Francisco G. Cigarroa, MD, was serving as director of Pediatric Surgery at the University of Texas Health Science Center in San Antonio (UTHSCSA) when he received a phone call from a member of the search committee for the center’s next president. It was 2000, and he had spent the previous five years building the center’s pediatric transplant service from scratch, the first of its kind in central and south Texas. The person on the other end of the line told him he was on the short list for the presidential post.“I became terrified when I realized that I made it to the final list only five years after beginning my academic career. I thought: ‘This might really happen,’” Dr. Cigarroa recalls. “I loved my life’s work and wasn’t so certain I wanted to move away from it, even for such an important position. So I got on a plane to Boston as quickly as I could.”
Hours later, he was sitting in the office of W. Gerald Austen, MD, former chief of Surgery at Massachusetts General Hospital, seeking advice about whether he should pursue the possible opportunity. When he was done, he knocked on the office door of Patricia K. Donahoe, MD, director of the Pediatric Surgical Research Laboratories at MGH, and did the same thing.
“I spent about two hours in each person’s office,” he says. “They gave me the confidence to move forward in the interview process and affirmed that the presidency would be a good professional choice because, we agreed, from that perch, I could have a bigger influence on medicine than as a surgeon.” Dr. Austen recommended that he continue to take surgical call on weekends when possible. Weeks later, he was selected to the position of president, and he accepted.
For Dr. Cigarroa, Drs. Austen and Donahoe are mentors going back two and a half decades. Beginning in 1983, he spent eight years at Mass General in its surgical residency program during Dr. Austen’s tenure as chief of Surgery, combined with a two-year stint in pediatric surgery research in Dr. Donahoe’s lab. Like his closest friends and family, they call him “Cisco”. The duo not only trained him but, in Dr. Donahoe’s case, inspired him to go into pediatric surgery — he initially wanted to become a cardiac surgeon — and also pursue a career in academic medicine where research and teaching would be central components to his work.
Dr. Cigarroa went on to make dramatic advances in academic medicine at UTHSCSA, and last year he was selected as chancellor of the University of Texas System, one of the nation’s largest public higher education systems with nine university campuses and six health institutions. (He consulted his MGH mentors when he was short-listed for that job, too.) The consecutive appointments made him the first Hispanic in the U.S. to head up an academic medical center and to lead a university system.
As with other successful alumni of MGH residency programs, the new chancellor’s career tells the story of Mass General’s powerful role in medical education and, as economists might say, the ‘trickle-down effect’ the institution has on raising the quality of medicine well beyond its own walls.
“Mass General’s impact extends well beyond the excellent care provided within its walls. The institution has trained countless physicians to become leaders in all areas of medicine and beyond. Our graduates’ influence on health care, education, public policy and in other realms is quite remarkable,” says Debra F. Weinstein, MD, vice president for Graduate Medical Education at Partners HealthCare (Mass General’s parent organization) and a former MGH residency director. Dr. Cigarroa, she says, is a great example of that phenomenon.
Born and raised in Laredo, Texas, Dr. Cigarroa, who is 52, comes from a family of doctors. They include his grandfather, who immigrated to the U.S. from Mexico and settled in San Antonio at the end of the Mexican Revolution, and his father, who is a Harvard Medical School alumnus and still practices cardiology in Laredo. Dr. Cigarroa — the chancellor — is one of 10 children, five of whom went into the medical field; his uncle was a general surgeon who inspired him to follow that path, and an aunt was a pharmacist. Two of Dr. Cigarroa’s brothers also trained at Mass General, both as residents in internal medicine, and one stayed through his Cardiology fellowship. A third brother was a medical student at Harvard.
Dr. Cigarroa graduated from Yale University in 1979 and, after receiving his medical degree from UT Southwestern Medical Center at Dallas, he came to MGH for his surgical residency, where he ultimately became chief resident. In those years, Dr. Austen used to appoint two “super-chief residents” who spent an additional year helping to oversee the other residents: Dr. Cigarroa was one of them.
He took a mid-stream break for a two-year research stint with Dr. Donahoe. What “amazed” him about Dr. Donahoe, “was not only her absolute commitment to patients but her incredibly inquisitive mind,” recalls Dr. Cigarroa. “She was always asking the questions: ‘Why did this child develop this disease? How can we improve the way we are taking care of this child?’ She taught me how to take an observation from a patient’s bedside and bring it back to the laboratory and begin developing experiments to answer our questions. She taught me what translational science actually meant, and this was before translational science was even a phrase.”
