The SUS is Pleased to Honor the 2019 SUS Lifetime Achievement Award Winner
Michael Longaker, MD, MBA
About the Lifetime Achievement Award
The Society of University Surgeons (SUS) has awarded Michael Longaker, MD, MBA, Deane P. and Louise Mitchell Professor and Vice Chair, Department of Surgery, the 2019 SUS Lifetime Achievement Award. Dr. Longaker will be presented with the Lifetime Achievement Award by SUS President Dr. Gregory Kennedy, with an introduction by SUS Past President and current SUS Foundation President Dr. George Yang, on Tuesday, February 4, 2020 at the 15th Annual Academic Surgical Congress (ASC) in Orlando, Florida.
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. Longaker 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. He was described as being one of the most distinguished surgeon scientists of our generation with contributions that have cut across multiple disciplines in medicine, biology and engineering. His outstanding academic, clinical, research and leadership track record was cited, which included his leadership in multiple societies, particularly with the SUS where he served as Treasurer and President and remains an active participant in the Academic Surgical Congress. With this Award, the SUS recognizes the quality and breadth of science he has produced, specifically in the field of regenerative medicine, defining the field of fibroblast heterogeneity, and identifying the skeletal stem cell. We wish to also recognize his immense contributions to the field of academic surgery.
Surgery is Action Oriented
Dr. Michael Longaker became interested in medicine broadly while an undergraduate student at Michigan State University. He was majoring in physiology, studying the functions of the human body. There was a family dentist in his hometown of Detroit who had kept in touch and had wanted him to go to dental school, with the plan being for Dr. Longaker to eventually take over his practice. However, while at MSU, Dr. Longaker discovered that he had a broader interest in the functions of all of the body’s organ systems. Dr. Longaker stated that, when he went on to Harvard Medical School, he knew very early on that surgery was what he wanted to pursue, because it was “action oriented.” For example, if a patient had appendicitis, then the surgeon would take the appendix out.
Level Setting and Reluctant Lab Time
When asked how he became interested in the type of surgery he currently practices, Dr. Longaker felt that his training pathway was an important story for young people to know. He matched at UCSF because it was the best surgical training program in the country at the time. The Chair of Surgery, Dr. Paul Ebert, was one of the most famous pediatric heart surgeons in the world. He also had played basketball at Ohio State University, which happened to be in the same conference that Dr. Longaker had played in at MSU. Dr. Longaker thought that he wanted to be a pediatric cardiac surgeon. This meant he would have to train in general surgery and then complete additional training in cardiothoracic surgery, then pediatrics. However, halfway through Dr. Longaker’s third year of residency, Dr. Ebert became the Director of the American College of Surgeons and departed UCSF. The new Chair was Dr. Haile Debas, who proceeded to meet with all of the 3rd year residents. Dr. Debas told Dr. Longaker that he seemed like a strong student except for the fact that he hadn’t done any research, and then asked if he wanted to do any research. To this, Dr. Longaker replied that he was not interested in research. In response, Dr. Debas asked Dr. Longaker to read his own name tag and then Dr. Debas’ name tag. Dr. Longaker recounted that this “established, in a ‘polite’ way, the food chain…Dr. Debas then inquired if we were ‘level-set’ and asked again, ‘Would you like to do a research fellowship?’; I replied that I would love to.” Dr. Debas laughed and wrote “Trainable?” in Dr. Longaker’s folder.
As a result of this conversation, Dr. Longaker was assigned to Dr. Michael Harrison’s lab. Dr. Harrison was a pediatric surgeon who operated on unborn patients, which was nearly unheard-of at the time. Dr. Longaker began in his laboratory in July of 1987. Three to four months into the lab year, Dr. Harrison asked him to look at how embryos heal wounds. This question was driven by a clinical observation: during the surgery, the unborn patient would have a Gore-Tex patch placed over their tissue defect; six to twenty weeks later, when the patient was born, the Gore-Tex patch remained but there was no redness or inflammation around it. In contrast, older patients develop redness within just a few minutes after applying a band-aid. Dr. Harrison, being an experienced clinician, identified this as a medical problem. Dr. Longaker’s research led to his discovery that during fetal development, patients heal wounds without any scarring. Dr. Longaker then became obsessed with why people as adults scar outside of the uterus without having changed their DNA. Dr. Harrison’s question enabled Dr. Longaker to be productive in the lab and they subsequently wrote NIH grants, papers, and textbooks. His reluctant one year in the lab suddenly turned into four.
