Trailblazer, team player, committed academician - in prior years we have celebrated many of the defining characteristics of our program graduates. In the case of Kevin Casey, the grace with which he effortlessly shouldered all of Weesam’s responsibilities during his initial illness and long weeks of difficult recovery - “He’s not heavy, he’s my brother”; George Lee taking a huge gamble to essentially start over again as our first integrated vascular resident; Chelsea Dorsey as the first woman to join our vascular training programs, Venita Chandra as our first woman fellow and first female graduate. Each of our 24 graduates can rightly stake their claim to their own accomplishments, their own “firsts”, both during their training with us and in their own distinguished subsequent careers.

In thinking about this year’s graduates, speaking for the faculty and our staff, we are humbled by the quality of individuals we are privileged to train.

We appreciate your trust - our talent pool is the envy of our colleagues across the nation - as exemplified by this year’s graduates, Chelsea Dorsey and Brant Ullery; ambitious, ethical, compassionate, technically gifted, well-prepared - and as with all our prior trainees, we have felt a great responsibility to help each reach their full potential. The research opportunities we provide, the range of clinical experiences and participating sites we have organized regionally and across the continent, our focused didactic educational activities and journal club, the resident & fellow-driven clinical conferences, unparalleled access to investigational devices and innovative procedures, the sponsored participation in bootcamps, skills competitions, research participations and clinical meetings nationwide: all have been purposely selected to maximize the value of your residency and fellowship experience.

In the sports world, athletes with raw talent and ability are courted by colleges far and wide. Their decision point as to which to attend comes down to which program offers each respective athlete the greatest chance of reaching their full professional potential. As fans, we have a chance to see those careers develop in person or on TV, and programs themselves are ultimately judged on how those skills mature and develop - whether the prodigies under their tutelage reach their full potential. In graduate medical education, the imperatives are the same, the stakes just as high, if not higher, based on our commitment to the public and our patients. While we can always do better, I feel gratified that the process has obviously worked so well this year, given the skills and accomplishments so evident in Drs. Dorsey and Ullery.

What I’d like us to consider today is the commitment we all have to our patients, and the choices that each of you will make regarding your own practices in the years going forward.  

Learning is a life-long endeavor - hopefully the norms of our educational processes, relying to the greatest extent possible on evidence to guide decision making, will help guide you in your clinical decisions going forward. Ethical practice is also a life long endeavor - as highlighted by the national events of this last year, Plato’s construct of the “examined life” is an ongoing requirement for the ethical practice of surgery. The example of the Florida cardiologist billing Medicare $18M for performing mostly peripheral vascular interventions, with, in his words, some of the best results reported anywhere. To experienced surgeons, this boasting simply confirms the surgical truism that patients without significant problems will always have predictably good outcomes.  At the 2015 VAM last week in Chicago, a solo practice vascular surgeon from Texas, who introduced his community-practice breakfast session by bragging that he was the second highest biller to Medicare in the State of Texas, provides us with a warning that avarice is a vice not limited to cardiologists. In his presentation, he emphasized that in his diabetic patient population, by virtue of his preference for retrograde tibial intervention performed in a serial fashion in his office-based interventional suite, he reliably generates a high ratio of procedures to patients, producing annual professional income in excess of $3.5M per year. By his comments, it seems he has started a business to help others learn to organize their practice in this way, too.

While everyone is entitled to fair compensation for the work they do, by any measure this surgeon’s practice is abusing the trust society places with physicians and surgeons. As a result, after learning of the details of his practice, the SVS membership voted down his application for membership. Each of us whose livelihoods dependent on our clinical productivity have decisions to make every day about which patient needs which procedure based on our best professional judgment. As nicely summarized by Peter Lawrence in his SVS Presidential Address last week, maintaining the highest ethical standards are essential to the future of our specialty, our ability to maintain the public trust, as well as our own personal and professional well-being as surgeons.

