by Paul H. Ward, MD

Most of the Members of the American Laryngological Association are academicians. We have devoted our lives to providing superior patient care, and we are dedicated to research and teaching laryngologists of the future.

I would I like to share some personal experiences in these endeavors. Then I'll present what I think are the responsibilities and opportunities each member of the American Laryngological Association has for the perpetuation of excellence for the future.

The opportunity of a lifetime, to have a positive influence on a single person, is a powerful force. The opportunity to influence the thoughts, behavior, and careers of young students, residents, fellows, and faculty is an outcome beyond comprehension. The wonderful thrill of finding something new through experimentation, of providing new technology and instrumentation, and of improving the quality of medicine is personally satisfying and is beyond remuneration. I have experienced and hope you are experiencing such a career.

We are all I products of our teachers, a synthesis of the best of each of them. The former residents and faculty of the late Dr John Lindsay, Chairman at the University of Chicago during my residency and early academic career, prepared a plaque showing an academic genealogy consisting of his former residents, 10 of whom became chairmen. They are Drs Walsh, Schuknecht, Hemenway, Naunton, Singleton, Connor, Matz, Moran, Kohut, and Ward. Added were the next 4 generations of their trainees. The ethics and scientific teachings of Dr. Lindsay were passed through these 4 generations. It was estimated that at least two thirds of all those in academic medicine had been influenced by Dr Lindsay and the 4 generations of his scientific grandchildren. Placed at the bottom of the plaque were the anonymous words "The impact of a great teacher is immeasurable." This is the best example of how we can influence the future.

Dr Harold Schuknecht, one of my admired mentors, in a 1984 article entitled "Reflections of a Chairman," questioned why anyone, including himself, would opt for an academic career ⁽¹⁾. He pointed out, and I quote, "The remuneration by comparison is modest, the hours are long and the administrative tasks can be arduous." He actually points out that the principal factor in choosing an academic career is a congenital motivation for a leadership role in whatever one does. This particularly applies to those who become chairmen in their specialties. In my opinion, academic medicine is the only career that provides research training, intellectual challenges and opportunity, unsurpassed prestige, and more than adequate compensation. After all, you can't take it with you, and only one pair of pants can be worn at once. (Well, California may be the exception.)

As a medical student, it was obvious that if I matched the dedication of my teachers at Johns Hopkins, I would have a satisfying career. These and subsequent teachers and investigators instilled in me, by their behavior and mentorship, the concept that nothing is ever achieved except by those who dare to believe that something inside them is superior to their abilities and circumstances. I believe that as members of the Laryngological Association we have demonstrated that there is something within that has allowed us to be better than our innate abilities.

A few words on how to build a world-class residency. I realize that the rapid changes currently going on in the world around us, and particularly those in medicine, will make the building and maintaining of a residency more difficult to achieve than in past years. However, there are some essential steps.

First, begin by selecting the best students, residents, fellows, and faculty. A superior residency program starts with a dynamic, well-trained leader who selects and builds a goal-oriented faculty who are bright overachievers, dedicated to producing and becoming the best. The faculty can be different in their individual interests, but must dedicate their time, body, soul, and intellectual and financial resources to achieving the goal of academic excellence. I illustrate the required dedication by a comment from Mozart. Someone once said to Mozart, "I would give my life to play music like you do." Mozart responded, "I did."

A prime responsibility of the successful leader of a faculty and residency program is to provide opportunity to the point of self-sacrifice. The leader must be a role model in his or her concern for and dedication to colleagues. The successful leader attracts patients and shares their care and remuneration with colleagues, fellows, and residents. The leader provides protected time for research, teaching, reading, writing, and other academic endeavors. During my tenure as chairman at Vanderbilt and at UCLA (about 28 years), it was common for the week to consist of 6 workdays of up to 16 hours per day. A good balance seemed to be one third of the time devoted to clinical practice and surgery, one third to research, and the remainder to other academic activities such as writing, teaching, etc. In the ideal teaching setting, these overlap. The residents and students are always present with the faculty in the clinic, operating room, and laboratory.

