A tribute to Josef E. Fischer, MD, FACS

Dr. Fischer

Editor’s note: Following is a tribute to Past-Chair of the Board of Regents Josef E. Fischer, MD, FACS, FRCSEd(Hon), who left his post in 2008 during a challenging period. Nonetheless, he significant contributions to the ACS and is fondly remembered by friend and colleague Michael S. Nussbaum, MD, FACS.

Josef E. Fischer, MD, FACS, FRCSEd(Hon), died June 14, 2021; he was 84 years old. The world lost one of the great surgical minds of the 20th and 21st centuries, and for those of us who had the privilege of training under Dr. Fischer and working alongside him, we lost a mentor, role model, leader, confidant, and friend. He was a renowned surgeon, scholar, trailblazer, and teacher who devoted his life to education, leadership, scientific discovery, and service to his patients and his community.

A native of Brooklyn, New York, Dr. Fischer graduated summa cum laude from Yeshiva University, New York, NY, in 1957 and magna cum laude from Harvard Medical School, Boston, MA, in 1961. He began his surgical residency at the Massachusetts General Hospital (MGH) in Boston, and from 1963 to 1965 he served as a research associate under Nobel laureate Julius Axelrod, PhD, at the National Institutes of Health. Upon completion of his residency in 1970, Dr. Fischer joined the faculty of the Harvard Medical School, rapidly rising to associate professor by 1972. He was an assistant surgeon and chief of the surgical physiology laboratory and the hyperalimentation unit at MGH; at that time, he advanced the standard for the provision of total parenteral nutrition in surgical patients during the advent of this new and revolutionary treatment regimen.

In 1978, at the age of 41, Dr. Fischer became the fifth Christian R. Holmes Professor and Chair, department of surgery, University of Cincinnati (UC), OH, and surgeon-in-chief of The University Hospital, where he served until 2001. Dr. Fischer was instrumental in many sweeping changes that occurred at the Medical Center and the College of Medicine in Cincinnati during his tenure. When he came to the university in 1978, you could count the number of full-time faculty in the department of surgery on one hand. When he left after 23 years, there were more than 60 full-time members of the surgical faculty. He was responsible for initiating or strengthening subspecialty areas, including burn, cardiothoracic, plastic, transplant, trauma/critical care, urologic, and vascular surgery. Dr. Fischer played a key role in transforming the Cincinnati General Hospital from a city-county hospital into The University Hospital, the premier tertiary hospital for the tristate region. In fact, he has the distinction of being the first faculty member to admit a private patient to Cincinnati General Hospital.

His input and insights were key to the expansion of the hospital with the building of the Barrett Cancer Center, a critical care tower, a medical office building, a new Shriners Burns Institute for Children, and new operating room and endoscopy suites. Dr. Fischer helped to establish the largest multispecialty physician group in Cincinnati, UC Physicians, and was instrumental in the strategic planning that resulted in the development of the 75-acre West Chester Hospital medical campus north of Cincinnati. Under his guidance and stewardship, the Medical Center Fund of Cincinnati became the financial underpinning for all the medical departments at UC. In addition to his responsibilities as chair of surgery, Dr. Fischer served as professor of molecular and cellular physiology and was associate dean for community affairs at the UC College of Medicine.

An exemplary educator

I was a senior medical student applying for a surgical residency in 1981. I knew I wanted to be an academic surgeon and was looking for a residency that would foster my ambition in this pursuit. The primary reason that I chose the University of Cincinnati was because of Dr. Fischer’s leadership. It was clear that this was a program on the rise and Dr. Fischer was both demanding and passionate about excellence in patient care, science, and, above all, resident education. Following in the tradition of his predecessors, George Heuer, MD; Mont R. Reid, MD; Max M. Zinninger, MD; B. Noland Carter, MD, FACS; and William A. Altemeier, MD, FACS, Dr. Fischer created a “school of surgery” of his own that produced a generation of surgical leaders. I was honored to be a resident and, subsequently, a faculty member in his department at UC and was the recipient of much technical surgical training and many years of mentorship from him. Between Cincinnati and then Boston, Dr. Fischer trained more than 150 surgical residents and fellows, many of whom went on to hold prominent positions in prestigious departments throughout the world (see photo, this page). When he left Cincinnati in 2001, the department was an exemplary top-level academic department of surgery, and he set the stage for continued growth and distinction under his successors.

Dr. Fischer and the late Dr. Robert H. Bower with the University of Cincinnati residents in 1994

In 2001, Dr. Fischer returned to Boston to become the William V. McDermott Professor of Surgery, Harvard Medical School, and chair, department of surgery, and surgeon-in-chief, Beth Israel Deaconess Medical Center (BIDMC), Boston. As he did in Cincinnati, Dr. Fischer focused on recruiting and was credited with building the newly merged departments at BIDMC into another world-class surgical institution. He added 29 surgeons to the faculty in his first three years at BIDMC, which was key to addressing that institution’s financial challenges. He retired as chair in 2008 but remained active in his many academic and scholarly pursuits as an emeritus professor at both Harvard and UC until his death this year.

