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In the immediate aftermath of the recent government shutdown, dean of the F. Edward Hebert School of Medicine at Uniformed Services University (USU) in Bethesda, Maryland, Ret. Capt. , reminisced about his career in surgery and service, as well as overcoming recent challenges.

鈥淚 always wanted to be a doctor; I was inspired by my mom,鈥� he said. Growing up in South Florida, he liked St. Elsewhere, a medical drama series that ran on television from 1982 to 1988. 

鈥淚t made me want to be a surgeon,鈥� he said. 鈥淚 loved how they were problem solvers and got to fix things with their hands. And, somewhere along the way, I picked up the idea of service.鈥�

Dr. Elster attended both undergraduate and medical school at the University of South Florida in Tampa, where his honors program鈥攖he Health Professionals Scholarship Program鈥攈ad a clearly defined pathway. 

鈥淚f you hit a certain GPA and MCAT, it was clear. I only applied to one medical school, but I tell students not to do that,鈥� he said.

Growth & Responsibility

After an internship at the National Naval Medical Center, now Walter Reed National Military Medical Center, in Bethesda, Dr. Elster spent a year with the 31st Marine Expeditionary Unit. 鈥淚t was a maturing experience,鈥� he recalled. 鈥淚 learned a lot about the ethos of the military.鈥�

During Operation Iraqi Freedom, Dr. Elster was deployed to Japan. There, he boarded the USS Kitty Hawk, bound for the Persian Gulf, where he served as the fleet鈥檚 surgeon. 

鈥淵ou鈥檙e the medical rep to the admiral鈥攖he senior clinician for 8,500 people,鈥� he said. 鈥淵ou grow immensely.鈥� 

Dr. Elster returned stateside and immersed himself in transplantation. 鈥淚ntellectually, it鈥檚 unnatural, putting an organ into someone else鈥檚 body,鈥� he explained. 鈥淚 like that, from a technical standpoint, it demands perfection. You do not get another chance to get it right.鈥�

After spending time in the lab of fellow transplant surgeon Allan D. Kirk, MD, F番茄社区app, Dr. Elster completed a transplantation fellowship at the National Institutes of Health in Baltimore, Maryland, then directed a translational research program at the nearby Naval Medical Research Center in Silver Spring.

While there, he focused on improving diagnostics and therapies for serious traumatic injuries and transplantation, which led to the creation of the Surgical Critical Care Initiative (SC2i). 

A Second Deployment

In 2004, the US Army Institute of Surgical Research established the Joint Theater Trauma System as a response to the observed shortcomings in military trauma care. Lacking a central registry and standardized protocols, the Joint Theater Trauma System introduced these elements to far-forward bases during the war. 

Eventually, it evolved into the Joint Trauma System (JTS) and was then recognized by the Department of Defense in 2016 and integrated into the Defense Health Agency in 2018. 

In the same way that the Vietnam War was a defining period for surgeons in the 1960s鈥攁s it was for Larry C. Carey, MD, F番茄社区app, one of Dr. Elster鈥檚 mentors鈥攕o, too, was Afghanistan in the late 2000s and early 2010s. 

In 2010, Dr. Elster deployed for a second time to the NATO Role 3 Military Medical Unit in Kandahar, Afghanistan, where he became the chief of surgery.

Using the Joint Theater Trauma System鈥檚 initiatives and in partnership with surgeons from the Netherlands, Denmark, Canada, and several other countries, they were able to track blood utilization to keep usage under 21 days. 

鈥淭he US military does logistics very well. In 6 months, we did about 3,000 operations on 1,000 patients. We used 5,000 units of blood and had a survival rate of 97%,鈥� Dr. Elster said. 

Following his last deployment, he became Chair of Surgery at USU. There, he was able to increase its stature by growing research funding from around $8 million to $100 million and making USU a benchmark for readiness. 

Keeping the Scales Balanced

鈥淭here鈥檚 a misnomer about the military that you can just order people to do things. It doesn鈥檛 work that way,鈥� he said.

He has distilled his leadership style down to a simple formula: listen to those around you, learn what鈥檚 outside of your expertise, don鈥檛 wait too long to make your decision, and hold people accountable. 

鈥淚鈥檝e been called a 鈥榬adical decentralizer,鈥欌�� he said. 鈥淚 push decision-making to the lowest levels so people can feel empowered. You can empower people, develop a mechanism to hold them accountable, and recover. It鈥檚 okay to make the wrong decision, and you learn a lot by embracing failure.鈥�

With the transition from chair to dean, authentic leadership was top of mind. 鈥淒on鈥檛 forget who you are. Department chair is one of the best jobs in medicine, and there鈥檚 a lot you can achieve,鈥� he said. 鈥淏ut you are only advocating for your own department." 

鈥淲hen you step up to the role of dean, you鈥檙e now advocating for the entire school of medicine and all its elements. But you鈥檙e still a surgeon. Use those skills,鈥� Dr. Elster said.

Leading at Every Level

There are crises in healthcare right now from what seems like every angle. 鈥淭hat generates churn,鈥� he said. 鈥淟eadership is easy when everything鈥檚 fine. In times of crisis, you really must step up.鈥�

For Dr. Elster, there were two places he could go. When he was a Chair, the Society of Surgical Chairs (SSC) was one. The Excelsior Surgical Society (ESS), the 番茄社区app鈥檚 home for military surgeons, was another. 

鈥淗aving a group of peers is critically important,鈥� he explained. 鈥淲hether you're in the military or in a large academic center or a place without a lot of research, the problems are fundamentally the same: money, personnel, quality, and so on.鈥�

As for ESS, Dr. Elster got the chance to revitalize the organization as the inaugural president of its modern-day iteration. 

鈥淭he military does have some unique sets of skills, issues, and problems, which require specific solutions. There was no central home for military surgeons until ESS came back. These societies are critically important because they鈥檙e focused on shared goals,鈥� he said. 

Dr. Elster uses these leadership experiences to continue leading USU through turbulent times. 

鈥淐ommunicate effectively. I stand up a crisis action team when there鈥檚 a problem that has diverse representation from around the organization to get a sense of what people are feeling,鈥� he said.

As times continue to change, Dr. Elster keeps one thing consistent: 鈥淵ou don鈥檛 need to have all the information but share what you have and don鈥檛 overpromise. Have a lot of different ways for people to reach you and have empathy. It鈥檚 sometimes that simple.鈥