RALPH S. GRECO, M.D.
1942 - 2019
Ralph Greco, MD, a pioneer in the movement to support work-life balance for physicians and trainees and the former chief of the Stanford University School of Medicine's division of general surgery and director of its general surgery residency program, died March 31, 2019 at his home on the Stanford campus, surrounded by family. He was 76. The cause of death was prostate cancer, said his wife, Irene Wapnir, MD.
Spurred by the suicide of a former resident, Dr. Greco created the first program to promote well-being among general surgery residents in the United States and pushed successfully for changes at the national level to require residency programs to support work-life balance.
"He was fearless about taking on the surgical establishment," said Claudia Mueller, MD, a Stanford pediatric surgeon who was associate director of the Balance in Life Program Dr. Greco established when it was launched in 2011. She now directs the program. "Ralph's ideas about wellness for trainees were not popular among old-school surgeons. It's a macho culture. But he was so committed to supporting trainees and so clever and farsighted about how to establish that program that he made it happen. It was stunning."
Dr. Greco was a product of that same macho culture. "You are expected to work all the time and never complain," Mueller said. "You're the captain of the ship, and anything that goes wrong is your responsibility. That's how Ralph was trained." And in his early years as director of Stanford's general surgery residency program, that's what he expected of his trainees.
"He was a great advocate for us. We knew he had our back, and that engendered a lot of loyalty, but he didn't seem to be emphasizing wellness when I was a resident," said Marc Melcher, MD, who now directs the residency program. "His attitude was more, ‘No whining.' But then he had this major conversion," said Melcher, associate professor of surgery. "He dove in full force."
This conversion occurred in 2010 after a well-respected former Stanford surgical resident, Greg Feldman, MD, killed himself just four months into a vascular surgery fellowship at another medical center. Feldman's suicide spurred Greco to develop a plan to change not only Stanford's general surgery residency but the trainee experience nationally. "He pushed with the zeal of a reformer," Mueller said, pointing out that when Dr. Greco presented his plan to the medical school's leadership, he identified himself as "Dr. Ralph S. Greco, formerly the director of a malignant program" and as a "repentant sinner."
He gained the support of the then-chair of surgery, Thomas Krummel, MD, to the Balance in Life Program, which provides general surgery residents with regular group therapy with a psychologist, mentoring partnerships between junior and senior residents, group activities planned and coordinated with input from the residents themselves, and a seemingly small but crucial element — a ready supply of healthy snacks.
"It was especially influential to build such a program in a surgical program, where the culture tended not to support the notion that physicians should ever be in need of help," said Bryan Bohman, MD, associate chief medical officer at Stanford Health Care and senior adviser to the WellMD Center, Stanford Medicine's wellness program for physicians. "To help overcome the ‘iron person' culture of medicine at the time, Ralph and Tom built their program as a performance-enhancement tool, aimed at deriving the highest performance from the trainee surgeons. This was very effective framing, and the program has been quite popular with the house officers."
Dr. Greco also successfully advocated for the residency program accrediting agency to require well-being support in all residency programs.
"Ralph Greco was a visionary force behind pioneering efforts at Stanford to support physician well-being," said Lloyd Minor, MD, dean of the School of Medicine. "His efforts have benefited not only physicians trained at Stanford, but trainees throughout the country. As the leaders of other training programs have come to recognize the value of work-life balance for surgeons, many have emulated the program he created here."
"We get calls every month asking how we do it. They think we have something golden," said Mueller, who is one of several Stanford physicians who have been invited to other academic medical centers to discuss how the program works and its impact.
Dr. Greco was born and raised in the Bronx, a borough of New York City. His mother was an elementary school teacher, and his father designed women's clothing. He went to college at Fordham University, graduating cum laude, and then earned a medical degree at Yale in 1968.
Dr. Greco completed his internship and residency at Yale New Haven Hospital, where he was chief resident in 1972-73; served as a staff surgeon in the military from 1973-1975 — at the U.S. Army Hospital in Seoul, South Korea, and at Kimbrough Army Hospital in Fort Meade, Maryland; and joined the faculty of Rutgers Medical School (now the Robert Wood Johnson Medical School), where he specialized in surgical oncology and became chief of general surgery in 1982. He became chief of surgery at Robert Wood Johnson University Hospital in 1997.
While at Rutgers, Dr. Greco began research on the clinical use of biomaterials, which he continued at Stanford. Over his career, he co-authored more than 100 papers in the scientific literature. He met Wapnir, now a professor of surgery at Stanford, during her fellowship in breast surgery at Robert Wood Johnson Medical School. They married in 1991.
