Fellowship RCSEng 2009.
Patrick, as you have recently ‘stepped down’ as Chairman and Chief of ORL-HNS at Toronto General Hospital, what next?
Firstly, so often I have been asked why I selected this career path, from a quote by Johnny Carson one of the most popular nightline comedians on NBC-USA on his final ‘Tonight Show’ performance he said and I quote “I am one of the lucky people in the world who found something I loved and enjoyed every moment of it”. That certainly characterises me in the arena of Otolaryngology-Head & Neck Surgery (ORL-HNS). Along the way I was inspired by so many great mentors and friends from both within and outside my specialty.
What next? Well back to the ranks as a head & neck surgeon, teacher, clinician investigator within my hospital, the university health network, where we have a most amazing department with talented faculty that I have helped recruit over my years as both Chief and Chair. They all feel like family and the support and friendship provided by each and every one of them is unprecedented. I’m looking forward to a more balanced life rather than the all-consuming challenges, responsibilities centred on my previous positions as Chief and Chair. I feel blessed to have colleagues who are providing remarkable leadership that makes me proud to be in their midst. In addition, I plan to serve as an ambassador for our department globally and help to further provide leadership in fundraising as the Advancement Coordinator for our University Department and its affiliated hospitals. From a quote by our prior President of the University of Toronto, Dr David Naylor who said, “We’d be in a real straitjacket without philanthropy as a catalyst for excellence and innovation at the university”. I am deeply grateful to the many donors who have supported my vision, aspirations and goals over the past many years. Without that generous support we would have been unable to realise our dream as a department.
Having been ‘married to the job’ for the past 30 years how will you spend you ‘spare time’? (1983)
In this position for more than 30 years, I was never sure when I was working or playing. I plan to keep playing at work and travelling more (if that is possible since I have done so much) but to places that my wife Barbara and I have enjoyed previously, explore them in more detail and try to improve my golf which my son John encouraged me to take up years ago. In addition, I plan to spend more time with my family, Barbara, daughter Kira currently in Medical School, son John who left the teaching profession and who has moved into the business world. In addition I have a very wonderful family, two brothers and one sister who reside in Ireland and where I so love to visit and plan to do more of it.
Having made many acquaintances during your professional career in ORL-HNS, what friendships are there outside work?
In addition to family, I have innumerable friends that I have met through donor contacts, patient and colleague contacts. My challenge is not the friends but how to remain in contact with such a wonderful selection of individuals from all walks of life i.e. politicians, astronauts, business people, entrepreneurs and so forth, that have impacted significantly on my career and personal life.
Patrick Bradley and Patrick Gullane.
Canadian trained ORL-HNS lost its reciprocal qualification agreement with the USA? How has this helped or hindered ORL-HNS development locally?
This loss has had no impact on our specialty in Canada. In actual fact it has had a positive effect in that our graduates are less often migrating south of the border so that we have been able to retain the brightest and best. The Toronto programme is in the top 1% of North American training centres and our fellowship training in all the subspecialties is one the most attractive in North America. Of our six head & neck positions in the matched programme of the American Head & Neck Society this year, we have 50% of the positions filled and matched with American resident graduates. It’s now one of the most sought after Fellowships in North America. The quality of the programme, with opportunity to have both major ablation and microvascular reconstruction available in the one unit, is what separates us from so many other training units.
Patrick with Governor General Johnson.
Receiving Hon Fellowship RCSI 2012.
Patrick receiving his Hon Fellowship in 2009 from President Black.
With the advent of ‘non-surgical’ treatments for advanced head and neck cancers what advice would you give to future head and neck surgeons?
Overall, the most encouraging gains are coming from prevention and innovation. Worldwide, some 15-20% of cancers are caused by infections i.e. Human papillomavirus (HPV), Epstein–Barr virus (EBV), etc. My advice to the young surgeon is to get involved in prevention programmes and better understand the future role of technology in surgery. The Guided Therapeutics Programme led by Drs Jonathan Irish and David Jaffrey at the University Health Network, University of Toronto, is helping to facilitate the integration of research in high performance skull base, sinus and temporal bone surgery where new surgical interventions can be developed and tested in clinical trials within our specialty. This programme also incorporates technology that includes robotics and nano-robotics which in the future will help repair and reverse cellular damage. This exposure will ensure that our trainees will receive advanced training and so help to lead clinical trials in this arena.