It is a fact of medical practice today that all of us need to honest with ourselves about why we choose the choices we make in our daily professional activities. Almost certainly, as new doctors we begin practice with only the best of intentions. The pressures of practice and life’s unpredictabilities often conspire to influence us in unfavorable ways, however. A few years ago the Medical Board of California ran a series of articles in their newsletter detailing how physicians had come under MBC review, categorized by examples from each of Dante’s seven deadly sins. In one particularly memorable edition I was shocked to see that the medical license of one of my medical school classmates had been revoked based on a particularly egregious act of unprofessional conduct/greed. How my formerly idealistic classmate’s career had progressed to that point was beyond me, but clearly somewhere along the way, she had lost her way, with grave consequences to her as well as the community in which she practiced.

All around us today the framework of medical practice is changing, perhaps exemplified best by the long-expected “volume to value” transition. In the next few years, most of us will be working in an accountable care environment where our professional rewards and recognition will be increasing dependent on how our patients are doing rather than how much surgery we are performing. Anticipating this change, our focus needs to shift to the holistic care of vascular disease - maintenance of ambulatory status and independent living, judicious use of screening tests and focused physical exams to identify patients at risk, constant attention to care pathways and procedural enhancements that reduce surgical risk, recovery periods and length of stay, commitment to optimizing risk factor and medical disease management within applicable guidelines- in short, population health. In this brave new world, patient satisfaction and likelihood to recommend scores will ultimately mean more to us than the Work Relative Value Units for which we are currently compensated. Honestly, this change is long overdue, and will go a long way toward eliminating the egregious abuses rampant in our fee for service practice system today.

But regardless of how or when this change unfolds, as vascular surgeons we will always have choices to make about how we can best serve our patients and our families. And today, as we recognize and celebrate your accomplishments and usher you into the next phase of your career, we have the utmost confidence that you both will continue to make professional choices that will reflect well on both you and us. Doing the right thing will always be in fashion, regardless of whatever other changes the future may hold. Thank you both for choosing to train with us, thank you for bringing such honor and fame to Stanford during your time here on the farm, and best of luck to you both in all your future endeavors.

And, I would be remiss if I didn’t take the opportunity to emphasize this, if by some twist of fate either, or both of you, do become fabulously wealthy (in an ethical way, or course), Wajhma, our Division Manager, will be happy to connect you to our colleagues in the Development Office who can explain to you the long-term tax benefits of a structured giving program to assist those who will follow in your footsteps here at Stanford Vascular Surgery. The Stanford Vascular Training Program, otherwise known as the gift that keeps on taking! Thanks to everyone for joining us tonight, and enjoy the rest of the evening!! 

Ronald L. Dalman
Walter Clifford Chidester and Elsa Rooney Chidester Professor of Surgery 
Chief, Division of Vascular Surgery

The modern Stanford Vascular Training program was founded twenty years ago next month.  For at least fifteen years prior to that, going back to the late 1970s, vascular trainees at Stanford were required to complete  two years of cardiac surgery, as well as one year of vascular training, to be board-eligible in either Cardiac Surgery, Vascular Surgery, or both.  In years when Cardiac Surgery could not fill their "vascular" training position, foreign fellows were accepted for one year of vascular training. Phil Walker, now Chairman of the Department of Surgery at Queensland University in Australia, was the last foreign fellow to train in this paradigm, finishing in 1992.  Jim Fann, an Associate Professor of Cardiothoracic Surgery at Stanford, was the last American fellow to complete that training, in 1993.

Our first vascular-only fellow, appointed in the Department of Surgery, was Robert "Bob" Hooker, recruited outside the match from Surgery Residency at the University of Chicago.  At the time, there was no endovascular training in the fellowship, and the research year, since it was not ACGME accredited, was considered optional by some fellows, including, ultimately, Bob. The fellow at that time trained exclusively at Stanford Hospital - VA vascular was covered by general surgery residents. Compared to today's standards, our 1994 SHC practice was miniscule - most of patients were referred from Stanford faculty.  Imagine how small our practice would be if that were the case today.  The full-time faculty (John Harris, myself, and Chris Zarins) competed directly with established community surgeons working in SHC, some in practice almost twenty years in the area, who also served as clinical faculty for purposes of providing sufficient operative volume for the fellowship program.