In 2000, Dr. Greco was recruited to Stanford for what he described in a 2011 article in the Journal of Graduate Education as a "job of a lifetime," with an endowed chair — the Johnson & Johnson Professor of Surgery — and the position of chief of general surgery and director of the general surgery residency program. As the program's director, he developed a new curriculum for the residents, restructured the program in expectation of new national guidelines limiting residents' hours on duty, established an elective rotation in Haiti for residents and created the well-being program. He served as chief of general surgery from 2000-2006 and as director of the residency program 2000-2009.
In recognition of his accomplishments, the Accreditation Council for Graduate Medical Education bestowed on him in 2012 the organization's highest honor, the John C. Gienapp Award, for his work as a surgery program director, humanitarian and innovator of a surgery curriculum focused on resident well-being and wellness.
Though Dr. Greco didn't begin advocating balance in life until he was decades into his career, his life had long been an exemplar of the concept. "He was very doting with the kids, and quite easy-going — letting them be themselves," Wapnir said. "He loved sharing his love of sports, especially baseball — Yankees — with the boys and always indulged them. He was a poor disciplinarian and the opposite of a helicopter parent."
Alongside his work in surgery and his involvement with his family, he immersed himself in the world of art. Dr. Greco began learning to sculpt in 1987, studying briefly with sculptor Lilli Gettinger, and then pursuing it on his own. "It is the pursuit of beauty — nothing more, nothing less," he told MED debate, a medical humanitarian organization, in a 2015 interview.
He went on to create dozens of sculptures, working in many types of stone, wood and terra cotta, creating both representational and abstract pieces. His sculptures can be found in the collections of Johnson & Johnson and the Robert Wood Johnson University Hospital, as well as in the homes of individual collectors and on the Stanford campus.
He also had a longtime connection to Haiti, where he traveled frequently for working visits at Hôpital Albert Schweitzer. In a 2002 article in Stanford Report, he said he fell in love with the country when he first visited as a resident in the 1970s. He later took surgery residents with him and established a month long Stanford rotation there.
"The Haiti experience was a lesson in humility," said Yale Popowich, MD, a former resident who went to Haiti with Dr. Greco three times, including Dr. Greco's last trip, in 2014. "I learned so much about life, survival and the human spirit on each trip. For surgery residents, it was an opportunity to hone skills, diagnose and treat under some very difficult situations. For Dr. Greco, Haiti was a lifeline. It was a place that captivated his soul; the people, the artwork, their passion."
Dr. Greco was deeply serious about his responsibilities as a surgeon and teacher, but laughter was an important part of his life, too. "He was very irreverent," Mueller said. "There was nobody who was a god or who was unassailable. He liked and respected his colleagues, but he would call them out for their silliness. There were meetings when I laughed constantly."
"He was very sarcastic but funny, and you really had to be sharp to catch it. Not all can," said Nicole Delgado, his administrative associate for many years.
"To someone who doesn't know him, I would say he looks intimidating, but in reality he is a big softy with an amazing heart," Delgado said. "He truly cared about his patients and those around him."
"A lot of my fondness for the Stanford general surgery residency is because of Dr. Greco," said Arghavan Salles, MD, PhD, a former Stanford general surgery chief resident, now at Washington University School of Medicine, who helped Dr. Greco develop the Balance in Life Program.
"He was always willing to listen and give advice," Salles said. "He never hesitated to offer assistance because he was committed to helping residents succeed."
At a graduation dinner for chief surgical residents in 2009, he received a 400-pound marble boulder as a gift. From this he sculpted an abstract letter S, representing "Surgery." It is displayed in the complex of offices just outside the chair's office in the Department of Surgery.
Dr. Greco was the recipient of many awards over his career. In addition to ACGME's Gienapp award, he especially valued the council's 2006 Parker J. Palmer Courage to Teach Award, given to outstanding program directors annually, and Stanford's 2016 Shumway Society Lifetime Achievement Award.
He retired from Stanford in August 2017 but continued his involvement with the Balance in Life Program.
In addition to his wife, Greco is survived by a brother, Ronnie Greco of New Jersey and Florida; a daughter, Ilana Greco of Stanford; two sons, Eric Greco of San Francisco and Justin Greco of New Haven, Connecticut; and three nieces and nephews.
JEFFREY A. NORTON