Nicolas J. Mouawad

As a vascular surgeon, I have a very busy clinical practice. I operate three days every week and spend the other two days seeing patients in the outpatient setting. When I joined McLaren Bay Region, a specific vascular surgery unit did not exist but, since then, we have made massive strides in developing it as a regional referral centre for cardiovascular disease.

As Assistant Professor of Surgery at Michigan State University and Central Michigan University, I am involved in educating medical students and surgical trainees. I also serve on a number of national and regional surgical society committees and serve as the site principal investigator in clinical trials.

The business of health

After a BSc in Biochemistry from Magill University, Canada, I moved to Dublin to study Medicine at RCSI. I graduated from RCSI in 2005 and served several years as Senior House Officer at Beaumont Hospital. I then matriculated to the US where I completed a general surgery residency at St Joseph Mercy Hospital, Ann Arbor, Michigan. I pursued higher education with a Masters Degree in Public Health (MPH) focusing on Health Policy and Management, as well as a Masters in Business Administration (MBA) concentrating on Hospital and Healthcare Management from Benedictine University, just outside Chicago, Illnois.

In 2014, I took up a post as a consultant vascular and endovascular surgeon at McLaren Bay Region, and was appointed Vice-Chair of the Department of Surgery in 2016, and appointed Chief, Vascular and Endovascular Surgery in 2017.

In the US, medicine is primarily a business. Having trained in Ireland, specifically in RCSI hospitals, the patient-first mantra drummed into us as surgical trainees stays with me to this day. Doing right by the patient should always be our guiding statement. But many other aspects as well as patient care come into focus – for instance, how resources, financial and otherwise, are allocated and the types and models of healthcare delivery, yet these are areas that are not covered in a primary medical degree.

I wanted to equip myself with a better understanding of these issues. So much of what matters in relation to patient outcomes is controlled by systemic decisions and approaches. For doctors to bring about positive patient-outcome focused change, we need to be well informed – taking an MBA seemed like a logical step for me and I found the process of learning about these aspects of hospital administration and public health policy fascinating.

Preparing the surgeons of the future

The adequacy of the five-year residency model has come into question in recent times. With the introduction of work-hour restrictions and the decline in the number of traditional open surgery procedures, surgical training is at a crossroads. It’s clear that the exceptionally high standards demanded from young trainees and other issues around operative experience and working conditions has resulted in an unacceptable attrition rate among general surgery residents. It is good to see that new ways of delivering training experience, encouraging confidence in competency among trainees, by means such as simulation, are being developed. And RCSI is at the forefront in this kind of training. Again, proactive leadership by surgeons, I believe, is an important driver of change.

The American College of Surgeons (ACS) has done a great deal of work to address the opioid epidemic in the US, promoting the use of prescription drug monitoring programmes and taking steps to change the direct relationship between the providers of drugs, and how they are paid and patient pain control. As Chair, Resident and Associate Society Member of the ACS, I fully support this work. Nearly 40% of all outpatient prescriptions that surgeons write are for opioids – a rate second only to that of pain management specialists. I believe surgeons are uniquely placed to effect change in this area.

Looking back ... and forward

I have very fond memories of RCSI. Having grown up in Bahrain, I was aware of RCSI and its reputation internationally. To this day, I have found that it is well-known wherever I go and among surgeons all over the world. In fact, the camaraderie is endless – two of my partners in my practice are graduates of RCSI, and two other RCSI Alumni work in the hospital across town! When I am operating, I sometimes still hear the voice of Professor Paddy Broe and his words of advice still resonate.

As for the future, while there was no particular reason why I was attracted to Michigan, I appreciate its many attributes and love its mid-west laid-back way of life. It is not a big city, but, professionally, it (and the rest of the US) presents wonderful, interesting opportunities every day.

I also keep in touch with fellow RCSI Alumni elsewhere in the world – I am open to the possibilities that Europe and the rest of the world holds.