History

Eastern Cardiothoracic Surgical Society
(formerly knows as Pennsylvania Association for Thoracic Surgery)

PATS: A History of Initiation and Development
George J. Magovern, M.D.
Founding Member, Pennsylvania Association for Thoracic Surgery

The preservation of the history of PATS is in large part due to Dr. Thomas Ryan, who in 1970, as the eighth president of the association, presented “an outline of the history of this organization…in the hope that it will be included in the minutes for future reference.” He attributed the beginnings of the association to Dr. Edward Kent, with whom I first became associated when I was a resident in 1956.

Kent, EdwardDr. Kent, who was at that time a representative of a subcommittee on fees relative to thoracic surgery for the Pennsylvania Medical Society (PMS), germinated the idea of PATS in 1959. At that time, there was no unity and, in fact, little general knowledge about the fee structures in thoracic surgery. Dr. Kent contacted the members of the PMS who were also members of the American Association for Thoracic Surgery (AATS) regarding fees for their specialty, stating that this was necessary because there was “no Pennsylvania group representing thoracic surgeons.” The letter was mailed March 2, 1960. Thus, our roots originate in the parent organization for all thoracic surgery in the United State, the AATS.

There were seven senior, 12 active and 12 associate members of the AATS in Pennsylvania at that time, and it was estimated that there were probably another 10 to 12 thoracic surgeons in the state who were not AATS members who could also comprise a founding group. On March 22, 1960, a letter was sent to all members listed in the most recent program of the AATS concerning the formation of a state group. Most who replied answered in the affirmative, including Dr. Julian Johnson and Dr. John Gibbon, the latter despite his many duties as president of the AATS. The positive response confirmed the idea that a state thoracic surgery association would be worthwhile, especially for the younger surgeons. The foresight of those who founded the organization lay in an understanding that the socioeconomic conditions of the 1960s were in flux and that this should be an important consideration of the organization.

Subsequently, in December 1962, Dr. Kent planned a meeting of the thoracic surgeons that coincided with the American College of Surgeons’ meeting in Pittsburgh on March 13, 1963, at the Penn Sheraton Hotel. The meeting was attended by Drs. John Gibbon of Philadelphia, Julian Johnson of Philadelphia, Edward Kent of Pittsburgh, Charles Kirby of Philadelphia, Thomas F. Nealon of Philadelphia, George P. Rosemond of Philadelphia and Thomas C. Ryan of Greenville. There was discussion about the needs of a state thoracic organization, and Dr. Kent was proposed and approved as the temporary president to act until elections were held at the first meeting. Dr. Thomas Ryan was proposed as the temporary secretary.

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It was determined that founder membership in the state organization would be eligible to all active associate and senior members of the AATS residing in the state of Pennsylvania. Any additional founder members would be decided by the membership committee, composed of Drs. Kirby, Nealon and the temporary president and secretary.

Photo - RosemondThe first meeting was scheduled for the latter part of September 1963, and the proposed sites were the Hershey Hotel, the Pocono Manor Inn or the Bedford Springs Hotel. Other members in attendance were Drs. Blakemoore, Burnett, Gibbon, Johnson, Kirby, Nemir, Nealon, Rosemond, Ryan, Sanes and Templeton. The membership and the program committee consisted of Drs. Kirby and Nealon, and Dr. Ryan was acting as secretary.

At the AATS meeting in Houston, Texas, Photo - Willauerthat year, the program and membership committees of the new Pennsylvania group decided that their first meeting would be at the Pocono Manor Inn Friday, September 20, to Sunday, September 27, 1963, and they established the general format of our meeting that remains. It was decided that founding membership be offered to all thoracic surgeons in Pennsylvania who were members of the AATS and to all those certified by the American Board of Thoracic Surgery who resided or worked in Pennsylvania. The initial list had on it names of about 64 eligible thoracic surgeons.

The first meeting at the Pocono Manor Inn was a success, both scientifically and organizationally. It was then that we adopted the constitution and bylaws of the AATS, and they have served reasonably unchanged since. At that meeting, Dr. John Gibbon was elected president, a capacity in which he served at the next meeting in 1964. In 1965, Dr. Julian Johnson was elected president and directed the meeting in Buck Hill Falls. He was followed by Henry Bahnson at Hershey in 1966; Wilbur E. Burnett at Bedford Springs in 1967; George Willauer, the most colorful of all of the former presidents, at Shawnee-on-the-Delaware in 1968; John Schneider at Hershey in 1969; Thomas Ryan in 1969; and, in 1970, Paul Nemir at Lancaster in 1971. I presided over the 10th annual meeting at Fernwood in Bushkill, PA.

