Hail to the Chief: Dr. David Spain

This article is part of a series of interviews with Stanford Surgery faculty who were, are, or will be presidents of surgical societies. David Spain, MD, is a Professor in the Division of General Surgery, Chief of the Trauma Section, and Director of the General Surgery Residency Program. He was elected President of the American Association for the Surgery of Trauma in September 2019.

Rachel Baker: You just finished hosting your association’s annual conference. How was it?

David Spain: It was interesting. We did an entirely virtual meeting. A lot of groups are abbreviating their meeting; we decided to keep the same amount of content and spread it out over 10 days. We thought 3-4 hours of Zoom was a maximum anyone wanted to do in a day, so we had 2-3 hours in the morning and 2-3 hours in the afternoon. We didn’t want to short-change anybody, so we really stuck to the same format.

It’s hard to know what the participants thought. We had the second highest registration ever. That might be because we let the residents sign up for free, but it also could have been the lacklower o expense or time commitment. We also had a lot of international people sign up for the meeting.

Overall the feedback has been good. The chatter seems to be positive. At the same time, I think a lot of us missed the in-person component. I think we’re always going to have a hybrid meeting going forward.

RB: Did you accomplish everything you wanted to during your term?

DS: My term isn’t over. My term is over in Atlanta 2021.

RB: Wait. What?

DS: It’s happened twice before (9/11 and WWII). I gave a committee of past chairspresidents the assignment to give us their best recommendations. Other societies have done different things, but they decided in May to hold all officers in place for another year.

In hindsight, I have mixed emotions about it. I did miss out on a lot of the perks of being president, all the travel. Hopefully, this will give me the opportunity to have an in-person meeting, but there’s a chance I’ll give my presidential address to a Zoom screen. Hopefully, I’ll get to give it live to at least a contingent of some people.

RB: Okay, back to the original question.

DS: I started off with two ideas and then I fell onto a third one.

There was a reorganization of the board itself that I wanted to put in place. The organization has gotten busier and gotten more complex. When I started in this society, we had two or three committees and now we have 10 or 11. There were a lot ofare also “managers-at-large” with no clear responsibilities, no job descriptions. I put some structure in there and have now each of the managers has specific responsibilities and oversights. We haven’t seen all the effects yet, but I think it’s going to help keep the organization on track and facilitate communication and cooperation.

I think a lot of organizations don’t do well with succession planning, mentoring people for leadership. So, we started theis associate member category, which is open to junior faculty and residents. To get it off the ground in a positive manner, I had hoped 30 people would join our first year; we had 110. They spent their first year getting organized and putting their thoughts together and choosing their leadership. Our own Dr. Knowlton was voted the inaugural president in August. By the meeting, they had put together their goals for their first year, and I was unbelievably thrilled and impressed. There are things they’ve already done in their first few months and the things they have plans to do are really pretty incredibly. That was really satisfying to have that young contingent get so involved.

Last September, for a variety of reasons, at the last minute, on the fly, I created an ad hoc committee on diversity, education, and inclusion. I literally did it during the meeting. I wanted them to help us outline our guiding principles. In hindsight now, it was really a good maneuver, .and I’m glad we did it. When George Floyd and all the events of thise summer happened, we had already started collecting our thoughts, and so I think we were a bit ahead of the curve by having that. They put together a really nice game plan for what our organization needs to do.

I think most societies have shied away from these issues because they feel political. But health disparities are a public health problem. COVID-19 and gun violence—people are now seeing these as public health problems, and—as physicians—we would be irresponsible if we didn’t respond to a public health crisis that is affecting our patients. It’s really been great to see over the last 6 to 8 months, especially on Twitter, how these issues have been transformed. I think #thisismylane was one of the first things that really pushed it. Let me tell you about bullet holes in humans, because it does affect my patients.

RB: What drew you to trauma?

DS: I actually went to med school thinking I would be a pediatrician. I can remember the exact place and time when I went, “Wow! I want to be like these people!” It was in Detroit Receiving Hospital’s ER. The surgery resident was so smart and knew a lot about medicine but could also operate on someone and make them better. I knew then–third year clerkship—that I wanted to do trauma surgery and never changed my mind.

RB: How did you get involved with the AAST?

DS: Back then the ASST had a closed membership, so someone had to turn 65 or die, and then they would let X number in. I had great mentors when I was a fellow who set me up for success, so I was able to become a member at a young age.

Once in the organization, they teed me up for success early on. I was one of the early recipients of their research scholarship, the 3 or 4 years when they first started doing it. I used that scholarship money to get federal funding through the VA and DOD. I later won the best paper by a new member award for that research. Those things put my name out there, and then I got put on a committee, and then I became chair of the committee.

The guyperson who was my main mentor was David Richardson, MD. He’s an amazingly brilliant human being; he’s basically been president of everything. He just has a certain genius about understanding organizations. One thing he told me: “The only thing you can do is try to do good for the organization and hope they’re smart enough to recognize it.” I’ve seen people try to get ahead, and it always backfires in the end. That was my mantra through the whole thing: try to give back. Over the years you do different stuff and eventually you get the phone call. It’s pretty amazing.

There are two officers in the AAST: secretary/treasurer and a recorder/program chair. If you become one of those officers and don’t do something crazy (like abscond with funds) eventually you’ll be president. Some day. Every third year is a wild card year. So, 5 years ago, when I got the call to be the nominee for recorder/program chair, I knew that one day I would be President…if I didn’t screw it up.

The great thing for me is that the president-elect this year has been one of my helpers and mentors for years. I met him as a chief resident; he was a new faculty 30 miles away. He took me out to lunch, advised me to go to Louisville, and put me on the path. I owe a lot to him. It’s a little crazy that I was president before him, but I’m glad he’ll introduce me next year. That will be really special.

RB: If you could talk to yourself before you took on this role, what would you say?

DS: I’m not the most mindful sort of introspective person you’ll ever meet, but my attitude going into this year was to take some time to think and be grateful for the opportunity. Things have been a little weird this year—I haven’t gotten to experience a lot of perks (in the last six months I was supposed to get to go to Europe, Taiwan and give talks at the Brigham and University of Maryland), all of which got canceled. On the other hand, you look at what’s happened the last 6 months and I felt sorry for myself for about 20 seconds. I’d say: “Learn different ways to connect with people.”

RB: How do you maintain work-life balance? Or I guess I’m not supposed to say “balance” anymore…

DS: Yeah, I wrote a piece for the RAS-ACS maybe two years ago. I don’t like the optics of “balance.” It’s like saying you can’t have one without giving up the other.

I think it’s rare that the job demands you to be unbalanced – sometimes – but I think most of the physicians who are out of whack would be CEOs or lawyers who are out of whack. It’s the choices you make.

I can’t say I’m always perfect at it, but I’ve always tried to pay attention to it. When my kids had a band concert or a sports game, their events went right on my calendar and Rose [my assistant] knew not to schedule me on call that night. You need to make an effort, be pretty organized, know when to say “no” and how to make things a priority. I’m also really good at compartmentalizing.

You can only become president of a national organization like this if you have a great team at home. There is no way I could have done this if it weren’t for Drs. Maggio and Staudenmayer and everyone else in the trauma section: our trauma program manager, Shelly, and our nurse practitioners. It’s almost like a team victory. It takes the whole division to support that vision. The ability for me to have this position really does reflect on what a great team we have.