Pulling Back the Curtain: Roy Silverstein, MD

In this edition, Roy L. Silverstein, MD, talks about meeting his wife in the seventh grade, balancing research with practice, and being ahead of the curve in mindfulness.

New London was a small enough city that everybody knew everybody, and my brother and I went to school with the same cohort of classmates pretty much from third grade on. He is 18 months older than me, so we hung out all the time and fought all the time, as brothers do. We spent a lot of time outdoors – my mother would shoo us out of the house when we got home from school, so we would play sports with the other neighborhood kids. We lived near a beautiful, white sand beach with a boardwalk. I spent a lot of time as an adolescent hanging out there, playing miniature golf and the pinball machines at the boardwalk.

New London was a great place to grow up. My mother, who is now 98 years old, still lives there and my brother lives nearby and works as a real estate appraiser. Also, I met my wife in New London, so you can’t do better than that.

How did you and your wife meet?

We met in seventh grade – she sat behind me in homeroom because she was a little bit taller than I was. We actually “went steady” for a few months in eighth grade, and then at the end of high school, we started dating. We were together all through college and got married right after graduation. We’ve now been married for 44 years.

What was your first job?

From the beginning of my senior year of high school, I sold women’s shoes at a store owned by one of my uncles. I did it for several years – at his store on breaks from college and then at a store in a shopping center on Peachtree Street when I went to medical school in Atlanta.

I was good at it! I loved talking to people and, honestly, I think retail is good preparation for being a physician. Being a doctor is the ultimate form of customer service, but I have to say that selling shoes was, in some ways, almost as personal. You have to communicate well and figure out how to get people to tell you what they want.

When did you decide you wanted to explore medicine as a career? Did you ever think about going into another field?

When I was growing up, in the back of my mind, I always thought that I might like to be a physician, but I can’t say I had an “aha moment. I didn’t really settle on medicine until about my second year of college. My brother actually went to medical school before I did. After he completed his undergraduate degree, he studied medicine in Mexico for a year but realized that wasn’t the career path for him. He came back to Connecticut and worked in real estate with my father and uncle. Ultimately, he started his own business, which he still runs today.

I’ve always been a curious person. I thought about all kinds of different careers growing up. I love mathematics, so I thought I would be a mathematician. But when I got to college, I realized that, although I loved mathematics, I couldn’t compete with the long-haired guy who sat in the back of the room who intuitively understood all of mathematics yet spent all his time writing music. Then, I thought a little bit about physics, but I had heard too many stories about physics PhDs driving cabs in Boston, so that didn’t seem like a great option.

Ultimately, I knew I loved science, so it made the most sense for me to become either a biologist or a physician. Eventually, the people-focused aspect of medicine won me over.

When did you know you wanted to specialize in hematology?

I can tell you exactly when: November of my second year of residency at New York Hospital-Cornell Medical Center.

By that time, I knew that I wanted to give research a try. I had some great experiences as an undergraduate learning from my professor, a fruit fly geneticist, and all through medical school I had my eye on a career that included science as well as medicine. I told my chief resident that I was thinking about doing endocrinology because it seemed like a scientific field where one could easily combine research with practice. He told me, “You’ll want to do your fellowship in the best place possible, particularly if you want to do science.” In those days, that was Columbia, but that meant that either I or my wife, who was working on her PhD at Hunter College, would have a long subway commute every day.

He suggested, “Well, if you really want to do research, what about hematology? Ralph Nachman, MD, is the chief of hematology here. He’s a great mentor and a terrific hematologist and scientist. Why don’t you go talk to him?”

I met with Dr. Nachman the week before Thanksgiving and I was immediately struck by the fact that, although he was a very accomplished physician-scientist, his office was a desk in the corner of his lab. We talked for probably 45 minutes about the hematology fellowship and he said, on the spot, “If you want to be a fellow here, we’ll take you.” We shook hands on it, and a year and a half later, I started my fellowship.

