The SUS is Pleased to Honor the 2021 Trailblazer Award Winner Julie A. Freischlag, MD, FACS, FRCSEd (Hon), DFSVS
About the Trailblazer Award
The Society of University Surgeons (SUS) has awarded Julie Freischlag, MD, FACS, FRCSEd (Hon), DFSVS, Chief Executive Officer at Atrium Health Wake Forest Baptist, Dean at Wake Forest University School of Medicine, and Chief Academic Officer at Atrium Health Enterprise, the 2021 SUS Trailblazer Award. Dr. Freischlag will be presented with the Trailblazer Award by SUS President Dr. Kasper Wang on Tuesday, February 1, 2022, at the 17th Annual Academic Surgical Congress (ASC) in Orlando, Florida.
The SUS created the Trailblazer Award in 2020. This award is designed to recognize individuals who have developed a new area of academic pursuit or opened new avenues of investigation or academic thought that have the potential to be groundbreaking for years to come. The “trailblazing” contributions of the nominee can be broadly interpreted and are not limited to traditional surgical science. Nominations should specify how this individual has created a new and sustained domain of scholarship or knowledge. The SUS seeks to honor and recognize these individuals because of their embodiment of the principles of the Society and to establish role models for future generations of surgeons to honor and emulate their contributions to the science of surgery. The inaugural winner was George Yang, MD, PhD in 2020.
Dr. Julie Freischlag was nominated and selected by her peers because of her absolute dedication to medicine and serving as a strong health system and community leader. She is a revered colleague in surgery and across health professions, and a national voice for improving health and healthcare. Dr. Freischlag is the embodiment of true leadership and has espoused “leadership development” for many of her disciples. Her academic contributions, which are significant and impactful, led to her election to the National Academy of Medicine. She has received numerous teaching awards, a Distinguished Service Award from the Association of Veterans Affairs Surgeons, and recognitions as a Triad Power Player and Most Admired CEO by the Triad Business Journal (Winston-Salem, NC). She is also the current President of the American College of Surgeons. Dr. Freischlag has steadfastly mentored students, trainees and young faculty and is a content expert not only for vascular diseases but perhaps more importantly on teamwork and patient safety, leadership, work-life balance, and how women can succeed in health professions. Most notably, however, has been her profound personal and professional impact on past and current generations of leaders, particularly of women surgeon leaders who transcend to hospital and health system roles.
It Made Sense to Me
Dr. Freischlag originally planned to be a high school biology teacher following in her mom’s footsteps, but instead chose to pursue a career in medicine. She attended the University of Illinois for her undergraduate degree and later attended medical school at Rush University. At Rush, she originally aspired to become a pediatrician and, therefore, chose to do her surgery clerkship first to “get it out of the way.” However, she found that she really enjoyed surgery because “I could use my hands and it made sense to me. I had no previous exposure to surgery but I loved surgery as a student, and did it as a Sub-I. I had a great chief resident, Dr. Tom Witt. He was a wonderful mentor and role model and encouraged me to go into surgery.”
An internationally recognized expert in the treatment of thoracic outlet syndrome, Dr. Freischlag is also known for addressing the treatment of abdominal aortic aneurysms, carotid artery disease and peripheral vascular disease utilizing outcome data and clinical trials. Dr. Freischlag did her general surgery residency at the University of California, Los Angeles (UCLA), with her first rotation being on the vascular surgery service in 1980. At that time, there were many new vascular surgical procedures coming out of UCLA. Dr. Wes Moore was the head of the vascular surgery program at UCLA, and Dr. Ronald Busuttil (a SUS Lifetime Achievement Award Winner) was a junior faculty member. Dr. Freischlag recalls that all the innovation was very exciting. Dr. Herb Machleder was the champion of thoracic outlet surgery and conducting research on the physiologic changes in the involved muscles. Dr. Freischlag spent 2 years in the middle of her residency in Dr. Busuttil’s research laboratory doing neutrophil function assays in an appendiceal model. She finished her residency in 4 years, having negotiated her way out of an extra year. There wasn’t a match then so UCLA kept her on as a vascular surgery fellow. In all, Dr. Freischlag did 4 years of general surgery, 2 years of research and a 1 year vascular surgery fellowship to complete her training.