Photo - BahnsonThus, those first 10 years of the organization were a wonderful time of innovation when each meeting was presided over by individuals who contributed to our field on a national level and who, in the early years, were absolute giants in thoracic surgery – namely, Drs. Kent, Gibbon and Johnson, all of whom were or would be president of the AATS. During this 10 year period, those who performed a marvelous job of recording our history as secretary for the association were Thomas C. Ryan of Greenville and George Haupt of Philadelphia. The following serves as a brief summary of each of the first 10 meetings of the association.

The first executive session of the association was called on September 20, 1963, by Dr. Kent. The nominating committee consisted of Drs. Kirby, Nealon and Bahnson, and it boasted an organization committee of Drs. Julian Johnson, William Lemo and myself. The meeting committee consisted of Drs. Alfred Frobese as chairman, Gilmore Sanes and Thomas Ryan, and a medical economics committee was made of Drs. Henry T. Nichols, Edward Kent and William DeMuth. On the following day, Dr. Kirby forwarded the recommendation of Dr. Gibbon as president-elect, Julian Johnson as vice president, Thomas C. Ryan as secretary, George J. Magovern as treasurer and Wilbur E. Burnett and George Willauer as counselors. I was at this meeting, and it was delightful as a young surgeon to be introduced to so many giants. I remember the golf and tennis tournaments, but more importantly the unique storytelling that went on after dinner by Dr. Chuck Fineberg.

Chuck was a member of the faculty at Jefferson with Dr. Gibbon, and his stories were legendary, particularly the story of the “Irrowade Reptile”, which he told with the accent and mannerisms of an English colonel serving in India, or, as he pronounced it, “Inja.”

Photo - JohnsonThe following year the governing board of our organization met at the Queen Elizabeth Hotel – in conjunction with the AATS meeting – in Montreal on April 27. Under discussion was the registration for the upcoming annual meeting, and it was decided that the registration desk would be staffed by program committee members’ wives and that there would be no charge for present members, residents and interns, but non-members would be charged $5.

Our second annual meeting was held at the Bedford Springs Hotel with Dr. Gibbon as president. As treasurer, I reported that we had collected $770 in dues, had $212 in expenses and that the treasury as of September 24, 1964, had the magnificent sum of $557.69. Of significance was the report by Dr. Henry Nichols, chairman of the Economics Committee, who reported that he had performed a survey of thoracic surgeons throughout the United States and that there appeared to be a wide divergence in fees in our specialty. That year, Pennsylvania had the lowest fee schedule in the Unites States for thoracic surgery, particularly for cardiac surgery. We decided that Dr. Nichols would meet with Blue Shield of Pennsylvania and state the case for cardiac surgery in Pennsylvania.

A major blow at that meeting came when Dr. Snyder reported the untimely death of Dr. Charles Kirby, a pioneer member of our organization and an associate of Dr. Julian Johnson. Dr. Kirby’s death was secondary to a myocardial infarction at the age of 50. His great ambition had been to perfect an implantable artificial heart device about which he said, “The engineering know-how and cost of it compared to the Manhattan project would be minuscule.” He felt that an artificial heart could be constructed and functioning in three to five years.

The Nominating Committee at that time was chaired by Dr. Kent, who proposed Dr. Johnson as the next president and Dr. Bahnson as vice president. These candidates were unanimously accepted, and Dr. Johnson opened his inaugural address with jokes about his relatives in Tennessee and their hunting dogs. At Dr. Thomas’ suggestion, council recommended that an honorarium of $150 be given for the best paper submitted by a resident.

The Photo - Nemirthird annual meeting was held at Buck Hills Falls and was presided over by Dr. Johnson. Eight new members were admitted to the association, including Drs. Cohen from Pittsburgh, Julio Davila from Philadelphia and Ben Musser from Harrisburg. Dr. Bahnson was elected president, but he was not present to accept the honor.

The fourth annual meeting was at the Hershey Hotel. It was recommended at the meeting that the four speakers, as well as the resident who presented, be compensated with an honorarium. It was noted that if this motion were approved, however, the honoraria would exceed the dues for that year. It was then agreed by Council that only one guest speaker would be paid an honorarium.

At the business section of the fourth annual meeting, it was indicated that the treasury was doing well, with a total income of $2,100 and total expenses of $1,100, showing a net balance of $998. It was at this meeting that the Economics Committee reported that the insurance commissioner of the Commonwealth of Pennsylvania had been contacted, that they had met with the officials of Blue Shield, and that the major problem, as PATS saw it, was to seek a change in the maximum fee of $300 allowed for major thoracic surgery, particularly for open heart surgery.

Reminiscent of the previous year’s meeting, it was reported that Dr. Fred Dasch, at the age of 50, had died of a sudden coronary occlusion in Wilkes-Barre, PA., in the late summer.

