The Leading Edge: Research leads to self-discovery for U. of Michigan plastic surgeon

by Michele Shermak, MD, PSN Editor
04/20/2011 at 10:00AM

When former University of Michigan Health Systems Chief of Plastic Surgery William Kuzon Jr., MD, was not accepted into a plastic surgery training program during his residency at the University of Toronto, the setback ultimately led to him finding his comfort zone in the research lab - and to becoming a better surgeon. His combination of work ethic and hunger for knowledge - two traits no doubt passed along from his father - has forged an approach to plastic surgery that elevates those around him. Dr. Kuzon preaches and practices rigor, principles and ethics as he shapes the next generation of innovators and risk-takers with a charge to push themselves and the boundaries of plastic surgery.

PSN: What were important formative experiences for you?

Dr. Kuzon: I'm from this bizarre family in terms of the timing of when things happened. My dad's first wife died, and he married my mother - her second marriage - during World War II. My dad was born in 1908, and if he were alive today, he would be 103 years old. I was born in the mid-1950s after my parents had
been married for more than 10 years. My half-sister is 17 years older than me, and my half-brother would be 85 if he were still alive. I have two nieces who are older than I am. With everyone out of the house, I was essentially raised as an only child.

My parents were working-class people who had a powerful influence on me. My dad was an independent businessman who ran a trucking company. He would work all day, come home for dinner and go back to finish his work at night. My dad had very eclectic interests - skiing, photography, sailing - which were all unusual for his time and socioeconomic status. In the winter, which is most of the year in Buffalo, N.Y., we skied almost every day when I was growing up. He was always studying something out of the ordinary, like celestial navigation. Maybe this is why it bugs me if I don't know something - the biggest thing shaping the way I ended up. My dad died when I was 19 years old, and a lot of responsibility for my mother, who was mostly on her own in Buffalo, fell to me. Taking care of other people and myself came from that. I will hardly let anyone do anything for me because I needed to be so independent at an early age.

PSN: Talk to us about your career path.

Dr. Kuzon: I was always interested in science and math, and I had an aptitude for those subjects. Being from a working-class family, you don't envision yourself becoming an astrophysicist because you don't know what that is. In college, I planned to either go to medical school or graduate school in English lit. Medical school presented more likely success, though I had no clear idea of what it would be like. Unlike kids who go to medical school today, I had very minimal exposure; I spent my summers making money.

In medical school at the University of Rochester (N.Y.), I immediately gravitated to surgery. I thought about training in surgery at Rochester, Cleveland, Pittsburgh or Toronto. I asked the chair of the Department of Surgery at Rochester about Toronto. You could see Canada across Lake Erie, and I was thinking about not going too far because of my family obligations. It turned out that Bill Drucker, MD, chief of surgery at Rochester, had previously been chief at Toronto. He recommended Toronto as the best in the world for training and thought my going there would be great. I matched as a surgical intern at Toronto General Hospital in 1981. At that time, the system of residency application in Canada was that during internship, I would have to apply for the plastic surgical residency program, which was my goal. They've always had integrated plastic surgery training in Toronto.

I got up there for the internship, and I remember my first day like it was yesterday. It was an incredible culture shock - the medicine names were different, the whole system was different. Expectations for interns were way different. Canadian medical students used to get paid by the federal government because they took first call in the E.R. and took care of patients on the floors. By the time they were interns, they were way ahead of most American medical school graduates. My first months of internship there were rough, and I had to apply for plastic surgery residency within one to two months in my disheveled, unfortunate state - and I didn't get it.

PSN: What did you do?