In those years, the biggest challenge to our practice (and professional viability) was the town-gown dynamic. We struggled to grow the academic practice in the face of established and capable internal competition, most of whom carried faculty titles of their own, even though many were in private practice. Even general surgeons like David Gregg were performing vascular procedures at SHC on a regular basis. One particular image from that era was literally emblematic of our situation - a picture of Dr. John Mehigan, a community vascular surgeon with privileges and an established practice at SHC,  featured on the cover of Gentry magazine as the personification of Stanford Vascular Surgery, leaning on one of the pillars in the Dean's Courtyard across from the Alway building, his arms crossed in a self-contented pose. We didn't even control our own name! How could this happen, we asked? His wife, as it turns out, was good friends with the publisher. Dr. Harris and I took general surgery trauma call on a regular basis, in part because we had the bandwidth to do so. The scope of vascular practice was much smaller nationally than it is now,  and there were many specialists competing to provide care to a finite number of patients at SHC. Many trainees nationally finishing vascular training expected to practice both general and vascular surgery.

Since 1994, all our graduates have gone on to successful practices in vascular or cardiothoracic surgery. All, with the exception of Dr. Alkhatib, are still in practice.  Uniformly, all have brought honor to our program.  Preparing for this evening's event, I am struck by the unifying theme of "opportunity", as it applies to both the twentieth anniversary of the founding of our program, as well as to the accomplishments and perseverance of this year's graduates.  As the more experienced of us in the room recognize, opportunity comes in all shapes and sizes, sometimes obvious to all, sometimes obvious to none.  

When Chris Zarins accepted John Niederhuber's invitation to serve as an external consultant to the Department of Surgery for Vascular Surgery, he had no intention of leaving his faculty position at the University of Chicago. True, despite his long and successful tenure as Division Chief in Chicago, Chris had experienced some recent professional disappointments at the time, and true, Chris and Zinta had enjoyed living in California during his Naval service in the Vietnam War, but the environment here posed significant, and on first glance seemingly insurmountable, challenges to the establishment of a nationally prominent vascular surgery program.  

In addition to local competition from faculty cardiothoracic and community vascular surgeons, and the formidable market position of UCSF Vascular Surgery, already twenty years established itself and arguably a top-three program nationally at the time, at Stanford Hospital, Vascular Surgery had no block time, no dedicated anesthesia service, no dedicated ICU (or ICU service), no offices, clinic, or vascular lab in the hospital, very capable and innovative interventional radiologists working in the same hospital, who had a two year head start on building their own vascular practice, all in the setting of a weak Department,  with  consistent prior history of ineffective leadership.  Despite the obvious challenges, we began to see the beginnings of something larger, an "opportunity" that, at the time, no one else except Drs. Niederhbuer, Zarins, Harris and myself saw.

From our own individual experiences at other programs before Stanford, each of us recognized that a great research university needed capable and innovative vascular specialists and scientists, and that a successful vascular division needed a robust university community from which to draw sustenance and inspiration. We all agreed that the School of Medicine needed a strong vascular program. Dr. Zarins' recruitment brought attention to our fledgling Division, and from his first weeks on campus, we worked hard to catalyze on that opportunity.  On the clinical front, taking stock of the local competition, we integrated some community surgeons into our practice, out-competed others, established a robust VA practice, dis-engaged vascular from its roots in cardiac surgery, established specialty-specific office and clinic space for Vascular at SHC, bought out the Vascular Lab from the Fogarty practice, as well as ramping up academic productivity, midwifing the development of EVAR, the biggest technological disruption in our specialty since the discovery of heparin, and established vascular surgery as a viable "brand" at Stanford, complete with fundraising events, CME meetings, regional clinical events such as "Holman Rounds" to showcase our clinical skills, and an aggressive policy for accepting transfer patients.  Our success in these endeavors was quickly recognized by the Dean's selection of Dr. Zarins as Interim Chair of the Department Surgery, following Dr. Niederhuber's departure, and, within five years, the subsequent ascension of both Drs. Fogarty and Zarins to the Presidency of our primary national academic society, the Society for Vascular Surgery.  All ultimately a consequence of recognizing and relentlessly pursuing opportunity.   