Halfway through those four years, Dr. Harrison said that there was a lot more about wound healing that Dr. Longaker didn’t know and he encouraged him to reach out to Dr. Michael Banda, who was a biochemist. Dr. Longaker ended up splitting his time between the two labs in his last two years. This opened up the cell biology and biochemistry side, in addition to the surgical side, of Dr. Longaker’s research. Dr. Harrison’s suggestion that he spend time with Dr. Banda, and Dr. Banda welcoming him, was a great experience. After four years in the lab, Dr. Debas told Dr. Longaker that he might be “overdoing it,” since he had put him in the lab for a year and he had done four years. He asked Dr. Longaker if he wanted to finish general surgery or get a PhD and join the faculty. Ultimately Dr. Longaker wanted to finish general surgery, but was obsessed with scarring and was told plastic surgeons work on scars. In the end, he completed nine years of general surgery (five years of clinical work, four years in the lab), two years of plastic and reconstructive surgery, and finally a third year of training in craniofacial surgery. All in all, it ended up being twelve years of training. Dr. Longaker’s “reluctant” one year in the lab changed his life and his career pathway: he is still obsessed with scarring and fibrosis. He stated that “a million things had to go right for me to end up in Dr. Harrison’s lab and I feel like the luckiest research fellow of all time to get that opportunity.”
Productive Collisions and Mentors
Dr. Longaker says “there are productive collisions in your everyday life and there are non-productive ones.” He believes that he was incredibly lucky to be assigned to Dr. Harrison’s lab because Dr. Harrison had done an NIH fellowship and was a pediatric surgeon and an immunologist. The concept of fetal therapy was so foreign that the ability to operate in an animate lab and dissect what goes wrong when there is a blockage in the kidneys or diaphragm was invaluable and a unique experience. Further, after ultrasound came out, it became possible to diagnose abnormalities in the fetus anatomically, which was a very exciting development for fetal surgery. On the other hand, Dr. Banda was a biochemist who worked on enzymes that degraded collagen and how one could inhibit them, which was a totally different approach from the surgical angle. Dr. Longaker felt that he needed both approaches – the fetal surgery mentorship and the biochemistry mentorship – to be able to ask more complex questions.
The Evolution of Mentorship
Dr. Longaker has many roles at Stanford University including Deane P. and Louise Mitchell Professor and Vice Chair, Department of Surgery; Co-Director, Institute for Stem Cell Biology and Regenerative Medicine; Director, Program in Regenerative Medicine; Director, Children’s Surgical Research Program; and Director of Research, Division of Plastic Surgery. He has a broad mandate and still defines himself by his lab. He sees patients for a half afternoon every other week who have unusual scars and wounds. His lab is, despite all of his other administrative roles, the core of how he views himself. He has trained almost 200 people. Dr. Longaker walks through his lab five to ten times a day and meets with people informally. Everyone presents at every group meeting, every email is answered every day, and he edits all manuscripts in real time with a 24 hour turnaround time for the fellows. Everyone who is in his lab remains in the lab family forever. Dr. Longaker is a hands-on mentor, taking a little bit from each of his past mentors – including but not limited to Drs. Harrison, Banda, and Debas – but also developing his own style over the past 25 years. He believes in being encouraging and relentlessly positive.
The surgical landscape has changed substantially with the growth of minimally invasive surgery and implementation of the 80 hour work week. There has been a subsequent general shift in surgical mentorship. The trainees are changing: they are savvy with electronics and like to multi-task. They don’t want to look at one gene at a time but instead are looking at the entire genome, and they often have two or three mentors. Dr. Longaker has had to evolve in terms of being more open minded about the different ways that people learn, and his mentorship style has evolved in turn. Dr. Longaker stated, “If you want to stay in touch with the trainees and not go extinct, then you need to evolve your mentorship style.”
Asking Bold Questions
Dr. Longaker has authored/co-authored over 1300 publications. With funding being more limited and an emphasis being placed on surgeons to generate revenue, Dr. Longaker stated that “you have to ask pretty bold questions – the funding level when I started out was 35%, and now it’s less than 10%. The ability to get funding becomes increasingly difficult. Trying to balance RVU production, whether you are in the red or the black so to speak, dominates young faculty’s first appointment. What I have tried to do is, if I make a commitment to a young faculty member, then I don’t just want it to be for three years or so – I will extend out the hard money for a long time.” Stanford University Director of Surgical Innovation Program Dr. Thomas Krummel had the vision for a building at Stanford for pediatric regenerative medicine and, paired with Dr. Longaker’s MBA, they have been able to obtain their own laboratory space and recruit around seven to nine faculty surgeon-scientists. Dr. Longaker’s belief is that supporting the faculty for longer than three years, and being able to provide a niche or “sandbox/soil” for them to grow in, is critical. As he says, it’s a balance of giving the faculty food, water and sunlight so that they can grow, but not being overly involved, so that they can become independent. He stated that these faculty have been very lucky to publish in the best journals, but the process is difficult. Dr. Longaker stated that “if you ask big questions and are in relentless pursuit of them, Stanford offers the opportunity to work with extraordinary young trainees in the technology center of the world. It’s a good fit for me, and I try to create an exciting environment in the lab for young faculty and trainees and support them.”
