Presidential address to the triological society


  • Roger L. Crumley MD

  • Presented at the Annual Meeting of the Triological Society, Nashville, TN, May 4, 2003.

Dr. McCabe, Honored Guests, Triological Council, Members, New Members, and Guests:

I am deeply honored and greatly humbled to have been your president for a year. This has been the highlight of my career. The experience of traveling to the four Section meetings, observing the typical Triological Society scholarliness, science, and research coming together in these scientific programs, has been special to me. In addition, I've learned more and more about this wonderful organization during this year, and I'd like to share just a bit of that with you this morning.

The Triological Society has a unique and deep heritage. This heritage is in fact our “noble legacy.” I have looked through our book, A Brief History of the Triological Society, coauthored by Roger Boles and Pat Doyle, several times this year. It has enriched my appreciation for what we are all about, and humbled me tremendously as I read about the stalwarts and charismatic leaders of our 107-year history. Let me share just a few highlights of this history.

The Triological Society was initially an amalgamation of the otologists and the laryngologists. It was “Spawned by Specialization,” as noted in 1896 by the first President, Edward B. Dench, who observed, “In the early days of medicine, each follower of our profession was supposed to cover the entire field of medical knowledge. The extraction of a cataract at one end of the surgical block and the amputation of a great toe at the other was an everyday occurrence. Usually the result was equally unsatisfactory in both cases.” The founders of our Society were concerned that specialization could be problematic because it might encourage poorly trained generalists to simply declare themselves “specialists.” Accordingly, a society was needed to keep specialty work on a higher plane. So the early Triological Society was an opportunity to learn from colleagues and maintain medical quality and was helpful in preventing fragmentation into “otologists” and “laryngologists.”

Certainly no one epitomized the work ethic and scholarly focus of our Society more than Harris P. Mosher. Dr. Mosher was president of the Triological Society and the American Laryngological Association (ALA) the same year. He was founder and first president of the American Board of Otolaryngology and is best known for his passion for teaching and his many surgical innovations.

Mosher's Creed (Harris P. Mosher, 1948) includes the following interesting quotations:

  • If medicine is not your greatest fun, you are at the wrong job.

  • Watch the clock and you will often miss the train.

  • Overtime is opportunity.

  • The cases from which you learn the most come on Sundays and holidays.

  • Meet the busiest men and women and take their overflow jobs–scientific jobs, I mean.

  • Never resign. Work to the age limit. It will come quickly enough.

  • Set aside a stated time–I take an evening a week–for scientific medicine. Spend it in your library, the hospital library or in a laboratory. Come to an understanding with the family about it, peacefully if you can, by force if necessary.

  • Read regularly something worthwhile besides medicine. Often, in such reading, words, phrases, or even ideas which can be used in medicine will literally jump out at you.

  • Make yourself better than the practitioners in your community in at least one thing. What this medical thing is, matters but little.

Of interest to me was the career and nomination for Triological Society presidency Lewis Morrison, then Chair of Otolaryngology at the University of California San Francisco (UCSF), particularly since two of his successors at UCSF, Roger Boles and Frank Sooy, became Triological Society presidents. Dr. Morrison was a recurrent laryngeal “neurophile” like myself. He was elected to be 61st president but died at his home in San Francisco of a heart attack November 10, 1956, before he served his term.

Then there was the legendary Dean Lierle, Dr. McCabe's predecessor at The University of Iowa. Born in Marshalltown, Iowa, Lierle attended Stanford University for his undergraduate degree, then the University of Iowa for his medical degree. Dr. Lierle was secretary treasurer of the American Board of Otolaryngology for nearly 30 years. During Dr. Lierle's Triological Society presidency, the Council approved the concept of honoring the best thesis with an award each year, subsequently giving the first Mosher award to Harold Tabb of New Orleans for his thesis and work regarding carcinoma of the maxillary antrum.

Incredibly, the first woman member, Dr. Maxine Bennett, was not elected until 1962. Dr. Bennett, who was Chief of Otolaryngology at the University of Wisconsin, was a noted mountain climber, conquering the summits of the Jungfrau, the Matterhorn, Mexico's Popacatepetl, and Mount Rainer. She was vice president of the Middle Section in 1984. However, the Society has yet to elect its first woman President, and I'd submit to you this morning that it is about time that we do so.

And then there's one of everyone's favorites, Frankie Ritter. Possibly the most humorous of them all, Frank has elicited chuckles from everyone who knows him. During his presidency 10 years ago, he tried to get the Council to move the annual meeting to January and the Section meetings to later in the spring (something the Council is still discussing and debating).

But what this Society is all about is scholarship. In fact, the Three Pillars, or building blocks, of the Triological Society are scholarship, research, and collegiality. What sets this Society apart, makes it special, is the thesis requirement. Often discussed, sometimes maligned, the thesis requirement creates a special stepping stone, a hurdle, if you will, for young otolaryngologists, and then (when the thesis has been completed) a common bond among full fellows. In older days, one-third or more of the theses were rejected as not measuring up to Triological Society standards. More recently, in part because of the extremely high academic standards and quality of the young physicians entering our specialty, far fewer theses are rejected.