What made Dr. Nachman a great mentor?

He was a wise presence, a brilliant scientist, a great clinician. He set high expectations for all his trainees but was very encouraging and loved hearing about the latest experiment in the lab. What stands out to me about Dr. Nachman’s lab is the culture of inquisitiveness that he created.  We had a weekly journal club that trainees from all around Cornell, Memorial Sloan Kettering, and Rockefeller University would attend. Our lab’s weekly research and progress seminars were extremely well-attended and rigorous. I think if you talk to hematologists my age who have been in academia for their entire career, you’ll find that story replicated over and over again around the country. The academic medicine environment of the late ’70s, ’80s, and early ’90s was very special, particularly in hematology.

I’ve had other role models and mentors, as well, like Aaron Marcus, MD, who was a professor at Cornell and became a very dear friend. And I always loved bouncing ideas around with Lawrence Leung, MD, who was a few years ahead of me in fellowship, and Adam Asch, MD, who was a first-year fellow with me.

How long did you work in New York?

I spent almost 25 years in New York, the last 11 as chief of the hematology/oncology division at Cornell. Then in 2004, I had an opportunity to move to Cleveland to serve as chair of the department of cell biology and vice chair of the Lerner Research Institute at Cleveland Clinic. I was attracted to the ability to focus more on research and step back a bit from the clinical world.

The seven and a half years I spent in Cleveland were probably the most productive research years of my career, but, eventually, I started to miss the day-to-day energy of the clinical world. So, in September 2011, when the opportunity came up to take on the role of chair of the department of medicine at the Medical College of Wisconsin (MCW) in Milwaukee, I made the decision to move. I’ve now been here for eight years.

Tell us about transitioning from New York to the Midwest.

I don’t miss New York that much, but I do miss the energy on the streets and in the people. After I left, though, I realized that everything is a little more difficult in New York. It takes more effort to get almost anything done. Some people think that New Yorkers are nasty, but they’re not – they’re just tired.

Part of the reason my productivity went up when I was at Cleveland was simply because I wasn’t as tired. My commute was only 10 minutes! I’d get home and finish up work in the evening, and I could even run back to the office or the lab if I needed to. Now that we are in Milwaukee, if we want to feel the pulse of a big city, Chicago is only a 90-minute train ride, and then we can go back home and relax.

What career accomplishment are you most proud of?

It sounds kind of trite, but what I’m going to say is true of many people who have been in academics for a long time. I am most proud of the successes of people who have trained under me. Thirteen PhD students have trained in my laboratory over the years, and they’re doing extremely well in industry and academia. Many of the post-docs and fellows who came through our training program at Cornell when I was chief of hematology/oncology also went on to do great things in clinical and laboratory research.

It’s remarkable: Students start in the lab not knowing much about how to be a scientist, then emerge as a PhD having published papers and conducted some significant research. Attending their graduations and participating in the doctoral hooding ceremony has been a huge source of pride for me.

I’m also proud of having had a successful, sustained academic career. Frankly, it isn’t easy, but I’ve had 35 years of continuous funding from the National Institutes of Health (NIH) and the opportunity to be part of research teams at three great organizations.

I’ve never been the kind of person who looks backward, or even that far forward. Dr. Nachman once told me that, as a successful leader and administrator, things shouldn’t cross your desk more than once. You never want to second-guess yourself.

I found that mindset to also fit my personal lifestyle. If things don’t work out, that’s fine; just move on to the next thing. I don’t set timelines on my goals, like becoming a division chief or a department chair by a certain age. I try to just enjoy what I’m doing and do the best I can at the job I have. Nowadays, that’s called mindfulness, so I think I was just way ahead of the curve!

