The SUS Honors 2018 Lifetime Achievement Award Winner Layton “Bing” Rikkers, MD
About the Lifetime Achievement Award
The Society of University Surgeons (SUS) has awarded Layton F. Rikkers, MD, Professor Emeritus, University of Wisconsin School of Medicine and Public Health, the 2018 SUS Lifetime Achievement Award. Dr. Rikkers will be presented with the Lifetime Achievement Award by SUS President Dr. Allan Tsung, with an introduction by SUS Past President Dr. Sharon Weber, on Tuesday, February 5, 2019 at the 14th Annual Academic Surgical Congress (ASC) in Houston, Texas.
The Society of University Surgeons initiated the Lifetime Achievement Award (LTAA) in 2005. This award was designed to recognize individuals who have had a sustained career in academic surgery with contributions to surgical science. In addition, these individuals have demonstrated a commitment to the Society of University Surgeons whereby they have participated in the Society even after superannuating to Senior Membership status. Their participation in the Society is evidenced by the attendance of the meetings yearly and active participation in discussion of papers, attendance of the banquets, society functions, and mentoring the next generation of leaders in the society.
The Society of University Surgeons seeks to honor and recognize these individuals because of their embodiment of the principles of the Society. We seek to recognize these individuals to establish role models for younger generations of surgeons to honor and emulate their contributions to the science of surgery, and moreover to the Society of University Surgeons.
Dr. Rikkers was nominated and selected by his peers based on his leadership and contributions to academic surgery, as well as his strong support of the SUS. Dr. Rikkers was described as being the consummate surgeon-scientist, mentor, teacher and colleague. His outstanding academic, clinical, research and leadership track record was cited, which included his leadership in multiple societies, organizations and editorial boards and his contributions to the professional development of countless successful academic surgeons. With this Award, the SUS recognizes Dr. Rikkers’ endeavors in the fields of clinical research, HPB surgery, surgical and medical student education and national leadership. We also wish to recognize his track record of establishing important educational opportunities for surgical leadership and his immense contributions to the field of surgery. Dr. Weber stated that Dr. Rikkers is the “consummate servant leader.”
Choosing Academic Surgery
Dr. Layton “Bing” Rikkers grew up in the small town of Waupun, Wisconsin. His father was a lawyer and while his uncle was a doctor in Milwaukee, he worked for Northwestern Mutual Life Insurance rather than practicing his profession. His grandfather on his mother’s side was a physician but passed away before he was born. So while there were physicians in the family, his interest in surgery came about through a series of serendipitous events.
Dr. Rikkers was an Eagle scout, quarterback of his high school football team, and valedictorian of his graduating class. After graduating high school, he went to the University of Wisconsin and became interested in biological sciences. He ended up majoring in it and wondered what he was going to do with that major. He had an interest in meeting and interacting with people and thought that the field of medicine would marry those two interests. His older brother was two years ahead of him at Wisconsin and became the President of the Pre-Med Society. Self-described nepotism took hold and he would pass the baton to Dr. Rikkers.
During his undergraduate time at Wisconsin, Dr. Rikkers met his wife Diane “DeeDee” Foster. They knew that they wanted to be married in the summer between undergraduate and medical school. They were children of the ‘60s and wished to be independent. While both had families in Wisconsin, they ultimately decided that they would be adventurers and head off to the far away land better known as Stanford University. Dr. Rikkers originally intended to become a primary care physician in a small town but this objective actually lasted only minus 3 days and here’s why. Students at Stanford had to buy a microscope for their pathology and histology labs. The usual practice was to buy a used one from another student who was graduating. He heard of a student who had one for sale and as he visited the lab in which that student was working, he saw that they were doing a heart transplant in a dog. Noticing Dr. Rikkers’ interest, they invited him to put on scrubs and take a closer look. By the next morning at 6:00AM, he was working in the lab with Dr. Norman Shumway, the “Father” of heart transplantation. Dr. Rikkers conducted research in the heart transplantation lab throughout his preclinical years at Stanford. Long before he did a hernia operation, he was doing heart transplants and replacing heart valves in animal models. This would ultimately lead him to a career in surgery and also stimulated an interest in academic surgery. At the same time, his wife, who was an English literature major and was their total support system financially, got a job as a secretary in the Chair of Surgery’s office. DeeDee worked for a wonderful man named Dr. Robert Chase while Dr. Rikkers worked in the lab with Dr. Shumway. Both Drs. Chase and Shumway became strong mentors. He stated that they “were the principal reasons I became a surgeon.”
