Hopkins Voices

An Interview with Julie Freischlag, Hopkins' New Surgeon in Chief

Julie Freischlag, M.D., Hopkins' New Surgeon in Chief.

F or as long as she can remember, Julie Freischlag wanted to teach biology. But after she learned that teaching was difficult to break into, she took her love of teaching and science to medical school. Three decades later, Freischlag finds herself educating tomorrow’s doctors in a position she hardly imagined—head of surgery at Johns Hopkins, the birthplace of surgical training in the Unites States. How did she become a leader among American surgeons? What impact will she, as a woman, have on the specialty? How would she change the training of surgeons today? In a recent interview, Hopkins' new surgeon in chief answered these questions and more.

Question: Surgery was an unusual choice for a woman in the early 1980s when you were in training. How did you decide to specialize in this field?

Dr. Freischlag: When I went into medical school, I thought I was going to be a pediatrician. In fact, I decided to do my surgery rotation first because I knew I wouldn’t like it and I wanted to get it out of the way. Well, I really liked the pace, the people, working with my hands. My personality was surgical.

Question: Were you concerned about entering such a male domain?

Dr. Freischlag: I didn’t think about it because 50 percent of my medical school class was women. It never dawned on me that I couldn’t do surgery or that anyone would have an issue with my doing it. Years later, I found out that women applying for surgical residency spots tended to be put on the bottom of the pile.

Question: So, will your position here attract more women to the Hopkins surgery program?

Dr. Freischlag: Maybe, if you consider the fact that over half the medical school students in this country are women, only 6 percent of women ever think about surgery and only 3 percent ever go into it. We need to increase that number because you can’t just pick from the 50 percent male pool. I think we’ll recruit more men, too, because they understand that I understand lifestyle issues. But Hopkins has never had trouble attracting the best and the brightest to its surgery program.

Question: Looking back at your training, what were some of your goals?

Dr. Freischlag: My number-one goal was to be a good doctor—taking care of patients, educating them and their families, knowing that you’re making a difference. I like the academics, teaching, doing research at the edge. But being a good doctor and teaching that to others—that’s the one thing I hold on to.

Question: How would you change the surgical training program you went through?

Dr. Freischlag: It was the old style of training where we were in-house, or in the hospital, every other night. Training was very rigorous, we did research, and when we were out we were on-call. Now we’re finding that being around all the time doesn’t necessarily make you a better doctor or a better surgeon.

Question: Can you explain that?

Dr. Freischlag: When I trained, we did a lot of things in the hospital that were service related, like drawing blood and transporting patients. It was for the patient, but not necessarily for my best education. Now we’re refocusing on the education piece, on exactly what we need to be teaching residents. And they can have a lifestyle, too.

Question: A lifestyle?

Dr. Freischlag: We’ve learned that a lot of people grow apart from their families during residency. When they finally come home, they find their family has moved on without them. They have to be well trained, really focused and confident that they’re ready to go out and be the kind of surgeon they want to be. But they should also be able to make a commitment to their personal life, which actually helps in taking care of patients, too.

Question: How’s that?

Dr. Freischlag: If you don’t have any semblance of a family life, if you don’t retain your humanity, then it’s really hard to listento patients.

Question: You’re a surgeon and a researcher, too?

Dr. Freischlag: Yes, and the fact that there are quite a few surgeons here who are excellent researchers is partly what attracted me to this institution. What they bring to research is the translational piece, the ability to study the tissue or tumor in the research laboratory and bring their findings to clinical practice. I want to enhance that research piece even more.

Question: In what way?

Dr. Freischlag: By continuing to look at the pathogenesis of diseases to develop preventive measures and ways to prolong survival after we get these diseases. But also by placing greater emphasis on developing innovative surgical approaches using new technologies. We’re also exploring new ways to teach these techniques to residents in our minimally invasive surgical training center.

Question: New technologies?

Dr. Freischlag: Certainly there have been advances in imaging and surgical tools that allow us to operate more effectively and more safely. Also, we’re increasingly using robotics in both open cavities like the abdomen and in harder-to-access areas like the chest and the heart to make surgery less invasive and easier for the surgeon and the patient.
 
Question: How else do you see surgery changing at Hopkins?

Dr. Freischlag: One new ush is to make the services that we offer multidisciplinary and one stop. For example, patients who come here with a cardiac problem should also be able to see a cardiologist, a cardiac surgeon, a vascular surgeon and anybody else who can help them. Similarly, we want to build transplant surgery into one multidisciplinary team where the liver transplant surgeons, for instance, work closely with hepatologists. In oncology, we want to enhance the connection between medical oncologists and cancer surgeons.

Question: What does Hopkins offer international patients?

Dr. Freischlag: We do offer evaluations, procedures and technologies that may not be available in the international patient’s native country. For example, I perform thoracic outlet surgery (see sidebar story), which is not offered everywhere. Moreover, we’re recognized for being able to provide clinical services that many other centers in this country cannot provide.