Dr Duvvuri - NYU Grossman School of Medicine

 

Umamaheswar Duvvuri, MD, PhD

Mendik Foundation Chair of the Department of Otolaryngology

NYU Grossman School of Medicine

 

Dr Duvvuri earned his MD and PhD at the University of Pennsylvania and completed a residency in Otolaryngology-Head and Neck Surgery at the University of Pittsburgh. He then trained in Head and Neck Surgical Oncology & Reconstruction at the MD Anderson Cancer Center. Currently he is the Chair of the Department of Otolaryngology at New York University. Dr. Duvvuri has over 190 published papers and more than 8,000 citations. He has taught in many countries around the world, trying to improve the quality of head and neck cancer care.

 

 

 

My first question is somewhat generic, and I intentionally include it in most of my interviews. This is because I believe it's valuable and helps me gain a good understanding of your background and perspective. So I wanted to know why you choose to subspecialize in head and neck surgery after after residency. What drew you to this field in particular?

So, in fact, I would say for me it was a little bit the opposite. I was drawn to the field because of head and neck surgery. You know, I have always had a very strong desire to help people. Clearly, that's why we're going to medicine. But specifically coming from India and having my background, - head and neck cancer is a very big problem in India- I thought that at some point, I would like to return and contribute by educating, training, developing, and establishing scientific enterprises there. And I thought the best way to do that would be for me to be trained in an area that was of particular relevance to India. And so, I was always drawn to head and neck cancer from that perspective. I was also drawn to cancer because my uncle unfortunately died from lung cancer when I was younger. So I was always sort of tuned to the cancer and the oncology world. And it was a confluence of events. I remember thinking about this. I could have pursued head and neck cancer as a general surgeon, plastic surgeon, oral and maxillofacial surgeon, etc. And I was talking to people about what the field of head and neck oncology looks like in this country. And they said that most of it is done by otolaryngologists, and so you should do otolaryngology first, and then you specialize in head and neck. So I realized that that's what I wanted to do and I applied to ENT.

 

That's very interesting! Is there something that you dislike about the subspecialty?

Well, to be honest with you, one of the things I think is hard to swallow is that it is one of the more underappreciated of cancers, in the sense that it's not consider such a big problem in the US, right? It doesn't get the same attention as other cancers. And I am not comparing it to lung or colon or breast cancers, which are very, very common. But if you think about it, pancreatic cancer has about the same incidence as head and neck. Right? Same for glioblastoma. But it feels that those diseases tend to get a little bit more press. I hope that answers your question.

 

You did! Like I said, these first two questions are somewhat generic and I constantly keep thinking about whether I should keep including them in my future interviews. But the kind of answers that I get, how different they are and how fascinating they are always convincing me to keep them in there. Moving on to the next question, you have a somewhat unique background. My understanding is and you were born in India, but you actually grew up in two different countries: India and Jamaica. And then you came to the US to pursue higher education. So I wonder how this diverse background shape you as a surgeon, as a leader and as a person, and what did you learn from it?

Oh, that's a very interesting question. I would say that I learned a couple of things from this. One is I learned that we often end up in very, very different scenarios than you think you might project yourself to be in. So, I started it in India. Then we moved as a family to Jamaica. And when I moved there, I realized that there's a whole different world, which is very different from what I knew. And yet people are still very much the same. So number one, it taught me the real value of diversity and harmony. The best way to put it, is the national motto of Jamaica “Out Of Many One People”. You know, in Jamaica you'll find people of Indian heritage, Asian, Chinese, East Asian, African heritage, Caucasians, Europeans, etc. And they are all melded into this this pot. So it really is a very, very interesting country from that perspective. And, you know, when you come from a very homogeneous country like India, where a lot of people look very similar, it's very different! So, it really taught me the value of diversity and respect for other cultures. And that I think this has carried over into my work and to my professional life.

The other thing that I've done a lot in my career is that I've traveled a lot and I've taught all over the world. I've operated in lots of countries. I've operated in Antwerp, Singapore, India, and Brazil. You're gonna learn from your patients- you can learn from everybody. And you have to be able to be a good doctor, and a good surgeon. You have to be able to relate to people on their level and make them feel trust and confidence in you because they're giving us an awesome privilege of literally cutting on their body. They’re putting their life in someone's hands. I just don't even have words to describe it. It's one of the most awesome and fantastic privileges to have. We shouldn't take that lightly. That's a very, very profound level of respect and trust that people place in us.