Mentorship and Sponsorship
Dr. Freischlag described her surgical mentors along the way and how they impacted her career path and surgical practice/research interests. As stated previously, Dr. Tom Witt was the chief resident at Rush and a great mentor. Dr. Steven Economou was the Chair of Surgery at Rush and he wrote Dr. Freischlag a wonderful recommendation letter to get into residency. She stated, “He was a great leader and teacher, and I really enjoyed his support as I went off because there weren’t any women. I was only the 6th woman to finish at UCLA and most times I was the only woman interviewing.” Drs. Moore, Machleder, and Busuttil were her mentors at UCLA and were incredible. She cited Dr. Bruce Stabile as an incredible role model. He worked at the San Diego VA where she took her first job as faculty at the University of California, San Diego. UCLA vascular surgeon Dr. Denny Baker introduced Dr. Freischlag to conducting clinical trials. Dr. Baker was an incredible teacher and thinker. Dr. Freischlag credits both Drs. Stabile and Baker for helping her establish an extraordinarily productive 33 year career in the VA system. Dr. Freischlag stated, “They were mentors, but they were also great sponsors. Even before we called it sponsorship, they made sure I wrote abstracts and presented at meetings and that I was on panels. And frankly, I don’t remember feeling that I was one of the only females there; I was just the chief resident Julie.” She added how valuable female mentors have been throughout her career. “A woman mentor can proactively speak up for you, which is really important at times. As I became a leader, I had more women mentors who were lawyers, head nurses and fellow leaders. When I was at UC Davis the Chancellor was a woman and an incredible mentor to me. I have always enjoyed that because it actually is different leadership styles. Now the new President at the University here is a woman. It’s just different styles as you look at how things happen.”
Be the Best Surgeon You Can Be
When deciding on career opportunities, Dr. Freischlag explained that she moved a lot in order to get promoted to new opportunities. In fact, she went back and forth to UCLA 3 times to do that. When a surgeon gets out of the blocks, their first opportunity is to be the best surgeon that they can be. Dr. Freischlag emphasized that, “You need to spend the time to become a very good clinical surgeon, making sure that you can make the diagnosis, do the procedure and, if you’re in academics, that you can teach well and then develop a research portfolio, whether it’s clinical, basic science or translational. For the first 5-10 years, you’re really just trying to be the best at what you want to be. You can’t go be a leader or change the world if you’re not excellent at who you are.” Being an excellent vascular surgeon was what she really wanted to do. She was in San Diego and then came back to UCLA and eventually moved to Milwaukee to get a fresh start. When she went to Milwaukee, Dr. Freischlag was Chief of Vascular Surgery at the VA and then Chief of Surgery at the VA. However, she really wanted to be a Division Chief of all of vascular surgery and moved back to UCLA in order to do that. She was a Division Chief for 5 years, then decided she wanted to run a department and led at Johns Hopkins for 11 years. She stated, “So I began to look at the next layer above me and how I could make those decisions and what I could contribute to make a difference. You can influence the world from below but you can’t change the world from below, so if you really want to make change, you have to lead, and you need an excellent team with you to make that happen in a meaningful, transformative way.”
There are Answers Everywhere, You Just Have to Find Where They Are
As the Chief Executive Officer of Atrium Health Wake Forest Baptist, Dean of Wake Forest University School of Medicine, and Chief Academic Officer of Atrium Health Enterprise, Dr. Freischlag is leading through a time of opportunity and growth. Dr. Freischlag explained that Wake Forest Baptist Health and Wake Forest School of Medicine expanded their footprint by joining with Atrium Health in a strategic combination in 2020. Together, the new combined organization cares for patients at 42 hospitals and more than 1,500 care locations. As the academic core of the enterprise, Atrium Health Wake Forest Baptist is expanding academic research capabilities and planning to open a regional medical school campus in Charlotte. Charlotte is currently the largest city in the United States without a 4-year medical school. This expansion is an exciting opportunity to transform medical education, advance research and further improve health.