Do What Makes You Happy
Many mid career surgeons are looking to attain a leadership position and/or trying to determine if they should stay or go. Dr. Longaker thinks that if you are successful, “they’ll find you, and you’ll have lots of opportunities.” He has stuck with running a lab and running the Institute for Stem Cell Biology and Regenerative Medicine because it’s the right fit for him. Dr. Longaker has come close to Chair and Dean positions and, most recently, President at a University. His advice is “at the end of the day, do what makes you happy. Don’t view success as a surgeon-scientist as a springboard to another job because if that doesn’t come, you will ultimately be unfulfilled. If you’re doing things you like and you’re productive, you’ll have lots of options. The question is the opposite: is that what you really want? I would ask you what is the best part of your week, then I would ask what the impact is of becoming a Chair or a Dean on that part of your week. It’s likely that the best part would go down and the part you may not like will go up. You have to think about the impact of moving, of restarting your lab/practice, or what you have to give up to accommodate more administrative responsibilities. For me, as I said earlier, I define myself by my group so it’s very easy – this is what I love to do.“ Dr. Longaker admits that he has taken long hard looks at other options but at the end of the day, he cannot imagine a better job.
The Values of an Organization
Dr. Longaker was the Treasurer and President of the SUS, and has held leadership positions in other professional associations and societies. For those interested in pursuing leadership positions and involvement outside of their institution, he encourages people to get involved at a level that they can manage at the beginning, to determine if they like it and if it’s an organization that they enjoy working with. Additional things to consider include are if this is a good use of their time and whether they feel good about the time they serve. Dr. Longaker reminds us that “these are servant roles; if you start out at an entry level and you like it, then you will continue to serve and in all likelihood be recognized. If you don’t like it, move on to something else. Don’t bite off more than you can chew, but get involved at the committee level, and determine if the values of that organization are your values and if the other members are people that you enjoy spending time around. This can be done in a graduated fashion.”
Surgical Innovation
Dr. Longaker has been an inventor and holds numerous patents, and has also funded several venture-backed start-up companies. For those who are interested in pursuing this avenue, Dr. Longaker thinks that it’s an acquired trait whether or not you know how to bring new technology forward. He considers himself lucky that Stanford is in the heart of Silicon Valley and is a very progressive and young thinking university. Developing technology is “in the water” in Northern California, with almost half of the world’s venture capitalists based there. Wanting to develop a different skill set in terms of business, Dr. Longaker completed an MBA shortly after moving to Stanford almost 20 years ago. He received that formal training and then benefited from very talented trainees and colleagues. One in particular is Dr. Geoffrey Gurtner, who is not only a scientific colleague but also a creative and talented investor. Dr. Longaker believes that “if you surround yourself with colleagues who want to do those things, you’ll have a critical mass. I’m not naïve, I know that most universities don’t think like Stanford. My worry is if a surgeon is just a RVU machine, then we don’t evolve in terms of technology, because you don’t have the time to say ‘how could I do this better?’ People like Dr. Tom Fogarty and others who have worked at Stanford have changed the way we treat patients. Surgical innovation is incredibly important and we want to make sure the young trainees and faculty members aren’t so busy that they don’t have time to do this. At Stanford, it’s a priority, but it is a unique department of surgery. Chair of Surgery Dr. Mary Hawn has continued to build on top of what Dr. Krummel did, and it is a very unique ‘sandbox’ so to speak.”