And so going back to your question, growing up in different parts of the world and operate in different parts of the world, I've been able to see how the different cultures interact and how we can take from each of those cultures. And learning to be worldly allows us to then meet people on their levels, so that you're not talking down to them and really develop a rapport and build some trust in us. I’m not sure if I answered your question, but I think that's probably the best one I have.

 

Thank you! Yes, you absolutely did! The uniqueness of your background is not necessarily limited to this aspect of your life. You have a PhD in biochemistry and molecular biophysics, and you also did your your fellowship training at MD Anderson. You are, by definition, a surgeon-scientist. You could have probably been very, very successful in one of these areas individually, but you chose to do both. Why is that? What drew you to try and combining them throughout your career?

This is an interesting, and colorful, and funny story. It really started when I was an undergraduate student at Penn. I studied engineering because I wanted to be a scientist. I wasn't really that keen on medicine. It wasn't my passion. But I liked the medical aspect of engineering and trying to have an application relevant to healt. So my interest was not just building bridges, but doing something that was relevant from a healthcare standpoint. So we had to do a senior design thesis as undergraduates. And I found a person in the medical school to work with.

His name was Jack Leigh. He was in biophysics and he was also in bioengineering. And Jack was an amazing guy. He was a complete iconoclast. I had worked with him as an undergraduate and I had written two papers with him. I was very proud of myself for that. And I asked him: “I want to go to graduate school. Would you write me a letter of recommendation?”. And I was fully expecting him to say yes. And he looked me straight in the eye and said no! And I said, “Why not? I've worked so hard. I wrote two papers- one as first author. I mean, most undergraduates don't do that!”. And he looked at me and he said: “listen, there are three kinds of people in this world. There are the ones that can build a hammer to solve a problem. These are the scientists and the engineers. The nails are the problems that need to be solved. There are the ones that use these tools to see the problems to be solved. The doctors, the dentists, the nurses, the people that actually take care of patients. And then finally, he said there's a third category, a very small group of people, that does both. He looked at me and said, “So if I gave you a choice right now, which one would you want to be?”. I looked at him and said, “Well, if you put it that way, then I want to be number three- the one who knows the problems and solves the problems”. And he looked at me and said, “Right, so I'm going to write you a letter of recommendation for an MD-PhD program. That's what you're going to do”. And that's why I did what I did.

But that story stuck with me my entire life because, you know, we do sit on that very cool interface between straight clinical, which is knowing the problems; and straight science, which is solving the problems that you think you know the answer to. But the hardest thing to do is to actually understand what the real problems are. You know, a lot of scientists stay in the lab, and they do great work. They write really, really impressive papers, but they don't necessarily truly understand what the problems are that the patients or the physicians are dealing with. I think we need to train even more people to do this. That's why I've always tried in my career to straddle that fence and be both clinically active and scientifically active. Yes, I could have maybe been a bigger scientist had I only done science, or maybe been a bigger surgeon had I only done surgery. But being on that on that interface, I think has given me the opportunity to see the best of both worlds.

 

This story is truly amazing. Wow! You said you could have been maybe a bigger scientist or a bigger surgeon. But in reality, you are producing a lot of very impactful papers every year, and I understand that you are also very clinically busy. So, what does it take? What does it actually take to stay on top in both of those two areas?

I’ll have to go back to my mentor, Jack Leigh, again, who as you can tell, had a profound impact on my life. You need mentors. That's really, really important. But Jack also gave me a very good piece of advice as I was a young trainee in his lab. He looked at me and he said, “you know, there are three kinds of people in this world, who are successful. There are those that work hard and they're successful. Then there are those that work very hard and they're even more successful. And finally, you have the top of the top, the best of the best, most successful people, and they display prodigious effort”. So the key here is, a) you have to be passionate, and b) you have to display prodigious effort. And that's the only way to be successful in this. There is no other secret sauce. There is no other magic. There's nothing else. The environment is of great importance. Because you cannot be prodigious and successful if you are in an environment that doesn't support that. You have to have mentors who recognize this. People who recognize the value of doing this. Because it's much easier to have a straight clinician on your faculty, for example. Now that I'm a chair, I see that. It's much harder to recruit physician-scientists. It's hard to give them that environment. It's hard to put them in that in that space. It's easier to have a scientist. Us physician-scientists, surgeon-scientists are in this weird amalgam. But we also have a lot to contribute. To be able to translate from the bench to the bedside and so on and so forth. I think is really, really important. As a young person, look for a place that has an environment to allow you to develop.

 

I've never thought about that in this in this particular way, but it makes makes a lot of sense. I can definitely see that. Now, you talked about you being Chair- you recently began your new appointment as the NYU Langone Chair. So, I wanted to know what is your vision for the Department.