When Nobel laureate Robert Lefkowitz, MD, spoke at the MCW graduation ceremony a few years ago, he offered a helpful career perspective. He told students that his two favorite times of the day were waking up in the morning so he could get to work, and then leaving work in the evening so he could get back to his family and friends. I feel the same way. I love going to work every day, but I enjoy coming home as well. It makes life easy. The hard part and the disappointments come from navigating the financial pressures that we’re facing in academic medicine. Everybody has great ideas but, without enough resources to go around, we can’t grant everybody’s wishes.

What advice do you pass on to early career hematologists and oncologists?

Aim high, ask important questions, do good work, and work hard.

Also, find a good mentor. Working with Dr. Nachman was the most important career decision I ever made. When talking to medical students or residents, I’ve noticed that they often obsess over what specialty to practice in and what fellowships to apply to. I try to counsel them – usually without success – to shift their focus to asking, “How do I want to spend my day when I finish training?” It’s a hard sell, but it’s important to get the concept across.

What have been the biggest changes in medicine that you have witnessed throughout your career?

In hematology, I’ve seen what I would call the delivery of the promise of science. When I started in hematology, there were few therapies for patients with serious blood disorders. We all thought monoclonal antibodies or genetics were going to be the answer, but things were moving slowly for a while. Then, over the past 10 years, there’s been a blossoming of new opportunities. So much has been brought forward – from new diagnostic tests to new therapies and new devices – out of studying basic immunology, genetics, virology, cell signaling, and health services.

As part of my advocacy efforts in my role as ASH president, I speak with Congressional members about the importance of investing in scientific research and increasing the NIH budget. Now we have many examples of how that investment has paid off.

We’ve gained so much in medicine, in terms of our ability to treat and care for patients, but we’ve lost plenty, in terms of the professional interaction and the ability to combine academic and clinical work. The model of academic medicine has changed. Researchers used to be able to take leisurely coffee breaks in the middle of the afternoon to talk about science; now, a fast-paced, business mindset has taken over. We have to pay close attention to maximizing our productivity.

I had the chance to slow down and reflect on other things besides the day-to-day issues of being a trainee or a junior faculty member. Today’s early-career trainees don’t have that same opportunity. That has been probably the most difficult thing to watch in my career. Still, the plus side is amazing.

What do you enjoy doing in your time away from work?

I like to run and play golf. I don’t have a chance to play much golf as I used to, but I still enjoy getting out on the course.

My wife and I don’t have children, and we both have busy careers in academia, so we try to spend as many of our off hours as possible together. In the early part of her career, my wife was a developmental biologist who studied cardiac development using the chicken as a model system. As her career developed she began to take on additional roles in academia and, for about the last 25 years, has been in positions of academic leadership – from serving as associate provost at St. John’s University while we were in New York, to chief academic and student affairs officer of the community college system in Cleveland, to now part of the University of Wisconsin system.

We have breakfast together every morning (which is part of a pact we made many years ago) and we like to spend time outdoors. We live 100 yards from Lake Michigan, so, when the weather’s good, we go out almost every day to walk along the lakefront. We also go to the theater or to see live music.

We’re both avid readers and like to bury ourselves in books, as well – typically fiction for my wife and historical nonfiction for me. I’ve read many books by historian Doris Kearns Goodwin and really enjoy how she examines leadership and presidential history.

And, when we have a chance to do it, we love traveling.

What’s your favorite place that you’ve been together?

We love Italy. We’ve been to several different parts – Rome, Sorrento, Florence, the Amalfi Coast, Naples – and loved every place we visited. That’s also where I picked up one of my little-known hobbies: making fresh pasta.

On one trip, we went to a cooking school in a little village south of Naples. A young chef taught a small group how to cook in a professional kitchen. For two days we cooked in the morning, then ate what we cooked for lunch; the next two days, we cooked in the late afternoon and ate what we cooked for dinner. We also toured a couple of farms to find fresh ingredients. I fell in love with Italian food, so at home, I started to make pasta from scratch. It seems daunting, but it’s actually pretty simple when you get right down to it. I don’t use a pasta maker – I roll it out by hand. The hard work adds a little extra flavor.