The Path from Surgical Intern to ‘Senior Surgeon’

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At last, I have arrived at that pinnacle category of a surgeon’s career—to be considered a “senior surgeon”! It has taken 48 years of surgical training and practice to achieve this “lofty” title, and now I can contemplate the full perspective of my career from surgical intern to this point in my professional life.

It is important for me to acknowledge at the outset that I am greatly indebted to all of my mentors, educators, colleagues, friends, family, faith, and, most importantly, my patients, all of whom have shaped my career and my contributions to the profession of medicine. As one of many senior surgeons who continue to remain clinically active, I hope the following reflections may represent some common opinions of my experienced colleagues.

Have I become a better surgeon as I have gotten older, and how do I view surgical procedures at this point in time? I have come to understand that there is a balance between experience and technological advances, as well as how eagerly I approach recommending surgery versus conservative therapy. As a young faculty surgeon, I looked upon disease states as a “challenge” for my surgical capabilities, and I was considerably more aggressive about recommending surgery than now. Through experience and an increasing awareness of patient self-determination, I am more likely to accept a patient’s declination of surgery, given that I have adequately explained the risks,

benefits, and other treatment options in plain language they can comprehend. I want the patient to fully understand what they may be facing with a surgical procedure, and allow them to ask questions in order to arrive at their autonomous decision. What senior surgeons can offer to patients and resident physicians is a broad perspective of disease and treatment that comes from years of experience, trial and error, and judgment. I also appreciate the importance and richness of the patient–physician relationship now more than ever.

I am often asked, “When should a surgeon know it is time to retire?” I believe this is based on many factors—cognitive function, physical conditioning, manual dexterity, judgment, self-awareness, continued altruism, and the strength of love for medicine. Senior surgeons who can maintain the reliability of the above factors have a great deal to offer the patient, the profession, and medical education. Keeping the body healthy and capable is a fundamental requirement for a surgeon, so I am all about exercise, and always have been. Learning for a surgeon is indeed a life-long affair, and while head and neck anatomy does not change much, everything else about otolaryngology-head and neck surgery, as well as medicine in general, is in a constant state of renewal and discovery. The brain must be stimulated, and I have found over the years that working with medical students and resident physicians generates a keen sense of stimulation for my knowledge acquisition.

The brain must be stimulated, and I have found over the years that working with medical students and resident physicians generates a keen sense of stimulation for my knowledge acquisition. —Richard Holt, MD

At this point in my professional career, I am not as interested in performing surgery as the primary surgeon as I am in teaching surgery to trainees. I like nothing better than to ask questions when staffing a resident surgery, challenging the resident surgeon to consider “what ifs” and “what is the pathophysiology and anatomy of this condition,” or drawing diagrams and illustrations on the sterile sheets that I think will help explain how to perform a certain step in the surgery; I am a very visual surgeon. I have always enjoyed surgery as a “group effort,” and my own enjoyment comes from stimulating and encouraging the resident surgeon. If I can impart a few teaching points as I staff a surgery, then I feel relevant and helpful.