The good leader listens to colleagues, shares thoughts with them, incorporates them in projects, and gives both positive and constructive feedback. When good work is recognized, promotions are in order. Promote the up-and-coming young colleague for academic posts at other institutions. Remember they are likely to spread your academic fertilizer elsewhere. If you follow these tenets, you can anticipate a successful program and many personal rewards.

I now would like to address the current medical health care delivery system. The chaos is threatening the survival of the most highly developed medical training and investigative systems the world has ever known. The greed of corporate management, in its ruthless reduction of costs by sacrifice of quality for the bottom dollar, is paralleled by the goal of the federal government to reduce medical expenditures. There is a threatened reduction in teaching and research funds to the extent that all educational and research programs face severe hardship, if not dismemberment. With loss of opportunity goes loss of many fertile minds, just as the dust storms removed the fertile topsoil of Oklahoma in The Grapes of Wrath. Chaos is not always bad, for out of it can come opportunity. Such a situation faces the American Laryngological Association.

Three years ago, Past President Dr Byron Bailey convened a strategic long-range planning committee consisting of Drs Cantrell, Crumley, Hudson, Schild, Snow, and Ward. Strengths and weaknesses, threats and opportunities were given in-depth consideration. The Council and members of the ALA planned and launched a new direction for the Association.

Recognizing the emergence of new technology in the increasingly dynamic field of voice, neurolaryngology, and molecular biology, the Association headed in a new direction of inclusion rather than exclusion. During the last 2 years, you voted to increase the membership from 100 to 125 members. These and attrition memberships have been filled. Your Council is asking for your approval to increase our membership to 150 so that more worthy candidates can be accepted. As restricted as our funds are, new competitive seed money for research grants for young investigators has been established. These grants need to be increased manyfold to meet the current requirements to provide resources to our young investigators.

This year the Council has, with legal assistance, established an organization that will allow all of us, our patients, corporations, and anyone interested in the disorders and diseases of the larynx to participate in a quest for excellence. The American Laryngological Association's Voice Research and Education Foundation, Inc, is now a reality. A Board of Directors is in place. In the future, new Board members will be elected by the Council with membership approval. Dr Matina Horner, our Honored Guest, was elected President of the Foundation. The process of raising funds from our members, patients, friends, business corporations, and others interested in disorders and diseases affecting the larynx has begun.

We will utilize the tax-deductible funds to provide additional competitive seed money grants for our residents, fellows, and young teacher- investigators. This is an opportunity for the American Laryngological Association, through the Foundation, to lead the field of laryngology into the 21st century. By cutting through the chaos, we can collectively enhance the image of the Laryngological Association and lead the way to the future.

As a beginning kickoff for the Foundation, each of your officers and Council members has pledged or already contributed $1,000.00 each. I want to ask each of you, as members who care about the future of laryngology, to make a pledge or donation of at least $1,000.00 to the American Laryngological Voice Education and Research Foundation.

I also want to request that you ask your patients for contributions, donate an operation in return for their contribution, or let us know of their interest and provide us with their names and addresses so we can approach them on your behalf. If you have friends or patients who are business or corporate executives, please let us know, and we can solicit them to be included on our Advisory Committee. These are untraditional approaches for us, but these are untraditional times.

Order out of chaos. Success is at hand. Let's grasp it and make the American Laryngological Association a bright star in the future. I am deeply indebted to all of you and to those who have preceded us for the opportunities to serve the ALA on committees, on the Council, as Historian-Editor, and this year as your President.

For the joys of intellectual stimulation and fulfillment, fellowship, and friendship experienced in membership in the American Laryngological Association, I am grateful. As Bob Hope would say, "Thanks for the memories."

REFERENCE

1. Schuknecht HE Reflections of a past chairman. Am J Otolaryngol 1984;5:157-8. Return