With the evolving health care arena also comes challenges. Some faculty learned that they couldn’t be in private practice and be a full-time faculty member given that academia is quite different. Nowadays, newer institutions with larger healthcare provider networks actually generate revenue for research and education. The newer model is pluralistic with practicing physicians who want to see lots of patients, others who will teach and others who will conduct research with full appreciation of what everyone contributes. Dr. Freischlag stated, “For example, if you have a patient who has the flu and you want to see someone this afternoon, it’s going to be a network physician or someone in the urgent care clinic and not necessarily an academic doctor. There are answers everywhere, you just have to find where they are.”
There has been some concern expressed about the proliferation of health care systems and the emphasis on RVUs. Dr. Freischlag explained that there are different approaches. For example, there are some divisions that have big clinical health care institutions and those that do a lot of research, and they share the money and on-call. The problem with RVUs is that some people like to make more money, and then they don’t have time for academics and there is no work-life balance. Dr. Freischlag believes that we’re going to head towards outcome-oriented value-based care, similar to how surgeons are paid at Veterans Health Administration and Kaiser Permanente hospitals, where surgeons earn their salary doing all the right things, and not necessarily by performing a high volume of surgery.
Friends and Colleagues are Critical
Dr. Freischlag is the President of the American College of Surgeons and Past President of the Society of Vascular Surgery (SVS), the Association of VA Surgeons, and the Society of Surgical Chairs, among many of her societal leadership positions. She believes that societies provide opportunities to meet other surgeons and develop mentorships. As an example, the SVS originally was a small group of surgeons, with very few women. Recently, the SVS held a dinner with over 150 women in attendance. Dr. Freischlag advised that joining these types of organizations gives access to a myriad of specialties and networking events outside of a specific field. Those friends and colleagues are critical. If there’s an issue, there is an occasion to discuss it with someone in the same area. Dr. Freischlag recommended that surgeons choose one society that is specific to their field, and then one that’s more general, for a well-rounded approach.
Make Some Plans That are Fun
Dr. Freischlag was asked about the challenges facing mid-career academic surgeons today, both generally and specifically, and how academic surgeons may deal with the “mid-career” crisis. Dr. Freischlag believed that the pandemic has been hard on leaders because no one knows when it’s going to end. It has also been hard on mid-career surgeons specifically because it has interrupted their ability to progress in their societies, it curtailed surgery, travel and networking and their responsibilities at home, if they have children, have been huge. It is estimated that 5 million women have left the workforce across the country and 18% of medical staff have left the work force to work from home. Mid-career is hard anyway, when surgeons are considering their legacy and impact. On a wider scale, it’s dismaying that the COVID-19 surge continues and that there is a vaccine controversy. Dr. Freischlag stated, “Part of getting through the pandemic is recognizing that mid-career is really hard, especially right now, and finding those areas of focus that are manageable, but will help you move forward within your current limits. It could be to focus on your practice, your family, one research project, or going to only one or two meetings. Be careful that you don’t spend 14 hours a day looking at the computer screen. You need to forgive yourself, take a deep breath, stay healthy and make sure you have hobbies. Make plans that are fun, not only with your work, but come up with 2 or 3 things to do by yourself or with your family, and realize that you will have time to catch up later. There will be time for future growth.” In line with this advice, Dr. Freischlag does 5 minutes of meditation every morning and begins her day by thinking of a few things she is thankful for.
Have Mini Balances so Your Day is Balanced
In addition to serving in various national and international leadership roles, Dr. Freischlag has mentored students, residents and young faculty and is an expert on topics including vascular diseases, teamwork and patient safety, leadership, work-life balance, and women succeeding in health professions. What is particularly notable is her profound personal and professional impact on past and current generations of leaders, particularly of women leaders and surgeon leaders who transcend to hospital and health system roles. Dr. Freischlag noted that she was the 4th women Chair of Surgery ever when she took the position at Johns Hopkins in 2003, and there are now around 22-25 women who are chairs and many have moved on to become medical school deans. Women chairs are a diverse group in terms of age, ethnicity, orientation, and with different leadership approaches.