Finding Your Niche in Surgery
To ultimately decide what type of surgery he wanted to practice, Dr. Rikkers embarked on a circuitous journey. Dr. Shumway had an unusual cardiothoracic training program in which he didn’t wait for residents to finish general surgery training before embarking on their specialty training. Stanford was a five-year medical school with the first three years being pre-clinical. On the advice of Drs. Shumway and Chase, he took the opportunity to graduate after four years so he actually had only one clinical year of medical school. By happenstance, one of the visitors to the lab was Dr. Keith Reemtsma, who was Chairman of Surgery at the University of Utah and a transplant surgeon. Dr. Rikkers mentioned to him that he was finishing up medical school a year early and felt a bit unprepared for a surgery residency. Dr. Reemtsma said that they would be able to offer him an excellent mix of medicine and general surgery in a mixed medicine/surgery internship at Utah. The plan was to spend two years of residency at Utah and then return to Stanford for cardiothoracic surgery training.
Dr. Reemtsma then left for Columbia University towards the end of Dr. Rikkers’ first year of residency and Utah recruited Dr. Frank Moody as Chair of Surgery. Dr. Moody, an energetic and inspirational leader, became Dr. Rikkers’ main mentor and encouraged him to complete his surgery residency at Utah. After spending a year in Dr. Moody’s research lab studying liver regeneration and then a year with Professor Sheila Sherlock, a pioneer in hepatology, in London, Dr. Rikkers’ interests moved from cardiothoracic to liver surgery. The year in London with one and three-year old children was transformative for Dr. Rikkers and DeeDee.
After completing his year in London and his residency, Dr. Moody emphasized to Dr. Rikkers that to be successful in academic surgery, you need a niche. He recommended that Dr. Rikkers take an additional year of training in the field of hepatic surgery. The icon of that relatively new specialty in the United States was Dr. Dean Warren at Emory University who accepted Dr. Rikkers for a year of mixed clinical research and operative training in portal hypertension surgery. Dr. Warren became another key mentor for him.
Dr. Rikkers then accepted a faculty position at the University of Utah, where he served for 7 years before being recruited by the University of Nebraska as Professor and Chair of the Department of Surgery. For 2 of the 12 years in Nebraska, he also served as Interim Dean of the Medical School. Dr. Rikkers was recruited to the University of Wisconsin as the A.R. Curreri Professor of Surgery and Chairman in 1996 and served in that capacity until 2008 when he became an Emeritus Professor of Surgery.
Advice on Mentorship
When asked about his philosophy on mentorship, Dr. Rikkers stated that the one critical piece of advice that helped his career advancement is that you need several mentors. You might have them in different areas of your professional and personal life. For example, Dr. Rikkers stated that Stanford Surgery Chair Dr. Robert Chase “taught me what it was like to be a decent human being and a surgeon at the same time.” Dr. Chase not only provided the advice but followed it. Bing cites the following example to demonstrate what a unique individual Dr. Chase was. Dr. Rikkers’ wife DeeDee was one of many of Dr. Chase’s secretaries. Dr. Chase was invited to go to Madison, Wisconsin as a visiting professor in plastic surgery. While he had a few extra hours, without mentioning it to either Dr. Rikkers or DeeDee, he called DeeDee’s parents, hired a taxi and traveled to their home to meet them. Dr. Rikkers said it “provided a longstanding lesson on how to be decent to people that aren’t necessarily going to advance your career in any way.”