Is there still a need for ORL-HNS surgeons in the ‘advanced countries’? Any thoughts on how the plight of the shortage of ORL-HNS clinicians in the ‘third world’ can be solved?
Yes of course there is a great need for individuals with advanced surgical training and knowledge to care for the complex challenges in the ‘Third world’. In 2008, we undertook the first world tour to try to standardise education in head and neck oncology that included a multidisciplinary faculty with the intent to help our colleagues understand the nuances in head and neck oncology in different parts of the globe. So we need to provide more opportunities in our teaching units for individuals from underserviced countries to visit for a mini select course so that they can update their knowledge and provide them the exposure to current therapies. It’s important that other centres outside North America become involved in this mission as well.
What advice would you give to medical students considering a career in ORL-HNS?
Go into it with your eyes open. Spend time in the specialty in advance of selection, understand the breadth and depth of opportunities, be aware of the future changes that may occur with prevention, innovation etc. The specialty may become more medical with less surgery and more minimal access approaches.
Patrick with wife Barbara, daughter Kira and son John.
To what do you consider your personal success? Has all of this success been a ‘personal drive’ to be ‘the best’?
Luck, and being in the right place at the right time. I received the best training possible working with leaders in the specialty. Knowing what I wanted to do. Collaborate with hospital and university administration, educate and recruit the best and brightest, understand the needs of your specialty, convincing others that you are sincere in your goals, demonstrate that you can consistently deliver and evaluate your outcomes and share those results with your colleagues through audit and publications. In addition demonstrate that what you are doing is effecting change and enhancing improved patient care. In addition continue to be prepared to change how you did something. What one does do today is not what you will be doing in five years’ time. Move with the times, remain connected with all aspects of your specialty and continue to be visionary and open minded. Finally, as a leader you must secure funding through grants, donor support and philanthropy.
You are the only personality that has been interviewed previously (2006) in ENT & audiology news (formerly ENT news) – any thoughts? About that picture of the ‘helicopter and yacht in Australia’ – can we have the true story? Or has a career in ORL-HNS been that lucrative?
I so enjoyed that interview and its impact as it related to Barbara and I pictured with our yacht and helicopter on White Haven Beach, Whitsunday Island on the North East Coast of Australia. Well this was all timing. We had rented a helicopter and pilot to visit the location and the yacht in the background moored close to the beach had a couple on board who wanted to look at our helicopter (rented) and so gave us the chance to visit their yacht. Timing, communication and be convincing is the theme of what it’s all about.
Being congratulated on receiving Hon Fellowship RCSEng 2009.
Hon Fellowship RCSI 2012.
Recently you were awarded honorary FRCS (Eng) 2010 and FRCS (Ir) 2012 as well as Member of the Order of Canada (2010). Are there any honours remaining that you wished had come your way?
The above honours and recognitions were so totally unexpected but very cherished. I’m indebted to so many people for the support, guidance and friendship including my many colleagues and former trainees who over so many years have impacted on my career opportunities that resulted in these awards.
My contributions in Otolaryngology Head & Neck Surgery within the University Health Network (Toronto General, Princess Margaret and Toronto Western Hospital) and University of Toronto was recognised with the Endowment of a three million dollar Chair in my name. This will provide continual support for the future Otolaryngologists-in-Chiefs within our hospital and university. Dr Ralph Gilbert is the first named recipient of this Chair.
And finally at the ‘cross-roads of life’, your thoughts on your achievements and career?
From a quote from yoga Berra, “If you come to a fork in the road, take it”. Well I did that from my home in the West of Ireland, medical education at NUI-Galway, Residency in Surgery Western University, London Ontario, Fellowships in Pittsburgh and New York, Faculty position at Western University and then recruitment to the University of Toronto in 1983 where I have served as Otolaryngologist-in-Chief at the University Health Network 1989 to 2012 and in addition Professor and Chair, Department of Otolaryngology-Head & Neck Surgery University of Toronto from 1 July 2002 through to 30 June 2012. I now continue to enjoy my role as staff surgeon at my hospital and university with wonderful memories of the past many years and I’m so proud to see my prior trainees taking the hospital and university department to even greater heights.
Advice for future aspiring trainees?
My advice is to you – “If you can imagine it, you can achieve it. If you can dream it, you can become it.” So it’s time therefore to take pride in our past accomplishments, reflect on our strengths and anticipate a future full of promise.
Interview conducted by Prof Patrick J Bradley.