By the late 1990s, the Vascular Division was growing rapidly in academic stature and clinical volume.  Unfortunately, the larger Department of Surgery continued to struggle, hampered by Dr. Niederhbuber's dismissal after just four years, and three years of well-intentioned but interim leadership by Drs. Zarins and Reitz, respectively.  And the challenges for the Department ran deep; leadership issues, or more specifically, lack of consistently effective leadership, had plagued the Department almost since the School had moved from San Francisco to the main campus in 1959.  Financially challenged, the Department was recognized nationally, when it was recognized at all, as a second tier program, with almost no extramural research funding, lingering internal dissention and resentment from Niederhuber loyalists, an underperforming residency program and no marquee general or pediatric surgical practice to speak at an otherwise world-class hospital.

As we all know, Tom Krummel recognized the opportunity inherent in the Department of Surgery, and took a big chance of his own moving his family out here in 1998.  Fortunately, with his stewardship and vision, the larger Department has thrived in the subsequent sixteen years.  The Dean's office recently reported that the search for Dr. Krummel's successor will generate more than 200 applications from surgical leaders from across the country - I wonder how many CVs of similar quality were submitted for the search that ultimately selected Dr. Krummel, in 1998? Perhaps a dozen? That difference alone speaks volumes to what Dr. Krummel has accomplished on behalf of all of us in the Department. Regardless of what the future holds for our Department, we faculty, and particularly the few of us remaining who were here in the desperate years, owe a great debt of gratitude to Dr. Krummel for everything he has done for our Department, Division, and the University Community.  Thank you Dr. Krummel.

Our second Integrated resident, Mohamed Zayed also recognized opportunity at Stanford.  A medical scientist training program (or MSTP, in NIH parlance) graduate of the University of North Carolina at Chapel Hill, graduating at the top of his medical school class, Mohamed easily had his pick of the few integrated vascular surgery training program positions available in 2009.  He cast his lot with us, as the first resident to match into our Integrated Program, exactly because he saw opportunity here.  And throughout his five years in our program, Mohamed has consistently sought out additional opportunities, opportunities for training, learning, writing assignments, and national leadership positions.  And he has pursued those opportunities relentlessly - concerned he wasn't getting enough surgical exposure, Mohamed's case list has grown to enormous proportions.

My memories of Mohamed will always include the picture of him smiling with colleagues at McMaster University Hospital (wearing a McMaster lab coat), his advocacy efforts on behalf of all integrated residents as the national resident representative to the Vascular Surgery Program Directors Association, his boundless energy and creativity as an investigator and author - speaking on behalf of the faculty; we couldn't have asked for a more enthusiastic and committed resident, at a critical juncture in our fledgling residency program.  His willingness to seek out opportunities extended to the way he conducted his job search this year, cold-calling programs across the country looking for the right opportunity when even the programs themselves didn't know one existed.   Again, making his own breaks.  John Harris will review Mohamed's background and accomplishments in more detail, but I want to take this opportunity to thank Mohamed for his faith in our team,  and our then novel educational scheme, when he joined us in 2009.  We know he will do well, and wish he and his family the best.

