Profiles in ACS leadership: A few questions for Tyler G. Hughes, MD, FACS

Editor’s note: The Bulletin of the American College of Surgeons is publishing a monthly series of articles profiling leaders of the College. The questions are intended to give readers a look at the person behind the surgical mask and to inspire other members of the College to consider taking on leadership positions within the organization and the institutions where they practice.

For this month’s profile, we interviewed Tyler G. Hughes, MD, FACS, Secretary of the American College of Surgeons (ACS) and Editor of the online ACS Communities. Dr. Hughes previously was a member of the ACS Board of Governors and Founding Chair of the ACS Advisory Council for Rural Surgery. He is clinical professor of surgery and director of medical education, Kansas University School of Medicine, Salina.

Why did you choose to go into surgery?

I was born with a bilateral cleft palate, and a surgeon gave me intelligible speech, which I didn’t really have until I was about 13 years old. From that time on, I decided I wanted to do for others what had been done for me. I didn’t think I was “cut out” for plastic surgery, but I knew I wanted to be a surgeon because I wanted to help people get better right away.

Did anyone in particular inspire you to go into general surgery?

As I tell my students, the specialty picks the candidate. I was sure I was going to be an orthopaedic surgeon until I started my general surgery rotating internship, when I suddenly realized that I like knowing a lot about a lot, and I did not want to restrict myself to a surgical specialty—which may have been a financially poor decision, but emotionally it was the best thing I could have done.

I went to medical school at the University of Texas Southwestern, Dallas, and trained at St. Paul Medical Center, which worked closely with Parkland Hospital in Dallas, and two people come to mind. The first is Ernest Poulos, MD, FACS. He was a dramatically good surgeon and a pillar of strength. He inspired me. In fact, it was watching him do a carotid endarterectomy that convinced me to give up orthopaedic surgery for life.

And the other moment I remember very well is when I, as a second-year resident, and Jose Aguirre, MD, FACS, who was a fourth-year resident, were just sitting around late at night talking, as residents do, and suddenly his eyes got big, and he ran from me and said, “He’s arresting.” Next thing I knew, he ran to the patient’s room and started opening the chest to relieve a tamponade, and I thought, “Wow, could I ever be that capable and observant at the same time?” If he hadn’t done what he did for that patient, I’m sure the patient would have died. So, those are two of my stories of inspiration during my residency. I was amazed at what they could do, and I wanted to be like them. I know it sounds a little like an 11-year-old admiring a football quarterback, but that’s the way it was for me.

What they taught me is that there’s no such thing as “sort of” trying. Everything you do, you have to do to your maximum capability and with maximum effort. You have to be ready all the time. You have to be willing to put yourself and your ego at risk for the patient. For all of my mentors, it was always about the patient. I think a common misperception about surgeons is that it’s all about us, but for the really great surgeon it’s always all about the patient. I remember one night, Dr. Poulos brought me in on a really terrible abdominal emergency case, and he looked at me across the table and said, “I don’t know what that thing is in there, but it’s trying to kill this patient, and we are not going to let that happen.” General surgery is frequently about whether the patient will live or die, and if you’re not vigilant at all times, you can harm people. I tell people that the average surgeon is like the average astronaut—there’s no such thing. They are all tremendous, and they will not give in. They will do whatever they can to help their patient.

Later in life, I have been lucky to get to know some of the great surgeons of our time. J. David Richardson, MD, FACS, ACS Past-President, changed my life. George F. Sheldon, MD, FACS, another ACS Past-President, changed my life. ACS Executive Director David B. Hoyt, MD, FACS, changed my life. Past-President A. Brent Eastman, MD, FACS, was another surgeon who changed my life. Dr. Richardson taught me that it’s not about the high-profile patient, it’s about every single patient. He recognized the importance of surgery at every single level of patient care. Dr. Eastman taught me you can be forceful but at the same time be a gentleman of polish and eloquence. ACS Regent Gary Timmerman, MD, FACS, taught me about being brave enough to stand up for your beliefs and being a person who does not automatically follow the crowd. And of course, Dr. Hoyt taught me all about what it means to be a truly great leader. When I was on the American Board of Surgery, Spence Taylor, MD, FACS, showed me you could be extremely capable but also a ton of fun to be around. A lot of surgeons are just neat, interesting people.

What do you like to do when you’re not in the operating room?

I don’t know if you’re familiar with the TV show Ted Lasso. It’s about soccer, and there’s this character named Dani Rojas, and he’s always going around saying, “Football is life,” and I’m kind of like that about surgery. It seems like everything I like to do is somehow related to surgery. I play the piano. I flew airplanes for 26 years. I sailed boats on lakes and oceans. I enjoy travel, which I’ve been able to do through my involvement with the ACS, and it’s great to be able to go around and meet people. I write all the time—nothing publishable, other than what I’ve written for College publications—but I like to write and consider the great issues of our time because I find they always come back to some sort of decision I have to make regarding surgery.