With regards to work-life balance, Dr. Freischlag believes that surgeons need to be able to “turn it on and off.” For example, on her work trips, she works on the way to the meeting but reads a book on the flight back. She advises everyone to be sure to take their vacation, exercise and have mini breaks, like going shopping or seeing a play or movie. These are really important events to put on a calendar. Dr. Freischlag explains, “I call this mini balance because you can’t always go climb Mt. Everest every week, but you can take a 3.5-mile walk or make sure that you go see a movie. When my son was younger, I always made sure I put all his sporting events on my calendar, and I did the timing for his basketball team. I made sure I was at his football games and to attend all of his activities and didn’t book a big case on the evenings when he had an event. You can monitor and rearrange what you do. You have to have a lot of energy and move fast. Having these mini balances so that your day is balanced makes such a difference, versus having a bunch of unbalanced days and then trying to make up for it later.”
The Biggest Thing Now is Team
On pursuing new areas of academic pursuits or opening new avenues of investigation or academic thought, Dr. Freischlag stated that the biggest thing now is teamwork. “If you have something new you want to do, whether it’s a procedure or a style of intervention, getting a team together is the way to go. For my thoracic outlet procedures, I work with the pain management team, surgeons, physical therapists, nurses and many others. Group think is especially important for discovery. We used to have our silos, and we would get a grant and try to discover something on our own. Now it’s more of a team science. If you have a new idea, a team can amplify it. Team science is faster and accomplishes more. I did several clinical trials at the VA, and those are some of the most important contributions I made, looking at comparisons of different operations and how they turned out. I think working with a team brings together an incredible community of thought, and now you can get a team together virtually as you look at something new.”
I Have Raised My Hand
When asked if there were any barriers to her ascension, Dr. Freischlag stated that she actually didn’t see barriers as a trainee as she was so busy working 110 hours a week. At that time, surgeons did everything including the pushing of the beds and all of the procedures. She explained that “you just survived, worked hard and tried to be as smart as you could and as alert as you could. I just wanted to be a surgeon so badly that the joyfulness of being a surgeon drove me through it. I chose UCLA because I saw Dr. Marjorie Fine (the first woman) finishing, and I had interviewed at a couple of programs where they did not have a woman resident. You could tell they wanted you to come but weren’t quite sure what to do with you to make that happen.” Dr. Freischlag noted that she didn’t notice barriers until she started to look at leadership positions. She recounts that a Dean told her he could not have the first woman Chair be in surgery because people couldn’t deal with it. Dr. Freischlag believed that the Dean at Johns Hopkins, Dr. Edward Miller, “changed the surgical world” by hiring her. She recalled that “he really believed in me and helped me move forward and find new opportunities. I just kept barreling through obstacles, chasing opportunities and being as good as I could. I raised my hand when people weren’t fair or said untrue things. Speaking up for each other is so important. Sometimes, there is a phenomenon called Queen Bee where they think only one woman can succeed, but we really all need each other. We each bring different strengths, talents, experiences and perspectives to the table. There are still more men than women in CEO, Surgery Chair and Dean positions.”
Dr. Freischlag is also passionate about inclusion and equity and works to ensure that diverse voices are heard and elevated across her organization. She has learned a great deal about race over the last few years, working together with faculty, staff, students and community members to create a Racial Equity Task Force. She shared, “I think that teaching and training about acceptance, belonging and equity is critical, so that you establish a culture where everyone has opportunity and that the care you give reflects the community that you serve. You also have to make sure that you call out bias and racism. We created bystander training to better understand our own implicit biases and share tools so that we can all interrupt instances of incivility with professionalism and respect. This is just one way we are creating an inclusive space where all belong.”
I Like to Gift People with Things I Have Made
When asked if there is something she is interested in that might surprise people, Dr. Freischlag stated that she is a big-time crafter. She likes to sew and make clothes for her grandkids. She makes holiday ornaments, craft pictures, paints, and used to knit a lot. She explained that it’s mainly about using her hands and is her favorite thing to do – decorating things and putting colors together. She even used to make all of her own clothes. She likes to give gifts to people of things that she has made.
Dr. Freischlag thanked Dr. Sandra Wong for nominating her and stated that she never thought of herself as someone who was a trailblazer; she just wanted to be a surgeon. Dr. Freischlag thanked her family for their support.
The Society of University Surgeons is honored to present Dr. Julie Freischlag with the 2021 Trailblazer Award at the Academic Surgical Congress on February 1, 2022, taking place in Orlando, Florida. She is the true embodiment of the type of individual that this award seeks to recognize.