That approach drove him “almost overnight” to enter an academic career in pediatric surgery, he says. In her lab, he helped advance Dr. Donahoe’s investigation of a natural protein called Mullerian Inhibiting Substance as a potential inhibitor of ovarian and uterine tumors. He made a critical breakthrough in the study, and his outgoing personality, says Dr. Donahoe, helped him bring two labs together to make it happen. “Cisco was fearless in undertaking pretty sophisticated problems that were equivalent to what our post-doctoral fellows would do,” says Dr. Donahoe.
Since those days, Dr. Cigarroa says, “I don’t do anything in my life that’s substantive in regards to medicine or health care without seeking Patricia’s counsel.” In fact, he adds, “One of the most amazing things about Mass General is that when you become a resident there, you really become a lifelong family member.”
Dr. Austen, who developed friendships with many of his residents and their families, grew close to Dr. Cigarroa and his wife, Graciela, and their two daughters, who were born during their years in Boston. “He was extremely bright, had fabulous medical knowledge, was a great diagnostician, was a first-class surgeon — and, on top of all that, was the nicest person in the world,” says Dr. Austen. Just the kind of surgeon MGH likes to keep, he adds. Both he and Dr. Donahoe lobbied their colleague to stay.
But his Texas roots pulled hard, and Dr. Cigarroa and his wife wanted their girls to grow up surrounded by their large, extended family. He also had a great devotion to the Hispanic community he was part of, and felt compelled to return to it.
So the Cigarroas left Boston for Baltimore, where he did a fellowship at Johns Hopkins Hospital, and a year later moved to San Antonio when UTHSCSA hired him as its first pediatric and transplant surgeon with a joint academic appointment. The expectation was that he would start a pediatric transplant program.
Glenn Halff, MD, interim dean of UTHSCSA’s School of Medicine and director of its Transplant Center, performed many surgeries with Dr. Cigarroa in those years and calls him a “superb surgeon”. The two surgeons led a team that did the first successful pediatric small bowel transplant in Texas. They also performed the first surgical procedure at University Hospital (a UTHSCSA teaching affiliate) in which a donor liver was split in two — which he learned at Mass General and Hopkins — for transplanting a half of a liver into newborn or infant recipients. Until that procedure became more common, most young children in need of new livers died because adult livers are simply too big and those of the correct size for infants are very rare.
As UTHSCSA president, Dr. Cigarroa followed Dr. Austen’s advice to keep his hand in surgery, taking surgical call two weekends out of every month, which, he says, also gave him exposure to the day-to-day activities in the hospital and thus helped him be a better administrator. Back at his desk on Monday mornings, he was the chief executive to the center’s five schools: a medical school, a dental school, a doctoral program, a nursing school and an allied health program. Today, as the UT System chancellor, he travels one weekend a month from Austin to the medical center in San Antonio, for rounds and on-call duties.
Dr. Cigarroa’s impact has been felt widely in Texas. During his nine-year UTHSC tenure, the center’s spending on research increased to $146 million, up from $86 million. And, working with state legislators, he spearheaded the establishment of a new academic medical center in south Texas along the Mexican border, a historically medically underserved area with a large and fast-growing immigrant population. Today, the Regional Academic Health Center (RAHC) is comprised of a teaching hospital, research facility, a school of public health and medical education facilities where third- and fourth-year UT medical students can train and study. It partners with the Veterans Health Administration to serve the large military population.
By his and other accounts, the RAHC initiative has become a huge success, boosting the number of newly minted doctors, creating jobs and dramatically improving medical care throughout the region. Its research investigations focus on health challenges particular to the region, including diabetes and hepatitis C.
Despite his successes, however, Dr. Cigarroa resigned in late 2008 to return full time to the operating room as a pediatric and transplant surgeon. He never started the job: the search was on for the UT chancellorship, and the search committee moved fast.
As a new chancellor — overseeing 194,000 students and 84,000 employees — he has new ambitious objectives. He wants to secure more training slots for medical residents; more than 40 percent of Texas’ graduating medical students leave the state for postgraduate training because of the shortage of slots, and many never return. That, in turn, will address Texas’ particularly dire shortage of physicians. He also wants to reverse the underrepresentation of Hispanics and blacks in the health professions to better mirror the changing population; he cites an Institute of Medicine study showing that doing so will improve clinical outcomes. His fluent Spanish is always handy, and Hispanics, Dr. Donahoe attests, see him as a role model.
As chief executive for nine university campuses, he’s focused on keeping tuitions low, improving standards and ensuring more Texans gets a college education than ever before. He’s trying to bring in more money for research, remedy the 15 percent drop in endowment that occurred over the last year and rebuild a Galveston campus that was devastated in Hurricane Ike in 2008.
With all that on his plate, Dr. Cigarroa continues to draw on skills he learned in the operating room. “As a surgeon and physician,” he says, “you have to be a good listener and diagnose the problems facing you, and find the optimal way to solve them, not just by yourself but by effectively working within a team.”