Dr. Kuzon: I went to the chief of the surgery program, very anxious: I didn't match in plastic surgery, I was on a work visa, and I was going to be deported the next year on July 1. He recommended that I go to the chief of plastic surgery and ask him what I should do to get the best chance of matching in the program. W.K. Lindsey, MD, was the head of plastic surgery, and he told me to go to the lab. At that time, I never had an academic bent. I was painting houses in the summer for money, not working in research labs. I went to the research lab, and it was there I found my real comfort zone in medicine. I might have been out of medicine if I didn't have that experience. I stayed in the lab for four years, and I almost didn't come out because I enjoyed it so much. I earned my PhD and then trained in plastic surgery in Toronto. I was very fortunate to be in Canada, because training was at such an accelerated pace. As a PGY-2 they would leave you to do a radical neck dissection or gallbladder surgery. As a PGY-3 you didn't even get out of bed for appendicitis because the medical students and interns took care of the work-up and did the operation with the attending. I trained with 35-40 plastic surgeons at seven medical centers, so I had really strong clinical and research training. It took a long time: I finished at 37 years old. So, a couple of accidents, going to Toronto and not getting accepted into plastic surgery immediately, shaped my future.

I finished my residency on July 1, 1991. At that time, graduates would completely dedicate their time to studying for the Royal College written Boards in September and the orals a couple of months later. From July to September of that year, I studied at least eight hours every day. I also did a hand/microsurgery fellowship in Toronto until January 1992, and then from January to July, I went to Pittsburgh as a microsurgery Fellow while Bill Futrell, MD, was chief. Then I took a faculty position at Michigan, where I am today. I passed my American Board exams in 1994.

PSN: Who are your mentors?

Dr. Kuzon: The most important people in my training were Dr. Drucker, the chief of surgery at Rochester; Dr. Lindsey, the chief of plastic surgery at Toronto; Nancy McKee, MD, whose lab I worked in all those years in Toronto; and Ron Levine, MD, a plastic surgeon in Toronto.

Dr. McKee is one of the two or three smartest people I've ever met. She's from way up north in Canada. She ran a very active research lab and had a "hands-off" approach. As long as you were doing okay, she would let you go on. Joel Fish, MD; Howard Clark, MD; and Bruce Pynn, MD; spent time in that lab when I was there. We had the freedom to really become experienced and mature investigators.

Dr. Levine was the residency program director in Toronto, and his level of dedication to the training program - I haven't seen anything like it. Every other Thursday night, Ron held teaching rounds until late in the night. He was there every week to make sure we knew what we were doing. When I did nothing but study for my Boards after I finished residency, we met with him every single day. The recent grads would take practice written or oral exams, and Ron would go through every item, every day. He also gets full credit for me knowing how to operate.

PSN: What are the most important leadership lessons you've learned?

Dr. Kuzon: You learn from seeing good leaders and seeing leaders who are not effective. I learned a lot from watching people doing a poor job at leadership.

There are two major things I believe about my leadership position. First, my job is not about me - it's about providing opportunities for others. I'm not "leading" a budget, not "leading" a productivity target, not "leading" a list of accomplishments, not "leading" a ranking on some list of NIH funding or whatever - I've seen others get confused about this. Leaders who focus on leading people do well; leaders who focus on accomplishment generally are not as successful. Second, if you're going to work in big systems, you do that because big groups accomplish big things. With higher-order goals, you have to work effectively in a large group. It's not a game of politics - exchange of wins for losses. Groups of people behave in predictable ways, and your job as leader is to convince them of the value of your agenda, not to tell them what to do.

I give a talk on how to have a lifelong research career to my students and trainees. I believe research is about people and not the data you're collecting. I have helped dozens of students and residents achieve their goals of getting into medical school and residency, and figure out if research is part of their future. Science is about rigor and principles and ethics. This is my contribution, not just some data points.

PSN: What career advice do you share with young plastic surgeons?
Dr. Kuzon: If you're willing to accept difficult surgical challenges in our specialty, you'll have a line outside your door when you go into practice. If not, you'll be in a line with all the other "wannabes." Push yourself to your full capacity and you will always have a place.

We've been incredibly privileged and blessed to do something we love, and which is gratifying and noble. We're reimbursed well for this, and our Michigan grads are told that it's an obligation on them: Don't be comfortable, "set-for-life" types. I expect my graduates to be leaders in their hospitals and their communities, and to make a contribution to the whole.