When those in charge at the Orthopaedic Research Society (ORS) were reviewing potential presidents for 2012, they saw one extraordinary, seasoned researcher who could bring an expanded vision to the organization. They saw Dr. Ted Miclau.
“He holds coveted research grants.” But so do other orthopedists.
“He has built a research lab.” So have other orthopedists.
“He cares.” Don’t we all?
What makes Ted Miclau stand out is a combination of unusual achievements in the research and administrative realms, an exceptional understanding and compassion for those who are in need, and the fact that he routinely puts those emotions into action in a sustainable way.
No lab rat, Dr. Miclau’s true milieu is not the sterile, orderly world of flasks, beakers, cadavers and esoteric scientific inquiry. While his high quality research follows all the appropriate protocols, his background reveals a familiarity and indeed a comfort with real life…with the unkempt, irrational, often messy world of people, culture, poverty, and aspiration. Undoubtedly, he is a better physician for having lived it.
Dr. Ted Miclau, the next president of the ORS and a professor in the Department of Orthopaedic Surgery at the University of California, San Francisco (UCSF) School of Medicine, grew up knowing the difficulties inherent in navigating another culture, dealing with divorce, and barely having enough to live on.
A young Ted Miclau grew up in Puerto Rico and held a number of odd jobs—in some cases, truly odd—in order to buy his own clothes and otherwise help support the family. Dr. Miclau: “My parents moved the family to Puerto Rico in the ‘70s, but then divorced. My mother stayed and raised my brother and me, but most of the time we didn’t have two nickels to rub together. I did what I could to make money, from babysitting chickens, to unloading cargo on the docks of San Juan, to working the cash register at my father’s discotheque. All along I was learning the value of hard work and adversity.”
This grit runs deep in Dr. Miclau’s family. “At the age of 16, my paternal grandfather took a boat from Romania, landed in Patagonia, and worked his way up to the U.S. in a variety of different jobs, including railroad gangs. Once he reached Chicago he met my grandmother, and opened several businesses, including a nightclub…a nightclub that Al Capone frequented and wanted ‘a piece of.’ He left that dangerous situation and went to Cleveland, where he started new businesses. Overall, he made and lost his fortune twice, but still died a millionaire. This is a great American Dream story, and a recurrent theme in my family…work hard and never give up.”
But if he ever did flirt with the idea of giving up, it may have been during the “birthing” process of the Orthopaedic Trauma Institute (OTI). Dr. Miclau explains, “The concept of the OTI, a collaboration with UCSF and San Francisco General Hospital (SFGH), started in 2002 when I set out to develop a comprehensive center with an academic focus on trauma. My goal was to develop an entity that would add something to UCSF (rather than compete with its existing programs), as well as serve the mission of SFGH. The hospital is owned by the city, which contracts the university for its physicians and support staff, and its day-to-day activities involve an interesting mix of city and county and state university regulations and politics. In navigating these waters during the building of a completely new entity, I definitely honed—and taxed—my diplomatic skills.”
Dr. Miclau’s diplomacy skills were not learned from a book or a weekend course on how to communicate. They were born of witnessing and participating in real life. “When my parents divorced, my mother worked full-time, sometimes having to drive over an hour-and-a-half to get to her job. We still had very little. She was an exceptional female role model, working as an American female in a male-dominated Latin American world, and she set an incredible example for me. This level of respect has now carried over to my interactions with female professionals, which I believe helps me have a healthy, mutually supportive working relationship with them.”
Ted Miclau knows that if you’re going to make progress as a leader, then you had better feel comfortable loosening your grip on your perspective in order to see things from the other person’s perspective. “Puerto Rico in the ‘70s was a time of strong (and sometimes violent) anti-American sentiment. I grew up a minority in Puerto Rico, and learned what it was like to be different, including what it was like to be helped last in a store. I know what it feels like to not be considered important. Not only do I never want my patients to feel like that, I never want the opinions of my orthopedic colleagues to feel undervalued.”
And if the person across from him is experiencing something that he or she is not expressing, there is a good chance that Dr. Miclau will know. “As an undergraduate at Yale I majored in psychobiology, and my thesis involved using a facial recognition system that helped me interpret the emotions of patients with breast cancer and Tourette’s syndrome through their facial expressions. As a physician, this is a particularly useful skill. For example, if a patient is reluctant to question me about something, I can pick up on that…and then I can draw them out and have a more full discussion, something that inevitably contributes to a successful treatment. If the situation involves a colleague, this knowledge helps me to move closer to understanding his or her way of thinking.”
Which brings us back to the uphill battle of the OTI…“Just getting the building renovated was an exercise in diplomacy and fundraising. There was no available money from the university, and the city didn’t have the funds, so we did it all using other resources. To date, we have invested $6 million into the project—and this is in a county hospital with a poor payer mix. About one-third of our funding came from our reserves (doctors reinvesting back into their workplace), one-third came from extramural funding, and one-third came from creative negotiations with companies from which we needed equipment. Furthermore, we developed a new model for a surgical training facility that included collaboration with industry partners. I’m proud to say that we have now trained over 5, 000 surgeons from all over the globe.”
So how did this “surgeon’s surgeon” develop an interest in the medical arena at all? Via dogs and cats. “I worked for a veterinarian during high school in Puerto Rico. I did clerical work, cleaned cages, and restrained the animals for immunizations. Along the way I found that I preferred to be able to communicate with human patients, and I began to consider a career in medicine. I ended up being the first student from my school to be accepted to Yale University.”
When asked about his most career-altering experience, Dr. Miclau states, “Hands down, my most professionally influential experience was the research that I did with the AO Research Institute in Switzerland. It was not the most important work I have ever done in terms of the impact on the field, but it stimulated my interest in orthopedic trauma and academic medicine. I was especially captivated by fracture healing, and found it fascinating that bone was capable of regenerating with tissue that was indistinguishable from its pre-injured state…this is what led me to study the cellular and molecular mechanisms behind musculoskeletal injury and repair.”
After a trauma fellowship at Baylor, Dr. Miclau was recruited to UCSF. “My primary goal was to develop a research program at SFGH; four years into the process, I received a K08 career development award from the NIH, which was the first one of its kind to be granted to an orthopedic surgeon in ten years. In order to be successful in this grant, I had to work within a highly supportive environment. The take home lesson—for me as well as the younger surgeons I advise—is that one should seek the best possible situation to achieve one’s goals. It hasn’t always been easy, however…the second year into the grant the orthopedic division at SFGH collapsed, and I had to juggle departmental rebuilding and patient care, with my NIH-mandated research commitment…and I was working well over 100 hours a week.”
When asked about an unpopular topic—failure—Dr. Miclau is straightforward. “It’s going to happen. The most valuable thing that I have learned from failure is to persist, be patient, and realize that just because you haven’t yet achieved your goal doesn’t mean that you can’t try a different approach to the problem. The OTI is a good example of having to try something different when the first approach did not work. From something as simple as, ‘No, you can’t paint the door that color or put that sign there’ to rolling up my sleeves with my last remaining partner, Dr. Rick Coughlin, to figure out ways to bring in revenue in a highly resource poor environment. These experiences, coupled with the challenges of my youth, have most definitely taught me the value of persistence and creativity.”
In part two, learn about Dr. Miclau’s efforts to expand research capabilities for surgeons in Latin America, his research, and future plans for the ORS.