Dr. Rikkers recalls that Dr. Shumway taught him how to be a surgical scientist, while Drs. Warren and Moody were mentors in clinical surgery and surgical leadership. They remained his role models and mentors throughout his career. He explained that “mentoring is different than role modeling. It isn’t just a brief encounter, but often a long term and, in fact, sometimes a lifetime relationship between mentee and mentor.” For Dr. Rikkers, every time he considered a new position, all of his mentors got a call and gladly participated in helping to make the decision. Dr. Rikkers stated another sign of a good mentor “is to be compassionately critical of the mentee and give feedback both positive and, what is much more difficult for most people, negative when necessary. You need to challenge them.” When mentoring faculty as a chair in two different institutions, he would take notes during a mentoring session, and then in the next session he would review what they had talked about previously and discuss what had and what had not been accomplished. Although rewarding, effective mentoring takes a great deal of time. He said “if you seriously want to be a mentor, you have to be willing to give up some of your own achievements to facilitate the accomplishments of others.” His final thoughts on mentorship were that “you need to be aware of the generation gap. Although it is tempting to advise your mentees based on the values and goals you had at their age, it may not be the best advice. Being in a totally different generation, your mentee may have very different values and goals than you did and these must be respected.”
Encouraging the Development of Surgical Scientists
Dr. Rikkers stated “when attempting to develop a surgical scientist, one needs to be realistic. Even if that individual spent several years in the lab during residency, he/she will almost certainly require mentoring for several years, preferably by a basic scientist. During my time as chair, we estimated the cost in resources and protected time to be approximately $1,000,000. Even with this support, not all are successful in eventually developing an independent lab and peer-reviewed funding. Fortunately not everyone needs to be a basic surgical scientist. There are several other pathways to generating new knowledge. Outcomes, education, clinical, and translational research are all worthy pursuits and generally do not require as great an investment as basic science research. However, every new faculty member requires guaranteed free time in order to be successful in any of these realms. In my experience, one of the greatest challenges is getting a young academic surgeon to effectively utilize the free time. Once again, mentoring is essential. Nearly all surgeons love to be in the operating room to satisfy their own ego and often to enhance their income. Using granted free time to be productive academically is not always as attractive as doing another case. A department practice plan with well-balanced incentives will usually be helpful in developing well- balanced surgical faculty.”
One of the most popular topics at the SUS Mid-Career Academic Surgery Professional Development Course is called “Should I Stay or Should I Go.” For surgeons debating whether or not to stay at their home institution, or to look at opportunities to advance elsewhere, Dr. Rikkers offered the following thoughts. He stated that there’s absolutely nothing wrong with a very talented person staying at the same institution throughout their career if the values and opportunities in that institution suit what their goals are. He greatly admires those that remain at the same institution as they become the memory, culture and soul of the department. Based on his own experience, he was recruited to Nebraska at a young age. As stated previously, his mentors came into play. Dr. Rikkers didn’t think he wanted to leave the University of Utah as he was the Acting Chief of General Surgery at the time and was in fact a candidate for the Chair of Surgery position when Dr. Frank Moody left. He looked at the University of Nebraska Chair position and discovered that the Chair of Medicine was a charismatic and renowned hepatologist who, like himself, wished to start a liver transplant program. After consulting his mentors, he and DeeDee ultimately decided to make the move to Nebraska. At that age, he had very little administrative experience, but as it was a smaller department, it enabled him to grow administratively as the department grew. It was an ideal move for him because the emphasis in the Department of Medicine was on liver disease. This allowed him along with his first recruit, Dr. Bud Shaw, to initiate one of the earlier liver transplant programs that rapidly became busy and successful. Dr. Rikkers advised that the “the office of Chair has changed markedly over recent years as institutions have become much more centralized, and in many institutions the Chairs of departments don’t have as much budgetary control as they once did. I don’t think that being a Chair of a department has to be one’s ultimate goal. Even for the most talented individuals, it may be preferable to become a Division Chief, an outstanding surgical scientist, or an inspirational teacher and mentor to young people.” With regards to changing institutions, Dr. Rikkers noted that you need to be careful as there is always a risk to moving. He went from Utah to Nebraska to Wisconsin and both of those moves engendered considerable anxiety as at each stop he had to again prove himself as a clinician, teacher and leader. Dr. Rikkers recalled that when he moved to Wisconsin, he observed several of his faculty lined up at the operating room window to see if he could really operate. He stated that “every time you move, it’s a challenge. There’s nothing wrong with doing it but you need to make certain that the values of that institution and that department are your values. I think mismatched values often result in a lack of success when people make a move.” He advised faculty to seek the advice of mentors before considering a move.