Challenges to the Triple Threat Surgeon
Surgeons face challenges at every stage – starting out, and getting a practice and research going. The mid career surgeon specifically is transitioning from a K to an R grant and continuing to grow their academic enterprise, as they are determining what they really like to do clinically. Dr. Longaker worries that surgeons are drawn one way or the other too heavily. His advice is that the mid career surgeon has to understand how they really want to be spending their week ten years later. He also worries that fiscal pressures are so much that they are the driver to do more clinical work, and that being extremely clinically productive becomes the most important thing for a surgeon. But, he says, for the surgeon-scientist, you still have to have time to develop your academic enterprise. Dr. Longaker admits that he “worries that the challenges are to choose your path, but I think it’s not binary. If you want to be a triple threat, you have to be in an environment that appreciates all 3 phases of teaching, clinical care and research. If you are not in that environment, then I would try and find that environment.”
Enjoy the People and the Mission
When asked how he became involved in the SUS, Dr. Longaker replied that his good friend Dr. George Gittes, who is also a SUS Past President, encouraged him to get involved many years ago. Dr. Longaker was working on his MBA at the time and Dr. Jeff Matthews asked if he would be the NABR Representative. That was the position that he started in, which gave him a seat on the Executive Council. He decided that he liked it and then, when he had an MBA in Finance, he was nominated for Treasurer. Being Treasurer is a three year term and at the end of the three years, he was asked if he had any interest in the Presidency. Dr. Longaker accepted because he liked the people, believed in the mission of the organization, and liked serving. He feels that if someone does this as a kind of a “chess move” to see if they’re going to get a position, and if the position doesn’t work out, it shouldn’t make them not like the organization. As he sees it, “If they’re doing it because they enjoy the people and the mission, then it should be fun.”
An interesting footnote is that Dr. Longaker was very involved as Treasurer in the discussion of merging the SUS and AAS Annual Meetings. Dr. Longaker admitted that no one knew that it would be so successful and it was anxiety provoking at the time. At the end of the day, it was done with a great deal of care and consideration, and the Academic Surgical Congress has become incredibly successful.
One of the Best Places to Present
The Academic Surgical Congress (ASC) remains a priority meeting for Dr. Longaker who makes it a point to submit around 10 abstracts per year. He believes that it is the premier gathering place for the over 2000 people who are really interested in surgical science; whether it’s outcomes or molecular biology, these are the people that define the ASC. Dr. Longaker stated “it’s the best place to present your work and you are around people who are really interested in science. I have maintained this as a focus for my lab and feel strongly about it. You of course remember the meeting where you became President, but I always enjoy the Presidential Address because it gives you a perspective on who your leader is.” He always feels good when the trainees say that it was a good experience to present and answer questions. Every year is different but the level of science has continued to grow. He believes that it’s really important for someone who has been running a lab for a really long time to stay active and present.
A Championship and a Strong Work Ethic
It is a tradition for SUS to ask the winners if there is anything that they think would surprise people. People may or may not know that Dr. Longaker won the 1979 NCAA basketball championship as a guard for Michigan State, and played with Magic Johnson and against Larry Bird. He feels like he has been lucky enough to have multiple different careers. His father was a professional baseball player, which was a unique experience, and he got to play at a large university and won an NCAA championship in the most watched game ever. Dr. Longaker admits that it didn’t seem like it was that big at the time. It was unusual but incredibly fun. He said that it’s also humbling to compete against someone who is one of the top three or four players of all time. Dr. Longaker has been involved in Stanford Athletics and has had many athletes work in the lab, including Bryce Love, who finished second in the Heisman Trophy football vote in 2017. He has also trained athletes from almost every sport in his lab. Dr. Longaker said “athletics dominated my life in college, and now it plays a fun role for me. Former athletes make really good surgeons. It’s about time management and discipline: you have to manage your athletic schedule with your academic schedule, you perform when the stakes are high, you are used to expectations about performance. You have a very strong work ethic and you understand everyone has a role on the team. These are all character traits that are really helpful for surgeons.” He disclosed that he is, “after all, totally biased.”
Dr. Longaker’s wife, Melinda, is a Dermatologist. Dr. Longaker has taken up golf the past few years and is an “evolving” golfer. He enjoys golfing with his youngest son, Andrew, who is in 11th grade. His oldest son Daniel is a freshman in college playing basketball in the northeast. He remains continually humbled by sports.
Opportunity to Lead
Dr. Longaker stated “For the SUS to make a plastic and reconstructive surgeon President was pretty bold, and I have always remembered that. I am delighted that the SUS took a chance on me a long time ago and I’m very grateful to have had the opportunity to lead. I am very humbled by this honor.”
The Society of University Surgeons is honored to present Dr. Michael Longaker with the 2019 Lifetime Achievement Award at the Academic Surgical Congress on February 4, 2020, taking place in Orlando, Florida. He is the true embodiment of the type of individual that this award seeks to recognize.