I don’t have any single passion. I do lots of different things, and I guess that is part of why I like general surgery, and particularly rural general surgery. I didn’t want to be limited to working in one hospital or one big town or to doing just one or two or three operations. In rural America, patients need you for everything. My very first case was an emergency hysterectomy. The next one was a shotgun wound to the arm, and the next one was helping to repair a complex laceration in childbirth. It was fun to be doing all sorts of things. At the same time, you’ve got to know your limitations. I think that’s also part of being a rural surgeon.

Describe your journey to becoming Editor of the ACS Communities, Founding Chair of the ACS Advisory Council for Rural Surgery, and now Secretary of the College.

I don’t know who said it first, but most of life is showing up. I got involved with the rural surgery portal because I happened to be sitting next to Randy Zuckerman, MD, FACS, at an ACS meeting, and he said, “I edit the rural surgery portal for the College, but I think you’d be good at this,” and I said okay. That was George Sheldon’s project, and I got to know George. The rural surgery page of the web portal was very active. So, later when Dr. Hoyt decided to change the portal to the more interactive ACS Communities we have today, he called me up and asked if I would be interested, and I never turn down a combat assignment, so I said sure, and the rest is history.

In terms of the Advisory Council for Rural Surgery, that’s another example of J. David Richardson’s leadership. Somehow he got my name and called me up on the phone, and he asked me to gather some rural surgeons for a breakfast meeting during Clinical Congress in San Francisco, CA, which we did, and it was a great conversation. And then Dr. Hoyt invited me to speak to the Regents, and the next thing I knew, they invited me to chair this new Advisory Council for Rural Surgery—another combat assignment, so I took it. I was so fortunate that I had this most impressive group of surgeons join this council, like R. Phillip Burns, MD, FACS, Past-First Vice-President of the ACS; Philip Caropreso, MD, FACS, Past-Second Vice-President of the ACS; Michael Sarap, MD, FACS—the kind of people you would want to operate on you if you were really sick. I think that’s why the council has been successful. They got people who were doing the work to roll up their sleeves and establish it. The rural surgeons were stunned and delighted when it came to fruition. It used to be that if you were a rural surgeon, it was assumed it was because you couldn’t get a job in the big city, and now people recognize that we are a vital part of making American and international surgery work.

How would you describe your leadership style?

This sounds like a politician’s answer, but I use whatever style is best for the moment and, mainly, it’s finding the best people for the job, and then letting them go at it. Give them guidance and support so they’re not afraid to try something that maybe has not been tried before. If you’re going to lead, you have to be willing to accept the credit when things go right and the blame when something doesn’t work out and shield your people. I’ve always felt that if something blows up, I want to get the blame for it, rather than someone who is trying to help me. So, I think it’s important to let people be innovative and try new things.

The highest cliff you can fall off of is that of trust. If you can’t be trusted, you can’t lead. To build that trust, you have to let people know what you’re thinking. You have to be candid about what you like and don’t like. If you have an agenda, you have to let people know what it is. Dr. Taylor taught me that everyone has a movie playing in their head, and it’s important that you let them see your movie, rather than let them make one up for you. If your purposes aren’t aligned, everything goes to pieces.

How do you use this approach as ACS Secretary, and what are your responsibilities as Secretary?

It’s sort of an undefined role. The Secretary maintains the minutes of Regents’ meetings. One of the Secretary’s responsibilities is to serve as a Trustee of the ACS Insurance Program. It’s a tremendously good program and being a trustee is a very responsible position. It provides insurance to Fellows and Associate Fellows, as well as residents and trainees.

Officers are respected by the Regents, but the Secretary can’t vote. So, they know that the Secretary doesn’t have an agenda and isn’t trying to steer their decisions one way or another. I try to get people to look at the other side of the coin and to really think about the value of a certain policy. I tend to ask questions to get people to think about their motives and the possible outcomes of the decisions they make.

What advice do you give to young surgeons interested in getting more involved in the College?

Don’t be afraid to present. I think one of my first breaks was when I went to my local chapter meeting and presented a series of hernia operations I had done. You never know what’s going to come from that kind of meeting. In the audience was Thomas R. Russell, MD, FACS, who was ACS Executive Director at the time, and that gave me the opportunity to get to know him.

The other piece of advice is to never turn down a combat assignment. Nobody gets to high leadership in the College without putting in a lot of hours. Do something you love, and you’ll never work a day in your life, and that’s how I feel about my work in the College. If you have that attitude, you’ll go far in the College. If you want to get something for yourself rather than benefitting others, it’s probably not the place for you. You’ve got to want to improve life for the Fellows and the patients. All of the really great leaders I’ve met at the College are that way.

Anything you want to add?

I think the last two years have been really tough for every surgeon in America professionally, personally, or politically, and I’d like the Fellows to know that the College’s leadership knows that, too. Imperfect as we are, our common goal is to make the life of surgeons and our patients better. I think that’s what the leaders and the staff of the College try to do every day. It may not be visible where you’re standing, but that’s really the common goal.