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LEGENDS IN UROLOGY


(20) 6 Dec 2013

Robert C. Flanigan, MD, FACS
Albert J. Jr. and Claire R. Speh Professor and Chair
Department of Urology
Loyola University Medical Center and Stritch School of Medicine
Maywood, Illinois, USA

I am so very honored to be asked to write about my career in medicine by the Canadian Journal of Urology. I, like so many of you, have had the great fortune to have been mentored by a group of wonderful teachers and surgeons who have shaped my life more than I can ever explain. In addition, I have always been blessed to have a loving family, beginning with my parents and brother, my wife and our children and grandchildren.

I was raised in Lima, Ohio, a town of about 50,000 people, and attended its public schools for my first 18 years. My father was a steel worker turned steel salesman and my mother a housekeeper who became Director of the county’s Welfare Department after my father ’s untimely death at age 57. My early life was very typical of most small town boys, playing sports, having fun, and in my teens delivering papers and tending to neighbors’ lawns. I am the first in my family to attend college. During college at the College of Wooster, I had a “board job” washing dishes for the first 2 years before I became a resident in the dormitories. Beginning with my graduation from high school and until the summer after my first year in medical school, I worked at U.S. Steel, South Works in Chicago where one of my early life changing events took place. During my 6th summer at the mills, my foreman, knowing I was in medical school, told me of his brother who was Chief Surgeon at Chicago’s Shriners Hospital for Crippled Children. Realizing that I needed to work in the summers, he arranged for me to meet his brother who offered me a job during the summer after my 2nd year in medical school. As I worked with Dr. Edward Millar that summer, he asked me to come to the hospital early to help the nurses feed and dress the children, to come with him to the operating room and clinics, and to write a research paper by the end of the summer (I chose to write about tibia vara). This experience kindled in me a great interest in surgery and the beginnings of an appreciation for academic medicine.

During the first 2 years of medical school at Case Western Reserve University School of Medicine, I worked in the early morning before school began drawing patients’ blood. I also fell in love with surgery as I had the opportunity to observe first hand some caring and talented surgeons and to work in the animal facilities doing surgical research with one of them, Dr. Fred Plecha. As time progressed, I was accepted into the combined urology and general surgery residency program at Case under the tutelage of Dr. Lester Persky, who would be my mentor for many years to come. He had attracted some of the best and brightest who were my chief residents and who served as real role models for me. Five of us, who were Dr. Perksy’s residents during my 6 years there, subsequently became chairs of urology departments.

After finishing residency in surgery and urology, and becoming boarded in both, I spent 2 years in the Air Force as part of the Berry Plan program associated with the war in Vietnam. I very much enjoyed my time in the service and was able to practice the lessons of my training in an independent manner. I also continued to do research and attend academic weekly conferences throughout my Air Force time. I began to know even more fully that I enjoyed being involved in research, a lesson that would carry on throughout my career.

After the Air Force years, I decided to pursue an academic career. I had the great blessing to begin my career at the University of Kentucky under the leadership of Dr. Bill McRoberts. Bill helped me so very much. He taught me by example the great fun of being a good teacher. He also allowed me to complete an American Cancer Society Clinical Fellowship while I worked on his faculty, he helped me get started in the lab and he became my lifelong friend. As my practice and my laboratory grew, I also had the good luck to get to know and work with two wonderful friends who also had research labs. Together we decided to put our resources together and create a “super lab” where we all brought our grant ideas and funding together. With Drs. Ed Pavlik, PhD (Gyn oncology) and Dan Kenady, MD (surgical oncology) we developed an extremely productive laboratory based largely around our work with clonogenic assay and tumor cell proliferation.

Six years later, in 1986, I was recruited as Professor and Chair of the Department of Urology at Loyola University Medical Center and Stritch School of Medicine. To say that I knew little of how to be a chair would be a momentous understatement but I relied on the lessons I had learned from Bill McRoberts, Lester Persky and my colleagues from residency. I was also very fortunate to be helped in my early years in Chicago by the advice of Drs. Jack Grayhack and Jay Fowler, both chairs at other institutions in town. My career at Loyola has been more rewarding than I could have ever have imagined. I have had great administrative leadership to work with, terrific partners, wonderful residents and fellows and remarkable patients. Loyola has offered me many avenues to enhance my leadership skills. I have served, and led, many committees which have taught me how to relate in a positive way to my fellow chairs and other colleagues. All of this effort has culminated in many honors, including being named to the Loyola University Health System Board of Directors and having been awarded the most prestigious award given a physician by Loyola, its Stritch Medal.

During my career in academic medicine, I have always been cognizant of the “3 legged stool” concept and have tried to do my very best to be a good clinician, teacher and researcher. Research has paralleled every step on my career, with great support from the NIH, Veterans Administration and many other sources. I have always liked being an integral part of the development and initiation of clinical trials. When I think of the most productive times in my early research career, I look back at my time in the research lab at the University of Kentucky where I learned the great lesson of collaboration, and my efforts with the Bladder Cancer Clinical Collaborative Group A (with Dr. George Prout) and the National Prostate Cancer Project (with Dr. Gerald Murphy) where I learned about clinical trials.