The way that I feel about it now is that we've got a great clinical Department, with amazing people. They're doing great, great clinical work. There are also amazing people here doing tremendous scientific work. My vision is to try to leverage those strengths, build on those amazing, strengths and attributes to try to push us towards areas that we have not traditionally done here. Or to tackle problems with, with a slightly different light. As a physician scientist, I would be lying if I didn't say that I was committed and excited about developing the physician-scientists and developing abilities to treat people in that model. And I want to be clear: being a physician-scientist doesn't mean you have to be an MD-PhD. You can, but it doesn't even have to be that, you don’t have to be in the lab. You can be a physician-scientist in population health and clinical research and clinical trials. You can be a physician scientist in comprehensive general otolaryngology, or in a subspecialty. But, I don't want to present this as if physician-scientists are the pinnacle of greatness. No, that's not that's not the point. We just have a role to play like everybody else.  Like a football team. Everybody can't be a striker. Everybody can't be a goalkeeper. Everybody can't be a quarterback. Everybody has a role to play. This is just one of the roles. It's not better than anybody else. It's not worse than anybody else. It's just different. But you need some of those people to try to help develop the science aspect of things.

Most importantly the translational science aspect of things. I'd love to see NYU Otolaryngology under my tenure to grow in those areas. Surgical innovation, driving clinical growth and productivity as well, providing high value care. My slogan is: I want my Department to be patient centric, outcomes oriented, innovation driven.

1)    Patients first: Make it easy for patients to get their care.

2)    Excellent outcomes and high quality care.

3)    Innovate. Research innovation drives new technologies that will improve outcomes, push us to the higher levels while being patient-centric. So it's kind of like a triangle. All these three things should go together.

Another great mentor that I had was a surgeon scientist at Penn, Dr Doug Fraker, who did amazing amazingly high volume surgery and was a scientist. I asked him how he did that and he said “you need to make the operating room your laboratory. You need to find a way that your science comes from the OR. So your clinical practice gets folded into your science and into your investigation. That becomes how you do science, whether it's clinical trials or surgical innovation or taking the specimens from the OR to the bench to study it. These are the ways where your clinical work informs your science, and that's what I've tried to do.

Robotics has been my area. That's not all I do, but that's what I write about. Every patient that I operate on, I find a way to get their information, study that, write about new techniques, write papers on this stuff, and hopefully people will find it useful and it will help to be a force multiplier going forward by training other generations and other sets of people to push this forward.

 

And it probably allows you to create unique cohorts, unique samples, unique populations. Because you are actually seeing these patients. Like you said, you're seeing the problem that they're facing. Then you go back to the lab and try to create the right questions because you have the samples.

The biggest thing that that young people need to know is that they have to be able to say ”I'm not just going to keep doing something the way that I'm doing it, because my professor told me that's the way it should be done”. You need to ask the question, how could I do this better? Or is this the best way of doing it?. If we all thought the best way of treating cardiac disease was by giving everybody aspirin and just having them lie down with their feet off the bed, then we would still be having the same mortality that we did 50 years ago. It's because people said, well, is there some other way to do this? Is there some better way to do this going forward? That's why we invented stents, catheterizations, statins etc. That's why the survival for patients is so much better now.

We've moved because we've asked people to say, is there a better way of doing it? People have to ask that question. So that's what I think young surgeons need to know. And that's what, again, going back to your question about NYU, that's where I would like to go with my program for residency. I want to train the next generation of people who are not just great clinicians. They are going to be great clinicians performing standard of care as we have now. But at the same time be inquisitive enough to ask questions. I want to encourage them to think outside the box and to say, is there a better way of doing this? Because those are the people that are going to really change the field long after I'm gone.

 

Is it talent or is it character that makes a good surgeon, in your opinion? It's easy to say that it's both, but I know you're not keen on the on the easy choices.

I think here it is both, because both things play a role here. I think that it's hard to pick which one of those two very important things are there. I'll answer it this way. There's a famous quote that that I heard from Claudio Cernea, who was a maestro of head and neck surgery from Sao Paulo. And Claudio told me this when I was a young surgeon: one who works with his brain as a scientist, one who works with his hands is a craftsman, one who works with his heart is an artist but, the one who works with his heart, guiding his brain through his hands is a surgeon.

Compassion, intellect, character, and technical talent, are all really important aspects of being a surgeon. But what's what's more important in my mind is the thought behind that technical talent. There was a famous saying, I think it was by Halsted, that said, I cannot wait for the day when an academic institution will enroll in their faculty a surgeon without hands.

