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Julie Freischlag Steps into Surgery's Top Post

Julie Freischlag, surgeon in chief
On March 1, Julie Freischlag took over as head of the Department of Surgery. Formerly chief of vascular surgery at UCLA, she is an award-winning teacher, researcher, experienced administrator and national leader in academic societies. Now she's also, officially, the William Stewart Halsted Professor and Director of the Department of Surgery at the School of Medicine and Surgeon in Chief of Hopkins Hospital. It's a grand-sounding title, and it befits an influential post that will propel her into the stratosphere of American surgical leadership. As only the sixth chairman of the venerated Department of Surgery, Freischlag will be called on to carry forward the rich heritage that for more than 100 years has been its hallmark.

The appointment has been a long time in coming. Word of it began rippling through the ranks of residents last August. But it was not until January that the details were ironed out, and it was finally announced. No woman has ever headed a large clinical department here (Barbara De Lateur, up until now the only woman director in School of Medicine history, has led Physical Medicine and Rehabilitation), and Surgery, that uniquely male stronghold, was the last place anyone ever expected it to happen. From Freischlag's point of view, though, it simply makes sense. "Women have been in the profession long enough to have learned all the ropes. They're qualified, and they're available."

As chief, Freischlag will see patients and operate at least once or twice a week. An international expert in thoracic outlet surgery, a procedure designed to correct a syndrome in which the first rib compresses arteries and sometimes nerves and causes problems in the upper extremities, she will draw patients from around the world. As chairman, overseeing a large department, she also will be an administrator-and an innovator.

While Freischlag plans to expand research and add some specialty services, her chief aim is to reshape the surgical training program. At any one time, some 60 residents, including fellows, are training in the department. The vigorous program continues to attract the best and brightest applicants. Elsewhere, however, surgical internships are losing their luster. From 1978 to 1989, 10 percent of medical school seniors listed general surgery as their first specialty choice; by 2002 that figure had dropped to about 6 percent. And, although women now make up nearly 50 percent of medical school classes, only a tiny fraction (about 3 percent) go into surgery.

Why so? "The number one, two and three reasons are lifestyle, lifestyle, lifestyle," says Freischlag. As she herself knows all too well, the grueling hours of the surgical residency represent a long-standing tradition, if not a badge of honor. "We were in-house every other night on call. We just figured that was what you had to do in order to be a great surgeon," Freischlag says, recalling her own residency.

Soon, things will change, beginning with the 80-hour limit on duty hours mandated by the Accreditation Council for Graduate Medical Education, which takes effect on July 1. Also, Freischlag intends to begin participating in a pilot program, developed by the American Board of Surgery, that would shorten surgical training. Residents, after doing their core training, would enter specialty training a year earlier.

One of the things that intrigued Freischlag about the chairmanship was the opportunity to refashion training right here in its birthplace. Residency training was more or less invented at Hopkins in the late 1800s by Halsted, the first chairman. "Also, the residents are so good here, the faculty so excellent," she says, "that I knew we could be leaders in redoing training."

Freischlag, who was enormously popular among the house staff at UCLA, plans to meet weekly with groups of residents here. She will plan for most activities to be done during the work week. "I have a 7-year-old son, and the dimension that I bring is that you can do it all, but you can't do it all in one day." Freischlag's family also includes two stepsons, one who is currently teaching English in Japan; the other, an organic chemistry major at University of Wisconsin, now preparing for graduate school. She is married to Philip Roethle, a businessman who specializes in manufacturing accounting.

It had never occurred to Freischlag that she would be leading surgery at Hopkins. A man she's not. Nor is she East Coast establishment, having grown up in downstate Illinois, attended Rush Medical School in Chicago and trained at UCLA Medical Center. "It certainly wasn't on my list of things I thought I would do, or that I would even want to do." When the opportunity presented itself, a few colleagues were quick to say she'd never get the job. When she did, "everyone began to realize that if you're qualified and work hard, you could get it. They understood that people now are looking for the best person for the job."

Congratulations poured in from women surgeons around the country. Freischlag says she also got a lot of response from young male surgeons. "They perhaps realized that you don't have to be Hopkins-trained or Harvard-trained to lead those institutions." One note came from George Zuidema, chairman here from 1964 to 1984. Retired, Zuidema now lives in his native Michigan. "This reminds me a lot of when I took over in '64," he empathized.

Transitions in surgery have never been entirely smooth; not surprisingly, Freischlag has had to navigate her share of roadblocks. But with it all, there have been dizzying highs, "moments when I go, Wow! I'm so fortunate to have gotten this position! I'm sure I'll accumulate the knowledge and the experience I need, and I'll use the help of a lot of my friends and faculty at Hopkins to help accomplish our goals." Freischlag believes her appointment has the potential to diversify surgical leadership in other academic centers. "The impact of my getting this job is way outside of Hopkins," she says. "And if you think about the places that would do this, it would be Hopkins."

Perhaps nothing better epitomizes just how far she's come than a remark made by her young son. They were in the car, on the way to school, when suddenly he asked: "Hey Mom, can boys be surgeons too?"

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