During my years at Loyola, I am most proud of our work in basic/translational research over many years in DNA analysis and flow cytometric studies of urinary specimens (with Vince Shankey, PhD) and, over the past 15 years, my work with Dr. Vince Freeman studying the relationship of obesity and prostatic fatty acids and prostate cancer progression. I have also been able to continue to be very involved in clinical trials with the Southwestern Oncology Group (SWOG) and in other settings. With the terrific support of Dr. David Crawford, I served as Chair of SWOG’s Renal Cancer Committee while with Drs. Bill Catalona, Jerry Richie, Peter Scardino, Paul Lange and others I became involved in important research into of the usefulness of PSA and its components for the early detection of prostate cancer. When I look back at my time at Loyola, I feel so very gratified to know that my partners and I have really changed for the positive our department and its clinical, teaching and research programs. I am so thankful and honored for the opportunity to have worked with all of them. They are a remarkable group of physician educators and researchers! I am also very grateful to the donors who have supported our work and without whose generosity we would not have been able to accomplish so much.

Another part of my life, especially during my time at Loyola, has been time spent in what you might call “organized medicine”. I have had the incredible opportunity to be involved with, and have leadership positions in, many different urology organizations including the American Board of Urology, the American Urological Association, the Society of Urologic Oncology, the Society of University Urologists, the Society of Urologic Chairs and Program Directors, the American Association of Genitourinary Surgeons etc. In this regard, I have always lived by the axiom my mother taught me – “try to make everything you touch better”. During these experiences, I have learned so very much from my colleagues and developed life-long friendships in the process. I believe, organized medicine, like research, allows one the chance to make a difference, to lead and even change the missions of these organizations and what they do to improve the lot of urologic patients nationally and worldwide.

I am especially proud of my efforts as AUA Secretary, the most demanding of the leadership positions I have experienced. The AUA has such an important role, not only in North America but also worldwide. It is, I believe, the world’s premier educational organization. When I became Secretary, the AUA Board had completed a global strategic plan. I asked the Board to let me take a leadership role in this effort as I was convinced that the AUA should have an enhanced global outreach in order to make it the wonderful organization it has become. This effort involved a great deal of travel and hard work by AUA leadership but has resulted in very significant and productive educational bridges between the AUA and many country societies. In addition, and very importantly to me, it afforded me the chance to become friends and colleagues with many international leaders in urology - a blessing I cherish. Also during my time as Secretary, I was able to lead two important educational initiatives, the Core Curriculum for Urology and the Global Philanthropic Committee. The Core Curriculum represented a great deal of effort by me, my primary colleagues at the AUA, Lori Agbonkhese and Peter Plourd, and the many other urologists and other educators who wrote sections of the Core and amassed other teaching tools (e.g. key references, videos, meeting presentations, etc) that could be made available with hyperlinks to the Core user. I always say that the work we did with the Core is only the “tip of the iceberg” and that the Core will continue to develop to be the premier educational tool in urology worldwide. Through its translation into many languages, it has already had a profound impact on education internationally, especially in countries were the organizational basis of urologic education is not fully developed.

This leads me to the second effort which brings me great pride and which grew out of my involvement in enhancing the global mission of the AUA - the Global Philanthropic Committee (GPC). As AUA Secretary I saw many requests sent to the AUA for educational support from areas of the world where real need was apparent. It occurred to me that these requests were for substantial resources that would be difficult for any single organization to accomplish on its own. Together with the leadership of the AUA, the European Urological Association, the Societe Internationale de Urologie, and others, I suggested that we combine our efforts to create the GPC and begin jointly funding programs. Our first project was to fund two urologic educational programs in sub-Saharan Africa, in Nigeria and Senegal. One of the proudest moments came last year when I heard of the great strides these two programs have made and how the GPC’s efforts have resulted in increased recognition and support for these programs by their respective governments, industry and other foundations. Both are now largely self-sufficient and very effective. My great hope is that this global approach to urologic education will continue to move forward!

During the entirety of my career, the most important thing that has made a difference to my life has been my family and friends. I have been truly blessed with my wonderful wife and children who have often been understanding when I was away or working. Without the love and strength that Joan, Nancy, Charlie and my entire family give me, none of the above would have been possible or meaningful.

My life has offered me many lessons that have sustained my career. First, always be ready to see and respond to the life-changing opportunities that may present themselves to you. These opportunities can change your life in wonderful ways. Remember, you cannot do this alone, you need to work effectively with those around you. You should strive to develop life-long friendships in all that you do as these friendships will always be there for you, even in tough times. Always remember that you are a role model and mentor to others and try to lead your life in a way that sets a great example. I have certainly made many mistakes, but it is comforting to be able to look in your mirror and be happy with what you see. Remember that all those you mentor are the future and that if you can help keep “ the candle burning” inside them, they will do great things and the world will be better for it. Always be dedicated to your patients and try in every way to do your very best for them. Last but not least, always remember that there are so many wonderful people worldwide, the vast majority of whom you will never meet, who may need your help.

Dr. Robert C. Flanigan

Albert J. Jr. and Claire R. Speh Professor and Chair

Department of Urology

Loyola University Medical Center and Stritch School of Medicine

Maywood, Illinois, USA

© The Canadian Journal of Urology™; 20(6); December 2013

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