Because what we do with our hands is by far the least important of being a surgeon. It's all between the ears. It's all up here. This is where surgery happens. It's not the hands. So when you say talent, I think talent comes with character. I think it comes from people that display prodigious effort, which I think is character that asks the question why? Why aren't we doing it better? How can I do this differently? Or is this the best I can do? That's also a character, right? Caring for your patients is character. Wanting to do the right thing, even when it is easier to not. This is character. And this is right. This is why we see many, many talented surgeons do bad things and get into trouble. We see fraud of all kinds, not because these individuals are not talented, but because they lack character. And so I think that if you were to pin me down, I guess I would have to say both are important, but character is what defines surgical greats.

 

Thank you. What, in your opinion, is a predictor of success in residency? What are you looking for in an applicant, and what do you use to make an assumption about whether they're going to do good/ great/ poorly.

I think really what it comes down to is asking the question I mentioned earlier- somebody who is appropriately inquisitive and appropriately questioning will be successful. And so what I'm thinking on this, is how do we develop better versions of those in residency? The question we ask is, how do you know someone's going to be a good resident? Are they inquisitive? Are they thoughtful? Do they have character? Do they have the fortitude to actually do the right thing?. And are they willing to display prodigious effort to be great? Because you can coast through residency and be fine. Or you can work really hard and be great. And that is ultimately the measure. What residency is doing, in my opinion, is not just ending your training. You're just in the middle of your training, because you're going to continue to refine your art for your career. That's why it's called the practice of medicine. You're not done with residency. You're just learning how to think. That's my job- to teach you how to think. So if you can learn how to think, then you can continue to develop that.

At the end of the day, I'm looking for that. I'm also looking for people that actually want to drive some change in the field. That want to make an impact. And that impact doesn't have to necessarily be in the science or the bench. You can make an impact in your community by just being a great doctor that's practicing great cutting edge care in a rural community or in an urban center like New York.

 

So it sounds like you're looking for the foundation to build upon those qualities.

Yes. And I think some of these are qualities that people will develop over the course of their lives. I was lucky to have Jack as a mentor, who taught me and showed me that this is what I should be trying to aspire to. If I hadn't had that, I wouldn't be who I am now. I acknowledge that 100%. I owe much to him. And so, hopefully when I was applying to residencies, people saw that. And we're looking for that, but also acknowledging that not everybody is going to be like me and that's fine. Not everybody in residency has to do the same thing. We don't want everybody to do head and neck, or everybody to do general, or Peds. But some common themes in this are this desire to really be excellent.

 

What would you like to be remembered for as an academic surgeon? As a scientist? As a professional?

Wow, that's a great question. I don't know how to answer that one. I guess, there are a couple of ways. You know, people always talk about, what's my legacy going to be? People want to think of it from that perspective. I don't know that I necessarily think of it that way, but there are two things that come to mind. One is Satya Nadella, who is the CEO of Microsoft. He famously said once, “I didn't ask to be the CEO. That wasn't my next step. I just did the job in front of me as best as I could, at every point in time”. I think that's a great way of looking at it. I'm not looking at what my legacy is going to be. What I want, though, is to have the ability for people to say, you know, he did a great job at wherever he was at this point in time. Of course, I recognize that not everybody is going to like what I do. Not everybody like what anybody does. That's just life. But, I think there's opportunity for us to continue and push this forward.

So do the best job to be recognized as somebody that deeply cared about the people that that worked with me, my residents, my trainees, others. There's an old saying that the student of a master is a master and a half. I firmly believe that my goal is to train the next generation of surgeons, who are going to be even better than I am. Another great mentor of mine, who I'm very fond of, is Gene Myers, who was just amazing and gave me great mentorship. He was very proud of the fact that I became chair because he looked at me and said, “you know, you're the the last of the breed of the people that I trained”. And because I was that tail end of that career for him, he said, “you're the 28th chairman that I've trained”.

He was very proud of that. And why shouldn't he be incredibly proud of that? I would be, if I had that. He trained all of these chairs, and division chiefs and leaders. And so one should be proud of that. I think that there's great value in knowing that I contributed in some significant measure to that success for someone. And most importantly, going back to my slogan, patient centric. Feel that my patients benefited from my care for them as well. The most important reason we're here is to take care of the patients, to be patient centric, to do the right thing for the patients. And so if I innovate, if I develop, whatever I do, it should be with the idea that it's going to actually help people, not just write a paper for the sake of writing a paper.

 

I appreciate you sharing your thoughts.

Well, thank you for asking the questions. Good questions. Interesting. And I hope that it was useful to you and hopefully it'll be useful to other people.