Vinit also came to Stanford from Chicago, neatly bookending Bob Hooker's status as the first resident.  Aside from some solid recommendations, we didn't know much about Vinit before he arrived, and he didn't know much about us.  In a manner no less impressive than Mohamed's, and in some ways even more so, Vinit has recognized and taken advantage of his own Stanford opportunity. Leadership in quality improvement projects.  Embracing  endovascular approaches and skills, or "endohabits" despite his background as a classically trained general surgeon, and becoming quite good at "endo" in the process.  Vinit also has embraced opportunities to participate in academic projects, and has represented our program well at presentations and competitions across the nation. His sincere interest in the Marin General position, and his willingness to evaluate it in person with me, convinced the leadership of that medical center that we could deliver top-quality vascular services there, helping to cement that opportunity for further growth for our training program.  And Vinit continues to seek out further opportunities, with his plans to start a new vascular practice when none currently exists in Austin, Texas, replete with a new practice logo, his own building, physician extenders, office staff, etc.  Later in the program, Dr. Lee will review Dr. Varu's accomplishment in more detail, but I want to emphasize that both Vinit and Mohamed recognized their own respective opportunities in our program, and their success in this all-important endeavor gives me great confidence in their professional futures.

Opportunity is a pervasive theme at Stanford, celebrated in the entrepreneurial culture at the Graduate School of Business, the innovative ethos of the School of Engineering, and the strong track record of accomplishment of our own Biodesign Program, so capably co-directed by Dr. Krummel.  Learning to recognize opportunity is both an innate talent and learned skill, something that we nurture in every aspect of what we teach and practice in Vascular Surgery.  Much success and happiness in the practice of vascular surgery, as well as life in general, comes from learning how to balance risk and return, deciding where and how you can most effectively make your mark.  And on our twentieth anniversary, it is important for all of us to reflect on the humble origins of our program, and the role that recognizing opportunity has played in helping us all get to where we are today.  Congratulations to both our graduates, and thank you all for helping both Drs. Zayed and Varu make the most of their respective opportunities during their time here at Stanford.   

Recently, Vinit reflected on the structure of our weekly clinical case conferences, which require our residents and fellows to seek out the best representative references for their presentations and patient-specific clinical solutions from the available vascular literature.  Although time consuming, particularly on weekend afternoons and evenings, over the course of his fellowship, this experience has helped Vinit master the evidence basis for our specialty, building his confidence in his ability to thrive in his own practice.

Ronald L. Dalman
Walter Clifford Chidester and Elsa Rooney Chidester Professor of Surgery 
Chief, Division of Vascular Surgery

Given all that has transpired in Stanford Vascular over the past few years, this event has come to reflect, in part, the defining characteristics of each successive graduate of our program. In 2011, Kevin Casey’s grace and magnanimity in response to the unpredictable, inconvenient and ultimately prolonged incapacity of his co-fellow Weesam Al Khatib inspired me to reflect on professionalism as an essential element in the making of a vascular surgeon. In 2012, for somewhat less inspirational reasons, we emphasized the importance of compassion in the healing process, compassion both for the patient as well colleagues on the healthcare team.  Following after professionalism and compassion, 2013 is the year of the risk-taker – an uncommon characterization of vascular surgeons as a whole, but particularly apt this year. The experienced among us recognize that vascular disease management often derives optimal outcomes following adherence to guidelines and proven approaches. But the example established by this year’s finishing trainees, Venita and George, reminds us that, at particular and unpredictable moments, opportunity favors the bold. Both Venita and George are trailblazers in their own right, and tonight we celebrate their courage and vision in their choice of specialty training in vascular surgery.

First, the example of George Lee. Like an investment come due, the return on the effort required to design, fund, and operationalize our integrated vascular residency in 2008, the first such program established west of the Mississippi River, is realized today in the culmination of George Lee’s training. Taciturn as he is – compared to George even Tae Song seemed gregarious - George took the extraordinary step of resigning from his categorical surgical residency position for the uncertainty of integrated training. George’s prior life experiences prepared him well for this opportunity, as well as anyone could be prepared, but when offered the chance to become the first resident in our program, George boldly stepped forward. Not a man of many words – he lets his surgical skills and superior patient outcomes speak for themselves – George generally rejects the characterization of “trail-blazer”. While time has obscured some of the challenges, be assured that in 2008, integrated training was controversial, to say the least.  

