Military Surgeon Discusses His Path to Becoming a Surgical Chair

In the immediate aftermath of the recent government shutdown, dean of the F. Edward Hebert School of Medicine at Uniformed Services University (USU) in Bethesda, Maryland, Ret. Capt. Eric Elster, MD, FACS, FRCSEng, MC USN, reminisced about his career in surgery and service, as well as overcoming recent challenges.

“I always wanted to be a doctor; I was inspired by my mom,” he said. Growing up in South Florida, he liked St. Elsewhere, a medical drama series that ran on television from 1982 to 1988. 

“It made me want to be a surgeon,” he said. “I loved how they were problem solvers and got to fix things with their hands. And, somewhere along the way, I picked up the idea of service.”

Dr. Elster attended both undergraduate and medical school at the University of South Florida in Tampa, where his honors program—the Health Professionals Scholarship Program—had a clearly defined pathway. 

“If you hit a certain GPA and MCAT, it was clear. I only applied to one medical school, but I tell students not to do that,” he said.

Growth & Responsibility

After an internship at the National Naval Medical Center, now Walter Reed National Military Medical Center, in Bethesda, Dr. Elster spent a year with the 31st Marine Expeditionary Unit. “It was a maturing experience,” he recalled. “I learned a lot about the ethos of the military.”

During Operation Iraqi Freedom, Dr. Elster was deployed to Japan. There, he boarded the USS Kitty Hawk, bound for the Persian Gulf, where he served as the fleet’s surgeon. 

“You’re the medical rep to the admiral—the senior clinician for 8,500 people,” he said. “You grow immensely.” 

Dr. Elster returned stateside and immersed himself in transplantation. “Intellectually, it’s unnatural, putting an organ into someone else’s body,” he explained. “I like that, from a technical standpoint, it demands perfection. You do not get another chance to get it right.”

After spending time in the lab of fellow transplant surgeon Allan D. Kirk, MD, FACS, Dr. Elster completed a transplantation fellowship at the National Institutes of Health in Baltimore, Maryland, then directed a translational research program at the nearby Naval Medical Research Center in Silver Spring.

While there, he focused on improving diagnostics and therapies for serious traumatic injuries and transplantation, which led to the creation of the Surgical Critical Care Initiative (SC2i). 

A Second Deployment

In 2004, the US Army Institute of Surgical Research established the Joint Theater Trauma System as a response to the observed shortcomings in military trauma care. Lacking a central registry and standardized protocols, the Joint Theater Trauma System introduced these elements to far-forward bases during the war. 

Eventually, it evolved into the Joint Trauma System (JTS) and was then recognized by the Department of Defense in 2016 and integrated into the Defense Health Agency in 2018. 

In the same way that the Vietnam War was a defining period for surgeons in the 1960s—as it was for Larry C. Carey, MD, FACS, one of Dr. Elster’s mentors—so, too, was Afghanistan in the late 2000s and early 2010s. 

In 2010, Dr. Elster deployed for a second time to the NATO Role 3 Military Medical Unit in Kandahar, Afghanistan, where he became the chief of surgery.

Using the Joint Theater Trauma System’s initiatives and in partnership with surgeons from the Netherlands, Denmark, Canada, and several other countries, they were able to track blood utilization to keep usage under 21 days. 

“The US military does logistics very well. In 6 months, we did about 3,000 operations on 1,000 patients. We used 5,000 units of blood and had a survival rate of 97%,” Dr. Elster said. 

Following his last deployment, he became Chair of Surgery at USU. There, he was able to increase its stature by growing research funding from around $8 million to $100 million and making USU a benchmark for readiness. 

Keeping the Scales Balanced

“There’s a misnomer about the military that you can just order people to do things. It doesn’t work that way,” he said.

He has distilled his leadership style down to a simple formula: listen to those around you, learn what’s outside of your expertise, don’t wait too long to make your decision, and hold people accountable. 

“I’ve been called a ‘radical decentralizer,’” he said. “I push decision-making to the lowest levels so people can feel empowered. You can empower people, develop a mechanism to hold them accountable, and recover. It’s okay to make the wrong decision, and you learn a lot by embracing failure.”

With the transition from chair to dean, authentic leadership was top of mind. “Don’t forget who you are. Department chair is one of the best jobs in medicine, and there’s a lot you can achieve,” he said. “But you are only advocating for your own department." 

“When you step up to the role of dean, you’re now advocating for the entire school of medicine and all its elements. But you’re still a surgeon. Use those skills,” Dr. Elster said.

Leading at Every Level

There are crises in healthcare right now from what seems like every angle. “That generates churn,” he said. “Leadership is easy when everything’s fine. In times of crisis, you really must step up.”

For Dr. Elster, there were two places he could go. When he was a Chair, the Society of Surgical Chairs (SSC) was one. The Excelsior Surgical Society (ESS), the ACS’s home for military surgeons, was another. 

“Having a group of peers is critically important,” he explained. “Whether you're in the military or in a large academic center or a place without a lot of research, the problems are fundamentally the same: money, personnel, quality, and so on.”

As for ESS, Dr. Elster got the chance to revitalize the organization as the inaugural president of its modern-day iteration. 

“The military does have some unique sets of skills, issues, and problems, which require specific solutions. There was no central home for military surgeons until ESS came back. These societies are critically important because they’re focused on shared goals,” he said. 

Dr. Elster uses these leadership experiences to continue leading USU through turbulent times. 

“Communicate effectively. I stand up a crisis action team when there’s a problem that has diverse representation from around the organization to get a sense of what people are feeling,” he said.

As times continue to change, Dr. Elster keeps one thing consistent: “You don’t need to have all the information but share what you have and don’t overpromise. Have a lot of different ways for people to reach you and have empathy. It’s sometimes that simple.”