context of a team.
- Rule 5: Never take yourself too seriously. Always laugh at yourself; let people crack a joke about your big, fat head, in my case. Then you become more approachable.
It’s been a fun ride. Everybody who knows me knows that I’ve been “living the dream.” It’s been amazing to be able to enjoy myself doing what I love and not only that, but actually get paid to do it.
*Arnold Beckman: ‘They don’t make guys like that anymore.’ Los Angeles Times. April 30, 2000. Available at: http://articles.latimes.com/2000/apr/30/magazine/tm-26149. Accessed February 27, 2018.