Currently, our numbers are strong, and the Society is vibrant and stable. We have (or will have) a new publishing contractual agreement with Laryngoscope, which, under the absolutely superb guidance of editor Byron Bailey (kudos to Ron), has prospered and grown. It will only grow stronger and achieve greater success under new editor Jonas Johnson. So our Triological Society is in good shape, strong, viable, and financially successful enough to support more than $100,000 of research grants every year. But is this “good,” good enough????

Probably not. As Jim Collins's book (Good to Great) advises, we need to continually pursue “good to great.” Medical specialty societies, like good to great companies, must continually re-engineer themselves. How does that relate to our Society?

We need to survey the otolaryngological landscape for newer educational and research needs, and fill them. We need to look into new Triological Society educational ventures and venues.

As the Triological Society was spawned because of specialization (union of otologists and laryngologists), so has it matured and changed under sub-specialization and sub-sub-specialization. Our specialty has changed, our graduating residents have changed, our practices have changed, certainly the reimbursement paradigm has changed, and yes, definitely, COSM has changed.

How do we adapt to all of this? How do we preserve that special vibrancy, that Triological Society aura of scholastic excellence, in these changing times? Let's think a second. Yes, we have specialists of all kinds who provide health care in only a specific subspecialty of otolaryngology. But we have many more practitioners of our craft who cross subspecialty boundaries. Plus we have a rich tradition of highly meaningful, pioneering research papers presented at both our Section and our Annual meetings.

Clearly, the Triological Society needs to play to its strengths. Previously, the Triological Society was the centerpiece of COSM, when other societies needed to have 25% Triological Society membership to join COSM. Our Society requires that a candidate be proposed by two members; then, that the candidate complete a scientific thesis, which is reviewed by a committee; then, that the candidate's fellowship status be approved by the Council after the thesis is approved. Triological Society theses are generally of high quality, and often they are a career-focusing manuscript or event in a young otolaryngologist's professional life.

One of the COSM societies has recently (just 2 days ago) voted to strengthen the language about membership in the Triological Society. The ALA has voted to require Triological Society membership before admission as a member of ALA, just as our founders had conceptualized membership for both laryngologists and otologists. In my own view, in this era of increased sub-specialization, this is a healthy concept and one that other societies (particularly the American Otological Society [AOS]) should strongly consider, if not embrace. Requiring Triological Society membership would help maintain the high quality of our so-called senior societies. Such a proposal would foster better research and enhance our literature. It would mean that the young, career-building otolaryngologist would first need to write a thesis, to belong to his or her most desired sub-specialty society, such as ALA, AOS, or American Society of Pediatric Otolaryngologists (ASPO). The important hurdle of completing the Triological Society thesis requirement, as well as the challenge of writing this meaningful paper, the thesis, would stimulate these young surgeon-scientists to greater heights–a “win-win” deal for the young physician, his or her patients, and otolaryngology in general.

This year, for the first time, we tried having combined meetings with sub-specialty societies, specifically, today with American Neurology Society (ANS), tomorrow with ASPO, and Tuesday with American Head and Neck Society (AHNS) (when our Ogura Lecture will be given by Professor Arnold Maran.) I hope you will agree that this has created a high-quality scientific program.

Your Council is working on and discussing a number of other proposals and ideas to further strengthen the Triological Society, including the following:

  • Possible name change is being considered for Active Candidates (to Associate Members), to help them feel “included” in the Society's proceedings, providing better assistance in completing their theses, and in completion of requirements for full fellowship.

  • Having more “combined” Section meetings, such as next January's combined Eastern and Southern Section meetings in Marco Island, Florida (in 2004), is being discussed.

  • Another proposal is to have all four sections meet in the same location, with sectional scientific sessions held separately in January or May.

  • Still on the table is the thought of having the main Triological Society national meeting in a warm setting during January or February, with Section meetings held later in the spring.

What can you, the Triological Society Member, do? At the very least, I'd suggest that you try to sponsor one new member per year. Get these young men and women to the Section meetings to present their papers and become better known in their regions.

In closing, I'd like to thank, particularly, Gail Binderup for her unflagging work on behalf of the Council and the Society and Pat Brookhouser, our executive secretary, for his support. Special thanks go to our treasurer of 11-plus years, Bob Miller, for keeping our finances in order and for maintaining and in fact enhancing our critical Laryngoscope partnership with Lippincott. The biggest thanks and debt of gratitude go to my wife Janet and daughters Danielle and Erin, for allowing me to spend an inordinate amount of evening and weekend time on Triological Society matters this year. And thanks to everyone in the Society for providing me with this exhilarating and gratifying year!! Thank you very much.