How many of you would travel across the country, as George did, to repeat the least wonderful period of your life – surgical internship - all for the chance to begin training in an unproven pathway with indeterminate employability at completion? Like “Ground Hog Day”, only with a less predictable ending. Not only was the pathway itself unproven – could vascular be codified and learned as a specialty distinct from general surgery? – but so was the reception in the marketplace. Would existing surgical groups and health care systems want a vascular surgeon trained without prior general surgical experience? Would community surgical groups accept a potential partner who could not cover general surgical emergencies? Could George find love and companionship in California? At this point, that answer to each question is a resounding “yes”!

With the perspective of the past five years, it is also apparent that the success of our “experiment” in integrated training has been due in large part to George himself. Speaking for the faculty, I can state unequivocally that George has demonstrated to us, over and over again, that he was the best possible choice to be our first resident. Throughout the residency, with each new rotation, George has represented himself and our service well, with maturity, intellectual curiosity, commitment, and skill. The five year trail blazed by George has demonstrated to our surgical and medical colleagues at SHC and VA Palo Alto the value and utility of Integrated Vascular Training. Similarly George has represented Stanford well in our international rotations, also “firsts” for Stanford Vascular alone among all American surgical training programs, solidifying our reputation in both Canada and Europe and establishing important training opportunities for all subsequent trainees.

To do justice to the totality of George’s contributions and accomplishments would take far more time than we have this evening, especially considering that, for the first time since dedicated vascular training began at Stanford, this year we are privileged to be finishing two trainees, a resident and a fellow. No less a trailblazer than George, in choosing to complete the Stanford Vascular Fellowship, Venita faced risks certainly as consequential, if not more so, than any prior trainee in our program. A glance at our composite poster states the obvious; Venita is the first women to complete the Stanford Vascular Fellowship. Emphasizing that fact alone does a great disservice to the totality of Dr. Chandra’s accomplishments, and we will explore those in depth as well, but context is so essential to understanding the significance of this day to our program, out patients, our specialty and all future residents and fellows to follow.

For those of you who don’t know, academic vascular surgery has fewer women than almost any other specialty. Only 9% of academic vascular surgeons are women, and only 4 university vascular programs nationally are directed by women. To the best of my knowledge, there is exactly one women surgery department chair who trained as a vascular surgeon. While it isn’t unusual to see women surgeons in the hospital today, and I’m certainly glad I’m married to one, it wasn’t too many years ago that an emeritus neurosurgeon at Stanford, Dr. Fran Connolly, gained notoriety for her memoir of gender-based discrimination at Stanford, entitled “Walking out on the boys”. Our program is fortunate to have had two women as faculty members, and Dr. Wei Zhou provides a daily example of how to succeed in academic vascular surgery, but the fact remains that someone had to be first in our program, and Venita was it. Following in the footsteps of “The Long Grey Line”, as they describe it at the US Military Academy at West Point. But this certainly isn’t the whole of it, or even the majority.

Venita’s interest in Vascular Surgery came relatively late in her general surgery training. After her PGY-3 rotation on our service, she began to consider vascular as a real career possibility. This was after having one child, with plans for more in the future. Given her husband’s career, and her own interests in remaining local in the Bay Area, Venita approached us about the possibility of fellowship training when an opening developed unexpectedly in our program at the beginning of her chief resident year. Under the circumstances I didn’t know really what to expect, but from her first day as a fellow Venita has commanded the respect of the faculty and her peers. She is an outstanding technical surgeon – confident, competent, compassionate, and conscientious. Her easy manner, sound surgical knowledge, and outgoing personality instill confidence in our patients and their families. Indefatigable, Venita balances her surgical educational responsibilities with those for her now two beautiful daughters and husband. So essential for a surgeon, she is unfailingly upbeat, optimistic, and confident in her ability to do the right thing, at the right time, regardless of circumstances. Perhaps the greatest compliment we can pay to Venita is that, of her many accomplishments during the fellowship, being the first women was really just the icing on the cake.

