By Justin Barr ~
Michael DeBakey came to Houston in 1948 as the new chairman of the Department of Surgery at Baylor College of Medicine. Upon arriving, he discovered that “most of the physicians doing surgical procedures [there] were not qualified, they did extremely poor quality surgery.” He recalled one particular episode when a general practitioner tried to perform a complicated operation called a Whipple Procedure for pancreatic cancer and mangled it so badly the patient died. On numerous occasions, DeBakey had to step in to the operating room to help the local surgeons through their cases. Disgusted with the state of surgery in Houston, DeBakey set about to improve it.
Rather than exceptional, this scenario was representative of the state of American surgery in the 1940s and 1950s. In the early 20th century, most surgeons trained by a combination of apprenticeship and post-graduate courses. This model worked well enough when operations were rare and relatively simple, like appendectomies and draining abscesses. As the 20th century progressed, medicine and surgery changed to encompass new technologies and therapies. Everything from penicillin to blood transfusions to X-rays led to a dramatic increase in both the number and complexity of operations. The old educational model no longer sufficed. Producing competent surgeons required a new system called residencies: formal, 4-year, post-medical school, regimented experiences.
DeBakey himself did not complete a formal residency. He graduated from Tulane Medical school and then spent one year working as an intern at Charity Hospital with senior surgeon Alton Ochsner. Ochsner recognized the talented young man, took him under his wing, and mentored him. DeBakey later sought further education in Europe, a common pathway for those few doctors who aspired to work as university professors.
After practicing as a surgeon with Ochsner in New Orleans and serving in the US Army during World War II, DeBakey was hired to chair the department of surgery at Baylor in Houston, where he instituted a number of reforms.
First, he created a residency, and here the connections he made with surgical leaders while in the military proved helpful. “I called some of my…friends on the American Board of Surgery and told them I wanted to start a residency program and get it approved,” recalled DeBakey. “They gave me temporary approval so that I would start the program.” With this head start, he created a training program utilizing multiple Houston hospitals.
Second, he began restricting operations to physicians who were certified, either through the American College of Surgeons or the American Board of Surgery. By 1950, both organizations insisted on the completion of residency program, thereby eliminating the previous generation of apprentice-trained general practitioners. Thus, DeBakey ensured Houston patients had trained surgeons operating, with correspondingly improved outcomes.
While these changes affected local circumstances in Houston, DeBakey also worked to improve surgical education on a national scale through his efforts to improve the VA system. While still in the Army, he helped shepherd the affiliation of VA hospitals with academic medical centers. DeBakey implemented this model locally, too, ensuring the Houston Naval Hospital became the regional VA center and incorporating it into Baylor. This symbiotic relationship provided universities with an expansive patient population to help train young doctors while availing VA facilities of the expertise of America’s leading clinicians. In arranging this alliance, DeBakey helped created thousands of residency positions where American surgeons could train, elevating the profession and practice of surgery.
Justin Barr, M.D., Ph.D., is a Resident in the Department of Surgery at Duke University Medical Center. He was a Michael E. DeBakey Fellow in the history of medicine at the NLM in 2017. For more on this subject read his article “The Education of American Surgeons and the Rise of Surgical Residencies, 1930-1960” in the Journal of the History of Medicine and Allied Sciences.