Our fifth annual meeting was called to order by Dr. Wilbur E. Burnett in September 1967. Various committees were assigned. Although membership dues at the time were only $10, our total balance in the treasury was nPhoto - Nealonow $1,500, indicating tremendous growth in the association. In view of this, the honorarium for the resident paper was increased to $250. Dr. Julian Johnson, chairman of the Nominating Committee, reported that the recommendation for the following year’s president was George Willauer and for vice president, John M. Snyder.

Our sixth annual meeting took place at Shawnee-on-the-Delaware in September 1968. There was no urgent business at the first executive session called by Dr. Willauer, who arrived in an antique car and resembled Kaiser Wilhelm. At the second executive session, Dr. Sommers suggested that the Economics Committee be reactivated because, he noted, New York still had a much higher fee schedule than did Pennsylvania, and he hoped to push for a relative uniform fee schedule throughout the northeast area. John Snyder was nominated as the following year’s president, and Julian Johnson and Chuck Fineberg kept the meetings in order and in balance with a supply of stories.

At the eighth annual meeting, Joe Donnelly took over the Economics Committee, Dr. Ryan was nominated as president-elect and George Haupt became secretary of the Association. Through the years it became obvious that our programs were improving.

At the eighth annual meeting, Dr. Donnelly presented an unusually long report from the Economics Committee. Blue Shield of Pennsylvania had been totally unrealistic and had arbitrarily limited the maximum fee for cardiac surgery to $360, ignoring the cost-of-living index. It was the recommendation of the Committee that our members should not sign a new contract with Blue Shield at that time, nor should members accept Medicare assignment. However, the council and membership reviewed these suggestions and felt that both recommendations should be tables until the California Relative Value Unit Plan could be sent to all members of the organization for further evaluation.

From my own point of view, the most significant report at this meeting was that of the sudden death of Dr. Edward Kent, who died of an acute myocardial infarction while on a canoeing trip in Canada with his daughter. Dr. Kent, my mentor and friend, and one of the founders of PATS, deserves greater recognition in our organization. I would like to propose the Kent Memorial Lecture in honor of him.

PATS was growing, and the ninth annual meeting in Lancaster boasted the largest attendance of the association’s first 10 years. Bob Witmer, who was the host, provided a short visit to his beautiful farm and home, and a garden party was held there. The program was a huge success. Approximately eight new members were admitted to the association. Unfortunately, another founding member, Dr. Francis Bauer, died in the previous year at age 57.

It was interesting to note that at this meeting, for the first time, a peer review was mentioned along with relative value studies. It was recommended and accepted that we adopt the California and Massachusetts nomenclature for Blue Shield fee schedules, and that we also look into the prevailing fee program of the Pennsylvania Blue Shield. Additionally, for the first time the association decided to pay an honorarium to the secretary of the association, the large sum of $50.

At the 1971 meeting, we presented the Golf Cup to Bob Witmer and the Tennis Cup to Minster Kunkel, the latter of which became a continuing event.

At the 10th annual meeting, which was held at the Fernwood in Bushkill, PA. I was elected president for the upcoming year. My memory of the meeting once again included the wonderful stories of Chuck Fineberg, and I also remember talking with Bill Coughlin, his wife and son, the latter of whom was on his way to start school at Dartmouth. I remember thinking at this meeting that this was probably the most obscure and ill-equipped place to have a conference. During our scientific presentations, the waiters and waitresses persisted in walking through the back of the room, dropping dishes and other things, and constantly disrupting the meeting. Despite the interferences, however, the meeting was a success. Many new aspects of dealing with Medicare, Blue Shield, third-party payors and peer review were discussed. It was also pointed out that Dr. Rollins Hanlon, who was the executive director of the American College of Surgeons, did not agree that the ACS should be the one to implement a relative value scale for the country in establishing a fee schedule (How wrong could you be?). Ten new members were admitted, including one of my associates, Dr. George Liebler, as well as Dr. Pellegrini. Both became eventual leaders in the organization. Dr. William DeMuth was nominated for president and George Rosemond to succeed him.

It is with great pride and pleasure that I provide this summary of the first 10 years of the founding of the Pennsylvania Association for Thoracic Surgery to you. We thank our founding members, Drs. John Gibbon, Julian Johnson, Charles Kirby, Thomas Nealon, George Rosemond, Thomas Ryan and especially Dr. Edward Kent, whose foresight and devotion to thoracic surgery brought our association into being.

Credit for the success of our organization is in no small way also due to the wives and children of our members and resident trainees. At our meetings, they have discovered much in common and helped provide the impetus for further meetings. The coming years of our organization should prove to be at least as interesting as the past.