Clinical and translational research efforts

Dr. Fischer’s research expertise was wide-ranging and included surgical nutrition; metabolism, anorexia, and cachexia related to sepsis and cancer; gastrointestinal surgery with a focus on intestinal fistulas and inflammatory bowel disease; liver disease and portal hypertension; myasthenia gravis; surgical education models; and medical ethics. In 1978, Dr. Fischer and Lester Martin, MD, FACS, were among the first to preserve anorectal continence and create a pelvic reservoir in adults, in what has become the now standard ileal pouch-anal anastomosis operation. The critical evaluation of the technical aspects of this procedure and a continued focus on identifying its weaknesses led to several significant advances and improved outcomes in this operation. His dual interests in surgical nutrition and intestinal fistulas afforded him the opportunity to manage some of the most complex and challenging surgical patients. Evaluating one’s results in clinical surgery was a mainstay of Dr. Fischer’s clinical research efforts, and he demanded careful evidence-based outcomes research in clinical trials long before it was a standard of surgical research. This idea of evidence-based surgery and outcomes analysis in clinical decision-making was communicated to all who worked with him, either as a surgical trainee or a colleague.

Dr. Fischer published more than 860 journal articles and edited 21 books, including the last five editions of the standard surgical textbook, Mastery of Surgery, which has been titled Fischer’s Mastery of Surgery since the sixth edition in 2012. Prior to his death, Dr. Fischer was in the process of editing the eighth edition of this surgical classic. He was an associate editor of the Journal of the American College of Surgeons and served on the editorial board for 12 other journals. Dr. Fischer had an international reputation, and in 1999 the Archives of Surgery recognized him as one of the 24 most influential surgeons of the 20th century for having made “significant contributions to surgery in the areas of research, clinical care, and surgical education.”

Leadership in the ACS and other organizations

Dr. Fischer was a member and participant in numerous eminent surgical societies, taking on leadership responsibilities in many. He served on the board of directors and was chair of the American Board of Surgery; was president of the Central Surgical Association, Halsted Society, Society for Parenteral Alimentation, Society of Surgical Chairs, and the Surgical Infection Society; and chair of the Society of Surgery of the Alimentary Tract (SSAT) Foundation, which led to the establishment of the Karen and Josef E. Fischer International Traveling Fellowship of the SSAT.

A Fellow of the American College of Surgeons (ACS) since 1973, he served the College in numerous capacities. He was a member of the ACS Board of Governors, Advisory Council for Surgery, Surgical Education and Self-Assessment Program® Committee, Conjoint Council on Surgical Research, and Current Procedural Terminology/Relative Work Value Committee. He was Chair of the Professional Liability Committee, Vice-Chair of the Pre- and Postoperative Care Committee, First Vice-President and President of the Ohio Chapter, and Chair of the Board of Regents. In 1997, Dr. Fischer’s outstanding and sustained contributions on behalf of the ACS resulted in his receiving the College’s highest honor given annually, the Distinguished Service Award.

In addition, Dr. Fischer was recognized for his achievements on the national and international stage via many honors, including Honorary Doctor of Medicine, University of Lund, Sweden; Honorary Fellow, Royal College of Surgeons, Edinburgh, Scotland; the Crohn’s and Colitis Foundation of Southwest Ohio’s first Distinguished Leadership Award; the Ohio Chapter ACS Distinguished Service Award; the University of Cincinnati Medal for Excellence; and the American Surgical Association Medallion for Scientific Achievement.

A legacy of service

Dr. Fischer was a great believer in the role of the physician in the local community. He actively supported the arts and education in both Boston and Cincinnati. But most of all, Josef Fischer was passionate about the care of patients, particularly the most challenging surgical conditions, and tirelessly worked to both cure and ease pain. Despite all of his varied commitments across the country and around the world, he had a very busy clinical practice, and he set an example for all, rounding on his patients twice a day and always demanding excellence in patient care. The nightly 10:00 pm “Fischer call” to the in-house resident was both legendary and terrifying to his trainees. Regardless of whether he was in town or somewhere else around the globe, the call was consistent, and his expectation was attention to detail in the care of all patients. He was thoroughly devoted to his patients and they to him. He imparted that passion to all who were privileged to work with him.

Dr. Fischer was a loving husband, father, grandfather, and brother. He is survived by his wife of 55 years Karen, son Erich, daughter Alexandra, daughter-in-law Hallie, son-in-law Peter, and two grandsons, Asher and Aleksei. For those of us who carry on the surgical tradition that he imparted and for all our patients, we are forever grateful for Dr. Fischer’s leadership, scholarship, efforts, and insights. May his memory be a blessing.

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