Surgeons face immense pressure to do their jobs at their home institutions but also wish to participate in societies and organizations. In terms of trying to maintain a balance, Dr. Rikkers felt that first, surgeons need to realize their most important work is at home and to not sacrifice that for outside opportunities. Once they are established and respected in their home institution, they can become involved in surgical societies. Again, mentors are invaluable. They can often make contact with Committee Chairs who they know and advance your interests. Although not done as often as it should, one can advance his/her cause by contacting a society’s leadership and let them know of their interest. This often leads to a committee appointment and the opportunity to become more involved.
Balancing Your Personal and Professional Life
On discussing challenges to surgeons today, Dr. Rikkers believes that the greatest challenge to academic surgeons is balancing their personal and professional lives. He stated that “as one develops their surgical career, you need to make time for your spouse or partner, your children, and maybe, most importantly, yourself. It is essential to cultivate interests and even passions outside of surgery. They will help to balance your life and serve you well when you are no longer a surgeon.” He explained that this tension between the professional and personal life is real and one of the main factors responsible for the burnout now seen in about 50% of surgeons in both academic and private practice. Dr. Rikkers mentioned that, in the past few years, both the AAS and SUS Presidential Addresses have appropriately centered on this issue. He admires the present generation of surgeons who emphasize the importance of family time to a greater degree than his generation did.
From AAS, to SUS, to the ASC
During most of Dr. Rikkers’ career, the AAS and SUS were separate entities. He considers it a stroke of genius to combine the meetings to create one of the most vibrant and thriving surgical meetings in the world. He states that more and better surgical science is presented and discussed at the Academic Surgical Congress than anywhere else. He fondly remembers his early AAS meetings. Although at first lonely, he soon met people who have become life-long friends. After a couple of meetings, he was appointed to a committee that he later chaired. Dr. Rikkers wanted to highlight what he felt was a unique fact about himself. For 2 consecutive years, he was nominated for President of the AAS, but wasn’t elected either time. He jokingly says he’s not sure if anyone else in history has accomplished that feat.
Dr. Rikkers recalled his first year on faculty at Utah happened to be the same year that Dr. Moody hosted the SUS meeting in Salt Lake City. “Dr. Moody introduced his faculty to those attending the meeting by showing a video of each of us skiing down the slope at Alta. We were all invited to Dr. Moody’s home for the Executive Council cocktail reception that allowed us the opportunity to mix with the SUS leadership. At the time, I thought I would never be admitted to a society with so many luminaries from the academic surgery world. However, I eventually did gain admission and became the SUS Representative to the American Board of Surgery (ABS) for 7 years, one of the more satisfying activities of my professional career. Thank you SUS.”
What’s Most Important
When asked if he didn’t pursue a surgical career, what would he have pursued instead, for example quarterback of the Green Bay Packers? Dr. Rikkers laughingly told the following story. When he was about to start an operation and the patient was prepped and draped, he would put his hands on the abdomen and say to the residents or students scrubbed with him, “what do you think of these hands?” Seeking an “A” on their surgery rotation, they would generally reply that they were wonderful and skilled hands. Dr. Rikkers would reply “no, you’re all missing the point. If my fingers were one inch longer, I would have been an NFL quarterback.” He is an enthusiastic Packers and Badgers fan, and enjoys hiking, golfing, biking, and nature photography.
Dr. Rikkers acknowledged his wife DeeDee and was proud that they had recently celebrated their 52nd wedding anniversary. Throughout his entire career, being Chair for twelve years at two institutions and Dean at Nebraska, he stated that it has truly been a partnership. He said “my wife has been much more than just supportive. She has been a confidante with difficult decisions and an absolute first rate recruiter. She hosted many social functions at our home that gave a collegial, family atmosphere to the departments I chaired. Every time we moved, DeeDee had the opportunity to reinvent herself and did so successfully. And through all of this, she was a marvelous mother to our two children and now a beloved grandmother to our two grandchildren.” They hike, ski, golf, bike, and take trips together. With regards to nature photography, DeeDee is not a photographer but she spots the bird and he takes the photo, in true partnership. His nature photography has taken center stage during the last two years, resulting in production of a 240 page book of over 300 species of birds.
The Society of University Surgeons is honored to present Dr. Layton “Bing” Rikkers with the 2018 Lifetime Achievement Award at the Academic Surgical Congress on February 5, 2019, taking place in Houston, Texas. He is the true embodiment of the type of individual that this award seeks to recognize.