As many of you know, Sheryl Sandberg’s book “Lean In” was recently published to great acclaim. In the book Sandberg, current COO of Facebook and prior executive office at Google, tries to address what she sees are societal and personal barriers that prevent women from achieving the full potential of their professional and personal lives. Suffice to say there is no such thing as “having it all”, but with appropriate planning, commitment, and spousal support women can fulfill the promise of their often stellar educational pedigrees. In defining the phrase “lean in”, Sandberg observes that all too often, in her experience, given the chance to take on new challenges and leadership roles in their chosen careers, women all too often opt out, or “lean back”, citing conflicts and concerns regarding their personal lives that may not even exist at the time – for example, asking the question “what if I want to have a family?” before they are even married. Rather than vacillate in the face of uncertainty, Sandberg advocates for commitment and “risk taking” in career and personal planning, choices embodied by Venita’s path to date. And completing training alone as a trail-blazer isn’t enough for her; she has accepted our offer to join the faculty, and in doing so taking responsibility for Stanford’s new multidisciplinary Wound Care Center opening in Redwood City in 2014, a multimillion dollar investment by the hospital and the next big thing for our Division. If we are ever able to satisfactorily address the gender gap in vascular surgery, and truly provide appealing career alternatives to 100% of today’s medical school graduates, we will need to learn from and emulate Drs. Zhou and Chandra’s examples of how to succeed in academic vascular surgery, and have fun and personal satisfaction in doing so.

Indeed, vascular surgery needs more risk-takers, now more than ever. Risk-takers; not gamblers, not thrill-seekers, certainly not yahoos, but mature and confident surgeons with the vision and foresight to recognize the way forward. Understanding the underlying fundamental pathophysiology of occlusive and aneurysmal vascular disease is within our grasp, and will likely be accomplished in our professional lifetimes. Our training program needs to recognize and reward risk-taking when appropriate, and our practice needs risk-takers to help it grow to reach its full potential. All of us recognize every day the needs of our larger community for competent vascular care, and it should be our primary mission to provide that care as effectively as possible to everyone who can benefit from our help. How do we get from here to there? By recruiting risk-takers like Venita and George to our practice, to help us find the way.

One of my favorite surgical aphorisms is summarized as “be sure in all sure things”. This observation usually applies to when and how to achieve maximum efficiency in the operating room; operating quickly whenever circumstances permit, and taking more time to great things right when speed becomes less compelling. But happily this aphorism also applies to both this year’s program graduates. From the first day they proved that they were “sure things”, in the parlance, and our offers of employment confirm our “surety” in their future professional success. So here’s to the risk-takers; may their careers continue to challenge and reward them in due measure, and may they succeed beyond their wildest dreams.

Thank you everyone for joining us tonight in celebrating the accomplishments and potential of our two latest graduates!    

We need risk-takers; not gamblers, not thrill-seekers, but mature and confident surgeons who have the vision and foresight to fully realize the opportunity that is our practice. These last few years have provided us with up-close observations of the biggest profile practices in the country – how do we get from here to there?

Surgical aphorism – be sure in all sure things.

For Venita – the “long gray line”. All men at UW, OHSU, and until 2013, Stanford. Not just any woman, but a “real” woman, in every sense of the word, with a wonderful and supportive family and friends to attest to her many attributes. 

Ronald L. Dalman
Walter Clifford Chidester and Elsa Rooney Chidester Professor of Surgery 
Chief, Division of Vascular Surgery